There is a perfection in the juxtaposition of the simplicity … and the complexity of life. And yet, the vast majority of time, life itself gets in our way and prevents us from being in that space of wonder.

Even attempting to find that space of wonder can be daunting. So,  walk with me right now. The beach beckons and awaits us.

The laughter of revelers begins to fade as we slowly walk toward the beach. The raucous noise turns from individuals loudly laughing, to a quieter crowd noise, to a slight din, to quiet murmurs in the distance, to nothingness behind us. Only the slowly constant, almost symphonic music of waves lapping on the approaching shoreline awaits and is rising. Allow yourself to listen. Allow yourself to hear it.

Walk with me. We are going to embrace all of our senses.

It is nighttime. Away from any major city. And the night sky is that dark, inky black which only exists as civilization is left behind. Briefly look behind us. See the lights of the villas and the resort. Individual windows and torches aglow. Now, look up with me. Revel in the countless stars twinkling, shining so incredibly brightly. Pulsing dots of wonder, almost playful individual beacons of light to guide us.

The half-moon tonight is majestic. The night is so clear you can see craters and shadows on its surface. There is an aura around it. Illuminating all about you in a subtle glow. Even though the blackness of the ocean and the blackness of the sky combine to form a pallet of darkness stretching to infinity … there is no beginning nor end to either, the twinkling saviors above provide patterns of hope and light to us. We see the white caps of each wave sometimes lapping, sometimes colliding onto the beach. Our colors tonight are primarily ebony, white, silver and the darkest blue. Darkness and light. But, our journey is only starting. Stand with me here, on the beach, take my hand and trust in your other senses.

Close your eyes. It is ok. The light will always be there. It always is.

Now, breathe in deeply. You can smell the slight brine in the ocean air. Perhaps a faint smell of a Cuban cigar, its aroma carried over a significant distance by a stray wind current. If you keep your eyes closed, maybe you can detect a slight whiff of decay. But that too, is ok. For as surely as the ocean gives life, so too does it take it. Perhaps a nearby small crab or fish. But, we are ok. Life surrounds us.

The sights. The sounds. The smells. But, we are not done yet.  Please sit with me. The sand is soft beneath us.

The sand is whitish, light beige in color. Dig your toes into it. Feel the grains slide between your toes. Can you feel how some of the individual grains are coarse, and yet others are so smooth? Let the sand cover your toes. The coolness of the sand beneath the surface belying the slight heat of those grains of sand on the surface.

Now, dig your fingers into the sand. Feel the warmth on the surface, the coolness underneath. The soft nature of the sand as a collective substance, enveloping our fingers. As we lift our fingers, we feel the sand collectively sift through as it slowly empties to return to the place it previously occupied.

Embrace all of your senses. The sound of the waves. The light of the stars and moon above. The smell of the ocean. Revel and wonder.

Now, pick up some more sand and hold just a small portion in your hand. Set free nearly all of it until just a few grains are left. Until there is but one left. Feel with your fingers its unique qualities. It may be square in shape and coarse to the touch. It may also be round and smooth. That one grain of sand. Among the billions of grains of sand on our beach, there may be no other grain of sand just like it. It is unique. It is individual. It is also part of the collective nature of something far more majestic and grand. Hold that one grain of sand and know you are touching something as unique as yourself.

Now, please stand with me. Tilt your head up. Open or close your eyes, that is up to you. Maybe extend your arms a bit. And allow yourself to … feel. Feel the breeze against your cheeks. Feel the wind lifting each hair on your arms. Let the sound of the waves on the beach envelope you.

The past, present and future have all combined at this one perfect place in time … with you on this sacred ground. And now, allow yourself to remember. Allow yourself to whisper that one name. The name of that close friend. The name of that loving spouse. The name of a parent. The name of a beloved child. The name of a soul who you believe is no longer with you.

Whisper their name.

And know they are not gone. They exist in that one grain of sand. They exist in the twinkle of that far distant star. They exist in the glow of the moon illuminating all. They exist in the smell of the ocean air. They exist in the waves meeting the shore. They exist all around you.

They are alpha and omega. They certainly see us. They want to embolden us. They want us to thrive. They want us to live life to its fullest. They want us to know they are safe and happy. They want us to know that they are sending us messages to continue. Most of the time we cannot see, or experience or hear the message. And yet, when their message is received, it fills us with incredible strength and fortitude. They are here. They are with us.

Whisper their name. For me, it is “Morgan.”

Whisper their name as our senses are renewed and revitalized.

Whisper their name.

On December 18, 2019, just a few hours before the historic impeachment vote, the Fifth Circuit Court of Appeals in New Orleans, Louisiana issued a 98 page opinion affirming a lower court’s prior ruling that the “individual mandate” in the Affordable Care Act was unconstitutional. However, it also sent the case back to the lower court to determine whether all other aspects of the ACA should be allowed to stand or are they constitutionally infirm.

And so, the treatment of mental health care, the treatment of eating disorders and the ability to refer our loved ones to treatment facilities outside of their home state hang in the balance.

In this article, we will address (1). What is the individual mandate and why it is important; (2). Whether the rest of the ACA will be allowed to stand since the individual mandate has been determined to be unconstitutional, and; (3). What this ruling means to the mental health and eating disorder industries.

The Individual Mandate

When President Barack Obama signed the ACA into law on March 23, 2010, the ACA sought to “increase the number of Americans covered by health insurance and decrease the cost of health care” through several key reforms.

Some of those reforms implemented new consumer protections, aiming primarily to protect people with preexisting conditions. For example, the law prohibited insurers from refusing to cover preexisting conditions. 42 U.S.C. § 300gg-3. The “guaranteed-issue requirement” forbade insurers from turning customers away because of their health. See 42 U.S.C. §§ 300gg, 300gg-1. The “community-rating requirement” kept insurers from charging people more because of their preexisting health issues. 42 U.S.C. § 300gg-4.1.

Other reforms sought to lower the cost of health insurance through the use of the “individual mandate.” The individual mandate required individuals to “maintain health insurance coverage.” 26 U.S.C. § 5000A(a). If individuals did not maintain this coverage, they were required to make a payment to the IRS called a “shared responsibility payment.”

The individual mandate was designed to lower insurance premiums by broadening the insurance pool. See 42 U.S.C. § 18091(2)(J) (“By significantly increasing . . . the size of purchasing pools, . . . the [individual mandate] will significantly . . . lower health insurance premiums.”). When the young and healthy must buy insurance, the insurance pool faces less risk, which, at least in theory, leads to lower premiums for everyone. See 42 U.S.C. § 18091(2)(I) (positing that the individual mandate will “broaden the health insurance risk pool to include healthy individuals, which will lower health insurance premiums”).

The individual mandate thus served as a counterweight to the ACA’s protections for preexisting conditions, which pushed riskier, costlier individuals into the insurance pool. Under the protections for consumers with preexisting conditions, if there were no individual mandate, there arguably would be an “adverse selection” problem: “many individuals would,” in theory, “wait to purchase health insurance until they needed care.”

