"You've come all this way and succeeded in losing all this weight but suddenly the control is plucked from you and you don't know what winning is like - which in extreme cases, equals death - and feel a failure," he said.
Four years ago, doctors gave Mal's wife, Carolynne, a month to live and she was admitted to hospital weighing less than five stone.
The couple now run the Eating Disorders Club in Kendal, Cumbria. Patients are referred to their charity often after being force fed in hospital. One current patient is a 27-year-old woman who weighs four-and-a-half stone. On the brink of death, she was force fed.
Although there has been a marked improvement in her since she was put into the care of the Smyths, mentally the road to recovery is lengthy. She has made a living will stating that if she collapsed again and went into a coma she must die rather than be force fed.
Mr Smyth said: "She feels she cannot be successful even as an anorexic. She has knocked on the door of death but wants to have some semblance of control in her life. She tries to fox everyone all the time but my wife knows all the tricks."
Catherine Cowley, from Bristol, can empathise with such cases. An anorexic for 20 years, she was tube fed for five weeks in 1987 when she weighed six stone. "In that state you think you know what you want but there's no way you can. In a life or death situation, I think doctors should be able to force feed patients, although it's difficult to make victims of anorexia understand this."
Although she now feels in control of her weight, Catherine admits she is not fully cured. Now 40, she started dieting as a teenager. At 5ft5in and weighing 10 stone, the 18 year-old dreamed of being a stone lighter.
"I thought I should lose a bit of weight and it gradually got easier and dieting gripped me. I became obses-sive. I felt really ill but didn't under-stand that it was due to my spiralling weight loss. I was really frightened, but it became almost a thrill, too," she said.Reuse content