I’ll be finishing my secondment on the eating disorders unit soon, and returning to the life of a CPN in CAMHS. Before I say my goodbyes to the unit, I also have to make a farewell on behalf of somebody who’s featured in this blog.
You may remember The Kid, who I’ve spent months cajoling into eating her dinner. She’s provoked ethical dilemmas in myself, and philosophical debates on this blog.
The Kid is totally in the grip of the anorexia. Her every waking hour is devoted to Ana. She thinks about Ana day and night. Every calorie is to be obsessively counted, every opportunity for exercise to be taken, even if means lying to and manipulating everybody around her. Friends, family, doctors, nurses, these are just walking obstacles to her single-minded pursuit of anorexia.
And me? Well, I’m a cunt, a wanker, an interfering prick. I’ve always had it in for her. I’m trying to ruin her life. I’m the worst nurse in the world. I should never be allowed to work on a ward. I make her want to die. I know all this because she’s just screamed it at me while trying to punch the wall, all because I told her she still had a couple of minutes to go on her post-lunch rest period, and she insisted she didn’t.
Welcome to the relationship between me and the The Kid. It’s not a therapeutic relationship. It’s the relationship of two adversaries trying to outwit each other. It’s been like this for months.
The next day, she departs to spent a few days on home leave surfing pro-ana websites and manipulating her parents. When she returns, she asks me for a word in private. What she has to say is not what I expected.
“I’m very, very sorry for the way I spoke to you before I went on leave. It wasn’t me. It was the anorexia talking, and I didn’t mean it.” Then she shakes my hand and walks away.
Well, I guess it’s progress….Won’t last though.
Then, over the next few days, we notice subtle changes in her. She’s actually trying to make it through the meal without concealing any food under the plate. She’s volunteering to come and sit down, rather than trying to turn every activity into a medium for exercise.
In the nurse office, we tentatively whisper, after all these months of screams, tantrums, lies and emotional blackmail, could she have started to change?
No, of course she isn’t, some mutter. We’ve been here before. This is just another one of her little tricks. She’s trying to play ball in the hope she’ll be discharged, and then when she’s home she can go straight back to anorexia.
But the changes continue. She starts to put on weight. Her skin doesn’t look as deathly pale as it used to. Her eyes no longer just two black, dead sockets. She’s still struggling, and we do get the occasional bout of screaming, but not nearly as much as before. As her brain becomes less malnourished, her cognition starts to improve too. The outbursts over food and exercise become fewer, and eventually dissipate altogether.
We let her spend more time at home. Miracle of miracles, she starts returning from leave having gained weight rather than lost it. Normally she loses weight every time she goes on leave.
It becomes clear that this isn’t a trick. She’s chosen to recover. All that dedication, all that single-mindedness that she devoted to the anorexia: she’s turned it around and channelled that exact same dedication into the act of recovery. She’s decided that it’s time to get better.
We transfer her from the ward to the day unit. One morning we get a phone call from the day unit.
“Erm, do you have any sanitary towels on the ward?”
At the age of 16, The Kid has just started her first period.
Soon, she’s ready to leave us. Local CAMHS begin to take over, and help her to organise a college place.
One day, The Kid has to come back to finish off some therapy. One of my colleagues bounds in from the reception area.
“Have you seen her?” she exclaims. “The Kid’s in reception. She’s got boobs now!”
Some things really are better left to be said by one’s female colleagues.
Later that morning I bump into her on the way out. We stop and briefly say hello to each other. The thin, emaciated, almost lifeless girl is now healthy, smiling and confident. Where she would have been dressed in a loose-fitting tracksuit, her hair thin and straggling, she now takes pride in her clothes, in having her hair done and putting on makeup. She used to look half-dead. Now she looks beautiful.
I’m moving on, and so is The Kid. As I wave goodbye to her I start to wonder. In all those months we used every intervention in our arsenal. Systemic therapy to iron out the family dynamics, CBT to challenge her thought patterns, rewards and sanctions to encourage her to cooperate, mindfulness to relax her and encourage insight, meal and exercise plans to set boundaries, fluoxetine to raise her mood, diazepam to reduce mealtime anxiety, olanzapine to make her ravenously hungry and too sluggish to exercise combat the anorexic thought patterns.
