Tuesday, October 09, 2007

6 lessons I learned at NEDA

1. There are lots and lots of well-meaning but ineffectual folks working in the eating disorders field.
2. There is lots and lots of Big Money at stake in the eating disorders field, mostly in the form of residential treatment centers.
3. There are lots and lots of politics in the eating disorders field.
4. Family-based treatment, which the scientific literature recognizes right now as the only evidence-based treatment with an 80 to 90 percent long-term success rate in adolescents, is perceived as controversial in the eating disorders field, even by some of those who profess to support and use it.
5. The most commonly heard comment about FBT at the conference: "Don't you have to be a very special family to make it work?"
6. The intensive outpatient family therapy for eating disorders program at University of California-San Diego, headed by Dr. Walter Kaye, looks absolutely wonderful.

I'm sure there are more, and I'm sure I'll be posting about them too.

4 comments:

Kell Brigan said...

Good stuff (if sobering). I tracked back at my blog.

Admin said...

Comment from troll deleted by administrator.

Anonymous said...

Dictated to Dragon NaturallySpeaking 9 (R).
dear harriet.

i am a psychatrist who recovered from anorexia about 10 years ago at a residential treatment center.

i chose to concentrate my practice in california away from eds because i was concerned that my own experience would prevent me from being objective in helping my clients by advocating what worked on me over other approaches. harriet i am glad fbt worked for your family. but it is not in the benefit of ed treatment as a whole to bash other approaches with a sledgehammer.

the residential program that helped me in the mid-90s is one of the very few that were not owned by big corporations at that time. these coorporate programs go after money as your post said and hbo's documentary thin showed a clear example of how this greed can translate into mistreatment: a resident's insurance ran out and she was discharged... "sorry it's coorporate policy". i have heard that same story before from colleagues with ed patients.

the program that helped me did not work that way: i had no insurance because in those days insurance did not even know about anorexia and residential treatment. but they took me in for whatever i could afford and when the money ran out they kept me. i stayed six months and have not relapsed since my discharge.

would fbt have helped me? my family kicked me out when i lost my virginity before marriage. husband? i got married eventually but in my anorexic days i went for the bad boys. outpatient had no effect on me either.

there is big money in residential programs but don't throw away the baby with the bathwater. there are small programs that work for many women like myself and work well and they don't make big money because they refuse to put money over principles. i worked as staff at the center that helped me after my discharge and i saw how small the profit margins were when compassion comes before wall street.

the american psychiatric association has extensive science-based data that supports fbt and maudsley in some cases and residential treatment in other cases. do not confuse the american psychiatric association with the american psychological association which us psychiatrists look upon with the same scepticism that you did on an earlier post.

i am afraid that the program to which i owe my life is no longer owned by the family that started it. they just could not make it and big money took over. the family could not match the advertising budget of the big groups and they had to sell to pay off their creditors. the new policies of the facility as imposed by the corporation do not allow for free riding leeches like me.

i know i rambled on and im sorry but like many women who recovered in a residential setting i feel protective of the approach that treated me. aware of my bias i chose to stay away from treating eating disorders myself but i still follow the field including the occasional blog. i doubt any residential facilities are still independently owned besides monte nido and rain rock in California whose owner's husband was a real-estate magnate. if there are any left then lumping them with big money and discounting their ability to treat women only serves the interest of big business. they may go belly up and that is no reason to rejoice because even though fbt is superior in some cases residential treatment has its place also.

so please do not throw away the baby with the bathwater for the sake of women like me. thank you.

ps. apologies for the spelling. i have arthritis and use voice dictation. i blame my ed for it. not my husband who is also named ed really.
Dictated to Dragon NaturallySpeaking 9 (R).

Harriet Brown said...

hello anonymous,
thanks for writing. of course you are right, there's more than one way to recover from an e.d., and I'm glad to be reminded that residential treatment centers work for some people. i am frustrated at the ways in which they don't work, and the ways in which people are often exploited and manipulated by them, but that doesn't mean they're all like that. or that everyone's experience is like that. i'm glad yours was not.