Mental health patients do not fail treatment. Treatment fails patients.

You did not fail treatment. Treatment failed you. I lose count of how many times I say this. I had to say it again yesterday to someone who was convinced that she could not make a full recovery because she had been in and out of treatment so many times. So many failed attempts. Somehow she thought that this meant she has failed/was a failure.

My typical client profile is someone who has been in and out of treatment multiple times. Almost every client asks me if I think that they can recover based on the knowledge that they have been in treatment for years and not yet reached full remission. Yes.

Let’s stop and think about the statement “I’ve failed treatment.” We don’t tell a person with cancer whose tumor doesn’t stop growing after a round of chemo that they have failed treatment, we say that the treatment failed. If your eczema doesn’t remedy on a specific medication, your doctor doesn’t tell you that you failed treatment. She tells you that the treatment failed. Something different is tried. There are other options. It’s almost as if for physical complaints, one is treated as an organism, whereas for mental illness issues, one is expected to operate like a robot.

When you imply a patient failed treatment, you place the blame for them not getting better on them. Where else in the field of medicine does this happen other than in mental health? It may seem like an insignificant difference in word order … but it isn’t. It neatly moves the burden of getting well off the treatment provider and onto the patient.


Where is the hope?

Then there is the question of hope and motivation. When a doctor tells you “the treatment failed,” there is a feeling of hope, as different treatments can be tried. If you failed treatment, where the heck does that leave a person?

It implies that the patient should go away in disgrace and think about what they have done. It implies that the patient didn’t try hard enough, or even worse, that the patient purposefully got in the way of the treatment and caused it not to work.

“Come back when you are ready,” is often implied. 

Ready? Find me a person with Anorexia who feels “ready” to gain weight. Being ready isn’t required for starting recovery. Most of us aren’t ready, but we are resolved. We don’t want to gain weight, but we know we have to. Being resolved to gaining weight doesn’t mean that one isn’t going to be scared. Agreeing to enter treatment doesn’t mean that our brains automatically switch from seeing food as a threat and weight gain as fearful to suddenly no longer having a full on HPA axis reaction to both these things. Our brains take months … sometimes years to fully rewire after energy deficit is remedied.

If you want to work with cookie cutters go get a job in a bakery.

Now lets look further into the implication that a mental health patient fails treatment. Other, more physically based, medical illnesses frame failure as being the fault of the treatment not the person. The reversal of this blame placing when dealing with mental health patients illustrates the contempt for mental health patients that seems prevalent in the whole darn field of medicine. As if we are just being difficult. Our complaints are not as important or as serious as people who present with more tangible illnesses that can be neatly monitored. The illness cannot be seen, hence, it’s somehow much more under the patient’s control than say cancer or a broken limb.

Is the mental health field really still that basic that the underlying notion is still that patients don’t want to get better? Even with all the genetic studies and fMRIs that show how these illnesses manifest and are beyond the patients control. It still comes down to that stigma. Mental health patients are a pain in the arse.

Well call me a witch and burn me at the stake but if that’s the attitude then I’d be better off chanting magic spells in the woods than going to see my doctor.


We are not helpless, but we are not automatically culpable either

This is not to say that mental health patients are utterly helpless. We are not. We are not powerless, and often we do know what it is that we should be going in order to gain health. Any resistance comes from a place of fear. Anorexia, for example, causes us to be very fearful. Fear-based reactions are to be expected. Being fearful doesn’t equate to being resistant, or being willfully disobedient. When a person is scared, work out what they need with them in order to make them less scared. Help them achieve.

Most of us — especially those of us who have had an illness like Anorexia for ten plus years and are exhausted from it — aren’t totally opposed to getting and staying well. Most of us hate that we live in fear of eating. Most of us know that we need to eat more food and gain weight. Having Anorexia doesn’t make you completely stupid. Sure, it warps perception. Yes, there is this thing called Anosognosia. Anosognosia doesn’t remove all our brain cells and render us incapable of making the right decision. Anosognosia means that we often underestimate how sick we are, not that we are totally oblivious to our illness at all times. I’ve not met a single adult with Anorexia who didn’t know that they “should” gain weight and eat more. There is nothing more condescending than being asked if one knows that one has to eat. Knowing that one should eat more doesn’t always equate to being able to deal with the fear associated with eating more.  We need help with the fear part. By help I mean compassionate, firm, experienced, support, not being treated like idiots.