Did one of these suddenly hit home?
Or was it a combination of these?
Or really, ultimately, was our achievement simply to keep her alive until she herself was ready to make the decision that she was going to come out of it?
Who knows?
This is a brilliant post Z…
This was a really moving post, thank you for sharing it Z
What a brilliant story, thanks for letting us know how it turned out. Does The Kid know what changed?
Lola x
Good stuff.. thanks for sharing! A great post to read at the start of a day..
@Lola
I dont know if she knows, but my take on it is that she was a very disciplined, dedicated anorexia, and she turned that discipline and dedication around in order to use it to pull herself out of it by her bootstraps. All the therapies may or may not have had an effect, but ultimately I think she came out of it because she made a choice to do so.
That’s the thing isn’t it. The battle isn’t to start eating, the battle is to want not to be sick anymore.
It is the stories like this one that inspired me to change from general nursing to mental health and since making the choice I haven’t looked back.
Still good to be reminded tho
Thanks so much.
BB
I think that your interventions not only kept her alive, but also taught her how to live with feeling full after a meal, no matter how terrible it felt, and how putting on weight would make her ultimately feel better rather than worse. She needed to be shown these things as the disease had taken away her ability to know for herself.
Ultimately, her temporary freedom was lost but it was lost in order to allow her to have a long healthy life in which she will have a million options, choices and freedoms – all of which could have been taken by her disease. Your hard work has given her a lifetime of choices, including the choice to come ot of the anorexia.
I suppose I have to be the one to pour cold water over this backslap fest.
I`m off today and I`m starting to wish I was in work. Firstly, in response to the suspension of all Territorial Army training for six months, I listen to Jeremy Vine asking the ridiculous question of why do we even need a TA. The news with reports of all sorts of bombings in Pakistan and predictions that the Arctic Ocean will be ice free through the summer months in a decade, does little to cheer me up. Why do we need a TA ? How the hell do I know ? How does anyone know ? Argentina might invade the Falklands again. A 9/11 type event may occur. Krakatoa might erupt. Drought might ignite the North Yorks Moors. Swine Flu II might cause civil unrest. Yet despite the primary responsibilities of government being defence of the realm and contingency planning, we haven`t got £20,000,000 to keep the TA trained up.
We do, however, have money to keep eating disorder units open. I`d be all for it if they were proven to be effective but they`re not. The Kid has come through as something, seemingly not “months” of professional intervention, has stimulated her inate will to live. Why oh why are we lavishing services on those with eating disorders and addicts ? Why aren`t simple, cheap, challenging regimes being offered as an alternative ? Why, really, is there a complete absence of awareness, pragmatism and sense on this site ?
OSB,
Perhaps you could elucidate a little on what you term to be ‘ …simple, cheap, challenging regimes’?
P
There may be a germ of a good idea in what OSB is saying, in that assertive outreach teams have been found to be cheaper than inpatient services, and in some cases more effective at treating anorexia, though there will always be a certain percentage of anorexics who’ll need inpatient care purely to keep them alive.
I suspect, however, that this isn’t OSB’s point, since he’s been subjecting us to long rants about the virtues of the army and how we can’t see it because we’re all a bunch of hypocritical liberals. My guess is that he probably means military-style boot camps. To that, all I can say is that for a lot of anorexic kids the it would chime well with their compulsion to exercise and the black-and-white thinking that tends to come with anorexia, but wouldn’t actually challenge those tendencies. In fact it would probably reinforce them.
Bloody hell OSB, go to a political site if you’re that obsessed about it. This is MENTAL NURSE. Z was doing his JOB. FFS.
do not feed the trolls, do not feed the trolls, do not feed the trolls…..
‘This is MENTAL NURSE. Z was doing his JOB. FFS’ – this can be construed as a criticism, though, Azulinebloo.
Some commentators have suggested that the treatment infra-structure itself, particularly addiction services, perpetuate the very problems they are meant to ameliorate?
