Why do we consider patients to be "choosing" not to eat unless they are already gravely medically ill? Were the decisions more reasonable early on? Is a choice to starve yourself a bit, but not too much?
I believe patients should never be "force fed" any more than they are "force revived" when drowning. The problem is that we're not recognizing anosognosia and we think that food is somehow optional and don't see that the inability to eat is NOT A CHOICE.
Yes, I know this is what you are thinking. But is is not.
People with an eating disorder predisposition often lose their ability to think clearly when they are undernourished. Think of it as temporary partial blindness.
I've talked to plenty of former patients who are grateful that their family and clinicians did what needed to be done even when they were saying "I can't" and "I don't want to" and "I'd rather die."
Lack of insight and motivation are known symptoms of malnourishment. Without restoring a patient to normal brain function and waiting for brain repair we simply don't know what that person's real and lasting desires are. The evidence from people who have survived suicide attempts also bears notice: they most often regret their actions and want to live.
THIS is how I think of making sure anyone with an eating disorder history
is getting 100% of the nourishment they need in a safe, protective
environment. Eating every meal is no less urgent that breathing every breath.
Our job is to help those in despair, get them well and keep them safe - not to torture them by leaving them without treatment and support until they are nearly gone, and revive them only to start the process again.
It's not force feeding. And it shouldn't wait. Every meal, every day is essential to mental health for ED patients. If they can't, it's our job and it is US who have failed - not the patient. Our customs, our laws, treatment availability, and our thinking HAVE to change. We are torturing and killing these patients.