The individual mandate was challenged a few months after the ACA was implemented. This case went up to the Supreme Court. The Court, in Nat’l Fed’n of Indep. Bus. v. Sebelius (NFIB), 567 U.S. 519, 538 (2012) narrowly upheld the law’s individual mandate. The Court decided that the ACA’s individual mandate could be read as a tax on an individual’s decision not to purchase insurance, which was a constitutional exercise of Congress’ taxing powers under Article I of the U.S. Constitution. The Court favored this tax interpretation to save the provision from unconstitutionality.

Chief Justice Roberts reasoned that the individual mandate could be read in conjunction with the shared responsibility payment in order to save the individual mandate from unconstitutionality. Read together with the shared responsibility payment, the entire statutory provision could be read as a legitimate exercise of Congress’ taxing power.

Absent that interpretation, reading the individual mandate as a standalone command to purchase insurance would have rendered it unconstitutional. This reading could not have been justified under the Commerce Clause because it would have done more than “regulate commerce . . . among the several states.” U.S. Const. art. I, § 8, cl. 3. It would have compelled individuals to enter commerce in the first place.

The Court explained that the U.S. Constitution, “gave Congress the power to regulate commerce, not to compel it.” As Chief Justice Roberts observed, if the individual mandate were a proper use of the power to regulate interstate commerce, that power would “justify a mandatory purchase to solve almost any problem.” Id. at 553 (Roberts, C.J.). If Congress can compel the purchase of health insurance today, it can, for example, micromanage Americans’ day-to-day nutrition choices tomorrow. Id. (Roberts, C.J.); see also id. at 558 (Roberts, C.J.)

And so, for the time being, the ACA survived.

But then, in December 2017, as part of the Tax Cuts and Jobs Act, Congress set the “shared responsibility payment” amount—the amount a person must pay for failing to comply with the individual mandate—to the “lesser” of “zero percent” of an individual’s household income or “$0,” effective January 2019.

This effectively rendered the individual mandate unconstitutional because:

(1) NFIB rested the individual mandate’s constitutionality exclusively on reading the provision as a tax; and

(2) the 2017 amendment undermined any ability to characterize the individual mandate as a tax because the provision no longer generates revenue, a requirement for a tax.

Then, in February 2018, Republican State Officials from twenty (20) different states filed the case entitled Texas, et al v. United States, et al, Civil Action No. 4:18-cv-00167-O. (The case is generally known as “Texas v. Azar”).

That federal district court struck down the entire ACA on the grounds that the individual mandate requiring people to buy health insurance was unconstitutional and the rest of the law could not stand without it. Judge O’Connor specifically held that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power.”

On December 18, 2019, the Fifth Circuit Court of Appeals agreed with this reasoning and affirmed the finding that the individual mandate was unconstitutional.  But, it sent the case back to the district court to determine if the rest of the ACA could pass the constitutionality test without the individual mandate.

Can the ACA pass constitutional muster without the mandate?

The remaining seminal question is can the individual mandate be severed from the ACA or is it so inextricably intertwined with the remaining provisions that the ACA cannot stand on its own.

The Supreme Court has said that the “standard for determining the severability of an unconstitutional provision is well established.”  First, if a court holds a statutory provision unconstitutional, it then determines whether the now-truncated statute will operate in “a manner consistent with the intent of Congress.” Alaska Airlines, 480 U.S. at 685 (emphasis omitted). This first step asks whether the constitutional provisions—standing on their own, without the unconstitutional provisions— are “fully operative as a law.”

Second, even if the remaining provisions can operate as Congress designed them to, the court must determine if Congress would have enacted the remaining provisions without the unconstitutional portion. If Congress would not have done so, then those provisions must be deemed inseverable. Alaska Airlines, 480 U.S. at 685 (“[T]he unconstitutional provision must be severed unless the statute created in its absence is legislation that Congress would not have enacted.”)

“Severability analysis is at its most demanding in the context of sprawling (and amended) statutory schemes like the one at issue here. The ACA’s framework of economic regulations and incentives spans over 900 pages of legislative text and is divided into ten titles.”

As the Fifth Circuit Court of Appeals noted, “ …  this issue involves a challenging legal doctrine applied to an extensive, complex, and oft-amended statutory scheme. All together, these observations highlight the need for a careful, granular approach to carrying out the inherently difficult task of severability analysis in the specific context of this case.”

Health care for millions of United States citizens hangs in the balance. Health insurance policy and individual decisions are life and death decisions. The ACA is a complex, vast piece of legislation. As such, the Court of Appeals sent back the remaining portions of the case to the district court to make detailed determinations as to what parts, if any, of the ACA can survive separate and apart from the individual mandate.

Since the district court already made an initial determination that the ACA could not stand without the individual mandate, it is not a stretch to presume that the district court will make the same ruling but this time, will set forth a legion of supporting facts and legal analysis supporting the ruling.

The ramifications of this decision if affirmed by the Supreme Court could be catastrophic.

Ramifications

The impact on the mental health and eating disorder industries and communities could be catastrophic.

The following table sets for those states which have implemented plans, or have contingency plans in place should the ACA be held unconstitutional:

ACA Protection Bills Enacted Since February 2018

Only thirteen (13) states would protect those persons with preexisting conditions. As for the other 37 states in the Republic?

Clearly, the most catastrophic loss would be coverage for people with pre-existing conditions, a condition which is prevalent amongst those suffering from eating disorders. Treatment centers and counselors would necessarily become even more dependent on private pay patients as insurance coverage would be denied or limited. This could result in the growing manifestation of the self-fulfilling perception that eating disorders are merely a “rich little, white girl’s disease.”

Despite the passage of the ACA and Mental Health Parity Act of 2008, insurance providers have been carefully scrutinizing residential treatment for eating disorders for medical necessity. Weekly peer-to-peer reviews are not unusual. Insurance guidelines independent from those set forth in generally accepted standards of care are adopted in insurance policies.

With the harsh reality that the individual mandate of the ACA has now been ruled unconstitutional by two courts, we face the new reality … that is, insurance providers will increase their scrutiny of claims for treatment, that they will rely upon the Court’s holding that the ACA is unconstitutional and will phase back in their denying claims because of pre-existing conditions or and will remove the cap on the maximum amount of out-of-pocket expenses incurred by insureds.

The Texas v. Azar decision constitutes a grave crisis impacting all Americans. This crisis could shake the very foundation of the Republic at a time when both major parties are more intent on promulgating the power of their own party and tearing apart the other party. Confidence in our political leaders is non-existent. Collaboration is non-existent.

And yet, the only possible long-term solution is to rediscover that collaboration and come up with a bipartisan plan that results in health care being made available to all Americans at a cost which is affordable. Unfair insurance practices must be curtailed. The most vulnerable of our citizens must be provided with health care which is both substantive and affordable.

The crisis is here. The Visigoths are at the gates.

In early 2019, discussions were held with friends, family and professionals employed in the mental health field. The problems confronting persons suffering from mental health issues were legion. Stigma. Lack of treatment options. Lack of awareness. No public voice. Limited financing of research and few research grants. Politicization of communities. Purported leaders more concerned with perpetuating their own image rather than building the power behind the message.

When faced with overwhelming problems, one can allow despair to dictate future conduct. Or, one can take those problems and use them as inspiration to enact change. We determined that a weekly radio show could provide an opportunity to address some of these issues in a public forum. Mental health issues have been locked in families’ dark closets of despair, being held in shame-filled ignorance for far too long.  Thus, The Mental Health Moment was born. The name itself was the brainchild of Patti Geolat, the founder of the Something for Kelly Foundation. With this, the search for like-minded persons commenced.