Certainly the number of heroin addicts has risen dramatically since the 70s- so much so, in fact, that there is no longer any pretence that abstinence is amenable to professional intervention.
No, the emphasis nowadays has shifted to the lesser goal of ‘harm-minimisation’ (not a bad thing if it can be achieved, of course).
Similarly I do not see how those with an eating disorder can ever respond to ‘medical care’, however laudable the aims of mental health staff might be, because food issues, no matter how severe, cannot be classified as a ‘disease’ (and hence the concern of a doctor) – I do not dispute the importance of the interplay that occurs between staff/clients, just that non-existent physical pathology must always remain the elephant in the room.
This is not to say that severe physical problems do not arise if you starve yourself for long enough or fall prey to the chaotic life style that afflicts so many heroin addicts – anything from hepatitis to premature death can be on the menu, if you will excuse the lame pun.
As far as I can tell OSB is simply advocating the importance of socially valued and useful roles – surely in many instances these are the most effective remedy for those plagued by endless introspection, or psychological nihilism?
MRI used to Identify Neurological Basis of Anorexia
The aetiology of eating disorders
Similarly I do not see how those with an eating disorder can ever respond to ‘medical care’, however laudable the aims of mental health staff might be, because food issues, no matter how severe, cannot be classified as a ‘disease’ (and hence the concern of a doctor)
Surely eating disorders are some of the mental illnesses that most need medical care, for the fairly simple reason that if they run to their conclusion, they will kill the patient. Most of the others don’t have a physical end point that’s fatal, but eating disorders do.
@OSB
Erm…we’re not?
Eating disorder services are VERY thin on the ground. In some parts of the country, they’re virtually non-existent.
If there’s one criticism that I’ve never heard of the NHS, it’s that we spend too much on eating disorder services.
Z:Eating disorder services are VERY thin on the ground
It would be crass of me to return to MN and point out the black humour waiting to be pounced upon in that comment.
/crass
AECN: Some commentators have suggested that the treatment infra-structure itself, particularly addiction services, perpetuate the very problems they are meant to ameliorate?
Couldn’t agree more – and in fact will expand it to the whole of MH services.
I don’t suggest there is not a problem to address – but what I do state – so many therapies and therapists and research and drugs and yadda are designed for their own existence that the true problem is often re-designed to fit the latest trendy intervention.
/prozac-dig
Prozac is sooooooooo 1990s, Mr Ian. Now everybody has to stop taking their antidepressants and their (60-90% relapse rate, people!) long-term problems will be magically fixed with six to eight sessions of cognitive behavioural therapy. Cos that’s so fashionable right now.
The failings of prozac are an easy target – as they’ve been fairly well debated – and have also contribute to an historical era in psychiatry.
The failings of CBT are yet to emerge – but will less well remembered in time – they will fail with the inept “therapists” and by the conveyor belt ‘sheep dipping’ process.
Incidentally, OSB, I feel that your constant rants and insistence that absolutely every subject be turned into a monologue about the army is starting to become rather trollish, not to mention bizarre.
Hence, you’re now on the Mental Nurse Official Naughty Step for the next couple of weeks. You still have access to the forums, but not to the blog threads. Those wishing to make the usual protestations about censorship, freedom of speech yadda yadda please take them to the forums rather than discussing them on this thread, which is about eating disorders.
And now, back to the subject in hand…
oldschoolbaby said [from the Naughty Step]:Z, Excluding me from the main thread and then replying to my point secure in my knowledge that I can`t respond is cuntish in the extreme. Try getting out of your bedroom for a change. Outdoor activity is hardly the preserve of the Forces, not that I`ve ever advocated “military style boot camps” for anorexics. All I know is that “months” of inpatient intervention of indeterminate value isn`t affordable in this country and alternative out of the box thinking has to be brought in. Send them to some buxom, kindly, maternal stalwarts of the WI ? Wouldn`t it just piss on your over educated chips if lay people had an impact.
Included here surreptitiously cos I agree – if anyone gets moderated out of the thread – kicking them with their hands tied is cowardice.
