The Time in Between: A Memoir of Hunger and Hope

The Time in Between is the account of a 12-year period in the life of Nancy Tucker, during which she struggled with anorexia nervosa and its sequelae. The author tells us in the foreword to her book that her aim is to convey the 'devastating damage' caused by an eating disorder. In this she succeeds, sparing no detail of the pain and disintegration, both emotional and physical, engendered by her starvation; nor of the lengths to which she goes to deceive others into believing that she is acquiescing in the many treatment programmes and diet plans which she is prescribed over the years.

Throughout her illness and even in 'recovery' she is in thrall to the 'Voice' that represents her anorexia, drawing her ever deeper into disease and away from normality. Nancy describes her progression from anxious baby to bright child – desiring perfection in herself and admiration from others – into a child at the transition to private senior school. To be the best is suddenly more difficult to achieve, but she becomes increasingly desirous of perfection in all things.

Without fully understanding why, Nancy decides that the solution to her problems is to become thin, thinner than any of her peers. Before long, the familiar tale of successful diet, support from family, and admiration from friends, has led to intensified efforts to lose weight. This is followed by an increasingly 'relentless march of rule after rule' of self-imposed restriction, turning to starvation.

Thus far, the story is not unfamiliar to professionals with knowledge of eating disorders and those who suffer from them. However, the forensic detail with which Nancy journals the progression of the disease, with the gradual but relentless distancing of herself from friendships and family, as a result of her increasing inability to focus on anything but her internal state and her immense isolation, gives the reader a detailed and rare glimpse of what it must be to live inside the mind and body of someone with a severe eating disorder. This is not to suggest that Nancy can tell us how to help, or indeed what it was that made her 'better'.

Interestingly, one of the few helpful tools in her treatment was the suggestion that she write to her anorexia both as Friend and as Foe, a device by which she is able to verbalise some of her intolerable conflict, at least to herself, if not to others. Recovery, however, is not a sudden shift from being unwell to one of wellness. On the contrary, her personification of her disorder in the form of the 'Voice' makes it clear that living with an eating disorder can be like living with an inner alien, one who is empowered by its role as best friend in a world where the sufferer – for whatever reason – is unable to access a more trustworthy ally.

Nancy addresses the roles of therapist and family with intelligence, insight and humour. For example, she uses the medium of the a/b/c quiz question to describe the dilemmas posed when caring for a daughter with an eating disorder, and to demonstrate that whatever strategy a parent takes is bound to be mistaken. Eating disorder therapists reading this book may find it amusing to note the cynicism with which Nancy views the stream of professionals who attempt, with varying levels of competence, to dissuade her from her mission. But it is perhaps reassuring to read that 'The Right Therapist' was right not because she had the magic cure, but because she demonstrated both knowledge and compassion in the 'in between' period of the author's progress through 'an unruly collection of acceptances and realisations' on the path to wellness that she ultimately needed to follow.

More than simply a tale of suffering, this book is an illustration of the complexity of eating disorder and a reminder that the 'cure' for each sufferer may need to be as multifaceted and as personal as the disorder itself. At the end of the book Nancy informs us that she has been offered a place at Oxford University to study experimental psychology; but far from signalling a triumphant end to a painful story, she describes her growing awareness that life is more often about 'the time inbetween', the trials of the journey itself, and the need for acceptance both of being oneself as one is, and of an absence of control or certainty about the future.  

Icon Books; 2015; Pb £12.99
Reviewed by Sara Gilbert, who is a clinical psychologist