Charlie* is a third-year medical student, runner and autism campaigner. When she was 15, she was sectioned for three and a half months due to anorexia. Recently, as part of her studies, she completed a psychiatry placement in an inpatient mental health unit, which reminded her of her own experiences.

Charlie's story touches on eating disorders and mental health challenges. Please read with care.

*name changed to protect anonymity

When I was on the psychiatry placement at university, I spent a lot of time talking to people about their mental health. There's not much clinical stuff we can do as third-year medical students. We can take blood, and we speak to people. I spent all day speaking to people about their issues. It's really interesting, but also quite draining. You get to learn a lot about how different people's brains work.

I remember a lot of the older patients who I spoke to who had multiple admissions. You could see through reading about their histories and talking to them that they probably were autistic and not diagnosed. I said in a few team meetings that I thought certain people were autistic. I was told, 'They're old! What can you do about it now?'

Before I'd been on the psychiatry rotation, I had put my experiences of being sectioned to the back of my mind. But since that placement, it made me quite angry. I was seeing other people suffering when there could be simple things put in place to prevent this.

I was diagnosed with autism when I was 17, two years after I was sectioned for anorexia. I was an inpatient for three and a half months. My eating disorder was atypical, due to my autism. And clinicians didn’t understand that.

It’s hard to pinpoint how my anorexia started. It is something that just happened slowly over time. I am a very all-or-nothing person and take a lot of the things I do to the extreme. I think it was a case of what I thought I should be doing to fit in, but taking it to the extreme.

In hospital, I remember being given meal plans that weren’t tailored to my sensory issues, which I found distressing. And therapy sessions where they would try to get me to talk about body dysmorphia, and why I wanted to lose weight. That wasn’t what it was about for me.

My anorexia experience was different because I had sensory-seeking behaviours around hunger. The sensation of being hungry helped me feel grounded and calm. But I’ve since found more helpful ways to feel this, like running.

The environment of being in the hospital was stressful. I had a serious phobia of vomit, to the point where I missed a lot of school just because I was scared of catching any sickness bugs. When I was sectioned, I requested not to be near people who were going to be sick. One time, someone was sick near me. And I just ran off. And then I was shouted at for running off. But I couldn’t deal with it.

When I was ill, for weeks I’d go to meetings and they'd say, ‘This will be the last meeting before we discharge you’. A week later they’d say ‘Actually, it's another week’. That messes you around if you've got it in your head that you’re leaving soon.

To them saying, ‘Just another week’ wasn’t a big deal. But to me, it was a massive thing. I think people don't realise that it's people's actual lives. It’s a massive thing if you don't feel like you're in control of your own life – especially if you’re autistic and crave certainty. I think the need for a routine, to know what is happening next and to be able to plan things is key for autistic people. It's anxiety-provoking if it is not accessible.

I really struggled after being in the hospital. After a while, I got used to the routine there. So, when I came out, I found the change difficult.

I felt so ashamed and embarrassed going back to school. I think the Netflix series 'Everything Now' portrayed well how isolating it can be to miss school and go back to an environment where everyone has grown up so much in a short time. It feels like you are stranded in no man’s land.

I had a lot of outpatient treatment, probably three times a week. But it was still a change and a transition. It was a really hard time and, mentally, I got worse for a while. I couldn't cope. I think that's when my anxiety was worst.

I also struggled when I stopped therapy and left the eating disorder services, as I felt that I had no one to talk to about anything anymore.

How to break the cycle

More communication and clearer timescales would really help break the cycle of autistic people getting trapped in inpatient mental health units. There was always so much uncertainty. Clinicians could ask people what they need or how they behave if they feel a certain way, because a lot of autistic people, don't present in neurotypical ways. For example, they might get anxious when they feel pain.

I noticed, both from own experience and on placement, that the wards were always loud. People were getting distressed because of the noise. I think giving people noise-cancelling headphones would have helped keep people calmer.

What really helped me in my recovery was finding other ways to feel grounded. I do a lot of running. Running calms my brain down and it makes me feel connected to my body. A lot of the time I feel a lot of disconnect between my psychological self and my physical self. Running helps me bring those together and feel like I'm a whole person.

I do a lot of advocacy work. It helps me feel connected to society because I really struggle to connect with people and have friendships.

I've also recently started to dance. I'm bad at coordination and dancing, but I think it's a really good way to also feel connected to people and not feel lonely and get stuck in these negative thinking styles.

If I had had some sort of sensory workshop when I was younger and had a toolkit of positive coping mechanisms, then it is possible that I wouldn't have been as ill.

As a medical student, I want to do a research project on autism and anorexia. It presents differently in autistic people, and there’s still so much we don’t know. I’m also interested in psychiatry because I want to represent autistic people and advocate for them in my future practice, so they can have a clinician who not only understands but can empathise.