Judge John Payton has been hosting a radio talk show in morning drive time for a number of years in North Texas. With his history of helping troubled adolescents and commitment of service, Judge Payton was a natural ally. When approached with the idea of having a weekly 30 minute segment on mental health, Judge Payton enthusiastically got on board. So now, The Mental Health Moment had a public forum platform. The next task would be to find a broad list of experienced, mental health providers respected in their fields.

Enter Professor Carolyn Black Becker from Trinity University. Dr. Becker introduced us to the Psychology Expert Media Panel from the Coalition for the Advancement and Application of Psychological Science. With this, we now had a list of mental health experts.

The Mental Health Moment now with a public platform and a list of expert mental health providers sought financial support. To obtain this initial funding, Acadia Healthcare stepped to the plate. And on September 3, 2019, The Mental Health Moment aired its first program, stumbling and staggering a bit but with great enthusiasm and verve.

Each week has brought new insights, informative guests, moments of humor, moments of tears. We wanted to touch hearts, minds and souls. As time continues to march on, we hope to be able to continue to bring future guests on various aspects of mental health. To educate, to inform, to entertain and to help.

Our past guests have included [click on their names for the hyperlink to their talk]:

Dr. Cynthia Bulik

Eating Disorders and Genetics

Dr. Bulik spoke on eating disorders, the genetic and biological aspects of the disease, the ANGI initiative, and the possible future of the industry.

Dr. Stephen Hollon

Depression

Dr. Stephen Hollon, from Vanderbilt University spoke about depression, early symptoms to watch for and treatments for addressing and lessening depression symptoms.

Phillip Van Guilder

Suicide, Addiction and Mental Health Resources

North Texas mental health icon, Phillip Van Guilder discussed mental health resources available in North Texas, addiction issues and suicide prevention.

Dr. Jasleen Chhatwal

Complex Mood Disorders

Dr. Chhatwal, from Sierra Tucson spoke about complex mood disorders, early intervention and integrative medical treatment.

Elissa Myers

Eating Disorders Organizations and Treatment

Ms. Elissa Myers, the Executive Director of the Academy for Eating Disorders spoke of the organizations within the eating disorder industry, treatment modules and future needs.

Dr. Bethany Teachman

Anxiety

Dr. Teachman, from the University of Virginia spoke on anxiety, anxiety related issues, treatment of these issues and provided on-line resources to consult.

Dr. Lynn Jonen

Mental Health Check Ups

Dr. Jonen spoke on the importance of annual mental health check ups, the manner in which this could lessen the impact of anxiety, depression and stress.

Mr. Jesus Quiroga

Mental Health Resources for the Disenfranchised

Mr. Quiroga, Director at the Dallas Behavioral Hospital spoke of mental health services and hospitalization for those without resources, on government subsidies and the need for greater access.

Dr. Christine Peat 

Obesity and Weight Stigma

Dr. Peat, Director of the National Center of Excellence for Eating Disorders, spoke of obesity, weight stigma and issues surrounding BMI.

Ms. Cheri Garcia

Addiction, Alcoholism

Ms. Cheri Garcia, Founder of Cornbread Hustle, spoke of her journey addressing alcoholism and drug addiction and her work with felons and those needing mental health treatment.

Dr. Nicole Ortiz

Bipolar Disorders

Dr. Ortiz spoke about the complex nature of bipolar disorders, common co-occurring conditions, stigma and being proactive in seeking recovery.

Dr. Michael Lutter

Eating Disorders and Thanksgiving

Dr. Lutter spoke of the many issues of eating disorders and Thanksgiving. He gave information and knowledge to both those who suffer and their caregivers regarding dealing with triggers and how to not just survive, but thrive during the holidays.

Ms. Vanita Halliburton

Suicide and North Texas Resources

North Texas mental health guru, Ms. Halliburton spoke on teenaged suicide and resources to help those afflicted with mental health issues.

Michael Webb, LCSW

Anxiety and Stress during the Holidays

Michael Webb spoke to us about anxiety and stress during the Holiday Season and how we can approach and address these topics to allow us to better embrace happiness and love.

The Future

The future of The Mental Health Moment for the rest of 2019 and 2020 is bright. We are going to showcase Dr. Stephanie Setliff from ERC Dallas, Diana Leburn from The Refuge, Bianca Jackson from New Friends New Life talking about human trafficking and the mental health toll resulting therefrom, Don Blackwell discussing an upcoming Legacy of Hope and many other guests on wide and varying topics.

No topic regarding mental health care will be off limits. We recognize that some subjects may be difficult and even painful for some people. But, as a society, we can no longer allow mental health issues to remain in the closet, to fester, to grow and to destroy.

We ask you to walk this path with us, to embrace your own soulful journey, to live life to the fullest and to reach out one helping hand to those less fortunate, to those who need our help, to those whose lives can be changed through love, compassion, joy and understanding. Help us Save Lives … One Precious Life at a Time.

[We welcome any suggestions as to future speakers who you believe will be inspirational and who can help spread a message of hope.]

On November 6, 2019, the Academy for Eating Disorders (“AED”) in conjunction with the Strategic Training Initiative for the Prevention of Eating Disorders: A Public Health Incubator (“STRIPED”) a research and training program based at the Harvard T.H. Chan School of Public Health and Boston Children’s Hospital, announced they have teamed up to collaborate with economic consulting firm Deloitte Access Economics to develop the most comprehensive report to date on the social and economic costs of eating disorders in the United States.

Although garnering very little media attention in the United States, this Report could result in tremendous breakthroughs in the treatment of eating disorders in the United States. Its importance cannot be understated.

According to the November 6 release, “A national advisory steering committee of members bringing expertise in psychology, medicine, epidemiology, economics, decision sciences, policy, and lived experience with eating disorders will oversee the project. Most of the advisors are members of AED with some additional advisors from outside the field to bring unique perspectives to the work. The Deloitte team will have responsibility for the technical economic modeling and for writing a final scientific paper for publication and a full report to release to policymakers, healthcare provider, and community advocates to inform resource allocation decisions related to research funding and health services.”

So, what does this mean? Isn’t there a significant likelihood that this Report, like many reports before it will simply fall into “the gap” and be disregarded? And what possible impact could it have in the eating disorder industry?

The answers to these questions can be derived from a similar study conducted in Australia, the results of which were released in 2012.

South to Australia

The Australian Deloitte Access Economics report, commissioned by the non-profit Butterfly Foundation for Eating Disorders, studied the economic and social impact of eating disorders including anorexia, bulimia, obesity and binge-eating disorder.

The Australian Report found that 913,000 Australian citizens were living with an eating disorder. This figure dramatically contrasted with the last official estimate released in 2003 by the Australian Institute for Health and Welfare. (“AIHW”) That report estimated the number of people suffering from this disease at 23,464.

The Australian Report also estimated the costs to society in terms of costs of care, productivity cost and deadweight loss defined as “foregone productive opportunities to society associated with higher taxes due to illness.” This estimated “costs to society” was $69 billion in 2012 alone. The costs of treatment alone for eating disorders was found to pose a substantial economic burden. For example, in the Australian private hospital sector, the treatment of an episode of Anorexia was estimated to come second to the cost of cardiac artery bypass surgery.

