Building Bridges

Bridges: constructions linking, traversing or spanning one place to the next; human constructs making connections possible across gaps or impassable areas. Everyone knows what they are and what they symbolize, and it’s time we built them. In the world of eating disorders, I mean.

It’s time we quit treating others as quacks, dividing our field up into tribes and warring nations, time to stop acting on guild protectionism and engaging in turf wars, all of which has nothing to add to the world of healing.

That’s not to say that bad treatment must not be called out, standards established and research read, dissected and criticized. But it is to say that the overwhelming majority of us are on the same side, actually fighting the same battle against the same enemy: disorders of thought and eating behavior that rob those affected of their life, freedom and the pursuit of ordinary happiness.

In 2014 the lines of battle have been drawn up fairly clearly: those who believe in protocolized family-based home re-feeding; those proponents of psychotherapy and looking for the “underlying issues”, those who work in in-patient and residential settings, those who deliver outpatient care as part of a far flung team, those who work in partial hospital settings and those who, like Kartini Clinic, offer treatment in most of those settings but under one roof. There are many different approaches to getting food back “into the system”: free for-all-high-calorie, hospital style meals, naso-gastric tubes, defined meal plans (like Kartini), lots of highly palatable foods, no highly palatable foods for a defined period of time (Kartini), a mixture—but you know, it’s probably a bit like arguing about the “best” cuisine. French? Chinese? Italian? Louisianan? All good in their time and place, all adding to the palate of those lucky enough not to be forced to exclude any of them by convention or pressure to conform to local custom.

So maybe there are some really bad treatment philosophies. I know which ones I find dubious, even harmful, and I certainly don’t shy away from conflict, from calling out what I consider to have the potential to do harm —but I also think it’s time for us to engage in a rigorous but respectful conversation. Nearly everybody has the same goal: to alleviate suffering. Those who consider their own lives or that of a family member to have been saved by one treatment paradigm or another are understandably fans of that method— but in the same way that you cannot increase your own stature (metaphorical or physical) by decreasing the stature of those around you, trying to diminish the contribution of others in the field is not likely to bring us closer to “a cure”.

Case in point: Julie O’Toole and Carolyn Costin. Two opposite ends of the spectrum—although if “the spectrum” is a circle, this puts them both in the same place. “She’s really nice,” Laura Collins told me of Carolyn a few years ago, “I think you’d like her. She’s dedicated, like you.” Hmmm. We walked a bit warily around this. Then Carolyn called me one day to let me know she’d read my book Give Food A Chance and…. liked it. “We have more in common than anyone would imagine,” she said. And since then we have talked, every chance we get, which is not as much as it should be, given the press of duty.

Carolyn and I represent, I think, the proverbial “more than one way to skin a cat”. And while our communication has proven refreshing and broadening, it has underscored something sad: we both have admirers and proponents who believe themselves to be acting loyally to our treatment approaches by bad-mouthing the other team’s approach. Broadmindedness, in this case, can sometimes not extend to the troops. This must change. It is not helpful. Patients rely on us to be advocating for the best outcomes humanly possible for them, not engaging in intellectual and financial turf wars.

So the appearance of this Kartini blog on a website owned and operated by Carolyn Costin and her team, is an attempt to open free and civil discourse about something we all care about: best possible treatment for children and adults who suffer from all conditions of disordered eating and the brain/mind disorders that cause them.


One Comment

  1. Chris said:

    Parents should be told by clincians that these battles are taking place in the eating disorder profession. This would include informing parents of the various schools of thought about how best to treat anorexia nervosa, and the evidence base (if any) for each. Parents should also be directed to authoritative sources of evidence, such as and encouraged to perform their own research into the treatment options available and to decide, given their unique knowledge to their kids, what type of treatment is likely to be most successful. Clinicians should then work to support, not undermine the parents’ decision. I think all parents should also be informed by clinicians of the existence of the problems that plague the eating disorders profession, including high rates of mental illness, job burnout and emotional exhaustion, low levels of adherence to evidence-based standards, and low levels of training and education. This will serve to warn parents that they shouldn’t necessarily believe everything they are told by professionals and that they will need to be well-informed and skeptical consumers. Parents should also be told that many children and teenagers recover from anorexia nervosa and other eating disorders as a result of the parents’ efforts alone, without any involvement by professionals, and that many parents have discovered that eating disorder professionals in many instances have fueled eating disorders, causing more harm than good, as a result of using outdated, ineffective methods. In addition, parents should be informed that the best treatments are not necessarily those that cost the most money, and that in fact FBT tends to cost only about $3,000, a fraction of the cost of most alternatives.

    July 11, 2014

Leave a Reply

Your email address will not be published. Required fields are marked *