This is another post in which I’m going to talk about the flaws in treatment that all too often we stay quiet about. I’ve been told so many times that “treatment centres are a necessity and they provide a vital service” so I should be more forgiving of the not-so-perfect aspects.

Are you kidding me?

Let’s say if we were talking about any other medical procedure that was inadequately preformed. What if doctors were using sellotape to cast limbs? What if vasectomies had a 60% risk of not working? What if the ER was staffed by nurses who believed that mind over matter was the answer to stab wounds? Would you tell me to cut them some slack? That it’s okay because they have good intentions at least?

Oh come on. We can do better.

Only in mental health is grossly inadequate rates of relapse acceptable. Only in medical health can it be the NORM that you spend tens of thousands on a service with such a poor outcome and have no means to complain or even give feedback. Only in eating disorder treatment can outdated, unproven, not-based-on science-or-common-sense methods be used over and over and over again despite the fact that patients, parents, and recovered individuals are shouting “THIS DOESN’T WORK.”

You’ll complain if a bartender forgets the lime in your $5 gin ‘n tonic  but can’t say anything bad about the treatment centre that took away 4 months of your life and 40 thousand dollars and spat you out more fucked up than you were when you went in?

What’s my deal, you might ask? I didn’t even go to treatment. What do I care? Well, I care because it is wrong. I care because it is fixable. I care because I have seen the other end for people who “fail” treatment. I care because I work with people who have been in treatment 4-to-20 times and never recovered until they finally heard some common sense and found someone who told them that it is okay to eat a LOT. That it is okay to binge. That it is okay to trust their body.

So excuse me, but no, I’m not going to shut up about this.

Here are some examples pulled from the many emails I get from people who have been in and out of treatment. The third one in particular made me want to throw the computer across the room:

Hi Tabitha,

I’m in the maintenance stage of recovery, 5 months in, after one year of anorexia and compulsive exercise. My hunger cues are back in full force, and I’m able to eat more mechanically when they aren’t as strong due to anxiety or feeling unwell.  I’m still trying fear foods and I’m still following this meal plan. I know the meal plan is necessary for a certain amount of time, but it still stresses me out.
The treatment center I attended really helped me. However, my dietician said things about my meal plan which bothered me. She said things like “This meal plan is pretty standard, you could really follow this for the rest of your life if you want.”
That was probably the last thing I wanted to hear, as a girl who before her eating disorder, ate intuitively. I used to eat what I felt like when I felt like it.  Day in and day out while I follow this meal plan, I DREAM of one day eating like a normal person. To me, that means being able to sleep in and go out for brunch instead of waking up at 7 or 8 AM to follow my meal plan and make breakfast.  To me, that means being able to eat a bowl of Macaroni and cheese for dinner without worrying that I don’t have three proteins.
What you mentioned about the meal plan being a stepping stone gives me hope. My physical health is recovered, and as long as I keep it up, my mind will recover too. I think it is easier to adhere to the meal plan when I know it isn’t forever, just like my ED isn’t forever.  Not to mention, I don’t want to think about my exchanges when trying to pick snacks or meals for the rest of my life. Like you said, that’s disordered.
Best regards,     xxxxx

It is not normal to eat off a meal plan. Suggesting that a person should forever be on a meal plan suggests that you do not believe in full recovery, as you are saying this person will never be able to trust themself to eat normally and eat well doing so. If you are an eating disorder professional, and you haven’t seen full recovery … well, that’s a whole different problem. Either you have not been around fully recovered people, which means you are not immersed in your field, or, if you have been working with people with eating disorders for a long time, you might be part of the reason they have not fully recovered.

Hi Tabitha
My own experience was at a public hospital. My weight had stagnated and whilst I was fine with not eating more, my mother said to the dietitian that I needed more food. She had previously managed my anorexia and weight for a couple of years and was well familiar with the amount of food I’d need. The dietitian refused. At a different hospital the same thing happened. I said I was hungry and the dietitian refused to allow me to increase my meal plan.
A worse experience happened to a friend at an intensive day program. My friend had reached weight restoration as per their BMI requirements and was moved from a weight gain meal plan to a weight maintenance meal plan. She was also given a weight range which she was allowed to fluctuate within, from memory she was allowed ~1kg either side of her target weight. This weight range proved to be too narrow for her and with normal fluid shifts she often weighed outside of this. Her treatment team were concerned that she was still gaining weight and instead of simply increasing her weight range, they decided to reduce her meal plan. This resulted in her having half a portion of dinner. When we went around the table and expressed how we felt after dinner, she said that she was still hungry. They sent her home hungry. They were fixing her restriction with deliberate restriction.

Both these examples are utterly unacceptable. Nobody in treatment should be going away hungry. Nobody should be denied more food. The great irony, is that if one were in hospital for any other reason, one would likely be given more food if requested. Yet, a person who is in hospital in recovery from a restrictive eating disorder — that’s an under-eating, under-nutrition problem — is told no. I will add that if someone has been in treatment a while, they are not at risk from refeeding syndrome. So how can we possibly explain the reasoning behind this nonsense?

Hey Tabitha
Thanks for the podcasts on this matter. I’m 53 and have been in and out of residential and IP treatment since I was 22. I’ve too many stories to tell but will focus on the most recent. I was, as usual, the oldest person in IP. The main difference for me this time I am getting braver about admitting how, very, hungry I really am. I mustered up the courage to ask for more food. I asked my therapist first and was told I had to wait to ask the dietitian. That was 5 days until my slot with her. I was so hungry. I asked her and she told me the meal plan I was on was “adequate for my needs.” I felt like the world fell down around me when she said that. I felt I was wrong. I felt I couldn’t trust my body. I had asked for more food and been told no and that made me feel like there was no hope at all for me as the one thing I had been pushing myself to be brave enough to do for 30 years I had finally done and I had been shut down for it. Of course I didn’t let her know. I just nodded. It crushed me. 
I am no longer in treatment, but I’m not doing any better either. I hear “adequate for my needs” every time I feel hungry and want to eat more. That’s pretty much all the time. I’ve stuck to the meal plan I was on in treatment more or less. Okay, less. 

This email made me furious.
How dare you tell someone not to eat more if they are hungry. How dare you tell someone that you know better than their body as to what they need. How dare you do this to a person in recovery from malnutrition.
We can do better. We must.

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