Tuesday, March 24, 2009

Just because you're paranoid doesn't mean they're not out to get you

The world of eating disorders treatment is changing. Slowly. Infinitesimally. Minusculely. But change is creeping in.

Still, most ED patients and their families get smacked upside the head at some point with the old assumptions and stigmas about these illnesses.

Such as: Eating disorders are caused by cold or overcontrolling mothers; the child has no other way to establish a sense of autonomy, so she stops eating.

To their credit, many docs have left this one behind. Some say they've left it behind but still on some level believe it. And now I have an inkling into why: A friend who's in med school, and who just finished the hour or two devoted to talking about eating disorders in the curriculum, reports that this outdated and discredited point of view is still in the textbooks.

So on some level, these stigmas are still being perpetuated. Big surprise, I know. But you know, it was a surprise. I'm enough of a good girl academically that reading something in a book makes it shiny and important.

I feel pissed off and sad, though, at the thought that this kind of perspective is still living out there in print, for new generations of baby docs to read and take in. Especially since most of them get almost no training in treating eating disorders anyway. So this might be all they take away from med school on the subject. And it's wrong.


wriggles said...

It's surprising what nonsense we humans will believe, purely because we have nothing to replace it with.

Those cold mothers seem to be causing a whole load of other problems too.

Can't they be stopped??!!!

Katy said...

Worse than this crap still being in med school textbooks, imho, is that it's still in some PSYCH textbooks. I took a psychopathology course 2 years ago, and we used a 2007 edition of the textbook, and you would NOT BELIEVE (or perhaps you would, unfortunately!) how outdated the info was. No mention (or maybe a sentence?) of genetic influence, lots of drivel about control/appearance/upper-middle class prevalence/wanting to delay adulthood/etc., nothing about new treatments, and apparently nothing derived from research done since, say, the 80s. I stewed through the whole section, saying nothing b/c I was NOT getting into it with my prof in front of the entire class...especially since it's a fantastic way to say, "hi, I have an ED!" which is especially unappealing when everyone is hearing loads of stigmatizing misinformation. (Plus I was sick as hell at the time & terrified it would become obvious if I drew attention to myself.) I also took a child psychopathology class this past quarter, and though my prof was better informed & at least knew some about genetic research & wasn't at all blaming/shaming, it was still pretty painful to sit through w/o screaming my head off. So not only is the medical community sadly misinformed, even psych RESEARCHERS live in the dark ages. And it gets worse--I go to school IN CHICAGO (not U of C, but close by), so the freaking research is being done in our backyard, and profs are STILL clueless.

familyfeedingdynamics said...

We had very little training in medical school about eating disorders. I learned by doing in practice, and I know I made mistakes and that is not fair to the patients, even though I meant well and spent tons of time with individual patients. I am getting educated, and working with a group of professionals to educate healthcare providers about ED, healthful eating, wellness etc. On another note, is is accepted that dieting for weight loss fails roughly 90% of the time, extreme liquid diets have been proven harmful time and again, yet they are still being prescribed by nutritionists and physicians. The medical profession in general, is REALLY slow to accept new thinking. I recently was in on a presentation to a major health insurer to do some wellness/ Health at Every Size type work. The response was basically, "We agree, and we'll probably all be doing this in 15-20 years, but we're not ready for it..."

Harriet said...

I had a similar response from an insurer when I appealed their lack of coverage for my daughter's anorexia. I presented mucho evidence regarding the physiological nature of anorexia (we lived then in a state without mental health parity) and was told, basically, Yes, but for now we're holding to this line. Of course they had a strong financial incentive not to change in that case. What's the doctors' excuses??

familyfeedingdynamics said...

check out this post for part of the explanation...


