Those relatives and friends that know me well also know that I do not subscribe to the philosophy of one size fits all or that there is only one approach to treatment or that following the latest trend or research is the only right thing to do. I don’t believe that with regard to most areas of my life and I didn’t believe it or follow it when dealing with my son’s eating disorder.
Does that mean that I am a maverick and don’t follow any of it? Definitely not! Certainly there are standards and absolutes. The latest research has clearly defined that strep throat is a bacterial infection and antibiotics are the cure. This has been pretty well demonstrated and when my doctor tells me that my children have strep throat and prescribes penicillin or some other antibiotic I don’t argue for something different. That is only one example of many.
When it comes to eating disorders or other mental health issues, I have not been convinced that there is only one approach that works. While there is pretty much universal agreement that strep throat is a bacterial infection cured by antibiotics as well as the empirical evidence of people actually responding to the treatment in nearly all cases, there is much less agreement on the treatment of mental health issues and specifically eating disorders.
I have been in support groups and I do quite a bit of reading. I have become alarmed lately at the number of times I hear the latest treatment modality, book, or research being pushed on others as the only way an eating disorder should be treated. There is more than a tacit implication that you are harming your child if you don’t subscribe. I recently heard someone suggest taking a book on the latest approach to treating eating disorders and throwing it at therapists who are not practicing it or dare to disagree! What in the world kind of advice is that! I will not rewrite my article about advice in this post though. In this post I would like to talk about treatment options and why I don’t feel out of touch or guilty about not following only the latest research and treatment modalities.
Research is just that: research. It provides us with the latest understanding of or a new and different way of looking at a particular problem or issue. Sometimes, as in the case of strep throat, it is the last word on the subject for the time being. Should the germs defeat the antibiotics, research must begin again and a new “treatment” or antibiotic must be found. We have not been so fortunate with research and treatment in some other areas, mental health being among them.
In ancient Greece women were believed to be the only sex suffering from anxiety (which was called hysteria) and the latest research at that time was that it was caused by a wandering uterus. While one could argue that this was a very long time ago, I would argue back that the greatest minds available at that time, namely Hippocrates and Plato, believed and promoted this theory. It was the latest and best in its time. I sit here and wonder to myself where in the world of common sense did they think the uterus went? How could an organ that was able to withstand the rigors of bearing children, who are hardly quiet and still in utero, suddenly just take off and travel while empty. The body is not that big. Would someone not notice when it hit a major organ such as a lung or the heart, and would the fact that it didn’t hit something major not be a red flag that maybe this theory was ridiculous? But, if I was alive at that time perhaps I would have considered it plausible. Living in the day and age I do, I hope that some years later the latest research proved that women with anxiety outlived their men who suggested a wandering uterus as the cause. I doubt that the women would have resorted to violence during that time period though, so I would guess the men were safe for a few hundred years.
During the 1950’s and 60’s the latest research was that baby formula was superior to breast milk. I am myself a product of that formula generation. During that time women were given many reasons why formula was superior to breast milk, something that was tried and true for thousands of years. My mother was told by her doctor that the “latest research” suggested she would transmit her anxiety to my sister and I through the breast milk. Had my mother been the only one that told me this, I would not necessarily have believed that it was the standard, but my mother-in-law was told the same thing. That is certainly not an exhaustive list, but the fact does remain that formula was pushed over breast milk during that generation. That research has now been refuted and argued to be the result of the formula companies desire to promote their product. That may well be true, but it was the latest research at that time and it did influence a very large number of mothers to stop breast feeding or not begin at all. While my common sense might be offended sitting in my family room reading this today, if I had been an adult at that time perhaps I would have felt differently. At the very least, knowing my pattern of discernment, I would have looked at it and considered it carefully. Would I have dismissed it? Would I have partially followed it the and done some sort of hybrid? Possibly. By the time that I did have my own children, I actually did do a bit of a hybrid. I breast fed for a year, but supplemented with formula some of that time. The reality is that most breast fed babies have grown up healthy for centuries. I and most of my exclusively bottle fed cronies are still alive and kicking and my own children who had both seem to be physically healthy as well leading me to believe that all three approaches, which incorporate the past and the present, or both, work well for different people depending on their individual circumstances.
