Possible trigger warning with mention of behaviors
Chapter 23 – The Fundamental Flaw
“In a hospital they throw you out into the street before you are half cured, but in a nursing home they don’t let you out till you are dead.” – George Bernard Shaw
There is a fundamental flaw in the way patients are treated in eating disorders facilities. It's true that the brain needs calories in order to function properly, and only when it is functioning properly can rational decisions be made. Those who are too malnourished might need to have a feeding tube until the body is working more normally. However, there are aspects of some treatment centers that appear to be counterproductive to recovery. In her book Feeding Anorexia: Gender and Power at a Treatment Center, Helen Gremillion suggests that conventional treatments can actually exacerbate the problems associated with eating disorders. “The patients in the program I studied are required to have an exact calorie count every day. There is also detailed attention to even very small weight gains and losses,” Gremillion reports. “Of course, any treatment program must devise ways to encourage eating and weight gain, but I argue that such careful attention to the numbers plays right into anorexia’s hands. The focus of the treatment takes on a life of its own to the extent that it ends up reinforcing the problem.” She adds, “Young women today are expected to carefully monitor their consumption of food, and people who struggle with anorexia are caught up in this ideal with particular intensity. Treatment programs that don’t recognize this cultural pressure can contribute to it when they require patients to monitor their body size very carefully,” She suggests that “The goal of weight gain vs. weight loss in treatment pales in comparison to practices of self-control and self-surveillance that both anorexia and mainstream treatments for it require.”
Though it can take months and even years before recovery takes place, most insurance companies only cover approximately six weeks of hospitalization for an eating disorder. The 2006 documentary Thin tracked several women with eating disorders during their stay in a treatment facility. It is one of the most deeply disturbing movies I have seen, not just because it hits close to home but because it gives an honest look into the suffering that victims of an eating disorder must endure. In one heartbreaking scene, a woman is forced to leave treatment when her insurance runs out. In another, a woman’s mother begs for the administration to let her daughter stay after the decision was made to kick her out for breaking hospital rules. Rather than addressing the issue and realizing that rebellion is a common trait of many anorexics, the woman is forced to leave before she feels ready. It becomes clear in the movie that an “us vs. them” attitude is rampant at the hospital from the way the women talk about the administration and purposely break rules. Compliance is the best way out of treatment, and many women become model patients with the thought in mind that they can return to anorexic behavior once they get out.
The difficulty that treatment facilities face is that gaining weight does not cure anorexia. An August 2005 study in the Journal of Clinical Nutrition by Robyn Sysko even showed that improvements in both psychological symptoms and weight did not necessarily lead to a similar improvement in eating habits. The study reported the following:
The researchers fed 12 hospitalized women with anorexia and 12 women without eating disorders the same number of calories at breakfast followed by an unrestricted-calorie test meal at lunch. The test meal consisted of a large strawberry yogurt shake. Study participants were told to drink as much or as little as they liked. The anorexic patients were given the test both early in their hospital stay and later, after they had gained back a good deal of weight. The non-anorexic study participants ended up drinking about half of their shakes, taking in approximately 500 calories. Early in treatment the anorexic patients took in about 145 calories at the test meal, and later in treatment they took in 240 – still less than half of that eaten by the women without anorexia nervosa.
The study concluded that those with anorexia, left unsupervised, were more likely to eat less at mealtimes.
It appears that hospitalization does not always lead to recovery from the illness. Indeed, many hospital treatment programs seem to have an almost backward approach to treatment. Of course there is a need to address food issues, but what is questionable about the typical course of action is taking the control completely away from patients when they walk through the doors. This immediately puts an air of distrust in the treatment itself. In addition, by controlling patients’ food intake, the focus is still primarily on the food, only now someone else is establishing the rules. These rules may be healthier than what was done before, but they are still rules nonetheless. Forcing patients to follow a strict meal plan leads to a distrust of one’s own body, and relying too much on a food plan doesn’t allow for natural changes in life, be it hormonal or physical, that cause the body to naturally need more or fewer calories or different nutrients at various times.
When my friend Laura was in the hospital being treated for anorexia, she was not allowed to mix her food. For example, if she was given granola and yogurt, she had to eat the two separately. She was also made to eat at regular times during the day and had to consume absolutely everything she was given. In many cases the food is actually weighed out and exact amounts are measured.
Laura relapsed relatively quickly after her release and is at the point where those around her, as of this writing, are worried for her life. The last time I saw her, in 2011, she was out shuffling through a jog, looking like she was living in a country overcome with famine. Her mother cried when we discussed her condition. After meeting with Laura for an interview for this book, I felt compelled to send her an email expressing my concern. Unfortunately, and I know this from experience, it’s rare that an outside voice can change the course of a determined anorexic. However, I feel it’s essential to keep trying or at least not give up hope.
Another hurdle with recovery comes through the pressures of society and the flawed messages sent to us all. In magazines, it’s not uncommon to find the image of a frightfully thin model on one page followed by a fast food ad on the next, followed by a diet cola ad on the next. It’s very confusing. Both anorexia and obesity are reaching epidemic levels. The diet industry is capitalizing on selling the public foods that are energetically dead and devoid of essential nutrients with claims that these products will help a person lose weight. A study by Sharon Fowler in 2005 at the University of Texas suggested that diet soda increases the risk of obesity by 37.5%, while drinking the same amount of regular soda increased the risk of obesity slightly less at 30%. In the 2004 movie Supersize Me it was shown that children are bombarded by messages to eat fast food, and that this very food, if eaten regularly, can lead to illness and obesity. The messages are either subtle but continual, or blatant. Obesity is reached one Big Mac at a time, one missed workout that leads to more missed workouts, and the cure does not come in a bottle. What needs to be addressed is basic psychological and physical health together. These conflicting messages we receive from the media lead to an unhealthy attitude about what is important in life, which is a healthy lifestyle, feeling good and being happy, not being rail-thin or conversely eating as much as possible.
Another problem with getting well in this society is that it is nearly impossible to get any kind of financial assistance for eating-disordered patients. Though I was at one time eighty pounds, jaundiced and having seizures, I was not considered disabled enough to receive any government assistance. A lady I knew with bipolar disorder, on the other hand, was given assistance. In addition, there are those who are able to receive aid when they are not managing their lives well. It’s a very subjective decision to reward one person over another monetary assistance, and I’m not sure what leads to these outcomes. At the time, when I was so very ill, it felt like the decision was reached by the toss of a coin or whether or not the intake forms were received by someone who had just had a good breakfast or not. It seems ridiculous to me that someone so close to death would be denied help, yet someone else whose survival does not depend on assistance may be offered help.
Although psychiatry claims it takes approximately one month to change a behavior, this is not always so with addiction. Stopping smoking for a month, for example, does not necessarily mean the smoker will never touch another cigarette. Recovery takes more than just behavioral modification. This can help a great deal, but what needs to be addressed goes far deeper. We as a society need to recognize the triggers that lead to disordered behavior, so that we can better deal with the issues. It’s essential to consider the inner working of the person, which may or may not correspond to standard theories on recovery. When it comes to treatment and recovery, each person must be dealt with separately. A return to the self should be emphasized, so that each patient can assist in her or his own wellness.
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