The Cure Thing

Posted by fxckfeelings on June 23, 2011

If treatments were always beneficial, and people were always rational, and life was always fair, it would be easy to figure out how much help a person needs. Unfortunately, treatments often poop out, and people often embrace or reject treatment for the wrong, often irrational, reasons, and life is just a cruel mess. So deciding how much real, imperfect treatment to use in real, imperfect situations requires courage, acceptance of your limitations (and those of treatment), and the conviction to tell the unfairness of the world to go fuck itself, you’re going to keep trying, anyway.
–Dr. Lastname

Although I’m usually a big fan and praise your blog endlessly, this recent post [“Helping Head,” 6/17/11] isn’t a “like.” Eating disorders are treatable to full remission. In fact, the pervasive idea out there that people just struggle endlessly and that treatment doesn’t really work is self-fulfilling and even dangerous. Please consider re-considering. There’s new science on this!

Without irony, I can say that treatment for eating disorders is effective. In other words, I agree with you, except that the word “effective” has a hook in it.

“Effective” is the word most favored by drug companies because it implies no guarantees, solutions or cures, just that the treatment in question produces results that are better than no treatment at all.

Unfortunately, it does not mean completely effective, or effective for everyone, all the time. (And it also may cause dry mouth, constipation, etc., etc.).

The result is that people who commit their resources to such treatment (which is usually very costly) must work hard to monitor its effectiveness and know enough to stop it if and when it doesn’t help.

Here’s a common scenario—imagine you’re an uninsured parent of 3 kids, one of them has a dangerous eating disorder, and tens of thousands of dollars have gone into her second residential treatment. Under observation, she’s gained weight to the point of medical stability, but the moment she goes home on a pass she binges and purges and there’s been no progress in the past 3 weeks.

If you keep her in the program, you won’t have enough money to send your other kids to college or pay for another course of residential treatment if/when it’s necessary. The staff tries to be helpful by telling you that treatment works, it’s what they recommend, and when it doesn’t work quickly, they recommend more because they believe in what they’re doing.

What they don’t do, and have never been trained to do, is look for and identify the signs of an impasse, accept the fact that treatment sometimes stalls, and help you conserve your resources.

Emotionally, your daughter’s (partial) treatment failure may have you wondering what she, you, your wife, or the program did wrong. The answer may well be…nothing. Treatment works, but not always, and it’s no one’s fault. After all, it was effective, just not enough, and the possible side effects include bankruptcy.

If you begin any treatment with the strong belief that what ails you is curable and everything’s going to be OK once you accept “scientifically effective” treatment recommended by trained professionals, you face the possibility of draining yourself, your bank account, and your resolve in order to achieve something that, while possible, is not guaranteed.

While eating disorders can be treatable, it’s better to approach any course of treatment with the attitude that it might not take right away (if ever), it will be a struggle, you’re the one who needs to decide whether and when it’s working, and that, even if it doesn’t produce the desired results, you should always be proud of making the most of whatever treatment’s available, even if that includes shutting it down.

People should never give up hope in their ability to overcome illness by getting treatment and living their lives in spite of whatever disability remains. However, they should never make their hope dependent on the good ol’ effectiveness of treatment, particularly if it comes up short in the long run.

STATEMENT:
“I’ll try any treatment that has a reasonable chance of working and I’ll spend anything if I believe it’s necessary, but I must always do my own assessment of whether it’s working and conserve resources if it isn’t.”

When my daughter got dangerously thin, I knew she had an eating disorder and forced her to see a therapist, but she didn’t get better and I couldn’t get her to follow a meal plan or stop running 5 miles a day. Now, however, she knows she can’t return to college until she gains 20 pounds and gets permission from her doctor, so she’s willing to accept more help. I wonder how treatment can help her if she’s being forced into it. My goal is to find a way to get her to see the need for treatment.

Fortunately, as described above, treatment for eating disorders and other problems involving destructive behaviors don’t depend on a patient’s having insight and motivation. Unlike the old joke about the number of psychiatrists required to change a light bulb, it’s not necessary for the light bulb to want to change. That’s because, once people are exposed to a new routine and strong incentives to form better habits, their attitudes often follow.

With eating disorders, the effect of malnutrition on the brain makes it extra hard for patients to reason clearly. Once their weight normalizes, their thinking improves, at least partially, and the vicious circle reverses.

So don’t waste time persuading your daughter to see things more reasonably; you’ll get frustrated, she’ll dig in her heels, and you’ll have a harder time getting her to attend a residential or day program.

Instead, keep your mouth shut, open the car door, and convey your willingness to help her do what she needs to do to get back to college and her running. It’s very likely that she can get healthy again, but she doesn’t need to be reminded of that since she refuses to admit she’s sick in the first place.

Later, if she slips up on her meal plan when she gets home, you may well want to adopt whatever incentives seemed to work in the hospital to keep her going on her healthy behaviors. Again, less talk and less emotion are usually better. There are eating goals that you impose, there are consequences, and there’s your belief that they’re for the best and don’t need to be talked about.

In the long run, you hope that negative behaviors will lose their grip on her health and her values, but in the short run, you do whatever you think works. You’re the parent, and it’s your job to do what you think is best and create a customized treatment plan so effective that she’ll eventually be as willing to change as that light bulb.

STATEMENT:
“It’s agony to see my daughter starving herself and then insisting that she’s doing what’s best for her health. I can’t stand the lying and cheating. My job, if I’m going to be effective, is to do what seems to work and keep my feelings out of it.”