“The eating disorder world’s dirty little secret” – ED Bites

Back in May an ED blog that I avidly follow (because of its honest, open and questioning take of the experience of having an eating disorder and the world around this) published this post. It was fascinating because it pointed out that the above-named dirty secret was, in fact, that we simply don’t know how to treat eating disorders.

Whether assessing clinical know-how or research findings on treatments, ED Bites (who writes about the situation in the US) says that we just do not have a clue.

Thinking about this in terms of the UK in particular, with the NHS, my knee-jerk reaction is to say that I whole-heartedly agree. Then, the further I reflect the more I begin to question my initial reaction. So here goes: I think, ultimately, that I disagree (when it comes to the UK, which is the landscape I know about because of my own treatment and journey towards recovery). Instead I think we do know full well how the  myriad treatment methods through highly medicalised to practical to talking treatments can work successfully we just don’t use the ones that truly work for a single, fundamental reason.

What works is too expensive.

If we have to pay for treatment ourselves then we want tried and tested, successful methods of feeling better. It takes very little money to end up with an eating disorder and a hell of a lot to get out at the other side and often there’s a terrifying amount of trial and error and this is because there are many successful ways of working with someone with an eating disorder but there simply is not a one size fits all that can be guaranteed to work.

ED Bites’s argument is highly valid because everyone’s trying to market the next breakthrough treatment under the guise of an altruistic mission for well-being when in fact it’s usually the next money-spinner with very little clinical evidence behind it. How can the family of an eating disordered bloke possibly know for sure that the treatment they are supporting him through is THE treatment that will work?

They can’t know but not because we don’t have a clue how to treat EDs generally but because no-one’s honest about the sheer amount of money involved if the NHS were to fund it.

However, there is a distinct salience to the ‘we haven’t a clue’ argument when it comes to blokes – not only do we not know the treatments but we don’t fully understand men’s experiences full stop. I find it fascinating that our society s so solution and money-focused that eating disorders treatments pop up before we fully understand what it is we are treating. Is that our fault or the professionals? Both, I feel…

– the medical and therapeutic profession have to protect their own bastions of knowledge so it’s difficult to say openly ‘no, we don’t know what to do’.

– the researchers are not admitting that they are only researching what’s cost-effective (not what truly works) because that’s all they can get funding for.

– the people out there with eating disorders don’t want to hear that it can take a long time with several different strategies employed at different times during the ‘life’ of the disorder (certainly this was me 8 years ago). I definitely wanted to believe, when I was first diagnosed, that I would go for 10 sessions of CBT, maybe 20 at a push, then be told I was sorted. I have had my ED since I was 14, how unrealistic was I?

Most mental health issues stand a fighting chance if someone who is skilled, open, empathic, dedicated and patient works almost one-to-one with the experiencer (Breggin’s book is testament to that) but that’s not how any health services are set up, even private ones. It relies on a single professional working with several people; a single team working with a large patient group; a single staff working with entire wards and so on.

Therapeutic change is like teaching. It works its most strongest changes when two people join together in an alliance to help the seeker change. I liken it to the UK’s classrooms. If you want better-educated children, give them full access to an educating adult through smaller class sizes – don’t create more tests, benchmarks and measures. If you want stronger ED recovery, give the eating disordered male access to a solid therapeutic relationship with another who is dedicated to their recovery.

But that takes time, skills and patience. And in the current way our society works time, skills and patience cost money. And market forces dictate costs… not willingness to help.