I fully expect to get moderated and censored out of the thread for not following clear direction …
Of course you can simply delete both posts – then it didn’t happen, right?
Suspect the last thing an anorexic needs is to be fed by someone buxom and maternal. Wouldn’t that just feed (sorry, no pun intended) into her fears about how you turn out if you eat?
Researchers at Heidelberg University Hospital have used MRI technology to uncover the first glimpses of brain processes that MAY explain the eating disorder anorexia nervosa.
………. anorexia, bulimia and obesity are perhaps better regarded as heterogeneous disorders with complex multifactorial aetiology, involving the interaction of genes and the environment, particularly social factors. However, little is known about this aetiology, particularly its biological components.
In other words while there is no proof there are a number of THEORIES – similar arguments have been put forward for heroin addicts.
My own personal belief is that drug addiction or eating disorders are not biologically but culturally driven.
rturbing to say the least.Yes I knew it was pretty weak when I posted it. Still the second article had a little more food for thought.
My personal theory is that as with most of these things it is a mix of both. I also think both can be ‘treated’ (for want of a better word) by specialist help.
My, poor, understanding is that food is used as a maladaptive tool of environmental control. The core issues driving the condition are not actually about food.
At my place of work we have many people whose problems are caused by significant life events (abuse, bereavement, injury) and therefore probably not a disease but end up receiving medical care.
Apologies if I have totally misread and misrepresented what you have written but it is past my bedtime and work has been … aggravating of late as my team seems ready to implode. Stress levels are pretty high. Also there seems to have been a localised surprise outbreak of contagious psychosis which is perturbing to say the least.
Disease
That’s wonderful. Hope she keeps it up.
First time reading your blog. Great post
It’s good to hear some positive stories in EDs. Having been in a unit I’ve seen it first hand, particularly in younger patients, where it seems like they wake up or come back from Leave one day and for unknown reasons feel ready to start moving again towards adulthood. Whether it’s medications, therapy, or just the illness running its course, something changes and anorexia serves no purpose anymore.
I look forward to reading future posts, many thanks.
Becky x
OSB: Why, really, is there a complete absence of awareness, pragmatism and sense on this site?
errrm. would that be because anyone who bothers to engage some of the more pragmatic aspects of your thinking gets misrepresented, harrangued and abused? i think you dash half this stuff off after a trip to the pub.
anyways, you’re on the naughty step for two weeks now so you can’t reply to this.
ha ha ha. you twat.
Well, Lorna, I am slightly worried the ‘naughty step’ beckons if I put a foot wrong but here goes …………
You said – “surely eating disorders are some of the mental illnesses that MOST need medical care, for the fairly simple reason that if they run to their conclusion, they will kill the patient. Most of the others don’t have a physical end point that’s fatal, but eating disorders do”.
Obviously either starving yourself or over-eating can have serious and even fatal physical consequences.
I’m sure I mentioned this point myself a little earlier and I’m certainly not suggesting that medical attention (be it gastric banding or correction of electrolyte derangement) should be with held from patients who would benefit from this type of assistance.
These are indeed bona fide ‘medical’ problems and in some instances lead to severe or potentially life threatening problems – so far, so good?
But what I BELIEVE (allowing for the fact my ASSUMPTION may be wrong) is that the psychological processes around so called eating disorders (and addiction) are driven culturally, in the main, rather than biologically?
It follows that if we leave aside physical complications that may arise from such behaviour then we are in a bind as how to best approach ‘treatment’ since there is doubt as to whether the phenomena in hand can be shoe-horned into a medical paradigm?
Do we need more doctors ………. but trained as therapists? – and if so are we talking about a ‘systemic’ approach, ‘analytic’, ‘humanistic’, etc, etc.
Or more psychologists perhaps, trained in various behavioural or cognitive models?
What about nurses with years of experience + additional training?
Maybe we need the full panoply of health professionals accepting the symbiotic nature of such relationships?
But as OSB implies these models all have pathologising tendencies when perhaps there is more mileage in stimulating roles that are more productive (when ever this is feasible).
I realise there is a spectrum of ‘symptom severity’ and some individuals are simply be too disabled (due to dangerously low BMI, etc) to do very much at all – but what about teaching, say, in developing countries?
