Does Anything Justify Taking Away the Personal Rights of Someone with an Eating Disorder?

The history of the treatment of eating disorders mirrors old storylines in mental health about patients’, often women’s, rights. From hysteria to Borderline Personality Disorder and now eating disorders, psychiatry always seems to have a set of diagnoses that limit personal autonomy and personal rights for people who often appear to be legally competent.

Eating disorders are tricky though. People can get very sick from the symptoms. Medical follow up is often necessary and also generally misunderstood by the medical field. The compulsive thoughts about not eating or binging and vomiting food confuses most people including doctors. These thoughts sometimes lead to patients ending up in the legal system, getting a legal guardian and sometimes losing all personal rights, even though a conversation with this person seems as logical as with anyone else, unless the topic is food.

It’s one thing for a person with schizophrenia who loses touch with reality to need a legal guardian. Should a person with an eating disorder who is otherwise fully competent also lose their rights?

With guardianship in place, the current solution for these patients is either to go to inpatient treatment settings or see outpatient providers. These options all have limited success. Many patients prefer to stay outside the clinical system for fear of losing their rights or facing inadequate, possibly harmful, care.

My experience treating these people for several decades is that I have become increasingly frustrated with the rare circumstances when a clinician is willing to extend the kind of support that helps people get better. I believe that the extra steps—sending the message that someone actually cares—goes a long way towards the hope for a better day. This message makes a difference time and again, not for immediate recovery but for the hope that things can change.

What I also see is a field that tends to look down upon the extra steps a clinician can take, sees this approach as crossing boundaries and somehow even outside the bounds of acceptable practice. These reactions confuse me. Isn’t the goal to help people get well? In the case of people with eating disorders, the answer is yes but with a few caveats, the most important being yes but only on the recovery path prescribed by the established treatment protocols—the ones that very often don’t work.

When these treatments fail, the official conclusion is always that the patient just isn’t ready or doesn’t want to get better. Maybe the system is failing the patients rather than the other way around. In addition, taking away someone’s rights or autonomy does not match the message of do no harm. The answers to more effective treatment exist, but we as a field need to look outside the box to find them.