I am very opposed to telling adults with Anorexia that they have no control over what they are doing, or the decisions that they make, because it wrongfully disempowers them. That is really, really dangerous. Long-term recovery involves being able to be accountable for eating and accountable for not losing weight — accountable for asking for help when it is needed. We have to know that we have the power to make the right choice in order to be able to do it. We have to know that we are in control of our own recovery and that every choice we make reflects that. It’s also dangerous because it insults our intelligence and pisses us off making us want to rebel.  Some of us will bite our noses off to spite our faces with that all too often (it’s surprising I have any nose left at all!)

Empowering people to do the hard thing rather than the easy thing is not the same as trashing them or telling them that they failed treatment. How about empowering patients and then asking them what they need in order to make the changes that they have to make? How about working with patients rather than trying to make them fit the mold. How about listening rather than projecting? How about providing effective help rather than prescriptive help?

How about having some god darn motherfucking empathy.

That was a bit of a rant. I guess I’m just done with people with mental health problems being treated like delinquents rather than the brave and courageous people that they are.

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What do you think?

  1. This is so beautifully written, and it hits the nail on the head! Thank you for sharing all your incredible wisdom with the world, and thank you for bring a voice to many of the issues with the current model of ED treatment

  2. I think this is one reason I’m afraid to seek help. That whoever I see will not really know what they’re doing and that they’ll end up hurting me further.

  3. Once again you are the voice for all of us who have been struggling for years with anorexia. Sometimes I think we need an advocate not just in the war with the disease, but also and maybe more so, in the battle with the treatment world. I would go so far as to say that most eating disorder treatment doesn’t just fail the patient, it is part (a big part) of the problem. Shaming, blaming, misunderstanding, pathologizing … Anyway, I appreciate your distinction around willing and wanting, identifying how many of us need help to stand tall in the face of the million moments of fear in recovery. I heard this very smart psychiatrist (unfortunately not working in the field of ED research and recovery) say that if a patient can’t take the step, then the problem isn’t that the patient failed, it’s that the step was too big. You change the step into one the patient can start taking.

  4. Thank you so very much for speaking up..I have witnessed and experienced the most alarming behavior by so called professionals in eating disorder treatment. In what world is it ok to blame a patient, humilate them when they can’t finish a meal in 30 the name of good health be told to eat 5000 calories which includes nothing nutritious..then to dismiss violent vomiting and diarreaha as part of the refeeding process…wtf then to tell a patient when not meeting their timeline in recovery that your child is on Probation.. Probation, seriously do you tell a cancer patient who doesn’t get well they are on Probation? Was my child arrested? I am struggling so very much with all I have witnessed which makes me sick..I never thought anything could be more terrifing than a child with an eating disorder..however I know now that the eating disorder business is just that..a business…now imagine going through the treatment and learning that your child was misdiagnosed..WTF ? .not one in the 14 so called Drs believe I was not in denial or given me the time of day, they dismissed my mommy gut…my concerns my questions… I told them over and over something isn’t right…..they failed to listen…the damage done by eating disorders is horrible but the damage done in treatment is worse.. damage done when your child can’t get well due to a medical illness or misdiagnosis or .failure to diagnosis a medical illness.. No parent or patient should be shamed for not getting well no matter what..BOTTOM.LINE. Imagine the blame shame and intimidation my daughter experienced only to learn these eating disorders experts and Drs failed to diagnosis a medical illness ..Its a pain and outrage I won’t soon get past…I truly believe that eating disorders treatment failure has nothing to do with patients desire to get well but the lack of knowledge as well as the big money on referrals to residential one seeking help should ever have to prove they are worth it..when a patient with a medical illness doesn’t get well its not their failure.. Whether or not my child had a eating disorder or not I learned first hand that treatment is a business.. referrals are not based on need but in bed quota and availability..I have learned a medical illness treatment is based on what is best for patient treatment but for a mental illness demands are placed on the patient to proof they are worthy..I also know that when a patient with a mental illness who doesn’t get well it documented it’s their lack of wanting to get well, its their non compliance. Eating Disorders may be the most dangerous and have the highest mortality rate but I truly believe they are not anymore complicated to treat than another’s the perfect excuse to blame the patent.. it’s the perfect excuse.. Parents please listen to your instincts and gut and no matter if your child suffers from a medical or mental disorder or illness..fight for them don’t accept anything more respect.. advocate for child