Dangerous, perhaps but just think how rewarding it might be and how much children who are thirsty for knowledge would benefit?
One of the great myths perpetuated by dynamic psychotherapies is the idea that we have to return to earlier traumas, and then understand them if we want to be move on – bollocks, it MIGHT be useful, but not as a matter of course.
What is useful and nurturing is the sense of worth and connection that comes from institutions like the army – see how far endless introspection gets you when the life of your comrades is literally in your hands.
I can see that I am rambling now – but I hope you get my general drift?
“Culturally driven”
I think there is a dangerous insinuation here that people with eating disorders become ill because they read too much Cosmopolitan magazine. I never developed an eating disorder from the influence the media had on me. It’s precious little to do with that. I’ve spent time in Kenya, South Africa and Thailand, and whilst I think I understand what your getting at, I think it’s mildly insulting and reminsent of the “Be grateful for what’s on your plate, there are starving children in Africa” approach
Seems as helpful as telling a depressed person to pull their socks up if you ask me.
I’m not telling anybody to do anything, Lola – I am just offering my observations, no doubt many commentators will take a diametrically opposed view (see the links supplied by Mental above).
Yes, I do believe that ‘depression’ is increasingly mistaken for hardship, or old fashioned unhappiness in life which I don’t think is quite the same as ‘pulling your socks up’? – in fact, it won’t be long before SSRIs are added to the drinking water, at least there are fewer reservations nowadays when it comes to prescribing this class of antidepressant to children.
http://www.ich.ucl.ac.uk/press.....ease_00275
I am not so stupid as to claim that a single/simple factor like cosmopolitan ’causes’ either anorexia or obesity – to my mind culture equates to the sum of ALL the significant influences in our life, from family background, friend ship networks to the kind of life style, self image and so on suggested by various media.
As I say these are my beliefs the current state of evidence does not provide a definitive answer one way or the other, so in the absence of certainty we have to go with our instincts.
I’d say it’s an area that very much needs the benefit of the doubt. Given how inadequate eating disorder services are (not as in “they’re all crap and I hate them”, as in there just isn’t enough available), I’d say it’s very dangerous to go down the route of saying “well, it might not even be a real illness”.
I’m also suspicious of finding the root cause of long-standing mental illnesses (and by the time people are ‘sick enough’ for treatment, they’re usually pretty long-standing). This is more of a depression thing than an eating disorder thing, since my eating disorder ‘only’ lasted a few years. I’ve never really agreed with the idea that the cause is hugely important. In the beginning, probably. After enough, the thing’s got a life of its own. Bloody things run downhill if you don’t catch them fast.
I dunno. I’m a radical feminist lesbian, I read The Beauty Myth when I was thirteen, I should’ve been relatively safe if it’s all cultural. I ‘knew better’. Didn’t seem to help.
I mean, as far as I know, the only mental illnesses we know have honest-to-god proper biological stuff going on are bipolar and schizophrenia, right? And eating disorders at least have some evidence that starvation leads to eating disordered behaviour (as well as resulting from it). If we’re going to start throwing out stuff with no proven biological stuff going on, why start or end with eating disorders?
Good questions, Lorna – just about to start a long day – can I come back to you tonight?
“Eating disorder services are VERY thin on the ground”, nice one Z. Apologies for irreverence on this my first comment but it was just sitting there awaiting an immature nit to run with it.
Oops, now there was an unfortunate Freudian slip.
ahhh should have scrolled down before being an immature nit
Remember Szazs’s claim that it is only be a matter of time before psychiatry is consigned to the same category as alchemy?
The starting point for psychiatric excess is the simple fact mental disorders have never been proven, or disproven in the same way that Type I diabetes has, for example.
What is beyond dispute is that people suffer and perhaps due to the pervasive influence of medicine some are convinced that these experiences must somehow be caused by, or are related to brain dysfunction – on the basis of this logic a variety of bizarre diagnostic categories have arisen including the likes of school refusal, and shyness although some disorders like ‘homosexuality’ have now been removed from the list.
