Surfacing After Silence

Life. After.

who is responsible when treatment fails?


holding_hands-1418Reading around the internet today, I came across A Disordered World, and the home page drew me in.  A site about experiencing mental illness and accessing treatment.  I read a lot of passion in this site, and I believe this author’s story is one of the stories that need to be told.  But it’s only one of the stories, and the first article and second article in a series investigating eating disorder treatment centers raised a lot of red flags for me.

Let me be clear:  It is not my intention to nullify this author or to negate her personal experience, but to draw attention to another point of view.  I do think the “investigation” is flawed because it’s an openly biased position with no acknowledgment of any other view.  This worries me, because I am afraid that people would look at this site and use it as justification for not seeking treatment.

I also support anyone who suffers outright abuse at a treatment center and speaks out, but I won’t say that the entire treatment system is flawed and incompetent.

If you have an eating disorder, are suffering, and are scared, please seek appropriate treatment. 

I’ve been in treatment for anorexia multiple times: Inpatient, Partial, IOP, and outpatient group therapy.  I was labelled as “treatment resistant.”  Maybe those are harsh terms that bias providers against potential clients, but using the word “noncompliant” only puts a prettier spin on things; it doesn’t erase the fact that in the beginning of my eating disorder, I resisted treatment.  I played the hospital’s games and got myself discharged and went back to the eating disorder.  I certainly am thankful there were people in my life that “did this” to me.  I would not be alive if people had not intervened and forced me into treatment.  Did I benefit emotionally, or did I come to any understanding about why I suffered from an eating disorder?  No.  But I am alive today because of the NG Tube inserted against my will.  These hospitalizations bought me time. I certainly didn’t enjoy them, but I don’t consider them failed experiences.

Eating disorder treatment centers all have rules, and usually they are pretty strict rules.  A lot of the times, it’s because if those rules weren’t in place, clients would continue to use eating disordered behaviors.  So yes, there are meal requirements.  Early in my treatment, I learned to just play along and clear my plate and I could go home earlier.  When I made my decision that recovery was my only option, I didn’t just “play along.”  I cried at my first dinner and could only manage a few bites.  I believe the first few meals went along the same lines.  And because I wasn’t following protocol–by refusing meals and refusing supplements and, therefore, not gaining any weight–there were repercussions.  At the time, I would have cursed the entire facility and staff and anyone who stepped into my field of vision, and I would have blamed everyone but myself.  But even though I was noncompliant, my psychiatrist and my therapist were supportive and encouraging.  It’s not like I was the first anorexic they saw who didn’t want to eat.  Eventually, I was able to work up to my full meal plan and supplements, but it took a couple of weeks.

I felt like I “should be trying harder” and that I should “just suck it up and deal” and that “it was all my fault anyway.”  One of my proficiencies is accepting guilt for almost anything possible.  But for the first time in treatment, I was being open and honest and showing my true fears surrounding recovery, and I needed that.  Because then, when I chose to eat a couple more bites of food at one meal, it was a personal accomplishment and not just “doing it because I have to.”

I don’t think my experience is unique.  I know many other women and men have experienced similar journeys as mine.  Relapse after treatment is not unusual, but it does not mean treatment failed.  Eating disorders are insidious illnesses; they take over an entire personality.  Recovery is learning who you were to begin with, and who you want to become.  And although it’s cliche, journeys usually involve some stumbles along the way, even as overall progress is being made.

I question writing that offers a blanket statement that inpatient facilities are not the most effective way to treat eating disorders.  (Have we come up with THE effective way to treat EDs yet?)  That doesn’t mean they’re not effective at all.  In an ideal world, people with eating disorders would get help before they required inpatient care and, therefore, immediately benefit from outpatient modes of therapy.  In an ideal world, insurance would pay for these outpatient modes of therapy, but a significant majority of individuals are faced with the either/or decision of inpatient treatment versus once a week sessions with a therapist.  Yes, you can appeal your insurance company, but that takes a great deal of time and energy.  At the time I decided I was going to recover, no matter what, I did not have the time or energy to appeal, and I didn’t have anyone in a position to call the insurance company for me.

