Sarah, Duchess of York

It is an extraordinarily frank series of revelations. But then Sarah, Duchess of York, has always had a willingness to wear her heart on her sleeve.

Writing exclusively for The Telegraph, the Duchess describes “the profound scars” of her childhood that “led to feelings of unworthiness [that] contributed to an unhealthy attitude to food that often threatened to spiral into a full-scale eating disorder”.

She writes, too, of being marked by “tabloid headlines of the 1980s and 1990s” and more recent “comments on social media (which I regard as a cesspit)”.

Such was the extent of recent online vitriol, combined with a double cancer diagnosis, that she says her mind was forced “to some dark places”.

Coming to terms with all this, she says, was brought on by long discussions of post traumatic stress disorder (PTSD) and attention deficit hyperactivity disorder (ADHD) during a visit to a Swiss clinic.

Sarah, Duchess of York with her daughters Princesses Beatrice and Eugenie in April - Aaron Chown/PA

Her revelations, which you can read in full below, are a heart-rending reminder that this was a woman cruelly nicknamed the “Duchess of Pork” and “Fat Fergie” when she gained weight during her first pregnancy. Such language would never be tolerated today.

It is with characteristic candour that she admits that her difficult childhood has had a much more profound effect on her adult life than she ever realised.

Her description of how her mother’s decision to leave the family when she was 12 for a new life in South America “led to feelings of unworthiness” explains quite a lot of the Duchess’s difficulties.

As well as contributing to her “unhealthy attitude to food”, it perhaps also throws some light on why she has always tended to be so trusting of those who have shown her any attention.

When her mother, Susan, abruptly abandoned her to live with an Argentinian polo player Hector Barrantes, Sarah was left to look after her father, Major Ron Ferguson, with her elder sister Jane, who later moved to Australia.

Tragedy struck in 1998 when Susan Barrantes was killed in a car crash, aged 61. Coming just a year after the death of her beloved sister-in-law, Princess Diana, in a car crash – it left the Duchess completely bereft.

The Duchess with her mother Susan Barrantes at the Wentworth golf tournament in 1998 - Camera Press

She has previously blamed her fragile emotional state on her parents’ marriage breakdown.

In a 2018 TV interview with US show Modern Hero, she said: “Suddenly she’d gone and she never came back and I never saw her again really. I built a huge wall to the real Sarah. And I believed it was because I was worthless. Why would you leave your child? You wouldn’t.”

Little wonder, then, that Sarah has always stuck by her ex-husband, Prince Andrew, with whom she still shares a home at Royal Lodge, Windsor, despite his own string of nightmare headlines. She was similarly unwaveringly loyal to her father following revelations he had frequented a London massage parlour, The Wigmore Club, in 1988.

Father and daughter remained extremely close until Major Ferguson’s death in 2003, aged 71. He had cancer during the last decade of his life, having been diagnosed with prostate cancer in 1996 as well as skin cancer.

The Duchess had a similar “double diagnosis” of breast cancer and skin cancer in 2023 and 2024 – which has also had an understandable impact on her mental health.

As she writes: “Most recently, I don’t mind admitting that my mind went to some dark places – focusing on my own mortality – when I was diagnosed with first breast cancer and then skin cancer, which my father had when he died and also killed my best friend.”

This is not the first time Sarah has admitted to seeking help for her internal struggles. Like Diana, she dabbled with psychics and, in 1992, was reported to have visited a “mystic healer” called Madame Vasso.

Sisters-in-law: the Duchess of York and Princess Diana at Epsom racecourse in 1987 - AP

That was the year she suffered her most excruciating embarrassment, as tabloid headlines screamed “Fergie Toe-Job” to accompany photographs of Texan multi-millionaire John Bryan sucking her toes while she sunbathed topless during a holiday in the south of France with her daughters Princesses Beatrice and Eugenie.

To make matters even worse, Sarah was on holiday with the Royal family at Balmoral Castle when the gobsmacking images emerged.

