The Disgrace of Eating Disorder Treatment Programs

The last post attempted to distinguish between eating disorders and the deleterious and often traumatic effect of treatment. Clinicians often approach them as one issue, but time working with patients shows how different these two issues are.

The best place to start is to compare people with a longstanding eating disorder who have spent years in treatment to those who have not. With the explosion of private equity-funded programs, it’s harder to find people without any experience in treatment, but they do exist.

Those new to treatment have a much clearer path towards wellness. They need to be heard and to be understood as I explained in the last post. They need information about their eating patterns and how and why they have responded to food restriction over the years. They need guidance as to why this started and how to change it, if they want to. Last, they need to understand how their eating patterns are limiting and how to find what they want in life.

On the contrary, people who have spent years in programs have left behind all the original parts of their eating disorder. They are angry for having been locked up in programs, for having been treated like a child, for having been treated like a criminal, for being blamed for a problem as if an eating disorder is willful disobedience.

They are frequently obsessed with weight and calories because programs focus primarily on these factors. They want to manipulate their food to fight back against the system that has hijacked their lives for their own supposed good. They have lost hope on finding what they want in life and have internalized the idea that they are broken and have nothing left.

Treatment programs run by for profit financial companies intending to grow and sell a brand have little interest in healing anyone. Hospitals organized around the philosophy that eating disorders are a blemish on our society and need to be stamped out justify ostracizing an entire segment of people. Vilification of eating disorders pervades the broader social media world and allows people to blame this population for our own misguided obsession with food and weight.

Eating disorder treatment needs to focus on the individual first and foremost. These people, still mostly but not all women, feel unheard and unseen. In a culture that continues to idealize thinness, marginalized people fall into food restriction to seek out praise and attention. As I have written in this blog many times, the number one risk factor for an eating disorder is dieting. Many of the people looking for positive feedback by restricting food end up with an eating disorder and landing in punitive treatment.

Eating disorders are a cry for help from an isolated part of our society. We treat these people as the hysterics were treated years ago: blamed for their problems, locked up for their own good and punished until they give up any hope.

I feel so angry and powerless to make change despite treating this group of people for over two decades. I’m not sure what, but something needs to change.