Incidentally, I have never heard any serious explanation as to why those with a scientific outlook had the temerity to classify homosexuality as a disease in the first place – to my mind this embarrassing faux pas epitomises the cultural role that psychiatry is sometimes expected to perform.
By the same token the treatment meted out to political dissidents in places like Russia was difficult to argue against since nobody could ever prove that dissatisfaction with an oppressive regime was not related in some way to genetics or misfiring brain chemicals – no doubt MRI studies were performed highlighting the unusual brain activity that occurred when Solzhenitsyn & Co were ranting against harsh conditions in the gulag.
In many peoples minds the entire psychiatric edifice rests on the credibility of schizophrenia as a bona fide neurological disease although this does not preclude cultural factors shaping certain features – for example, people of Irish heritage experiencing religious delusions, or individuals with critical or emotionally remote parents experiencing paranoia, etc.
Schizophrenia is the only reason I do not fully come down on the side of Szasz but most other disorders including mood disorders and so called personality disorders are shaped (in the main) by life experiences in my humble opinion.
This begs the question – for those who have serious doubts about the disease paradigm, how are we to offer help without pathologising what are likely to be problems in living?
Ah, but I am gay and agoraphobic. So on the one hand, I see your point, on the other, your grandma is quite familiar with the sucking of eggs
I am very, very wary of such an approach for the reason that it leaves stuff untreated. And most mental problems are left untreated quite enough as it is. (I know, I know, overprescription of SSRIs, but that doesn’t mean it’s the people with severe depression who’re getting them.) My own experience, and studies into long-term relapse rates, say that not treating something properly is a good way to turn it into an intractable illness, even if it wasn’t one to begin with.
Because – and I can’t believe I’m saying this, with my own loathing of my bastard of a shrink – mental health treatment isn’t actually that bad any more. There are abuses and some of the drugs they push are awful. A lot of the doctors need smacking upside the head with the social model of disability and the concept of wanting to live a decent, independent life. But we’re not in the days of thorazine and lobotomies. Before people respond in outrage – I hate most of the treatment I have received, I’m very angry about it and I don’t think everything’s peachy. But we’re not living in the age of routine, horrific, permanent damage to patients that a lot of the anti-psychiatry movement came from.
As such, I’d rather err on the side of caution. I’d rather treat than risk things running downhill. I think the current approach, of “why don’t we just take you off the antidepressants and see if you cope, because you might not relapse and antidepressants are unfashionable right now” is horrifically negligent in patients like me. (For that matter, most patients, looking at the long-term relapse rates.) It’s a thing I bang on about, but if these problems aren’t taken seriously in the first place, they tend to show up in a few years’ time, having got worse all the time, and make you take them seriously.
I love you, Lorna.
I would never want to deny someone treatment when they actually want it. But I think it is stupid that they have to get diagnosed with a mental illness in order to get that treatment. If it makes you feel better, why should it matter? (Wouldn’t this parallel “preventative care” in physical health care?) If you aren’t mentally ill, why should you need a diagnosis? (I am okay with over-treatment, of people who want it, but not okay with over-diagnosis.)
But in practice, there is this “right to treatment” thing that usually seems to mean more “right to treat” than its name implies. A right to treatment should not mean much more than “you can have treatment if you want it” except in very rare circumstances.
Are professionals suggesting you not take drugs because they aren’t fashionable? My shrink would let me take drugs forever if I wanted to; it was me who initiated coming off them, to see if I could, because I find it wasteful to be on the drugs if I don’t really need them (in terms of money, resources, and dealing with side effects). If I need them again, I will take them again. I fully expect to relapse at some point in the future, but until then, I’m free! (As of Sunday.)
Your last paragraph – pretty much every health professional I’ve met in the past few years has been of the “when you come off these” persuasion. I’m pretty sure my GP won’t give me 40mg capsules because he wants me to step back down to 20mg soon. (Yeah, not gonna happen.) I want one of those mythical doctors that writes people prescriptions and doesn’t talk to them, I swear. I could maybe live with it, if they weren’t simultaneously pushing things like venlafaxine, which are very difficult to stop taking once you start. It does stink of fashion rather than psychopharmacological expertise. Actually, once I snapped at my GP that it was fashionable right now to get people off drugs and into CBT, and he admitted this was the case.
