Several years ago, when I was in the process of moving back to New York, a patient sat me down at the end of a session and said she knew best how to start a practice working with people with eating disorders. She suggested I create a website and let patients find me online. This is somewhat unorthodox for a psychiatrist so I thought long and hard about the ramifications of this decision. But after several lengthy discussions, I thought I understood what an online presence would mean for my practice. For many reasons, people with eating disorders feel much more comfortable finding treatment on their own, but I think it boils down to two central ones: anonymity and the difficulty in finding experienced providers. Hopefully, I could provide an online contact to help lead people to the right treatment, either with me or with another resource. I have since received emails and calls from patients, mothers, fathers, siblings and other treatment providers all looking for help in one way or another. They are almost universally surprised at how hard it is to find adequate care and appreciative of any useful leads or guidance.
Despite our country's fascination with eating disorders both in celebrities and in our own communities, there is so much confusion about eating disorder diagnosis and treatment. Anorexia and Bulimia are the only disorders recognized in the field of psychiatry: every other set of symptoms is filed away under Eating Disorder Not Otherwise Specified. In my experience, almost anyone sick more than a few years has EDNOS, which means that even the classification system is woefully inadequate. In addition, there appear to be few practitioners trained to handle the complexities and struggle involved in eating disorder treatment and recovery. Here in New York City, where it often feels like there are more therapists per capita than anywhere in the world, it can be hard to find people able and willing to help patients with eating disorders. After insurance is taken into account, the process of finding treatment exhausts even the most persistent. I have had countless conversations with patients and family members desperate to find someone willing to help them navigate the system to find the right treatment.
But those were the calls I had anticipated.
The other kind of calls caught me off guard. One morning, a few months after I put up my website, a father called in a huff of anger, apparently right after an argument with his wife at the breakfast table. He wanted me to settle the debate, and I quickly realized that my availability online might mean something very different. He was calling about how to feed their six year old daughter. "She never eats," he said. "We keep putting food in front of her, and she just doesn't like anything." Understandably, they were at their wits end. He insisted they should just let her eat when she wants to, and she said they should force her to eat her meals. She insisted their daughter needed to eat healthy food no matter what, and he wasn't so sure it was worth the prolonged battle every day. Apparently, my answer was going to resolve the debate. Did I belong here? Was this where my training led me: all the way back to the formative years of eating? I had my own internal debate at that very moment: stay focused on the treatment of people with eating disorders or consider my role more widely as a source of knowledge in the muddle of addressing food and weight in our society. I felt this was a turning point: remain the neutral psychiatrist focused on his work or take the plunge. Plunge into what? That I had not figured out yet.
"Just let her eat what she wants and give her a range of choices. She knows how to eat and will remain healthy. Nothing to worry about," I said. He was palpably relieved.
I, on the other hand, remain hesitant and confused, but I have not looked back. Even more deeply rooted in our society than the fascination with eating disorders is a disorientation and confusion about food: what to eat? what not to eat? when to eat it? what is healthy food? what should I feed my children? The questions are endless, and people apparently have no reputable source to go to for answers other than doctors. Since I talk to people about food all day and think about what is normal and abnormal eating, perhaps I was a reputable source.
I thought I could start to answer some of the more universal and pressing questions I receive by writing about them. Some of the topics may relate primarily to eating disorder treatment, but many questions relate to the reality of struggling with food and weight in our society. I know I often have sound advice and useful guidance about treatment for an eating disorder. However, I also believe that talking and thinking about food and weight has put me in a position to offer insight and guidance as to how to handle these issues for the curious, not just the sick.
With all of this in mind, I have decided to take the plunge.
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