Other musings on why doctors are slow to adopt new ideas (especially if its not something a drug company can send armies of sales reps out to push...) Too busy? (It really is hectic day to day.) Many might only want to take care of the "physical" problems of ED and leave the rest to others (not realizing that a basic understanding is needed to at best do no harm, its not a "sexy" topic, not a quick cure, or miracle drug, but a relearning of the etiologies of ED, in many ways there may be a lot of money invested/riding on old thinking (like the weight loss industry etc.) I think that most doctors are good people, are overwhelmed, trying to do their best. Not making excuses, but how many general conferences or board review classes review this info? I would guess not many. I would guess that most of the presentations of new materials might be at specialist conferences where there may be some preaching to the choir. I know Harriet, you are trying to educate health care providers, I am too, that's where it starts. As Ellyn Satter says, "its like whistling in a hurricane." Maybe if enough of us whistle we will be heard...

arne97 said...

Doctors , and scientists in general, are slow to adopt new ideas because they think they already know the answers. Anyway- - -

I'm an evolutionary anatomist, not a psychiatrist. My area of interest is the mammalian pelvis, which includes the sacral spine connection and the peculiar curve of lordosis. This is merely the tilting of the pelvis forward and the drawing of the sacrum forward.

This is what makes the buttocks of human protrude. It is our skeletal structure but it also has an interesting behavioral component. Lordosis,as a gesture in the other mammals, advertises that a female is in heat. The word lordosis was given to the curve of the human spine because it mimics precisely the gesture of the female in heat.

I think that there is an elemental interpretation, on an unconscious level, in women/girls with anorexia, that their lordosis curve is a sexual signal.

Unfortunately for them they see this as a function of having a "fat butt" and spend the years trying to erase what cannot be erased. The spine will never straighten and their lordosis curve will never be dieted away.

This is probably a treatable condition but only if there is an understanding of what causes it. Which brings me back to the resistance to new ideas, even if the old ones do not work.

Harriet said...

Interesting idea, but it's a pretty big stretch from lordosis to anorexia. All the recent research points to biology, not psychology (even evolutionary psychology), as the cause of eating disorders. Your notion is the old one dressed up in some shiny new language--the idea that kids with EDs are afraid to grow up/become sexual. This is an ass-backwards (forgive the bad pun) attempt to explain the timing of EDs, which typically come on during adolescence. But I don't see any evidence for this and I don't buy it.

arne97 said...

"All the recent research points to biology,- - -"

What biology? Anatomy of the brain is biological, as is all anatomy.

The lordosis curve is hardly "psychological" and certainly NOT evolutionary psychology ( a pseudo science).

The lordosis curve is present in the young child, not just adolescents and adults.

I am merely presenting some data based on my observations. Even you cannot change the shape of the spine.

Harriet said...

To paraphrase Maria Muldaur, it ain't the shape of the spine that's the issue here--it's how you interpret people's reactions to it.

The shape of the spine per se doesn't mean anything. It's the meaning you assign to it--or that you think others assign to it.

arne97 said...

"it ain't the shape of the spine that's the issue here--it's how you interpret people's reactions to it."

The buttocks are a part of the anatomy which are a powerful sexual image. On a par, at least , with the breasts and for many people, more so.

Humans wear tight jeans to emphasize the buttocks and to draw attention to them.

H.sapiens does not have a "pass" from Mother Nature. All female mammals engage in display of the hindquarters when they want to mate.

In humans this "display" is an actual permanent part of our anatomy , present in men and children as well as girls/women. I cannot understand how this simple fact is threatening.

We humans recognize this curve as an invitation to mate. In a person with anorexia this understanding can be very frustrating since nothing that is done can change the shape. No matter how thin, the bottom looks big to the anorexic person.

Is this not the actual perception of the anorexic person?

Harriet said...

You're making the all-too-common mistake of interpreting the fear of fat as a rational (if misguided) notion based in reality.

Take a look at the Minnesota Starvation Study done by Ancel Keys in the 1940s. Healthy men without any issues about the size of their tushes or fitting into size 0 clothes, etc., starved for 6 months and developed all the symptoms we associate with anorexia, including a fear of fat, anxiety, depression, etc. etc.

The fear of fat is a physiological byproduct of starvation. Restricting comes first, then the distorted body perceptions.