sent to me by a mom, describing her daughter's recent experiences in an upscale residential facility for eating disorders:
". . . If my daughter cries in the facility, she is restrained in a punishment chair. If a girl regurgitates food at the table, she has to eat it again. The nurses tell my daughter to try to swallow her vomit at the table so she won't get the punishment chair. Over the past four days, my daughter's typical meal has consisted of two veggie burgers on buttered rolls, three cups (!!!) of canned vegetables, two cups of milk, two bananas, six TBS of peanut butter, and a granola bar, all of which must be consumed within 20 minutes. All food is served stone cold because the pediatric unit has no kitchen. We are allowed one visit per day, during which she cries to come home. . . ."
This is why I'm such a strong believer in family-based treatment (the Maudsley approach). Those of us who have been through the nightmare of anorexia know that you have to be tougher than the eating disorder to help your child survive. You have to allow no loopholes for the disease to continue its insidious mind-twisting.
But you do not have to punish the child. Someone with anorexia is already suffering torments beyond what we can truly imagine. The very concept of a punishment chair makes me feel ill. Eating stone-cold food? Being punished for crying? Who wouldn't cry, trapped in the hell of anorexia? Serving massive amounts of fruits and vegetables during re-feeding? You need the smallest volume possible of food during re-feeding, partly because the digestive system can't handle so much volume and partly because fat is a crucial part of the recovery process. Quality, not just quantity, is important, and the brain and body need fats and protein to begin to heal.
Imagine being ill with cancer and being punished for throwing up after each round of chemotherapy.
Treatment for an eating disorder should never look like medieval torture. There are other ways and options. Even in cases where a child requires an NG tube, treatment can be done with love and kindness and not punitively.