With regard to the standard mortality rate, the Australian Report, using the then latest meta-analysis of epidemiological studies from the published literature (the so-called gold standard of health research) indicated that mortality rates are almost twice as high for people with eating disorders and 5.86 times higher for people with Anorexia Nervosa compared to those without the conditions.

The Australian Report estimated the productivity impact of eating disorders at $15.1 billion in 2012, similar to the productivity impacts of anxiety and depression which were $17.9 billion in 2010. Of this cost, $2.0 billion was due to lost lifetime earnings for young people who die. Eating disorders also had lengthy duration – an average of around 15 years in survey respondents – which can mean long lasting productivity impacts for those living with eating disorders, such as lower employment participation (costing $6.0 billion) and greater absenteeism ($1.8 billion) and presenteeism ($5.3 billion). Productivity costs were borne largely by individuals, but also by the Australian Federal Government (in the form of less taxation revenue) and by employers (sick leave and lower productivity from presenteeism).

Finally, the Australian Report estimated that for every $1 spent in proactive, preventive care, it saved approximately $4 on reactive treatment care on the back end.

A well-known advocate in Australia opined that the impact of the 2012 Deloitte Study had been MAJOR. That its impact was ongoing. It presented facts, it separated facts from the emotions surrounding the disease, it presented statistics and it accurately calculated the economic cost. She later stated, “All this has been hugely influential in providing a foundation, an irrefutable reference point in challenging and correcting long-held misconceptions about eating disorders and in bringing about action at state and federal government level to improve access to eating disorder services and support.”

Back to the United States

With this background, it is logical to assume that the US Report will structurally be similar in many ways to the Australian Report.

Prevalence estimates would be categorized by the various types of eating disorders set forth in the DSM-V presumably using recent eating disorder surveys for the United States.

For the US Report to be broad based and useful, Deloitte would have to estimate the financial costs of eating disorders on the mental and medical health systems. Presumably, the US Report would include loss of productivity, other financial costs, and loss of well-being proximately caused by eating disorders.

Deloitte would need to estimate efficiency losses (a/k/a  “deadweight losses”) caused by eating disorders. Efficiency losses refer to the costs of raising additional taxation revenue to pay for publicly-financed services. Similar efficiency losses should also be estimated for additional taxation revenue as both federal and state governments may need to increase taxes to offset the reduction in revenue.

As with the Australian Report, the US Report should include additional financial costs, people’s pain and suffering and premature death from eating disorders. These factors can be quantified as costs in terms of diminished quality of life. In the Australian Report, the loss of well-being was measured using the burden of disease methodology, which was developed in the 1990s by the World Health Organization, World Bank and Harvard University.

The US Report would need to include diagnosis, complications and comorbidities, prognosis, treatment options, and descriptions of the specific types of eating disorders. Finally, the US Report would need to include a thorough and clear language explanation of the methodologies, data sources and modeling techniques used to calculate the economic burden of eating disorders.

Application in the Industry

If the US Report is as thorough as the Australian Report, its application and use in the United States would be invaluable. The eating disorder industry would have statistics assembled by a reputable third party with no conflicts of interest or any appearance of impropriety.

Accurate mortality rates. Accurate financial cost numbers. Loss of productivity. The financial savings to employers and insurance companies by embracing proactive preventive care instead of reactive, ineffective treatment on the back end. Being able to approach employers, especially those which utilize self-insured, group health insurance plans and advise them that if they spend $1.00 on proactive, preventive care they can save $4.00 on reactive health costs. [Assuming that these are the numbers discovered by Deloitte.]

This Report would also be another weapon in the arsenal for attorneys to use against insurance companies which deny claims in bad faith.

The Report could also be utilized as a baseline in establishing actual evidence based treatment guidelines with em

The US Report could also constitute the foundation upon which eating disorder bills in the nation’s capital and in state capitals are based. Long abandoned bills which once emphasized research could be resurrected since they would now be supported by objective, third party information, statistics and facts. Research exploring that aggressive, preventive, proactive measures with possible pharmacological involvement could be pursued. Bills which emphasize research into this disease and which explore actual evidence based treatment guidelines could be developed.

Imagine having generally recognized and accepted standards of care to treat eating disorders.

The US Report is coming. Undoubtedly, there will be those who oppose or criticize it. In the spirit of openness, certainly their voices will be listened to and when necessary, if legitimate deficiencies are noted, one hopes that they will be addressed. But so too, their incentives, financial or otherwise, who oppose the US Report and its many possible positive ramifications would also be subject to scrutiny.

But, change is coming. And this time, it appears as if that change is for the betterment.

“To fear death, gentlemen, is nothing other than to think oneself wise when one is not, to think one knows what one does not know. No one knows whether death may not be the greatest of all blessings for a man, yet men fear it as if they knew that it is the greatest of evils.”

          Socrates

“The day which we fear as our last is but the birthday of eternity.”

          Seneca the Younger, Roman Philosopher

When a loved one passes, especially if that loved one is a child, we mourn in a manner that cannot fully be grasped by those who have not experienced this personal tragedy. When a loved one has breathed their last, we suffer an initial, harsh shock. Whether we immediately fall into a place of numbness or loud lamentation, the pain we experience is deep, personal and intimate.

IF one is lucky, as time goes by, that pain goes from searing agony to a dull ache lurking just beneath the surface. Many believe that they will one day be reunited with the person who passed. And we grieve as we must. As our own gifts and flaws dictate.

Today marks the third year upon which my beloved daughter, Morgan was taken. And so, some of the many questions I ponder include thoughts of reunification, the soul, life, death, energy and humor. And yet, I also wonder if the very best parts of Morgan never left. If she, and others who have gone both before and after, are truly “gone.”

[This article may be a bit longer than most of my past musings. It involves three seemingly distinct topics and yet, all of which are intertwined. Bear with me, fill that glass of wine or cup of coffee more fully and soldier on.]

What are we?

What are we? What constitutes the individual? What is the nature of our far too brief existence on this third rock from the sun? What makes us what we truly are?

It is universally acknowledged that our biological bodies are a combination of matter and energy. That energy is both electrical (impulses and signals) and chemical (reactions). And as the understanding of the complexities of our own self becomes more informed, we embrace the understanding that the majority of our body consists not of matter … but of energy.

And energy is eternal. The First Law of Thermodynamics in part states that energy can neither be created nor destroyed. Energy cannot die. However, energy can change forms. Energy can also flow from one place to another.

All of our energy, every vibration, every thought, every Btu of heat, every emotion, every passion, every particle that we generated or which defined us, our very consciousness remain in this universe. The warmth of the sun we absorb on our faces, all of the energy particles whose paths are altered by the sound waves of our laughter, hundreds of trillions of particles, race on like joyful children, their pathways forever changed and yet still very much alive.

Since energy cannot be destroyed and our physical bodies consist of energy, are we not justified in questioning whether we truly die? Or, do we merely transition and transform into something else? Reincarnation? Become one with the Lord? Angels and demons? Certainly, once this transitional process toward what we refer to as death begins, so too our soulful energy must also transform. All is by design.

