The bellowing was coming from upstairs, probably from her bedroom. I begged God for mercy that this time the pain would subside quickly.

I gasped when I saw her. My niece was right to ask me to come; their mother – my sister – looked beyond awful.

The yellow skin on Emily’s face was sagging, her cheekbones seemed to have vanished. Her legs looked like knitting needles. Her dress clung to her bones; there was no flesh left on her body. It was a heart-breaking scene.

I picked up her weightless body and lay her onto her bed. She was so light and fragile. When the pain subsided, she smiled, exposing rotting teeth. She looked like a skeleton wearing a dress.

When the pain subsided, she smiled, exposing rotting teeth. She looked like a skeleton wearing a dress.

It was horrifying for her young children who were gathered around her to see her like this. I glanced at thirteen-year-old Naomi; panic in her eyes. There was also anger etched on her face. Unfortunately, her world revolved around her mother’s health. Naomi knew that at any moment her mother could collapse and that there would come a time that they wouldn’t be able to revive her. Naomi had lost her mother a long time ago; she was now one of her mother’s caregivers.

When Emily was finally asleep we tiptoed out of the bedroom. “Aunty Miriam,” asked Elisha, “doesn’t she love us? Is that why she doesn’t want to get better? Aren’t we enough for her to want to be healthy?”

My eyes filled with tears, “Your mummy loves you very much,” I tell the children. "I promise she is trying her hardest to get better.”

Anorexia is a mental disorder; the sufferer refuses to eat and is obsessive about losing weight. Anorexics often put weights in their pockets in order to cheat the scales. They also take laxatives so that whatever they eat passes straight out of their body. Emily has been a victim of Anorexia Nervosa for about thirty years.

At Emily’s thirteenth birthday party, my mother baked a special cream cake which was Emily’s favorite. When Emily asked for a third slice, my mother embarrassed her in front of all her friends. “No, don’t be greedy. You'll get chubby and you don’t want that.” My mother was also obsessed with her weight and being thin. This compulsion impacted my whole family. My siblings and I are all weight conscious, always dieting and exercising, though not to the extent of having a food disorder.

Around the age of 14 Emily became extremely fashion conscious. Perusing the fashion magazines with skinny models influenced her greatly. Around that time I noticed that Emily was always careful with what she ate and exercised a lot. Soon afterwards I noticed Emily began skipping meals. These were some of the early warning signs that, looking back, I witnessed. I'm sure there were others that we missed. Before Emily married she may not have had anorexia but she was obsessed about her weight and troubling signs were there if we knew how to look.

After Emily married David there were a few years when her weight was stable. She enjoyed going out for meals and seemed genuinely happy. But after her third child was born, Emily began lying, telling her husband that she’d eaten dinner earlier with the kids when she obviously hadn’t. Emily’s group of friends were all extremely weight conscious. Emily followed extreme diets and became addicted to artificial sweeteners. She drank incessantly, filling herself with fluids rather than food, chewing gum to avoid hunger pangs.

It didn’t take long for her body to stop being able to digest the few things she ate; her body was brutally starved.

The disease is terribly complex, affecting the person's physical, mental and emotional well-being. Eating disorders are a response to stress. Over the years Emily experienced a lot of stress in her marriage. David is an active member in the community as well as a successful businessman. Perhaps starving herself would give Emily the attention she craved from her husband. In the early days when her illness was still manageable David would beg Emily to eat and bribe her with gifts to achieve results. This phase didn’t last long because no one was dealing with the core of the issue.

Emily has adamantly refused treatment. She doesn't believe she suffers from an eating disorder.

Anorexia can be overcome but the patient has to want to receive help. Sadly Emily is now in her mid-fifties and until now she has adamantly refused treatment. She doesn't believe she suffers from an eating disorder. She makes it her life’s mission to find doctors who will back her up by finding different reasons for her inability to eat. She has seen hundreds of doctors and every time a doctor tells her she has an eating disorder she moves on to another, a classic sign of people suffering from anorexia.

David has always had the tendency to escape difficult situations. His inability and unwillingness to deal with direct confrontation has helped to enable this terrible situation all these years. Despite our pleading, David just doesn't have the stomach to have his wife sectioned and forcefully detained in a hospital. It is easier for him to remain in denial and allow himself to continue to be manipulated by her and the lies she tells him.

Tragically there is a lot of stigma attached to eating disorders and I think he feels this will reflect badly on him. So he chooses to believe the doctors that give different reasons for her inability to eat. For a long time I was very angry with David for not forcing her to go to a hospital or treatment center years ago. At one point I argued with him about it. Many appointments to therapists who specialize in eating disorders were made, and cancelled.

I fear that he has now given up. Since there is so little of her left, he just wants her to live how ever long she has left, with her family around her. And if/when the worst happens he will feel no guilt as he never acknowledged what her illness is in the first place. Denial is an incredibly powerful force.

Emily seemingly has everything to live for; she has a husband, children and a host of grandchildren. She has no financial worries and what’s more she is a most accomplished writer.

People who suffer from this become very aggressive, controlling and manipulative. Her children and husband bear the brunt of her outbursts. The sufferers are also obsessed with feeding people and she piles food onto her family’s plates. Emily loves hosting dinner parties. When she is busy cooking she is distracted and does not feel hungry. She stands at the buffet table, insisting on filling her guest’s plates. It is quite uncomfortable for her guests. Often after serving the main course she would be in so much pain that she would leave her guests and go upstairs. She would come down at dessert time, so that she could resume piling cakes on people’s plates.

Anorexia is a cry for help. The sufferers usually feel they have no control over their lives. The intake of food is the one thing they can control. Often adolescents become anorexic because of peer and social pressure. It does not only destroy the patient’s life but affects the lives of the whole family. Because there are so many stigmas around this illness, it may be easier to ignore the early signs. Unfortunately, it escalates and can be life threatening.

It is a chilling realization for her children to think that their mother may be willing to die rather than get better.

My niece Naomi and her older married siblings know what their mother is suffering from. They know it is too late for her to have a complete recovery, but they still hope that with the right treatment, she can still have a better quality of life than the one she is living now. It is a chilling realization for her children to think that their mother may be willing to die rather than get better.

Most of the married siblings have given up pleading with their mother and father to go to hospital and be treated; they have tried dozens of times to beg their dad to force her to get help. It is an extremely painful sight to take someone against their will to a locked down clinic. Sadly sufferers of anorexia after a certain point are unable to think clearly, it is only a spouse who is able to take this painful course of action. When the older children couldn’t convince their father to do this they had no choice but to protect themselves by focusing on looking after their own families.

Emily frequently passes out from dizziness and needs oxygen to revive her. Due to her illness she also suffers from osteoporosis, her bones are so brittle so when she passes out she is also at risk of breaking some bones.

My sister is literally fading away in front of our eyes. I haven’t seen her eating anything in front of me for a very long time. I know that she chews on pineapple and then spits out the pulp. Her body rejects most foods now. Every few weeks she has a flare up of awful pain because her gut twists and we all think that now she will be admitted and agree to be line fed, but her gut manages to be manually untwisted and the pain subsides. When these attacks occur, you can hear her screaming from the street.

I pray every day that Emily will open herself up to receive the help she so desperately needs and that with her family’s love and support she will slowly be healed.

I urge anyone who thinks they or someone they know may have this mental illness to get help as early as possible. Look out for the early symptoms which include skipping meals, lying about eating, avoiding eating socially, excessive exercise or wearing baggy clothing.

Here are some resources on anorexia:

The author is using pseudonym.