She had to walk into breakfast that morning as all the newspapers were laid out for the family – including the late Queen and Prince Philip – to see. Princess Diana summed up the mood in the Scottish Highlands with a message to journalist Richard Kay which simply read: “The redhead’s in trouble”.

Quite how the Duchess, now 65, coped with that unedifying episode is anyone’s guess. But the pain of being in the public eye didn’t end there.

The Duchess was thrust into the public eye on her marriage to Prince Andrew in 1986 - PA

The mother of two, who was married to Prince Andrew from 1986 to 1996, ended up being the subject of another tabloid exposé in 2010, when she was filmed by the News of the World offering Mazher Mahmood, an undercover reporter posing as an Indian businessman, access to Prince Andrew for £500,000. She later tried to sue Rupert Murdoch’s News Group Newspapers for £45 million in lost earnings.

If these high-profile incidents weren’t hard enough, spendthrift Sarah also had a succession of debt problems – and courted controversy once again in 2011 when it emerged that convicted paedophile Jeffrey Epstein had helped her to avoid bankruptcy. She later admitted taking money from Epstein had been a “gigantic error”.

Such highs and lows have helped make her the most relatable of all the members of the Royal family. Lately, her willingness to confront the lows confirms a fragility that has endeared her to the masses; something that was illustrated by the cheers from the crowd when she arrived at Prince Harry and Meghan Markle’s 2018 wedding.

This latest admission once again serves as a reminder that the Royals are, at heart, just like the rest of us: real people who carry the emotional baggage of the journey they have been on.

Mental health knows no boundaries

by Sarah, Duchess of York

(L-R): Dr Thilo Beck, the Duchess, and Jan Gerber at Paracelsus Recovery, in Zurich - Pablo Faccinetto

As a mother, a public figure, and someone who has experienced the profound challenges of mental health, I have always believed in the power of openness, kindness and compassion.

But being open about the struggles I have faced has not always been easy.

I’ve always known there were issues I needed to address, stemming from my childhood and my time in the public eye. Then I was diagnosed with cancer, twice in the same year, something that would be challenging for anyone in terms of mental as well as physical health.

I’ve always worked hard on my emotional wellbeing, so as well as exploring these issues, I was keen to understand how I could better use whatever platform I might have to advocate for more open discussion about mental health challenges and better policies in this area.

I am particularly concerned about the crisis in mental health we are seeing in our young people. There are escalating rates of anxiety, depression and other wellbeing issues in the next generation. This crisis is driven by a combination of social, economic, and digital factors, compounded by the many challenges people face in accessing timely and effective support.

All of this inspired my recent visit to Paracelsus Recovery in Zurich, which kindly hosted me as a guest. I am not embarrassed to reveal the clinic offered me a sanctuary, renowned as it is for its bespoke, cutting-edge treatment for those grappling with mental health and addiction issues – particularly those whose struggles are often hidden behind the facade of a public role.

You may have heard of Paracelsus, named after the 16th-century Swiss physician and pioneer who went against the grain by declaring that those suffering from mental illness were not possessed by evil spirits but deserved humane treatment instead.

The clinic that bears his name has proved successful because of two remarkable individuals: Dr Thilo Beck, the clinic’s lead psychiatrist, and Jan Gerber, its chief executive and founder. Their insights into conditions such as complex post-traumatic stress disorder, adult attention deficit hyperactivity disorder and the need for mental health advocacy have left an indelible mark on me and made me determined to do more.

The Duchess discusses the impact of trauma on emotional wellbeing with Beck and Gerber - Pablo Faccinetto

Dr Beck, with his decades of experience and roles advising governments on health policy, and his determination to make his expertise available to all, doing extraordinary work with homeless people suffering from mental health and addiction problems, provided an understanding of complex PTSD and adult ADHD. He explained that these conditions often manifest in subtle ways, making them challenging to diagnose, especially in high-functioning individuals.