That is because the Universe is perfectly on time. This includes the moment a person is born and when that person transitions away. No one leaves before his or her time. Perhaps death is not something unnatural or untimely. Perhaps instead, it is that person’s energy, their Higher Self creating whatever circumstances are necessary to achieve its own transformation.

What truly matters is that the energy essence of a person does not, and cannot perish. Instead, incarnations are completed and the soul, Higher Self, spirit, or whatever you wish to call it, moves on. This is not just an exercise in semantics or a belief in a particular religious dogma, but is clearly dictated by the First Law of Thermodynamics.

So, what makes a person, a person? Why did Morgan (or “Mighty Mo” as she was called by some) have such a strong impact upon so many young people with whom she shared her journey? When a loved one transitions on, isn’t it the intangible we miss most? We miss their intellect. We miss their wit. We miss their personality or outlook that inspired us or filled us with hope. We miss how we felt when we were in their presence. We miss that they made us feel better and stronger than what we perceived ourselves capable. We miss in some ways, a part of us that we believe was also taken. All of these things are not matters of the body. They are matters of the soul, our eternal energy.

Our loved ones remain, not just in our memories, but also in reality— perhaps just not in a reality that our limited senses can process and comprehend. And so, we experience the grieving process.

We place so much importance on the here and now. For many, our corporeal existence defines the extent of our knowledge and wisdom.  When a spouse, a parent, a beloved child transitions, we, the survivors mourn. We grieve. For some, that grief destroys them. For some, they wear a “shroud of grief” until their own physical existence ends. A shroud that defines their remaining days spent in a dull twilight consisting of mere shadows of gray. We miss our loved ones. We remember the last breath they took with pain and anguish.

And yet …

And yet, it is only the earthly vessel that has been taken. It is the mere vessel that perishes. That inherently fragile receptacle designed for one purpose. That vessel’s sole purpose is for the briefest of time, to be entrusted to hold our essence, our eternal energy. And our physical existence is designed to fail at that very task. Planned obsolescence.  Our physical bodies are weak and are susceptible to physical trauma, ailments and diseases. Our physical bodies are finite. And yet, our physical bodies have such importance since they are the conduit, the messenger to allow our eternal energy, our souls, to communicate and interact with the energy of others.

The Bell Tolls Again

[I began to write this article on October 14. Often times, I receive  a feeling or intuition to begin to write. When that happens, the words flow. The foundational basis above this paragraph was written prior to October 15. On October 15, my 88 year old father checked into a hospital with abdominal pain and bowel blockage. On October 16, his surgeon advised that his abdominal cavity was ravaged with cancerous tumors. Even in the event he becomes well enough to leave the hospital, he has been given maybe two months.]

And so.

And so.

And so, at this point, a reader may wonder whether the words in this article are just that, merely words. A hollow message. The commemoration date upon which my beloved daughter was taken, that being October 30, 2016 is upon me. My father facing a certain transition in very short order. Is the message in this article before October 16 meaningless drivel? Or are the words more of an indication of a resilient soul, an unquenchable spirit and a driven energy force which cannot and will not be denied? How we deal with what we refer to as “death” is just as important as how we deal with life.

And so, for the next two weeks, when emotions or thoughts or inspiration happen, I will journal them here and include them in a raw, open and transparent manner.

As surely I must.

His name is Richard E. Dunn. He is known to the many friends he has made throughout his life as, “Red.”

10/17 – You sit in a room in a hospital, the very same hospital in which your daughter breathed her last nearly three years before, as a surgeon tells your father that he has about three months left. Cancer had rapidly spread throughout his abdominal region. At 88 years old, you see that the message registers even though his mind is foggy with pain medication. You see that it registers in his eyes.

As the surgeon starts to talk about chemo and radiation, he interrupts and says he is not undergoing “any of that.” The surgeon goes into a few more topics, none of which seem of particular importance when compared to the news just delivered. As the surgeon walks out of the room, he shakes my hand and looks me in the eyes … he has a sad, yet professional look. You know he has delivered this type of news numerous times before.

Your father looks up at the ceiling, then at you. In a quiet voice, he says that he has lived a long time but some things you have to accept since now all hope is gone. The natural inclination is to say, “There is always hope.” But, that type of response sounds too contrived, too hollow. Instead, you kiss your dad on his forehead and tell him you love him.

Your older brother and older sister are in the room as well. Both strong willed, Type A personality people. But for them, for the first time, death is no longer an abstract concept. It is concrete. It is real. It has come for a family member. And especially in my brother, a pilot of over 30 years with commercial airlines who shares so many bonds with my dad, I see real pain in his eyes. To him, death is about to become very real.

Later that night as I sit alone contemplating the day, I believe I can feel a presence around me. A calmness. I certainly do not hear, but can almost “feel” a message. A message along the lines of, “Daddy, you have done this before. You have weathered far worse. You are needed. I am with you.”

And I know I am not alone.

10/18 – A  realization begins to manifest itself. In February, my father  had his gall bladder removed. Some cancer cells were found and also removed. In early September, my father was in the same hospital for a partial bowel obstruction. He was there for four days. A number of CT scans were run. The oncologist advised that a few faint shadows were seen but did not appear to be of concern. And the understanding hits that if that is the case, the spread of cancer has been at an incredibly fast pace. Months may no longer be the time table. It may be weeks … maybe even mere days. He does not know this.

As my older sister and I sit in his room, I find myself restless and so begin to wander. I end up in the Margot Perot Center for Women and Infants. This part of the hospital brings life into our world. Babies are born here.

After walking through winding corridors, I finally locate the nursery. Looking through the window, I see the perfect little fingers, the perfect little toes, the pink, black and brown faces, the promise of a full and happy life ahead. And instead of feeling sorrow, I have a feeling of hope, of renewed life. I was led there not to mourn and grieve for the life that was taken and the life which will be taken in the near future. But, to see those faces, those incredibly little bodies, to feel hope and joy and love. I don’t know why or what compelled me to see those angelic babies. I do understand that something beyond my comprehension is guiding me to various points on a journey, points which fill me with the necessary strength to weather the coming days and years ahead.

Birthdays and Tornadoes

10/20 —  The anniversary of my 61^st rotation around the sun. I have come to look upon birthdays not as a celebration of my own life, but instead, as a day to honor my parents for bringing me into this existence. I talk with my mother, telling her that I love her. I spend time with my dad. With a groggy voice, he wishes me happy birthday. I tell him I love him and that I know I have the best parts of him with me and always tried to make him proud.

I again feel calmness. Certainly, a sadness as well as we face the inevitable. Yet, when you leave your heart, and your mind and your soul open, you  allow them to be filled with strength and resolve.

That night as a I share a dinner with two incredible people in my life, I am filled with a wonder that can only come from … a sharing of the love of life.

That very same night, while we are dining, a tornado rips through the City of Dallas leaving a path of destruction in its wake. Homes, restaurants, property damaged or destroyed. The hospital in which my father may breathe his last is in the tornado’s path. All patients are moved out of their rooms and into the hallway until the all clear is given. Property less than one mile from the hospital is severely damaged some even destroyed. Fortunately, the hospital was spared.