When it came to my son’s eating disorder we did follow many of the latest treatment guidelines and when he was on the IP unit, the latest treatment modality at that time was being used and he was very successful with it. During the refeeding process, this modality worked well to restore his weight and heal his brain. It was not the only treatment that we used, however. We incorporated many different treatment modalities with the help of our outpatient therapist, not the least of which was common sense. We tailored our approach to meet the needs of our son and of our entire family. Our family needed to heal as well. Our approach to nutrition and even exercise was a bit different at times. It didn’t follow, to the letter, the latest research and the latest treatment modality, but instead followed an approach a bit older with elements of the latest modality incorporated as well. I have written about this in other posts, so I won’t repeat it here.
My objection isn’t that someone would follow the latest research or follow, to the letter, the latest treatment modality. If that is what works for that individual and for their family, that is exactly what they should be doing. My objection is being told that this is the only way and criticized for a more eclectic approach. I object to hearing that an eating disorder is caused by this or is definitely not caused by that, because we simply do not know for sure. The latest absolute I was told in a support group was that eating disorders are absolutely not about control. That may well have been the case for that person’s loved one and may well not be the case most of the time. I understand the thinking behind that statement because many people believe that eating disorders are purely behavioral and manipulative which is, of course, false. That said, it doesn’t mean that there cannot be an element of control involved with certain individuals. Many times this is the case with people who also have a trauma history. The fact that some element of control is involved doesn’t mean that the eating disorder isn’t an illness. It simply means that they might be interconnected and that both should be addressed. It might mean that more than one approach needs to be incorporated. It might mean thinking a bit outside the box.
There are many examples where old and new coexist. Many Native American tribes still use very ancient tried and true methods of curing their sick and controlling pain. This does not mean that they are not open to modern medicine as well. There are many new methods of dealing with pain now that do not involve medication, but Acetaminophen and Ibuprofen are not in danger of coming off the shelves.
I think that that latest research is wonderful. It has brought us many cures, has warned us of dangers to our health and safety, and has helped improve our quality of life. I try to the best of my ability to keep up with the latest thoughts and research whether related to eating disorders or anything else. Our approach to our son’s eating disorder was not solely based on the latest research, but was a hybrid of many things, the latest research and treatment modalities among them. We tried different approaches and when we found the combination that worked best, that is what we went with. This changed from time to time and required modifications along the way and a very healthy dose of common sense along with it. Our approach included not only what was right for our son, but was right for the entire family and was always done with the help of our fantastic outpatient therapist.
I found myself feeling guilty one day when hearing a support group member talk about the latest research and the latest treatment modality being the only one and the only way. I felt guilty because there was an aspect of that modality that didn’t work well with my son or my family. That one aspect didn’t feel comfortable for any of us. I found myself feeling that I was doing something wrong and neglecting my son’s well being when I was listening to her speak.
Today, I do not feel guilty. While this approach worked very well for my fellow group members, it didn’t work well for me. I shouldn’t have to feel ashamed or different for my multi-faceted approach. It has been a combination of past and present. It has served my son well and it has served our family well and, in the end, that is all that matters to me. I would never advise someone about the best approach because I think that this is individual. The only advice I would give to someone would be to find a provider with which you are comfortable and then to make your treatment decisions in concert with that treatment team. I will continue to use the past and the present to guide my decisions. It might well include the latest approaches, it might be a return to something in the past, or it might be some combination thereof. It will always be based on what works best for my family, developed with an open mind, and with the help of appropriate professionals. What I won’t be is defensive or guilty about it.