Monday, June 20, 2016

Anorexia - Excellent article

 Below are the two best NYT Magazine articles I've ever read, one from 2006 on anorexia and one from 2008 about suicide. Both fundamentally changed what I thought I knew about these two calamities. The first one argues that the best way to treat anorexia isn't sending your daughter to a shrink, but to force feed her (or threaten to do so unless she eats 3,000-4,000 calories/day and returns to a normal weight). The second argues that it is NOT true that putting up barriers on high bridges or removing guns from a house doesn't matter because someone who's suicidal will just find another way to do it.


This one on anorexia is still very much worth reading, especially if you have a daughter in or near her teenage years. A truly terrifying disease...

Had the diagnosis been, say, diabetes, we would have been given a list of guidelines and medications -- a road map for recovery. We would have looked at research and treatment protocols. Look anorexia up on Amazon, and you'll find hundreds of titles, but we couldn't sort the useful books from the flaky ones. And in terms of treatment, there isn't much systematic scientific research on the disease. No one could tell us exactly how to make our daughter well. All they could say for sure was that the odds weren't good. Anorexia is one of the deadliest psychiatric diseases; it's estimated that up to 15 percent of anorexics die, from suicide or complications related to starvation. About a third may make some improvement but are still dominated by their obsession with food. Many become depressed or anxious, and some develop substance-abuse problems, like alcoholism. Almost half never marry. It is thought that if anorexia is not treated early on, during adolescence, it tends to take an average of five to seven years for the person to recover -- if it happens at all. I pictured Kitty, starved and weak, at 16 and 18 and 21, and felt sick.

I went home and started researching, hoping to find another option. Among the few studies done on anorexia treatment, I came across one from 1997, a follow-up to an earlier study on adolescents that assessed a method developed in England and was still relatively unknown in the United States: family-based treatment, often called the Maudsley approach. This treatment was created by a team of therapists led by Christopher Dare and Ivan Eisler at the Maudsley Hospital in London, in the mid-1980s, as an alternative to hospitalization. In a hospital setting, nurses sit with anorexic patients at meals, encouraging and calming them; they create a culture in which patients have to eat. The Maudsley approach urges families to essentially take on the nurses' role. Parents become primary caretakers, working with a Maudsley therapist. Their job: Finding ways to insist that their children eat.

The two studies showed that 90 percent of the adolescents recovered or made significant gains; five years later, 90 percent had fully recovered. (Two other studies confirmed these results.) In the world of eating disorders, I was coming to understand, this was a phenomenally high success rate.

The idea that parents should be intimately involved in the refeeding of their children can be quite controversial, a departure from the conventional notion that the dynamic between parent and child causes or contributes to the anorexia. Many therapists advocate a "parentectomy," insisting that parents stay out of the treatment to preserve the child's privacy and autonomy. They say that a child must "choose" to eat in order to truly recover. Maudsley advocates see the family as the best chance a child has for recovery; no one else knows the child as well or has the same investment in the child's well-being. That felt right to us.

Over the last few years, most eating-disorders researchers have begun to think that there is no single cause of anorexia, that maybe it's more like a recipe, where several ingredients -- genetics, personality type, hormones, stressful life events -- come together in just the wrong way. Maudsley practitioners say that focusing on the cause is secondary, ultimately, because once the physiological process of starvation kicks in, the disease takes on a life of its own, unfolding with predictable symptoms, intensity and long-term consequences. Anorexics become almost uniformly depressed, withdrawn, enraged, anxious, irritable or suicidal, and their thinking about food and eating is distorted, in part because the brain runs on glucose, and when it has been deprived over a long period of time, when it's starved, it goes haywire. It's important to get the patient's weight up, fast, because the less time spent in starvation, the better the outcome. Adult anorexics who have been chronically ill for years have much poorer prognoses than teenagers.

One Spoonful at a Time

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