The damage elsewhere is devastating and widespread. And yet, there are no reported deaths. This is especially miraculous since the tornado remained on the ground for 16 long miles, was category F-3 in its intensity, and carved a path of destruction through a heavily populated area in the City of Dallas.

Overwhelming devastation and yet, all lives spared. No one leaves before their time.

10/21 – Less than 12 hours after the tornado, I was advised that my father’s days are indeed numbered … that he is expected to transition within 3 to 4 days at most. Frantic calls are made to siblings who reside out of town.

In fact, in a strange twist, after believing my father had months to live, my older brother departed for a long planned, brief trip to Italy, this time to get married.  Ironically, he was in Italy three years before when he received word that Morgan had passed. Just as then, once again, he is frantically trying to get back to Dallas. The strange, sometimes mocking, and yet sometimes humorous ways that the Universe unfolds is not lost. Later that night, my dad is transferred to the Hospice Floor.

10/22 – His transition is near. Numbness is certainly present. I also note that complexities in life also present additional obstacles and challenges. My younger brother, who resides in Orange County, California is currently suffering from another bout of diverticulitis, double hiatal hernias and severe pain in his back and spine. He is not cleared to fly. In fact, he discovers the doctor who treated him for these conditions prescribed the wrong medication. His departure to Dallas is delayed by another day. And so my older sister and I arrange a Facetime session when my dad is awake. The joys of modern technology. Sadly, my dad has reached a state where he cannot speak and for the most part sleeps until pain wakes him into a state of grogginess.

How easy it would be to fall into despair … to grieve, to be consumed by fear. And yet, when given the news of cancer and its severity, my dad faced that news not with outward fear, pain and anger, but with grace. The last life lesson he will give is how to face your transition with courage.

10/23 – Is today the day? My older brother is trying to get to Dallas from Italy. My younger brother’s flight is expected around 1:30 p.m. I see my father in the last bed he will be in … the bed in which he will transition. I have nothing but good memories and love in my heart. My sisters and I constantly have music playing in the background. Some of dad’s favorites, Les Brown, Sinatra, Dean Martin, Diana Krall.

And then, I am filled with the understanding that another point on the journey is beckoning, is summoning me. And I must surely answer its call. So, with unsure steps I walk to the fourth floor of the Haman Building in the hospital. The building, the floor, the room in which Morgan breathed her last.

As I walk down that 4^th floor corridor, I am trying to shut out all physical sensations and just … feel. The last time I was here the overwhelming feelings of grief, pain, shock and despair were my masters. As I begin to approach the last room she was in, I look and then … start to laugh. The room has a plastic construction tarp over it with signs noting that the room is under construction!

I am shaking my head still chuckling when a nurse walks by and asks if I need anything. With a smile on my face, I tell her that no, I got all that I need. There is only life here … not death. Not pain. Morgan has left the building! And so too, I need never return. There is nothing left here. The specter of grief has been exorcised from here. My heart is lighter.

Still, the reality of why we are assembling in Dallas remains. Firm in your belief that your father is holding on to that thin strand of life only until he sees all of his children one last time. It weighs heavily on the heart. No matter the strength of your convictions, the initial shock will arrive. You then rediscover the emotional and physical exhaustion that overwhelms you as you wait for the inevitable. An exhaustion that consumed you three years before. But, perhaps less so this time.

Your older brother manages to catch his flights from Italy and is expected to arrive at the hospital at 8:45 p.m. You know that your father’s transition will likely come shortly thereafter. You juggle the feelings of sadness, fatigue, resolve and faith. And you hope for a sign, any sign that may give you just a bit more inspiration, more strength for the coming days.

10/24 – Enveloped by the sound of loved ones crying, tears freely flowing. Later that night, enveloped by the sounds of love and laughter. At 12:54 p.m., Dallas time, my father breathed his last. Surrounded by all 5 children, their spouses, significant others. Surrounded by love. Once again, hearing those devastating words, “He’s gone.”

Tears of grief. Tears of sorrow. And yet, a firm conviction that his energy, his soul, his Higher Self is soaring. Since he is a military veteran, the hospital has a policy for these heroes. After they pass and are being escorted to their next resting place, hospital employees line the first floor passage. My siblings stand next to each other. My father being pushed out in a gurney covered by an American flag. They pause in front of us. The flag on top of him is reverently lifted and folded in a precise, orderly military manner. Another flag had also been draped over my father’s body. The folded flag is presented to my older brother, the first born, with respect, with honor.

I look around and see everyone with a hand on their heart. He would want it no other way. People’s eyes fill with tears as we feel the love, the respect, the honor paid to someone that no one other than the immediate family knew.

That night, the family gathers at the house. We drink some incredible wine, eat some delicious food and tell stories about my dad, and yes, Morgan which bring tears to our eyes. But this time the tears also come from laughter.

We remember.

And yes, we grieve. But sometimes, that grief does not destroy us. Sometimes that grief does not define us in a negative way. Sometimes that grief fills us with incredible strength, purpose and insight. Our soul’s, our Life Energy’s path reveals itself just enough to keep you on that path. Its ending is not clear. Nor does it need to be. You only need to find a way to stay on that path. And you know you do not walk that path alone.

A person whose path is placed in front of them, a person who is filled with resolve, inspiration and strength, a person who fears naught can do wondrous things. Not for his or her own personal glory, but because the message is powerful, clear and universal. The energy of others fill that person with hope. Hope that sustains them.

“Remember RED, hope is a good thing, maybe the best of things, and no good thing ever dies.” 

          Andy Dufresne, The Shawshank Redemption

“Beware lest you lose the substance by grasping at the shadow.”    

          Aesop

“Freedom to differ is not limited to things that do not matter much. That would be a mere shadow of freedom. The test of its substance is the right to differ as to things that touch the heart of the existing order.”

          Robert Jackson, Author

“Beneath every story, there is another story. There is a hand within the hand…… There is a blow behind the blow.”

          Naomi Alderman, Author, The Power 

“When you challenge other people’s ideas of who or how you should be, they may try to diminish and disgrace you. It can happen in small ways in hidden places, or in big ways on a world stage. You can spend a lifetime resenting the tests, angry about the slights and the injustices. Or, you can rise above it.”

          Carly Fiorina, Former CEO of HP and Presidential Candidate

“Censorship is to art as lynching is to justice.”

         Henry Louis Gates, Literary Critic

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Last week’s article on “F.E.A.S.T. – Friends Exasperated at Anorexia’s Special Treatment” was unique for the vitriol the article generated amongst the eating disorder community. By eating disorder community, I refer to the foundations, groups and individuals who have been impacted by this disease, including advocates and activists. The immediate aftermath resulted in banishment from groups, censorship, harsh words being directed at the author, a loss of whatever respect existed in some people’s eyes and a picking up of pitchforks and torches.

This vitriol was directed NOT at the substance and accuracy of the article, its facts and research. These were never challenged. Instead, the angst was universally reserved for its “tone.”

So, in the spirit of open communication, let’s address some issues and questions which were raised.

First, was the article necessary at all?

The answer is, of course not! … IF …

Had the subject of weight stigma and increasing awareness for binge eating disorder and bulimia been approached openly and in a collaborative, non-confrontational manner instead of being presented as a Zero Sum Game Equation, where “anorexia has to stop being centered and what can we do to change that,” the article would not have been necessary nor written. But, the true message underlying the topic of the broadcast was not presented openly.