I personally tend to emphasise the ‘Symptomatic relief’ element of psychotropics, whilst ackowledging the responsibility on the individual to work with appropriate nurse/psychologist/ counsellor/ doctor(?)/priest/ friend/ family/ jeremy kyle etc to tackle the underlying issue(s) in the medium to longer term.
But do you emphasise negative effects arranman? – the link between antipsychotics and irreversible tardive dyskenesia is well established, while this class of drug are also responsible for a three fold increase in sudden cardiac death
http://archinte.ama-assn.org/c.....12/1293?ct
Now, here’s a question, which may be off-topic.
The shrinks say ah, but the new antipsychotics are much nicer.
Ben Goldacre says ah, but you got those results comparing massive doses of the old ones to tiny doses of the new ones.
Anyone know who’s right?
Of course negative efects have to be considered, however if you go with the symptomatic relief approach rather than maintenance/ forever and a day use of psychotropics I belive you will naturally be minimising risks you mentioned. In the example of Lithium regimen for bipolar, if symptoms are well managed with medication (in the short/ medium term) then an informed decision for prolonged use can be made by the individual, weighing up pro’s and cons etc..
Psychiatry is bunkum!
Was ‘The Kid’ your favourite patient?
Brilliant post Z. I’ve been reading quietly for some time and I’m so glad that “The Kid” has finally fought her way through this. As some one who still relapses with anorexia after her first episode 6 years ago, the whole thing really meant a lot to me and I can definitely relate with the sudden turn around which comes before recovery.
Anorexia is a symptom of etheral casuation.
Since we can’t weigh or measure ‘happiness’ or ‘peace with oneself and those around me’ we treat the tangible aspects in isolation.
Despite my allegiance to ‘deeper causes’, I agree with AECN – we’ve no need to systematically delve into people. MH consistently bores me for its Rottweiler tendency to focus on removing the bad at the detriment of forgetting to improve the good.
Risk management doesn’t rely on simply removing the risk factors – but on strengthening the protective ones.
MH ought not run simply on attacking the dysfunctional elements but can less controversially be improved by encouraging the functional ones.
Eventually The Kid decides – ok, I feel a motivation to rejoin society now – and gets with the Big Brother program to be ‘normal’. Whether by some normal maturation process (the one that most often succeeds in forensic psychiatry – where we lock them up until they decide there’s something worth behaving for) or whether that be by some unattended and unobserved event (in this case perhaps Kid decided she was just being too much of a twat to those around her and time she grew up; Anorexia has outlived it’s purpose and failed to achieve its agenda – the agenda being the all important thing we fail to understand – [control? being a fashionable size 6? rebellion? pay attention to me? I don't want to conform? I feel rejected?])
We focus on the tangible practicalities using methods and interventions that probably reinforce the origins of the agenda and hence ‘failure to improve’.
I’m a believer in two things:
1. Do we HAVE to intervene?
2. Why is it the individual who is wrong and not society/service?
(whole stigma thing and why is it ‘wrong’ to hear voices/believe you’re God? – it’s only the expressed distress to the individual or risk of harm to self or others that makes it a point to address)
People are fundamentally simple creatures who require little more than Maslow’s Idiots Guide to Being a Human.
Weastern society is a complex do-gooder that insists if you ain’t ‘average’ – you’re wrong.
In The Kids case – assumptively – I suspect she’d tried being ‘a unique individual’ in response to feeling she was a clone drone and lacked any sense of unique ‘identity’ – but then got bored of the intense attention, social exclusion and disliked herself for the way she was treating others who seemed to be generally nice people by the method she had chosen to gain an identity – and essentially she got over it.
Kudos for keeping her alive.
Of course the ‘treatment’ was influential in recovery – but not necessarily for its overt assault on the dysfunctional components and probably more to do with the intense relationships created during its course.
I came to the conclusion that all nursing is about keeping the patient alive while they do the hard work. It sounds like a good win.