The Good, the Bad, and the Ugly

The Good:

The Lucille Packard Children's Hospital at Stanford University is expanding its treatment to those 18-21. We all know that EDs don't magically resolve once you turn 18; in fact, some don't emerge until college. And more, college is a strange limbo-land, where you're not quite a child but not quite an adult. Especially for people with eating disorders, development tends to stop dead in its tracks once the ED hits. So it very well could be that the specific issues being dealt with by the 18-21s have quite a bit in common with other adolescents than their non-eating disordered peers.

I've never been to the Stanford program, so I can't evaluate it from a personal standpoint. A number of the girls I was in residential with this past time had been there, and it didn't necessarily get glowing reviews from them. Then again, I don't know a hospital that really would. But a hospital isn't meant to be all fun and games; they're meant to help you get medically and psychiatrically stable. For someone with an eating disorder, this ain't going to be much fun.

More than that, though, I applaud the fact that Stanford uses the latest research in treating eating disorders.

"We're very family and developmentally oriented, and able to understand and address the differences between what a 9- versus a 14- versus a 21-year-old patient will need. It's a blame-free, solution-focused approach," said Lock.

He and his colleagues tailor their therapies to the specific family dilemmas, age and circumstances of each patient. Although hospitalization was the norm in years past, the team has found that many patients benefit from maintaining their social and academic connections while undergoing treatment.

"Lengthy hospitalizations used to be common," said Lock, "because we had no effective, research-based treatments.
Now we know that it's much more developmentally healthy to keep these kids in the community if at all possible and to involve their family in the re-feeding and recovery process." Physicians at the Eating Disorders Program carefully monitor the medical status of outpatients to ensure they stay medically safe while undergoing treatment.

(These quotes taken from a press release from Stanford University. Emphasis mine.)

This is the kind of approach more places need in order to treat eating disorders. No, not every treatment is appropriate for every person, but there should be better guidelines for what will work. And that means research. So kudos to Stanford.

The Bad:

This made me so angry and frustrated, I could just about spit. This is almost the opposite kind of news from the above. Also from a press release, but this one is titled, "Families Play a Role in the Development of Eating Disorders." It is from Remuda Ranch, the "nation's leading and largest inpatient treatment center for women and girls suffering from eating disorders."

I'm not very fond of Remuda, largely because they keep expanding and marketing and branding themselves, to the point where it seems more about the money than about the care. I'm positive that most of the professionals working there are genuinely concerned and considerate and compassionate and strongly believe in what they are doing. There is a great need for eating disorders treatment, no doubt about it, but when it becomes like a chain restaurant, that's when I start getting wary.

But, okay, fine. That's doesn't necessarily get my goat as much as the contents of the press release.

"Families are very much a part of the puzzle of eating disorders. There are biological, psychological, cultural, and family reasons why a person has an eating disorder."

Some of the common characteristics of the families that Remuda treats include:
  • Distant fathers
  • Chaotic families or families with substance abuse problems
  • Mother's high expectations for daughter and/or demanding parents
  • Parents who openly foster sibling rivalries
  • Over-controlling or domineering parents
  • Father's depression, rigidity, or excessive self-discipline
  • Marital conflict
  • Parents' sexual relationship problems
  • High levels of parent-daughter stress and family tension
  • Fathers who are chronically ill

"Another common thread we see are family members who are disconnected from their own feelings and become emotionally distant from others," said Wasserbauer. "Many families come to Family Week disillusioned because they feel they're a close family, but when they begin to understand that their loved one with the eating disorder never experienced validation for her feelings, felt unimportant because they never listened to her needs, they begin to see that although they did a lot of activities together, they weren't connected emotionally."

Now this sounds like basically any family I know. And to an ill teenager--hell, to ANY teenager--emotional connections can be strained and whacked out, to say the least. Plenty of families of people with eating disorders can have these issues, but that doesn't mean that this was the cause. And there's no scientific basis for this. Where is the research showing the effectiveness of resolving these issues?

The main difference, to me, between the Stanford program and Remuda Ranch is their vantage point. Stanford (and other research-based programs like it) looks forward; what can we do to help a person recover. Remuda looks backward; what brought a person to this point.

Except if you're always looking backwards, you'll never see where you're going.

The Ugly:

People love to comment on what other people are eating. It's kind of a hobby for many. I know it was for my former co-workers. They bitched about the chocolate on my desk, and about the whole wheat bagel and hummus "junk food" I was having with lunch. That last comment broke my resolve to stick it out in the diet-crazed workplace and I quit on the spot.

A woman who had recovered from anorexia was working at a grocery store and wrote an advice columnist about her co-workers comments on her food. She purchased snacks and treats, while she was working and said, "it is inevitable that when I buy junk food, I will get a teasing remark."