Other reasons supporting the necessity of the article will be elucidated throughout.

Second, why was the “tone” so harsh? Was that really necessary?

The answer lies in the context and circumstances surrounding the substance of that particular article which dictated its “tone.”

Between the time of the broadcast and prior to the article being published, a number of people and entities had opportunities to correct the misinformation regarding mortality rates.  Certainly, F.E.A.S.T. could have addressed and rectified the misinformation any time in the approximate two weeks after the broadcast. Yet, even that would not have been necessary had even one of the treatment professionals who appeared on the broadcast immediately corrected the mortality misinformation during the broadcast. Ms. Muhlheim, in all reasonable probability, had that information at her fingertips. Ms. Muhlheim, just four days after the broadcast published an article which had been medically reviewed by a board certified physician stating that anorexia had a much higher mortality rate than the other eating disorders.

Before publishing the article, I spoke with two medical doctors and asked them their understanding of mortality rates. Each not only immediately responded anorexia, but were quick to point out a specific type. Mortality rates are not a closely guarded secret being held by medical professionals in the eating disorder industry.

Eating disorder professionals, medical doctors, psychologists, counselors and clinicians who have the expertise and in depth knowledge of eating disorders have the non-delegable, absolute duty to insure that only accurate information regarding eating disorders is released to the public. That is because people and families who suffer from, or who have been impacted by this disease justifiably rely on this information and that it be accurate. Lives depend on it.

And yet, no one chose to correct this crucial misinformation. The eating disorder industry is already rife with false statistics, incorrect information, premises not based on reason, reality or accountability, no generally accepted standards of care, silo mentality and unfair practices from insurance companies.

F.E.A.S.T. dropped the ball in disseminating false information regarding the deadly nature of anorexia and then by not proactively providing correct information. And yet, the fault lies in so many other areas as well.

Third, you did not have to go after Laura Collins. You could have gone after F.E.A.S.T. Was that really necessary?

In this case, unfortunately yes.

The misinformation came directly from Laura during a live broadcast. This was not a circumstance where an organization generally issues art work that is controversial and then the person behind it cowardly hides behind a cloak of anonymity. See the graphic NEDA released on July 23, 2019.

This was Ms. Collins individually expressing her views. Days before, she also expressed her views by publishing that she was irritated or infuriated by the topic.

I respect Laura’s passion. In fact, Ms. Collins is performing an incredibly difficult job. I would not want that job. Not only that, I could not do her job. Laura has helped so many families. Further, in the not too distant past, I had reached out to Ms. Collins on a number of occasions asking for her input and advice on several topics in the eating disorder industry. She graciously responded and gave sound, substantive information and advice. At some point unfortunately, her spirit of collaboration changed. Since she is the founder and leader of a parent’s group, and the information contained in past articles have been of help to any number of parents (as expressed to me) I was disappointed when Ms. Collins publicly stated that I was to not send her any future articles. But, that is certainly her prerogative. And yet, censorship or closing your eyes to all relevant and material information is fraught with peril.

Nonetheless, the substance, research and facts set forth in my articles are sound. When mistakes have been made, I have publicly rectified and corrected the information. I often consult with others before publishing. But also, being a warrior for 35 years in courtrooms hones and impacts a person’s communication style and ability. If that sometimes results in an unpopular or perceived harshness of the “tone” of an individual article, there are reasons for that, some obvious, some subtle.

During the ICED Conference in New York this past March, I published an article on the past sexual assaults and circumstances at Timberline Knolls which were detailed in a Chicago Tribune article published just the week before. The “tone” in that article was attacking. Two people from Timberline Knolls approached me at the Foundation table in the Exhibit Hall during the Conference. One was an outreach representative. She started in on how unfair the article was and the discussion had the potential to become unproductive. The other person was Timberline Knolls’ medical director, Dr. Johnny Williamson. Dr. Williamson jumped into the conversation and within a very short amount of time, a frank open exchange of ideas and communication resulted. The next month, Timberline Knolls hosted a luncheon in Dallas that I attended. Dr. Williamson appeared as one of the main presenters. I had some very direct questions which were restricted to the topic at hand. And I believe a mutual appreciation for professionalism was reached.

During that same ICED Conference, I was approached by Dr. Ken Weiner, the CEO of the Eating Recovery Center. For those who have read past articles, you may recall that last year I published a number of articles on ERC, most of which were scathing and derogatory. Dr. Weiner approached me, we shook hands and had a very frank discussion. We both agreed that in the future, undoubtedly we would continue to disagree. But, I also stated that in the future, if concerns were brought to my attention, I would first contact him to see if the matter could be addressed in a private forum.

This scenario happened approximately 2 months ago. I was approached by a family which had issues with ERC with regard to their daughter who was then receiving treatment in ERC Denver. As I had represented to Dr. Weiner, I reached out to him via email. He immediately responded. The next day, I spoke with the medical director of ERC Denver. And we resolved the situation to the families’ satisfaction. No articles were written. This would not have happened had Dr. Weiner not approached me in New York.

The reasons supporting the manner in which an article is written are not always open and obvious. They often include subtle nuances not realized until a later date. And sometimes, the audience for whom the message is intended is not always apparent on the surface. It only manifests itself later.

Fourth, even still, your article came out as hateful and angry. That is not acceptable and don’t you think it needs to stop?

In this case, the underlying premise with regard to “hatred and anger” is not entirely accurate and the “tone” of each article is dependent on its course … and the true intended audience.

Hate is an emotion which takes far too much effort and energy to maintain. The vast majority of time, hate is a wasted emotion that only feeds upon itself creating further divisiveness.

I certainly do not hate Ms. Collins by any stretch of the imagination. To the contrary, I have found her to be a passionate, resolved warrior. I respect how she has built up F.E.A.S.T. and has helped families in numbers too extensive to even possibly list. And when that is the standard a person sets for oneself, it is very perplexing as to why obviously incorrect information would be disseminated under their watch.  

Listening to and understanding opposing points of view can be an art form. It is often a difficult concept since it goes against the grain of a person’s own, closely held beliefs. It can be uncomfortable and it is unfamiliar. And it is becoming increasingly rare.

Most people go through life embracing only their own viewpoints and staying close to people of like minds. With the proliferation of and dependence on the internet, the vast majority of people are drawn to information and beliefs which bolster their own views. We seek out like minded people. We seek out like minded ideas, articles, and information. Most people live life through the microcosm defined by CNN on the one hand or Fox News on the other. As a society, we find ourselves caught in a trap of only knowing what we know without the wisdom to understand that we don’t know what we don’t know … or even being open to the possibility that our views may not be completely accurate.

Only a small percentage of people seek out viewpoints and opinions which differ from their own. They are the explorers of the mind seeking information and knowledge. They strive to be educated. They strive to be enlightened. They strive to learn more about those ideas and vision which differ from their own. They know the universe contains infinite treasures and knowledge to satiate all desires both subtle and gross.

As for being angry …

You’re damned right I am angry. As any parent should be who is involved in the eating disorder industry or community.

I am angry that there is no vision to unify under one spectrum of eating disorders and present a united, collaborative front to mainstream society.

