Thursday, January 04, 2007

"Force-feeding" and anorexia

Recently I've been asked to speak about the Maudsley approach to healing anorexia on several radio shows. In every interview there is a question or comment about "force-feeding" anorexics, and it's always offered in a tone of mingled horror and contempt, as if there could be nothing worse than coercing someone into eating.

To which I usually respond something like, "Actually, there's nothing worse than watching someone compulsively starve herself to death."

Now an interesting paper published in the American Journal of Psychiatry takes on both the moral and legal issues around the idea of what the authors call coerced care for eating disorders. I love the analogy its author, Dr. Arnold Andersen, uses for how dieting can lead into anorexia: "The situation resembles that of a person boarding a canoe headed for Niagara Falls on a journey that begins voluntarily but ineluctably transforms into a nonvoluntary propulsion toward the Falls, with the person at times not recognizing that the upcoming Falls even exist."

That describes it so very well. Someone who is deep in anorexia cannot see the falls or even know they exist. They need the strong hand extended from the shore to pull them out of the current.

Far worse to watch the boat go merrily over the falls.


Unknown said...

You are SO right. Thank you for engaging that question so clearly.

They don't call it "force-breathing" when they do the Heimlich on you!

Fiona Marcella said...

In five years of treatment for our daughter's AN it took us until the spring of last year to encounter a psychiatrist who thought that "eating disorders are about control" and that therefore no guidance or help, let alone coercion should be used to get our daughter to eat. Ironiclly this happened during the only time when she was detained in a psychiatric hospital (it wasn't actually against her will but she was basically trcked to go in and it was very quickly against MY better judgement). Knowing where he was coming from and always wishing to see both sides of an arguement I did try to explain to my younger daughter the theory behind allowing choice. I won't quote her complete reply because you probably have profanity blockers on but it went something like " a hospital not making anorexic eat, that's f&^$ing sh%$e" I hope that she manages to use more appropriate language in the future especially if she gets into her chosen career and becomes a nurse, but I agree with her attitute (which comes of years of experience, something that the doctor will probably never achieve)

Harriet said...

I wonder if that's one of the differences between treatment here in the U.S. and where you are, Marcella, in the U.K. Here it seems like the whole control/choice thing is front and center. Good for your daughter, for understanding and being able to articulate, however profanely! :-)

Harriet said...

And Laura, that's an absolutely brilliant metaphor! Force-breathing--I will be quoting you on that for sure.