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The Good, the Bad, and the Ugly

Posted Aug 24 2008 9:36pm 1 Comment
The Good:

The Lucille Packard Children's Hospital at Stanford University is expanding its treatment to those 18-21. We all know that EDs don't magically resolve once you turn 18; in fact, some don't emerge until college. And more, college is a strange limbo-land, where you're not quite a child but not quite an adult. Especially for people with eating disorders, development tends to stop dead in its tracks once the ED hits. So it very well could be that the specific issues being dealt with by the 18-21s have quite a bit in common with other adolescents than their non-eating disordered peers.

I've never been to the Stanford program, so I can't evaluate it from a personal standpoint. A number of the girls I was in residential with this past time had been there, and it didn't necessarily get glowing reviews from them. Then again, I don't know a hospital that really would. But a hospital isn't meant to be all fun and games; they're meant to help you get medically and psychiatrically stable. For someone with an eating disorder, this ain't going to be much fun.

More than that, though, I applaud the fact that Stanford uses the latest research in treating eating disorders.

"We're very family and developmentally oriented, and able to understand and address the differences between what a 9- versus a 14- versus a 21-year-old patient will need. It's a blame-free, solution-focused approach ," said Lock.

He and his colleagues tailor their therapies to the specific family dilemmas, age and circumstances of each patient. Although hospitalization was the norm in years past, the team has found that many patients benefit from maintaining their social and academic connections while undergoing treatment.

"Lengthy hospitalizations used to be common," said Lock, "because we had no effective, research-based treatments.
Now we know that it's much more developmentally healthy to keep these kids in the community if at all possible and to involve their family in the re-feeding and recovery process ." Physicians at the Eating Disorders Program carefully monitor the medical status of outpatients to ensure they stay medically safe while undergoing treatment.

(These quotes taken from a press release from Stanford University . Emphasis mine .)

This is the kind of approach more places need in order to treat eating disorders. No, not every treatment is appropriate for every person, but there should be better guidelines for what will work. And that means research. So kudos to Stanford.

The Bad:

This made me so angry and frustrated, I could just about spit. This is almost the opposite kind of news from the above. Also from a press release, but this one is titled, " Families Play a Role in the Development of Eating Disorders ." It is from Remuda Ranch, the "nation's leading and largest inpatient treatment center for women and girls suffering from eating disorders."

I'm not very fond of Remuda , largely because they keep expanding and marketing and branding themselves, to the point where it seems more about the money than about the care. I'm positive that most of the professionals working there are genuinely concerned and considerate and compassionate and strongly believe in what they are doing. There is a great need for eating disorders treatment, no doubt about it, but when it becomes like a chain restaurant, that's when I start getting wary.

But, okay, fine. That's doesn't necessarily get my goat as much as the contents of the press release.

"Families are very much a part of the puzzle of eating disorders. There are biological, psychological, cultural, and family reasons why a person has an eating disorder."

Some of the common characteristics of the families that Remuda treats include:
  • Distant fathers
  • Chaotic families or families with substance abuse problems
  • Mother's high expectations for daughter and/or demanding parents
  • Parents who openly foster sibling rivalries
  • Over-controlling or domineering parents
  • Father's depression, rigidity, or excessive self-discipline
  • Marital conflict
  • Parents' sexual relationship problems
  • High levels of parent-daughter stress and family tension
  • Fathers who are chronically ill

"Another common thread we see are family members who are disconnected from their own feelings and become emotionally distant from others," said Wasserbauer . "Many families come to Family Week disillusioned because they feel they're a close family, but when they begin to understand that their loved one with the eating disorder never experienced validation for her feelings, felt unimportant because they never listened to her needs, they begin to see that although they did a lot of activities together, they weren't connected emotionally."

Now this sounds like basically any family I know. And to an ill teenager--hell, to ANY teenager--emotional connections can be strained and whacked out, to say the least. Plenty of families of people with eating disorders can have these issues, but that doesn't mean that this was the cause . And there's no scientific basis for this. Where is the research showing the effectiveness of resolving these issues?

The main difference, to me, between the Stanford program and Remuda Ranch is their vantage point. Stanford (and other research-based programs like it) looks forward ; what can we do to help a person recover. Remuda looks backward ; what brought a person to this point.

Except if you're always looking backwards, you'll never see where you're going.

The Ugly:

People love to comment on what other people are eating. It's kind of a hobby for many. I know it was for my former co-workers. They bitched about the chocolate on my desk, and about the whole wheat bagel and hummus "junk food" I was having with lunch. That last comment broke my resolve to stick it out in the diet-crazed workplace and I quit on the spot.

A woman who had recovered from anorexia was working at a grocery store and wrote an advice columnist about her co-workers comments on her food. She purchased snacks and treats, while she was working and said, "it is inevitable that when I buy junk food, I will get a teasing remark."

"Annie," the columnist, had this to say:

Dear California: They are trying to be friendly and don't realize what a sensitive issue this is for you. Since you don't want to share the information about your anorexia (nor should you feel obligated to do so), it's best if you can avoid reacting to the food comments. In time, the remarks will seem neither original nor amusing, and your co-workers will stop.

Well, not necessarily. Developing a thick skin is good, but developing a smart mouth can be even better . Someone told me I was "gaining weight quite nicely." So I said, "It must be something in the water because so are you!" They never said anything to me again. You don't have to be mean, but you don't have to be nice, either. Or quiet.

Trust me, people who comment and tease you about what you eat are NOT your friends, and you shouldn't treat them as such.

If someone starts commenting on my food or weight again and don't get the hint the first time that I'm not interested, I'll deal it right back. They don't need to stop because I was anorexic and feel uncomfortable; they need to stop because it's rude and ridiculous.

Remember, at the end of the day, it's not about you. It's all about them.

Comments (1)
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Be careful about assurances of coverage by Remuda sales staff.  This company is facing difficult times with insurers balking at coverage.  I was assured that my policy would cover this treatment by one of Remuda's "experts."

It did not cover this treatment.  The Chandler facility was deemed a "residential" facility, contrary to assurances by Remuda staff.

Do not expect coverage unless you get some sort of preapproval from your insurer.  You may face bankruptcy like me.

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