The anorexic or bulimic patients (90% women) have a decisive place of residence. If they live in one region or another, their sanitary treatment can be excellent or terrible, and therefore their chances of healing multiply or decrease. Despite being the mental illness with the highest mortality rate (0.56% of patients die every year, 12 times more than the average of young people in general), the 17 communities have opted for very different assistance solutions: from specific units with psychiatrists and psychologists at the bottom of the canyon for their needs, to confusing protocols that cause a pilgrimage through multiple units.
"My daughter has been sick for eight years and in this time has gone through units of cardiology, pediatrics, mental health, internal medicine and endocrinology in seven hospitals in Jaén, Albacete, Granada and Ciudad Real. The other option is to let her die at home, slowly. You have to battle continuously with the health system itself. Who protects our children and young people? How is it possible in a State that promulgates equality in any part of the territory that some communities have specialized units and others do not? " The desperate cry of Patricia Cervera, a mother from Granada who has collected 200,000 signatures to shake the consciences of the leaders of the Junta de Andalucía, it has taken effect. The Andalusian Government has advanced that it will create two specific units in this region, although without committing deadlines.
The treatments provided by the 17 communities have Madrid, Catalonia, Castilla-La Mancha and the Valencian Community as references, while the tail is Andalucia and the Canary Islands, territories where the desperation of families is most pressing and their only solution is a private center of internment in exchange for about 2,000 euros a month that few can afford. If in the first communities the patients visit the psychologist and the psychiatrist up to once a week, in the seconds it may take three weeks, an eternity that makes the treatment sporadic.
Anorexia nervosa is a disorder of neurotic origin in which the person refuses to eat systematically, while bulimia is an ailment that consists of eating compulsively after which, the feeling of guilt ends with the head in the toilet looking for a vomit provoked. In Spain there are about 200,000 affected, of which 5% can be serious, and the prevalence is similar to the surrounding countries, according to experts.
Given the inaction of the governments, for years the relatives of the sick, some 4,000 associates in two organizations, got down to work and created centers where to care for their daughters. "Our goal is to stop existing, but we have always asked for more public resources without success," criticizes Fátima Pérez, director of the Association of Bulimia and Anorexia of A Coruña, created 22 years ago. The Xunta has a specific unit with nine beds that families consider insufficient.
Carmen Galindo, president of the confederation of associations of parents, adds: "It does not seem logical, it would be normal for governments to provide public health means, it is very convenient to give you 20,000 euros," he says, without taking into account which personnel is contracted to tackle this insidious disease. María (fictitious name) explains why the triggers of the disorder are multiple: "At age 16 I suffered sexual abuse and from there I just wanted to empty myself, I restricted the food so as not to go to the bathroom. I have been sick for 20 years and I have seen many psychiatrists. He cheated everyone. Until one gave my precise treatment, without resorting to a specific theory, and now I'm super strong. " After a dozen failed specialists, this woman found the psychiatrist who took her out of the hole 600 kilometers from her town, in Ciudad Real.
Luis Beato is that specialist and directs the psychiatry service of the General University Hospital of this city of La Mancha, a center that receives patients from Andalusia, the Basque Country or Extremadura. "When I arrived in 1995 they told me: 'Here we do not have that problem', but soon after it appeared. The supply generates demand. The crisis stopped the development of resources. And today three pillars are necessary: the professionals, the support of the hospital management and the family association, "he analyzes.
Montserrat Graell, president of the Spanish Association for the Study of Eating Disorders (Aeetca), signs this uneven map that causes family changes and long trips to be close to her daughters. "The care provided throughout the country is very heterogeneous. It is a question of knowledge, not so much of money, and we must homogenize upward, not downward. In the future, specific units must be increased, "says Graell, who estimates the average cost of a specialized unit with 10 beds at around 700,000 euros.
The disease grows among young people but in a moderate way, at the same pace as the rest of mental illnesses, and today it affects approximately 5% of the population, with many cases undiagnosed, according to experts. The main novelty in the last decade is the early appearance of this ailment in children increasingly smaller, of 9 and 10 years, when once the first outbreak came in adolescence. In the eight communities with specific units, the waiting list is around one month, while for children or adolescents it is reduced to one week, according to the Aeetca.
Experts point to low self-esteem as the cornerstone of anorexia, but there are other factors: perfectionism, impulsiveness, bullying and image pressure. These eating disorders usually last four or five years on average, or become chronic.
"The patient has to understand why what happens to him happens and work the factors that have led him to that," says Idoia Duo, co-director of the Item center in Bilbao. If previously the physicians focused on physical symptoms, today they dig into lived episodes of bullying, sexual abuse or mistreatment.
Anorexia affects one man for every 10 women. Andrés (fictitious name) says: "We are all subject to the aesthetic canons of advertising, the media and the audiovisual. In the twenty-first century has touched the thinness and there is no distinction between sexes, the men you have to admire are portrayed as thin or muscled, never flabby or dissident bodies. He adds: "I always had a rather insane tendency to perfectionism".
Cristina (who is not called that either) became ill with bulimia at the age of 21 because of a sentimental break and only three years later she sought help: "They were 15 years of absolute secrecy and silence. I am a nurse and I help others, so I project a strong image. People understand that whoever helps can not have problems. " After the disease, the physical consequences such as malnutrition and cardiac and bone involvement are usually reversible, but girls keep the rest of their lives more likely to suffer from depression and personality disorders, among others, according to recent research.
The limited control over the social networks of adolescents does not help. "We have not taught them to see the terrible suffering behind those photos," says Miriam Sánchez, of the Institute of Eating Disorders. The president of the confederation of parents of patients, Carmen Galindo, adds: "Adolescents are sponges that absorb everything around them in this society that stigmatises those who have extra kilos." And Pedro Manuel Ruiz, affects that line in the book The face of women's violence: "The advertising and social push is irresistible for not a few girls".