SHE was found dead in the walk-in wardrobe of her childhood bedroom. Naked and gaunt, aged just 32, she was, said Fire Captain Paul Cook, who was one of the first on the scene at her parents' house in Los Angeles, "very thin. She looked like she weighed between 98 and 100 pounds" (about 45kg).
The tragic death of Karen Carpenter 25 years ago this week shocked the world. With a stellar career as one half of 1970s superstar brother-and-sister group The Carpenters, who had 12 top ten hits, more than 100 million sales and 11 hit albums, she wa
s one half of one of the bestselling bands of all time. She should have been, in the words of one of her greatest hits, on top of the world. Instead, she had been slowly deteriorating, both mentally and physically, the result of a long battle with a devastating and complex illness that eventually claimed her life.
Carpenter's death, caused by complications from anorexia nervosa, shone a spotlight on a hugely misunderstood disease. Anorexia was rarely discussed, indeed it was an illness many had never even heard of. Kept behind closed doors and seen as something to be ashamed of, it was a taboo subject.
Suddenly, following Carpenter's death, anorexia was in the headlines. Media commentators and doctors were discussing it openly, while women's magazines ran articles on how to spot the early symptoms. As a result, many who had suffered in silence began to talk about their problems and ask for help. For others, such as relatives of sufferers from the disease who had no idea of the severity of their loved one's struggle, it was a wake-up call.
Richard Carpenter, writing in People magazine just nine months after his sister died, came forward to say publicly that, up until her death, he had no idea how serious Karen's condition was.
"The shock was tremendous – I knew she was ill, but not that ill," he wrote. "But the more I look back on her life, the more I can see the indications. Karen had been a little overweight as a teenager – she loved tacos and chilli. But we never teased her – to us, she wasn't that fat."
Attitudes to anorexia nervosa, in common with many psychological illnesses, have progressed slowly. In the 19th century young women suffering from the disease were known as "fasting girls" and treated as freak-show oddities. They were often isolated from their families and force-fed by doctors who didn't understand the complex neurological issues at the heart of the illness.
By the 1970s, trends had not advanced much. Young women obsessively dieting and starving themselves in an attempt to reach what they saw as the perfect weight were still being force-fed, and were often sent into long-term residential care, leading many to become institutionalised. Carpenter underwent both of these treatments, checking into Lenox Hill hospital in New York for seven weeks where she was force-fed, boosting her weight from 80lb (36kg) to 110 (50kg) in just a few short weeks. "She put weight on too fast in these weeks in the hospital," her brother wrote after her death. "It put an undue strain on her heart."
While Carpenter did receive some therapy, counselling was still a rarity for many sufferers, and some women – including Carpenter – were given powerful drugs that were meant to boost their metabolism, but more regularly had detrimental effects on the patient's heart rate.
"In her time there would have been much less information," says Deanne Jade, principal of the National Centre For Eating Disorders. "It took people a very long time to get to the diagnosis of anorexia, and I think that was one of the problems. The poor girl was doing terrible things to herself, and there just weren't that many treatments available."
So, did Carpenter's death help change attitudes towards anorexia? Susan Ringwood, chief executive of b-eat, formerly the Eating Disorders Association, cautiously agrees. "We know it helped people to understand that this was a serious condition and it could be fatal," she says. "Yet that's something that still shocks people today. Many people still don't understand how serious it can be. It did raise awareness, but we still need to be reminded of that fact today."
Anorexia nervosa is a complex psychiatric illness. Sufferers – 90 per cent of whom are female – develop an obsessive fear of gaining weight for reasons that may be psychological, neurobiological or sociological, depending on the individual.They will then seek to control this by starving, exercising, purging, vomiting, or even resorting to drugs. In its most severe form sufferers' weight will drop below 100lb, they will gain downy hair all over their body, their periods will stop and their teeth will decay. Slow heart rate, hypertension, hypothermia and anaemia are all long-term implications. Because its causes are so various, treatment, and the understanding of it, has changed substantially in the years since Carpenter's death.
"There have been thousands of pages of research written into anorexia – why people get it, what it's about," says Jade. "There are so many different interpretations. We've gone from thinking it's a psychological illness to a neuro-developmental disorder, to an autistic spectrum disorder to a family disorder; we've even, in the past 25 years, had feminists saying it's a society disorder, that it's caused by disempowerment of women. And yet for all the writing and research done into it, anorexia still has the highest mortality rate of any psychological illness."
And since Carpenter's death, the numbers of those with the illness have risen. In the UK one in 100 women aged between 15 and 30 now suffers from anorexia, and according to b-eat, approximately 11 people in 100,000 develop anorexia nervosa each year. The number of admissions to NHS hospitals for treatment of anorexia nervosa in the UK was 620 in 2005-6 – a rise of almost a third compared to a decade ago, when the figure was 419.
But why? Some blame the increased focus on thin models in the media, and the whole size-zero debate. "The whole celebrity culture has added an area of blame that is unnecessary and doesn't help," says Ringwood. "We're seeing many younger people affected. That's one of the big changes over 25 years. Now children as young as eight are having to seek treatment for anorexia, which certainly wasn't the case 25 years ago."
But while the number of cases may be on the rise, there is some hope. "We now have a range of widespread eating disorder services," says Dr Alex Yellowlees, medical director of the Priory hospital in Glasgow, which treats patients with eating disorders.
"In recent years it's been realised that as well as restoring physical health, there needs to be psychological interventions. That was a major breakthrough in the treatment of the disease."
Ringwood agrees. "We're understanding that for any treatment to work it needs to include talking therapy as well as nutrition," she says. "it's not enough just to feed people. You need to help them understand the way they feel about themselves too."
Yellowlees says there is now a wider range of treatments available than existed a quarter of a century ago. "They range from self-help to outpatient and inpatient treatment, which is now reserved for a small minority of severe cases," he says. "There's also much more professional awareness about the illness on the part of GPs and specialists."
But there is a long way to go yet. Yellowlees admits that the medical profession still doesn't know exactly what causes anorexia. "Our knowledge is increasing but there are still large gaps," he says.
"There's still no single treatment programme where experts can agree, with their hand on their heart, that this is what you can do to get people better," says Jade. "If you've got smallpox you can say, 'We'll do this and we'll expect a good outcome in six months.' You can't do that with anorexia."
It wasn't until late 1981, just over a year before her tragically premature death, that Carpenter eventually sought the help she so desperately needed.
"She reached the stage where she came to me and said, 'Richard, I realise I'm sick and I need help,'" her brother wrote after her death. Sadly, however, the cry came too late.
Yet, in the words of a song she once sang, her legacy – and the quest for the true meaning of the terrible disease that killed her – had only just begun.
