Good Girls

British journalist Hadley Freeman spent ages 14 to 17 in psychiatric wards in London after developing anorexia nervosa shortly after her 14th birthday. In this memoir, she combines her personal story with interviews with psychiatrists, doctors, former fellow patients, and current sufferers, drawing on medical research and landmark legal cases to examine why girls develop anorexia, why some recover while others do not, and why the illness remains poorly understood. She notes that anorexia has the highest mortality rate of all psychiatric illnesses and that her own recovery took decades.

Freeman traces the onset to a moment in May 1992. During a PE class, she sat next to the thinnest girl in her class, Lizzie Cooper, and asked if it was hard to buy clothes at her size. Lizzie replied that she wished she were "normal" like Freeman, and the word devastated Freeman. Within a month, she had cut out entire food groups, begun obsessive exercising, and started standing naked before the mirror every night. She argues that this was a trigger, not a cause: Using the analogy of a corroded pipe bursting from a small drip, she contends that years of accumulated anxiety had already weakened her internally.

Before the illness, Freeman had moved from New York to London at age 11. She describes herself as an anxious, perfectionist, people-pleasing child terrified of upsetting adults. At six, a teacher cried after Freeman said she hated herself, teaching her never to reveal her true feelings. She became vegetarian at four after learning where meat came from, an early link between food, control, and identity she calls a gateway into anorexia. She also developed obsessive-compulsive disorder (OCD) tics. These traits, combined with her privately educated background and family predisposition to disordered eating, made her what she considers a near-perfect candidate for the illness.

Freeman presents the scientific theories she encountered. Professor Gerome Breen reports that eating disorders have a 60 percent heritability rate and identifies metabolic factors such as high metabolic rates and low blood sugar that suggest a physiological interplay with psychological processes. Professor Janet Treasure, Freeman's final psychiatrist, confirms that anorexia requires both "genetic soil and environmental triggers." Freeman also discusses the link between anorexia and autism spectrum traits, noting that 30 to 35 percent of patients with chronic anorexia may have autism spectrum disorder. Her own mother developed anorexia at university without receiving treatment, and disordered eating appeared on both sides of Freeman's family.

By September 1992, Freeman had lost more than a third of her body weight, and her obsessive exercising caused her spine to protrude and break through the skin on her back. Her general practitioner (GP), Dr. Georges Kaye, referred her to Dr. R., who headed the eating disorders unit at a private psychiatric hospital she calls Hospital One. When Freeman could not eat a single biscuit from an outpatient meal plan, she was admitted within 48 hours. The hospital used a reward-and-punishment system in which weight gain earned privileges. Dr. R. suggested electroconvulsive therapy, which Freeman's parents refused, then prescribed Prozac and lithium despite Freeman having neither depression nor bipolar disorder, leading to her first grand mal seizure and a lifetime of epileptic fits.

Between 1992 and late 1994, Freeman cycled through multiple admissions across four hospitals. She cheated scales by hiding paperweights in her underwear and lost her best friend Esther. As her weight continued to drop, Dr. Kaye told her mother to prepare for her possible death. Her parents parted ways with Dr. R. after recognizing his negligence; nearly 20 years later, he was struck off by the General Medical Council for an inappropriate relationship with a patient. Freeman's care transferred to Professor Treasure at a National Health Service (NHS) psychiatric hospital, where 12 patients shared a dorm and a nurse force-fed patients and screamed at them. Freeman befriended Nikki Hughes, a 20-year-old who had both diabetes and anorexia. Nikki died three years later at 23, and her case prompted new legal guidance on force-feeding patients with anorexia.

Freeman interweaves her narrative with stories of women she tracked down decades later. Alison, a fellow patient who became a mother figure during Freeman's first admission, was at 52 again a day patient after relapsing. She had been hospitalized nine or ten times, and the death of her first baby during delivery, later confirmed as avoidable, triggered a slow relapse. Fritha Goodey, another former patient, trained at the London Academy of Music and Dramatic Art and built a career in theater and film but died by suicide at age 32, consumed by anxiety despite external success. Geraldine, a quiet girl two years older, spent 10 years in hospitals before moving to Ireland, earning a degree, and becoming a working professional.

The ward eventually transferred to Hospital Four, a quieter suburban facility, where the turning point came. Freeman watched Caroline, an older fellow patient now 32, scream over the amount of butter on her toast and thought: "I will not be having temper tantrums over toast when I'm thirty-two years old." She received her GCSE results (national secondary-school exams) in hospital and felt a competitive drive unrelated to weight loss. Her therapist J.F., an American Jewish woman who had herself experienced an eating disorder, was the first clinician to see through Freeman's defenses. J.F. threatened that if Freeman lost two more pounds, her parents would hire a live-in nurse; the prospect horrified Freeman more than eating did. J.F. then suggested a crammer, an intensive exam-preparation boarding school, in Cambridge.

Before boarding school, Freeman's anorexia mutated into severe OCD: She washed her hands until they bled and became terrified that invisible calories might transfer through touch. She suppressed these symptoms enough to attend school, eating rigidly but maintaining her weight, and gained admission to Oxford University. Her first period arrived at 19. Dr. Sallie Baxendale, a professor of clinical neurology, explains that the brain has developmental windows during adolescence, and missing them means permanently playing catch-up.

Freeman broadens her analysis to examine why anorexia disproportionately affects girls, arguing the illness is partly a rejection of womanhood and an expression of anger by girls taught that good girls do not get angry. She connects anorexia to the modern surge of adolescent girls referred to the UK's Gender Identity Development Service (GIDS) for gender dysphoria, a condition in which one's sense of gender does not align with one's biological sex. She notes that clinicians see both conditions as related expressions of distress rooted in body hatred. After Oxford, she became a fashion journalist and argues that fashion does not cause anorexia but gives it "a softly fertile ground in which to breed" by fetishizing female self-denial.

In her twenties and thirties, the void left by anorexia filled with destructive relationships and drug addiction. She escalated to cocaine and was soon using drugs alone and having weekly seizures. In 2009, she moved to New York, but without drugs the anorexia resurfaced. A nutritionist who offered a weight-loss plan crystallized her understanding that no outside authority would save her.

She returned to London, entered a healthy relationship, and became pregnant with twin boys at 37. The babies' appetites overrode her residual barriers, and she ate freely for the first time. A daughter followed at 41. In 2022, she visited Hospital Four and found treatment had improved, but the ward manager confirmed that patients' thought patterns remained identical to those of 30 years earlier. Freeman concludes with what she wishes adults would tell girls: that growing up means getting bigger, hungrier, and angrier, and that this is normal. In the final scene, she sits in a Greek restaurant with her two-year-old daughter, orders what she wants, and eats.