"Annie," the columnist, had this to say:

Dear California: They are trying to be friendly and don't realize what a sensitive issue this is for you. Since you don't want to share the information about your anorexia (nor should you feel obligated to do so), it's best if you can avoid reacting to the food comments. In time, the remarks will seem neither original nor amusing, and your co-workers will stop.

Well, not necessarily. Developing a thick skin is good, but developing a smart mouth can be even better. Someone told me I was "gaining weight quite nicely." So I said, "It must be something in the water because so are you!" They never said anything to me again. You don't have to be mean, but you don't have to be nice, either. Or quiet.

Trust me, people who comment and tease you about what you eat are NOT your friends, and you shouldn't treat them as such.

If someone starts commenting on my food or weight again and don't get the hint the first time that I'm not interested, I'll deal it right back. They don't need to stop because I was anorexic and feel uncomfortable; they need to stop because it's rude and ridiculous.

Remember, at the end of the day, it's not about you. It's all about them.

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marcella said...

So do the parents all sit there in groups at this family week talking about their sexual disfunction?
It's completely daft really, as most recent research shows that while parents do not CAUSE eating disorders
there is evidence that they can inadvertently perpetuate behaviours. One of the key ways in which they can do this is by wallowing in guilt and having a "high expressed emotion" - just what these family weeks seem to be encouraging.

Libby said...

Preach it, sister!

Yesterday, my boss says to me, "Wow... that lunch looks insanely... (pause).... HEALTHY!" Even a comment like that is triggering because my brain automatically says, "Yeah! And most of what you eat is not!" It took all the effort I could muster not to haul out and hit him. Ugh. People need some serious etiquette lessons.

mary said...

The really strange aspect of the LIST of reasons a person gets an ED is that there's no mention of FAMILY history of OCD, perfectionism, shyness, ADD, learning disabilities, addictive behaviors, or any other genetic yet high risk traits that are often seen before one develops an eating disorder. They've totally excluded the qualities that can be warning signs, the real genetic clues. Parents aren't perfect but if your mom or dad is a perfectionist, now there's a risky connection in which we can see how a parent caused an ED.(not blame based cause but real "it's in our blood and I may have shared it with you" cause. Why these traits wouldn't be the ones on the list is part of the problem with treatment in many very expensive places today.As it is they didn't even get an honorable mention!
You've put forth some very disturbing truths about how far we have to go with treatment Carrie. Keep sharing it.
About being offended...please don't slap me. Yes, families and environment can effect who we are, sometimes making us stronger in order to deal with a crummy situation, others times pushing us over the edge. Just as we can be hypersensitive to comments or advertising we can choose our responses according to whether the remark was well intended...I mean we can't bite everyone....or if it was delivered with venom. If so I'll personally help you hang them. People will fail us miserably if we hold them to such high expectations regarding conversation that we ban all but the silent. In fact I am less likely to trust the silent than the brave fool who risked connecting with me. Those who are mean I just plain shoot or ignore as they aren't worth the energy and I've learned that I can't fix them. Would a response to food comments like "Healthy Smealthy, since I've been out of prison I eat what I want, sir or mam" or "thank you" when someone says you are gaining weight nicely work for you? I know, you may not agree. I'd like you to stay out of prison and be free to enjoy life again, quirky people or not. They will always be there!

A:) said...

Yes, families can perpetuate behaviours, but to see a family as a cause is a bit stupid.

Also, "Family Week" -- how can LIFELONG multi-dimensional interpersonal problems in a family be solved in one week of GROUP family therapy? This seems to be more patronizing for the family then anything else.

From what I have heard of Remuda, they SUPPORT getting an NG tube and their refeeding is quick with little followup. Don't get me wrong, it is important to restore a healthy weight, but an NG tube should be a last resort -- I had one forced on me at 15 because I would not eat, not because it was "in vogue" in terms of ways to be anorexic. In the latest adult program I was in, the inpatients had no idea what an NG tube was for because the program would not do it -- you would just be asked to leave.

About the lunch thing -- I still have trouble eating in public. At work, on the bus -- I feel like if I eat more than one thing (ex. I eat a sandwich and then an apple) someone will be like "OMG, that is SO much food!!" I still can't walk into a grocery store and buy a bag of chips -- even if that bag will last me 3 weeks. I can't justify it. And what would the sales people say?

Wow, I still have issues :P


Anonymous said...

You may wish to see a different perspective, which I have written as Hopeful on the thread "Clearing the Air" on Laura's parents forum.

Anonymous said...

I like the way you've framed the difference between the research-based programs like Stanford and Remuda as looking forward or looking back. It reminds me of something Thom Rutledge (Jenni Schaeffer's therapist and co-author) wrote, "Learn what you can from the past, then get the hell out of there!"

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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