Revelation: Eating Disorder Residential Treatment Centers are Today’s Asylums
I am trying to get back to my writing following a very rough couple weeks. After interviewing the Bazelon Center’s legal director, today, it struck me: my series on residential treatment has perhaps been arguing things the wrong way. It seems to me the issue is not: “We need a new paradigm for treating adult anorexia” - but perhaps instead, “How in the world did a practice which has been denounced for nearly every other form of disability - both physical and mental - been allowed to hold sway for eating disorders?!” Why is it that, while it’s now universally recognized that people with severe mental illness fair better with community integration/treatment - rather than institutionalization - this is NOT applied to eating disorders? I asked the legal director, “Well, but aren’t eating disorders a different animal - you have the medical component - your life can be at risk if you have a severe ED, etcetera” - but he said that’s not really a valid argument. Other mental illnesses also have symptoms which involve life-threatening behavior. So while yes, we all know if you’re seriously, seriously ill, hospitalization for a period (as short as possible, IMO) may be necessary. But otherwise - you can still receive - as the lawyer I spoke to pointed out - highly monitored community-based treatment within your own home/environment with the support of family/friends/community orgs. And look at people with schizophrenia or bipolar disorder - people who are also at times at risk of being a danger to themselves (self-harm, paranoid actions, etc.) - do we advocate institutionalizing them? For the most part, no - at least not on the social work/recovery model side of mental health service delivery. The discrimination and prejudice held toward individuals with severe or long-term EDs is truly astonishing. For those of us - and there are many - who fall victim to the revolving door of residential ED treatment - we are, in effect, being subjected to forced treatment, without knowing it. Because it’s almost-universally but incorrectly (and science backs the incorrectness of this) presented, by the ED professionals and advocacy orgs with power, as the THE ONLY route to recovery. They use language which disguises what they are doing - they make it sound like they are offering a voluntary, nurturing, effective treatment solution - when once you get to one of these places, you find most of them are anything but nurturing or effective. And once you go to one, you often become institutionailzed. We are inclined to believe people with fancy letters after their names, clinicians in positions of authority, who manipulate us into thinking being locked away in 24/7 care is the only route to full recovery - no matter how many times it’s failed in the past. Take this quote from the Bazelon site: “Many individuals with mental disabilities are unnecessarily segregated in institutions such as nursing homes, board and care homes, and residential treatment centers that are physically located in the community. Others are segregated in various types of smaller group facilities that may have the physical appearance of a home but, in fact, are quite isolated from mainstream community life. All of these settings are part of the public systems that Olmstead addresses when they are publicly planned and financed, regardless of whether they are government operated or privately run. The physical location of a living setting in the community, its private ownership, or the absence of characteristics generally associated with a hospital do not guarantee that residents with mental disabilities are free of the discrimination and segregation prohibited by the ADA. The Bazelon Center has joined with local partners throughout the country to litigate the ADA rights of individuals consigned to nursing homes, board and care homes, and other segregated community settings....”
This may be stretching things a bit, but could it be that eating disorder clients who’ve fallen victim to the revolving door of institutionalized treatment are - albeit indirectly - having their Olmstead (and ADA) rights violated?!
The legal director also mentioned how it’s been shown that segregating mentally ill youth into group homes is ineffective because 1) when you put a bunch of kids together with the same problem, that isolated peer culture tends to reinforce the problem, not lead to solution, and 2) Most of these group homes operate based on a level system, which is not at all how the real world operates. Um, hello? That’s exactly the same environment you find inside a residential ED center!! Every center I’ve been to has a level system, and I only started getting worse once I entered the system and saw how “bad” I was at being “anorexic.” And then you have the fact that these places are treating middle age adults - which I am - like children. Which needless to say doesn’t exactly help foster the type of internal motivation and self-empowerment one must find within themselves to achieve long-lasting, full recovery.
These are just some quick thoughts on a subject and angle I need to give more consideration, but I will certainly be addressing the issue in my next article, which I am hoping to finally delve into full-force this coming week...