I needed the inpatient treatment.  Because I was noncompliant by nature.  I needed the strict rules and consequences to get me through the initial stages of intense fear.  I would not have benefited from a partial program at first.  After six weeks of inpatient care, I did step down to their partial program, but I was ready for it then.  It was still scary and difficult, but I had also developed some faith in myself by that point.

I state on my blog that I do not recommend what type of treatment to seek.  We are all individuals, and have our own unique sets of needs and desires and tendencies and fears.  So I ask you not to write off a form of treatment because it wasn’t successful for some.  If we based decisions on that belief, every single treatment option would be scratched from the books.  I know people who have recovered fully using residential programs, inpatient centers, partial programs, IOPs, and outpatient therapy.  I also know people who have died after seeking each type of treatment.  But I know a whole lot of other individuals who died before seeking treatment at all.

If it hadn’t been for the “ineffective” treatments I received in the beginning of my journey, I would not be alive to say that I have been fully recovered for eight years now.  I may bear scars from some of those experiences, but I have to admit that I’m thankful for them.  I may have chosen recovery a little later than others had wanted, but in the end, I did choose it, and I thank everyone who helped me get here today.

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August 1, 2015 - Posted by | Eating Disorders, progress, recovery, treatment | , , , , , , , , , , , , ,

3 Comments »

  1. I just addressed some of your critiques of my articles in my response to the comment you left on my site this morning. I can’t fully reply at the moment, but I do want to say that your claim I am all “blanket statements” is not true. I do not say all treatment centers are bad – but many are, and due to lack of outcome reporting, among other things, it’s very hard to know whether you are entering a good one or bad one. And I really don’t want anyone entering a bad one because – for ME at least – it made me much worse, and my road to recovery much longer, than it had to be. Moreover, while I have questioned, in treatment how centers have treated me (the lack of dignity), I have never been one to break rules – I understand certain, strict rules are necessary for some people with eating disorders, due to the nature of the illness, but the way in which they were enforced was not necessary for me, and did not encourage recovery for me. And while certain strictness may have been necessary for the first few weeks in treatment, it certainly wasn’t necessary for the eleven months I was forced to comply with such rules at my last center. Anybody can achieve what LOOKS like recovery when they’re in an isolated setting and have no choice. I do not believe forcing people to eat for prolonged periods of time is the way to recovery. You have to want to do it on your own. And while I did want to do it on my own — the programs I was in didn’t afford me the opportunity to practice it. That’s why I believe community-based, outpatient treatment, where you have a mixture of meals with the program and outside the program (on your own) is a far more effective approach to recovery.

    Also, I am the type who gets very hyper-metabolic in treatment – so my meal plans were always much more aggressive and higher than others’. This made me constantly nauseous and was, I believe, a form of physical torture. I have never been in treatment with women who were required to eat the same amount of calories that I was within the span of 10 hours. It was inhumane, what they forced me to do, and it contributed to my ensuing relapses. If they had simply adjusted my weight restoration rate so that my meal plan was comparable to others’ – then that might be one way I could have had a different experience during treatment and a different outcome, post-discharge. This lack of individualization and constant inflexibility is one of the major problems with the for profit treatment industry that I am trying to shed light on in my stories.

    Comment by Jeanene Harlick | August 2, 2015 | Reply

  2. I apologize if I failed to clearly explain myself above – I know my reply is a little confusing and contradicting at points, but I am in a rush! Hopefully you can make sense of most of what I was trying to get at. I will try to better explain my points, at another time, when I am not rushed :-).

    Comment by Jeanene Harlick | August 2, 2015 | Reply

  3. Reblogged this on Authenticate You.

    Comment by Authenticate You | August 12, 2015 | Reply


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