Practicing with a license

I've given serious thought to going back to school and getting an MSW so I could get licensed as a therapist and work with people who have eating disorders. I've often felt this year like I was practicing without a license--giving therapeutic advice while not being a therapist or having any medical training myself--and wondered if I should get some training.

And I probably will get more training, at some point. But this advice column reminded me that a license doesn't necessarily mean that a) you know what you're talking about, or b) you give good advice.

It's written by someone with an MSW who displays appalling ignorance about eating disorders and the state of treatment. She sounds a lot like the first therapist we saw when my daughter was diagnosed with anorexia. A mother wrote in about her young daughter, who she believes is showing signs of anorexia, and this social worker responded by, first, pooh-poohing the mother's sense of her daughter's health:

Though child anorexia is now being diagnosed in girls as young as six years old, my gut tells me that it’s not the case here. X's weight is stable, and girls suffering from anorexia usually exhibit a rapid and profound weight loss.

Wrong, wrong, wrong. That's what I thought when my daughter got sick, and because she hadn't lost a lot of weight, I figured she couldn't have anorexia. In fact with children and adolescents the issue is often a failure to gain weight rather than a dramatic weight loss. When you weigh only 70 pounds to begin with, it doesn't take much to tip you into a state of malnutrition.

The therapist goes on to say that

Anorexia, which is an eating disorder, is linked to an emotional problem. It is not about food, but rather about feelings. These are often feelings of intense levels of tension and anxiety, or an inability to cope with one’s surroundings. It’s complicated, and it’s certainly not something that most parents would be qualified to “fix.”

Wrong again on every count. As readers of this blog already know, the latest research on eating disorders shows that they are biological illnesses--brain disorders. The head of NIMH has gone on the record saying so. And while they surely are complicated illnesses, there's no one in a better position to help "fix" them than a parent, because the treatment is food. Not psychobabble*. Not circular discussions about feelings. There may be value in therapy, but later on, when the brain is nourished and working properly again.

I guess having a license doesn't mean you know what you're talking about. And not having one doesn't mean you don't. I won't be going back to school but I'm going to keep on trying to educate families and professionals about the realities of eating disorders until the so-called professionals get a clue.


*Apologies to my therapist friends. I'm a big believer in therapy--just not for someone who's acutely malnourished. Food first, talk later.

Advocacy for what?

I've given a lot of thought to how those of us who have children with eating disorders can model our advocacy efforts after those of other groups. Parents of kids with autism, for instance, have been very effective in pushing for legislation covering treatments and other issues.

The thing is, most people aren't busy arguing about what causes autism in the first place, and they pretty much agree on treatments. Whereas folks in the e.d. world are divided in every possible way.

My friend Laura Collins says she'd like to lock all the e.d. experts in a room until they come to an agreement. Ha!

One of the biggest arguments, of course, is the biology-vs.-psychology one. Both parents and professionals have vested interests in taking one side or the other when it comes to both cause and treatment.

When I imagine trying to bring together a coalition of eating disorders parents and professionals to push for legislation and advocacy, I get a sense of how great the conflicts are. For instance, I don't think individual therapy is useful in treating anorexia, at least not during the active recovery phase, so I'm not sure I would want to push for legislation to cover lots and lots of individual therapy.

In case you couldn't tell, I'm of the biology camp, as in the Minnesota Starvation Study. I don't believe kids "think" their way into eating disorders, and I'm damn sure they don't think their way out of them.

I think what's needed most are more and better treatment studies, like the one Dan Le Grange is doing at University of Chicago. We need to know what the best treatments are for anorexia and bulimia.

What do you think we should be pushing for?