Photographer:Fotograaf: Loraine Bodewes
UM researchers take part in relay race against stigma
By the end of her study programme Anne Marsman had reached the end of her rope. She was having trouble remembering things and vomiting more and more often. What was going on? Back then she was as closed as an oyster, but now the Maastricht PhD candidate talks frankly about her ordeal, keen to dispel the common prejudices about eating disorders and depression. This weekend she will take part in the Social Run relay race: 555 kilometres in 48 hours, to combat the stigmatisation of psychiatric patients.
The third year of her Health Sciences degree has just begun. Anne Marsman, born in Hoofddorp, has a grade point average of 9 and has been selected to take part in the honours programme. This despite always having wondered if she was “too stupid” to go to university. She doesn’t make friends easily, often feels like an outsider. And yet she seems to be in control of her life. She lives independently in a small studio, works at UM Sports and is happy with her first boyfriend.
A few months later, things take a turn for the worse. Her relationship breaks down and Marsman plunges into a personal crisis. To push away the pain, she throws herself into a punishing regime of study, work and exercise. She wants to prove that she can overcome her grief, that it’s simply mind over matter, but her lifestyle takes its toll. She develops memory problems, sleeps poorly and falls into a vicious cycle of eating, not eating and vomiting. Meanwhile she writes two theses, one of them between the hours of three and seven o’clock in the morning. She is barely managing to tread water when, to top everything off, she is assaulted in her own home. This is rock bottom.
And that’s when something happened that turned it all around, Marsman says. "Something that saved my life. A student, someone I’d never even spoken to before, this girl of over six feet tall, comes up to me and says: 'Are you all right? Maybe we should talk.’ She literally saw me standing there, understood that I wasn’t okay, and had the guts to ask me about it. It was the start of a close friendship. Katinka had also struggled with eating disorders in the past, so she understood my pain. Not long after that I moved into her place; I felt safe with her."
Her new friend also suggested she speak with the study adviser. "That was a good move. I realised I needed help and decided to put my studies on hold for a year. I was treated in a clinic for eating disorders and by a haptotherapist."
Marsman (26) is now doing her PhD research on the influence of childhood trauma on stress later in life, including the stigmatisation of psychiatric patients. Stigmatisation refers to putting a negative stamp on people; the opposite, in other words, of what Katinka did: showing understanding and empathy. Stigma goes hand in hand with all kinds of prejudices, Marsman says. "In the case of anorexia, that you want to be a model. Or that you’re obsessed with yourself, you’re shallow and selfish. There are people in the world who have nothing to eat!"
The prejudices defy all reason, but what’s worse is that patients themselves begin to believe in them. This is known as self-stigma. "That’s how you bring yourself down. You tell yourself it’s your fault because you have no willpower, you’re weak, you’re not worth helping. At the same time you’re ashamed and don’t want anyone to know, so you keep yourself trapped in your misery. When all you really want is to be seen, to be recognised – but that doesn’t happen, which is very painful."
During her treatment Marsman slowly begins to recover. It feels liberating to open up about everything, writing a candid blog about her ordeal. Family members, colleagues, good friends – everyone is shocked to the core, but at least they now understand her struggle.
It all started when she was 13, when her best friend told her she had been abused for years and had recently been raped. She was pregnant, she said. After lengthy discussions she decided to have an abortion. “At a certain point she’d just had enough. She told me she wanted to kill herself, but I wasn’t allowed to tell anyone. It was our secret. I stayed loyal, even when she started cutting herself. One time she called and said: 'I’m sitting here with a knife, I can’t take it any longer, you’re the only reason I’m still alive.'”
The responsibility weighed heavily on Marsman’s shoulders, although it was a feeling she wasn’t unfamiliar with. For years she’d had to take care of her mother, who suffered from depression. As a child she’d learnt to keep a low profile, not wanting to be a burden. And so, when her friend spoke of suicide, she did not initially raise the alarm.
"Then one day my friend made the decision to take her own life. I didn’t understand it. We were best friends but apparently I wasn’t worth living for. I called the kids’ help line and then the suicide line. It’s just a cry for attention, they told me, especially at that age. Their advice was to talk to the school counsellor. On the day my friend made quite specific threats to harm herself, I told my parents. My father called the school counsellor but no meeting ever came of it. It was a bizarre state of affairs actually."
On the last day of school Marsman lost her friend for good, in an entirely unexpected way. "We biked to school together and suddenly she just rode away from me. I never saw her or spoke to her again. I tried to get in contact with her in all sorts of ways, but she never responded. I devastated; she meant everything to me. The uncertainty and confusion about what had happened drove me crazy. He name was Anne too, which meant the memory of her was and our friendship was always coming back to me.
“Later I wondered how much of her stories about the rape and abortion was actually true. According to my mother some details just couldn’t be right. She would know, because she had worked as a nurse in an abortion clinic."
After the loss of her best friend, depression and insomnia set in. "I was grieving and all these memories were going round and round in my head, but I never talked about it. It was around then that I started exercising a lot and eating less. Tennis, hockey, running, at least three hours every day. I exercised so much that it ruined my joints. At the same time I felt compelled to lose weight, literally make myself small, preferably disappear. I felt lonely. I didn’t make any more friends for fear of going through something so painful again.”
Home was not exactly an oasis of calm. Her brother had got into drugs, which caused a lot of stress and tension in the house. Marsman slept badly, suffering from flashbacks and debilitating grief, but nobody asked how she was. Not at home, but also not at school, although her teachers, counsellors and mentor were well aware of what had happened.
All the starving and abusing of her body left Marsman exhausted. “And then something happened that’s quite common with eating disorders: the anorexia turned into bulimia. It felt like the biggest humiliation of my life. Anorexia is associated with control and willpower, whereas bulimia evokes weakness and revulsion. I ended up writing my bachelor’s thesis about that, as part of the reflection and recovery process."
Towards the end of her bachelor’s programme, Marsman met the psychiatry professor Jim van Os. Not long after, they founded Psychosenet.nl, a digital platform where patients, relatives and therapists can share information and experiences, partly with a view to dispelling myths and prejudice. Experiencing a psychosis does not, for instance, mean you have a severe brain disease or no hope of a meaningful future. ‘Four in five people recover from a psychosis. It’s not easy, but it’s possible. What you need is hope and optimism.’
Marsman, who works as an editor at Psychosenet, now embraces every opportunity to challenge stigmatisation. Together with Van Os, she will take part this weekend in the Social Run, a 555 kilometre relay race around the IJsselmeer. She will be running with “a nice bunch of psychiatrists, psychologists and experience experts” who make up the HART team, from the public health centre GGZ. If exercise was once Marsman’s way of keeping her own head above water, now she runs to make life more bearable for her peers.
Depression and the university
Psychological issues affect academics and students more often than they do others. According to a survey held a few months ago among PhD candidates in Amsterdam, one third of young researchers may be depressed, two times as many as in the population on average. More female PhD candidates reported feeling depressed (40 percent) than their male counterparts (31 percent). The longer the doctoral research takes, the greater the chance of depressive symptoms.
In 2013 the Dutch Student Union (LSVb) surveyed some 1100 students, a quarter of whom reported having psychological issues; women more often than men and students in higher vocational education more often than those at university. Members of student associations had a lower risk of developing psychological problems. The most common complaints were depression, stress and fatigue. Among people under the age of 21, the use of antidepressants increased by 40 percent between 2007 and 2015, according to the Dutch Foundation for Pharmaceutical Statistics (SFK).