In a Facebook group I occasionally darken, a question was asked: 

“From my research, it appears that the recovery rate for EDs is not much better than it was 20 years ago. What are we missing?? I would love hearing your experiences & theories.”

Many of the responses were erudite, thought provoking and compelling. Studied contributions from true professionals. Some responses were less so. And as per usual, the “Clown Show” segment of the eating disorder community appeared and spewed forth their litany of “isms” to the exclusion of anything resembling accountability, reason, facts or logic.

In response to the question posed, the reality is … the problems in the care and treatment of eating disorders are legion and significant.

Private Equity

First, there are the PE owned treatment centers which purportedly provide a higher level of care. These treatment centers are profit driven. And the investors behind the PE firms demand that their investment be paid back… with contractual profits. The best way to achieve this monetary reality is by slashing expenses. The highest expense? Employee costs. The highest paid employees? Medical doctors.

So, we have seen medical doctors terminated or forced into retirement as full-time employees. Some may be brought back as part time independent contractors. But this obvious problem is growing.

Further, it appears as if the PE firms and their investors (who can, and do, operate with impunity) will start to turn these treatment centers into “addiction type treatment model” centers. That is, hiring more, lower paid, and lesser experienced therapists. Fewer doctors. Increase the number of lower-level employees. We are already seeing that. We will also see the ramifications and consequences from this failed treatment model.

A treatment model which is utilized to attempt to address the two mental illnesses with the highest mortality rates … opioid addiction and eating disorders.

And yet, nothing says appalling failure like overseeing and worsening the two highest mortality rates.

Insurance

Even as a growing number of therapists are turning away from accepting health insurance and only accept private pay, health insurance companies remain the engine driving the care and treatment of eating disorders.

They create and implement their own treatment guidelines. They run their guidelines through their finance and accounting departments to determine how much treatment they will agree to pay before the claim becomes financially unfeasible.

They utilize outdated and/or ineffective standards of “health determination” in deciding to terminate coverage.

And finally in many cases, an insured must show the insurance company’s decision was arbitrary and capricious in order to have that decision reversed. It is the perfect storm of avarice and lack of accountability.

Research Funding

Grants and funding for research are woefully inadequate. The EDCoalition has stopped introducing and/or pursuing legislative bills which provide collaborative funding for our research-based doctors.  At one time, they did. But that stopped about 10 years ago. Just about the time when the REDC was formed and PE firms took over.

Now, those PE owned treatment centers and their toadies pay the costs of their lobbyists. As such, they get to dictate the terms of the lobbyists’ engagement. To pursue a legislative agenda that does not include grants for research funding.

Research and university-based professionals seemingly only know of one well to approach. Most do not have the contacts nor desire to explore private funding.

Research is being ignored.

No Generally Accepted Standards of Care

There are no generally accepted standards of care for the treatment of eating disorders. Imagine the care and treatment of a potentially deadly and serious mental health illness which does not have generally accepted standards of care.

That leaves us with erratic, inconsistent and ineffective treatment therapies. For example, today it appears as if therapy has gone from “trauma informed” to “trauma entrenched.” Every small verbal slight is looked upon as a macro-aggression or “trauma with a little t.”

Concepts like resiliency, strength, self-determination and resolve have been replaced by precious fragility, hypersensitivity and expectations of being “owed something” by society. Yes, words have meaning. Absolutely. But to allow yourself to become mentally and emotionally paralyzed because of what a stranger, or third person may say to you?

Therapists

There are some incredible therapists providing insightful care who literally save the lives of many. Therapists who inspire. Therapists who have put aside their ego and go about their profession with intelligence and grace.

However, the flip side is that there are far too many inexperienced, incompetent therapists attempting to treat eating disorders.

These therapists don’t deeply study medical research. They do not understand the genetic and biological aspects of this illness. Some are still in their own recovery. Some try to bring their own social justice and political views into therapy rooms. Some have little self-awareness. Some do not wish to deal with, nor have the life skills to be able to reach those whose views on life, politics or society differ from their own.

They run from controversies which challenge their views of the world. Some have been shaped by their tribal views. And that detrimentally impacts the quality of the therapy they attempt to give.

Societal Issues

There is no doubt that societal demands impact a number of people suffering from eating disorders.  Certainly, no rational person can argue against the fact that medical and mental health services must become more available and more affordable to the African American, Hispanic, LBGTQ and other minority communities. Not just a worthy goal but an absolute necessity.

Access to care, whatever kind there may be, is out of reach for many. Stigma. Polarization. Discrimination. These issues must be addressed thoroughly and intelligently so that we may explore workable, rational solutions.

However, for the most part, eating disorder advocates are far too reductive and far too simplistic in addressing those views. They excoriate the diet and wellness industry, the food industry, the pharmaceutical industry, the medical industry and do not seek any type of understanding nor collaboration. They are mere shills who complain and criticize but provide no realistic nor practical solutions.

Instead of looking upon eating disorders through the lens of a “triage basis” supported by evidence based medical research, some advocates are more concerned with centering those whose social justice or political causes align with their misguided views.

For the sake of their own myopic beliefs, they would let the eating disorder community burn if they could be Queen of the Ashes.

Random Thoughts

If the statistics are to be believed, eating disorder mortality rates have worsened under the current “leadership.” More people are being diagnosed with eating disorders. More families in pain. The community is splintered. And still there is no call for change in leadership. No grabbing of burning torches and pitchforks.

Conferences where professionals were brought together to attempt collaboration have been sabotaged by advocates caught up in their own ignorance and self-loathing.

The mortality rate for anorexia is almost 4 times the rate of all other eating disorders. If we do not emphasize the needs of the sickest first, if we shirk our non-delegable duty to save as many lives as possible, if we choose to turn our backs on the sickest, what does that say about us as a just and compassionate society. Other than, it proves that we are the antithesis of that society.

The troubling issues are many. Recommendations on practical solutions are far too few.

We must recognize the way of doing business in the past has failed.  Not to revel in the failure of others, or like petulant children, point an accusing finger at others and repeat, “I told you so!”

But to perhaps come to the realization that instead of viewing past failed treatment regiments and community activism as being completely wrong, we view them simply as a lesson in how NOT to proceed. We actually gained productive insight and knowledge and can keep moving forward.

And with this knowledge, we can more boldly, more intelligently stride ahead into a better future. With a more open heart and mind and soul.