treating anorexia

[Ansciess]

I saw 2 documentaries on Youtube, one called "Thin" filmed at a treatment center for adult anorexics in the U.S., and another called "I'm a child anorexic" filmed at a treatment center for children in the U.K.

The forceful and authoritarian manner in which these patients were treated seemed so disrespectful (of autonomy and dignity), and often cruel to me. In particular with the adults (in "Thin"), the child-like way that the patients were treated seemed to me that it could easily make the problem worse - that patients come to see themselves as even more childlike, and incapable, and many of them were trying to "get away" with tricking the staff, who put themselves in the role of super-strict parents. The treatment seemed like a set-up for illness, rather than a system in which individuals are empowered to choose to get well.

I'm sure that different treatments work for different personalities of people, but the model that I saw I think wouldn't be appropriate for many. The room searches, extreme distrust of the patients, strict feedings, and threats of force feeding... Here's an article in which a judge forces feeding on an anorexic
http://www.guardian.co.uk/society/2012/jun/15/anorexic-woman-fed-judge
I'm not sure that force feeding is ever really justified, even for children. I understand that it is seen as a mental illness, and so the argument is made that people aren't capable of making their own decisions, but the treatments that I saw seem to me that they would reinforce the sickness. I don't know how typical those treatment programs that I saw are, but it doesn't seem to me that that's the best way to treat eating disorders.

Thoughts?

 

[yally]

Completely agree, I've seen both of those docs at some point and it all just seems so UNHEALTHY and unfair.

Plus they seem to obsess over numbers which can't be helpful either.

 

[ledboots]

I saw Thin and thought the same thing. I was so nauseous watching the way they treated the young female patients as if they were "bad" or doing something purposely wrong. VERY judgmental.

In nursing school (long time ago) I spent a week doing a clinical rotation at a hospital's eating disorder clinic. The staff were fanatics about counting calories and exercise, and mealtimes were *not* fun. My stomach was so clenched at the atmosphere that I had no appetite at all, and I am someone without an ED who is usually ready to eat. I had some really good discussions with some of the patients, though, or it would have been my least favorite rotation. (Mental health facility took those honors! )

 

[Scorpius]

Well this is quite topical for me . . .

I was *this close* to going to the Renfrew Center (where Thin was filmed) this fall, but decided against it because I got a bad vibe just reading about it. I haven't watched the documentaries because they can be triggering for me. But I've been to some pretty crummy treatment centers where the staff treats you like a disorder and not a human. Which is very counterproductive when you are trying to recover and separate your identity from the "ED" identity that takes over in the throes of the illness.

Now, whether or not it was ethical to film what goes on in places like this is another issue all together. If someone filmed me when I was in treatment it would not be a pretty thing to watch.

 

[Scorpius]

Also, being treated for an eating disorder as an adolescent versus as an adult is like comparing apples to oranges. Adolescents are more likely to get thrown into treatment facilities against their will, hence they refuse to eat, and end up getting an NG tube for force-feedings. As an adult, you are able to make our own decisions about treatment unless you are deemed a danger to yourself (I'm not sure how this is determined, by BMI or lab values, perhaps? I don't want to know!). Most of the adults I've encountered in inpatient units with NG tubes for feedings chose to have them placed if they don't want to eat food. As an adult, if you refuse to comply with treatment being offered, they'll simply discharge you from any program--rightfully so. As an adolescent, you can be held against your will, which I think makes kids more resistant and vengeful towards treatment and recovery in general.

Either way,

Spoiler

eating disorders suck major balls.

 

[Ansciess]

I was *this close* to going to the Renfrew Center (whereThinwas filmed) this fall, but decided against it because I got a bad vibe just reading about it. I haven't watched the documentaries because they can be triggering for me. But I've been to some pretty crummy treatment centers where the staff treats you like a disorder and not a human. Which is very counterproductive when you are trying to recover and separate your identity from the "ED" identity that takes over in the throes of the illness.

Now, whether or not it was ethical to film what goes on in places like this is another issue all together. If someone filmed me when I was in treatment it would not be a pretty thing to watch.

I heard about "Thin" because I saw an interview with the director of the movie. She said that at any time the women could say that they did not want the cameras there. It didn't sound like a "reality tv" show, in that for those the subjects have no say over the filming and can't pull something back that was captured on camera. She sounded like she was more sensitive to the subjects of this film. But yeah, I wouldn't want to be filmed either. It's some of the staff who came off looking horrible though, not the patients.

One of the staff called a patient a "bad seed" (and other staff agreed) because she was ostensibly encouraging other patients to act out (and then they kicked her out, and then she eventually killed herself). The staff and treatment model they followed just seemed so uncompassionate and unhelpful.

I saw Thin and thought the same thing. I was so nauseous watching the way they treated the young female patients as if they were "bad" or doing something purposely wrong. VERY judgmental.

In nursing school (long time ago) I spent a week doing a clinical rotation at a hospital's eating disorder clinic. The staff were fanatics about counting calories and exercise, and mealtimes were *not* fun. My stomach was so clenched at the atmosphere that I had no appetite at all, and I am someone without an ED who is usually ready to eat. I had some really good discussions with some of the patients, though, or it would have been my least favorite rotation. (Mental health facility took those honors! )

What I thought was most problematic is how the staff were infantilizing the patients. They treated them like they were infants, and then they began to act like little kids trying to be sneaky about stuff. And one of the patients featured was a 25 year old nurse!

I don't know what other treatment models there are for treating in-patient eating disordered patients. Do you? I wonder if it's done differently in other countries. In my mind they should have full autonomy, and the "stern parent" model should not be used, but instead just have a supportive system that people can participate in or not. Which I understand more explicitly "allows" patients to not follow the program if they choose not to - which I know is the issue, that staff figure if the patient can "get away" with their illness they will - but ultimately that's already the choice. Even for children I really question if that forceful model - and threat of force feeding - should be used. I don't know what evidence there is that that's the most effective treatment for everyone or anyone. I think it boils down to how much people think it's an illness that makes one unable to make rationale choices for themselves.

Should anyone be force fed if they refuse to eat (the article above)?