I learnt that complex PTSD, resulting from prolonged exposure to trauma, can lead to an inability to control or regulate one’s emotional responses, feelings of detachment and a pervasive sense of hopelessness.

I wasn’t there to be diagnosed, but we discussed my own childhood and the profound scars that were left when my mother left the family when I was 12 for a new life in South America. This certainly led to feelings of unworthiness and I’m sure contributed to an unhealthy attitude to food that often threatened to spiral into a full-scale eating disorder.

Spending most of my life in the public eye has been a great privilege, but has also presented its own challenges. The tabloid headlines of the 1980s and 1990s and intrusions into private life have doubtless left a mark, as do comments on social media (which I regard as a cesspit). Most recently, I don’t mind admitting that my mind went to some dark places – focusing on my own mortality – when I was diagnosed with first breast cancer and then skin cancer, which my father had when he died and also killed my best friend.

A lot has been written about ADHD in recent years, and I’ve sometimes wondered whether there might be signs of it in me. Dr Beck explained how adult ADHD often presents as chronic disorganisation, impulsivity and difficulties in maintaining focus, which can be misinterpreted as character flaws rather than a neurological condition.

However, individuals with ADHD often think outside the box, leading to innovative solutions and creative breakthroughs. Their ability to connect seemingly unrelated ideas can be a significant advantage in fields requiring originality. Despite being easily distracted, they also often have periods of what’s called “hyperfocus”, where they can concentrate intensely on tasks that interest them. This can lead to high productivity and exceptional performance in areas such as research, writing and creative endeavours. So people with adult ADHD can often be immensely successful and powerful.

What struck me most was Dr Beck’s emphasis on the importance of individualised treatment plans when treating mental health conditions. Patients must undergo comprehensive assessments, including functional medicine and genetic tests, to understand the root causes of their symptoms. This holistic approach ensures that treatments are not just reactive but proactive, addressing both the mind and the body.

Jan Gerber shared his insights into the societal stigma surrounding mental health. He noted that individuals in high-pressure or public roles often feel compelled to maintain a facade of perfection, leading to isolation and often untreated mental health issues. I could certainly identify with this. When you’re in the public eye, there’s a need to be the proverbial swan – gliding effortlessly on the surface, while paddling frantically beneath the water.

One of the reasons I am writing this is because I agree with Jan that we need to promote open conversations about mental health and how we can improve access to mental healthcare across society for all. Only by addressing the stigma head-on can society move towards a more compassionate and understanding approach to mental health.

He also introduced me to some cutting-edge therapies. One of the most innovative I witnessed was the Satori Chair. Today, there is increasing research to demonstrate that music and sounds can have a profound effect on our minds and body. This state-of-the-art device uses vibrational sound therapy designed to retrain the brain to relax, producing deep, lasting levels of relaxation, meditation and sleep. For me, its effects were remarkable.

Another groundbreaking treatment I experienced is intermittent hypoxia-hyperoxia therapy (IHHT), a therapeutic approach that involves alternating cycles of hypoxia (low oxygen) and hyperoxia (high oxygen) to stimulate physiological responses in the body. Administered through controlled breathing sessions, there is emerging evidence that IHHT can enhance cellular function, improve cardiovascular health and support cognitive performance. It left me feeling energised and focused.

Epigenetic and gut biology testing is also used, enabling targeted treatment via IVs, micronutrients and supplements and specially engineered diets to rebalance the biochemistry of the brain and body.

What the visit taught me is that mental health knows no boundaries. It affects individuals across all walks of life, and it is imperative that we continue to break down the barriers of stigma and silence. As a society, we need to foster an environment where seeking help is seen as a strength, not a weakness.

If you or someone you know is struggling, I encourage you to seek help. You are not alone, and there is no shame in taking the steps towards healing. Let us continue to support one another and work towards a future where mental health is treated with the care, respect and attention it deserves.

Sign up to the Front Page newsletter for free: Your essential guide to the day's agenda from The Telegraph - direct to your inbox seven days a week.

Mental health knows no boundaries

Post Related

Post Related