I am angry that so-called generally accepted standards of care are being dictated by insurance companies and not the brightest and the best minds in the eating disorder industry.

I am angry that even treatment professionals and clinicians cannot agree on the best way to treat this insidious disease.

I am angry that the top professionals in the eating disorder industry do not have, or will not generate a public forum where their differing views and experiences can be debated and discussed before the eating disorder community and mainstream society.

I am angry that blatantly false information in the industry can be disseminated and then embraced as if it were gospel truth.

I am angry knowing that the best way to fight this disease, that is through greater scientific research which leads to strong, proactive, informative, and intelligent treatment protocol remains elusive.

I am angry that accountability over counselors and clinicians is lacking.

I am angry that those organizations tasked to be the liaison with Congress are recalcitrant and have chosen to ignore their sacred duties and obligations to families suffering with this damnable disease.

I am angry that October 30 will mark the third commemoration of when my beloved daughter breathed her last.

I am angry that the eating disorder industry appears to be adrift and rudderless.

I am angry that the eating disorder community is allowing messaging that is irresponsible, not based on research, nor peer reviewed studies nor scientific facts and which arguable do not even apply to eating disorders to slowly ebb into the eating disorder mindset.

I am angry that while the eating disorder community stumbles along aimlessly, without a unified direction or collaborative purpose with little to no federal funding, on September 30, President Trump signed The Autism Cares Act of 2019 which recommits to spending a total of $1.85 billion over five years to research and study of Autism. I do applaud those persons with the strength, vision and wisdom behind the Autism movement and am angry that the eating disorder industry cannot demonstrate similar qualities. (More on that in a future article.)

I am angry that we insist on accepting a standard that does not even remotely approach a standard of excellence.

I am angry that segments of both the eating disorder community and eating disorder industry have made it abundantly clear that for them, “the image of the messenger is far more important that the power of the message.”

I am angry that the eating disorder industry is an annual, multi-billion dollar industry and the only parties treating it as such are the private equity firms which own the residential treatment centers and the insurance companies.

I am angry that we cannot disagree on issues … without being disagreeable.

And I am angry as hell that still … one person dies every sixty-two minutes as a direct result of this insidious disease.

And you should be too.

“If I had an hour to solve a problem, I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.”

          Albert Einstein

“Building a community is not a zero sum game in which there are winners and losers; if everyone engages, they and the entire community can all be winners.”

          Brad Feld, American Author and Investor

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The World English Dictionary defines “Zero Sum Game” as a “contest in which one person’s loss is equal to the other person’s gain.”

The eating disorder industry, i.e., research funding, funding for treatment, media attention, clinical care can never be treated as a Zero Sum Game. It is not only counterproductive but harmful to all since it inhibits collaboration, creates divisiveness and results in individualist mentality, an “us versus them” mentality. It is imperative to avoid any type of Zero Sum Game bias at all costs.

Sadly, on September 19, 2019, the eating disorder community was subjected to a Zero Sum Game bias in an egregious and reprehensible manner. To exacerbate the damage, this harm was inflicted by none other than a group which markets itself as a parent support group for families impacted by eating disorders. 

History of F.E.A.S.T.

Families Empowered and Supporting Treatment for Eating Disorders (“F.E.A.S.T.”) came into existence in 2007. Its initial purpose was to focus on parents of family members afflicted with eating disorders. 

F.E.A.S.T.  invited clinicians, researchers and activists in the field to serve as advisers and mentors. They have a Board of Directors and Advisory Panel who live and work in several countries.

From 2008-2010 they were exhibitors at the National Eating Disorders Association (NEDA) annual conferences. In 2018 they held their first “FEAST of Knowledge” at the Academy for Eating Disorders ICED conference in Chicago. A similar event was held in New York City on March 17, 2019. 

F.E.A.S.T. provides online services, such as a live Support Forum for Caregivers and Family Guides which are available at all hours of the day for families seeking information and support. They also maintain a list of support activities and a list of advocacy resources in every region.

They recently announced a collaboration with Project HEAL to start a Communities of Healing with Caregivers. They also recently started a “Tough Topic Thursday” video presentation in which they seek to address difficult or controversial topics impacting the eating disorder industry.

There is no denying that F.E.A.S.T. does some important work.

Ideally, F.E.A.S.T. should represent all persons affected and impacted by eating disorders, be it anorexia, bulimia, BED or the other DSM-V recognized variations and would never emphasize one aspect of the disease over another. Eating disorders are NOT a Zero Sum Game. To attempt to use “Zero Sum Game Bias” would betray the very principles F.E.A.S.T. purports to hold dear and would be sending a clear message to parents that certain sufferers’ conditions need to be deemphasized so that a “Stalinesque utopia of equality for all, quality for none” can be implemented and maintained.

Which makes the discussion on their Tough Topic Thursday held on September 19, 2019, entitled, “Why DO we talk more about Anorexia?” all the more perplexing.

The topic: Why DO we talk more about anorexia?

The first indicator of concern is that the title itself is inartfully worded and presents this topic in a negative manner. A simple change in the title along the lines of, “Let’s Increase and Improve Awareness and Study of BED and Bulimia” would have presented the topic in a nonconfrontational, non-Zero Sum Game, positive manner. However, F.E.A.S.T. chose not to approach the topic in this manner. Accordingly, they have to accept the consequences for this ill-fated decision.

The next indication of justifiable concern arose a few days prior to this event. As part of its Public Service Announcement, F.E.A.S.T’s Founder and Executive Director, Ms. Laura Collins Lyster-Mensh (“Ms. Collins”) published the following statement, “Eating disorder advocates, clinicians, researchers, does it irritate or infuriate you that so much of the attention in the media and research and the public is all about “anorexia?” Yeah, me, too. I have some thoughts on why that is, and how it can be addressed, and guess what: F.E.A.S.T is having a Tough Topic Thursday live broadcast and we want your thoughts, your participation, your voice. Send us comments in advance, mark your calendars, and tell your friends!” [emphasis added]

Irritated or infuriated … Irritated or infuriated? With regard to attention being given to the deadliest of all eating disorders, the Founder of a family based organization which advocates on behalf of parents whose children suffer from eating disorders is irritated or infuriated because she believes anorexia gets too much attention? And she is supposed to be the voice for parents whose children are suffering and dying from anorexia?

Ms. Collins defines herself as a writer. Accordingly, we can presume that she writes what she means and means what she writes.

And so, I listened to the broadcast several times. [It is left up on F.E.A.S.T.’s Facebook page.] Among the people who appeared and contributed were Courtney Banks and Lauren Mulheim, Psy.D., a psychologist from Los Angeles. Ms. Muhlheim is listed on F.E.A.S.T.’s Board of Advisors.

Ms. Collins also appeared and presented.  

Unfortunately, there was a legion of misinformation and flat out errors  throughout the broadcast which need to be addressed.

The Misinformation

Ms. Collins spoke about some of the “myths” of eating disorders. Unfortunately, some of Ms. Collins’ myths were themselves myths and to call them grossly and factually incorrect would be charitable.

The most egregious example of Ms. Collins’ “Flight of Fantasy” is when she stated, “Another myth is that anorexia is more deadly … It doesn’t seem to be more deadly. The 10% mortality rate seems to be true across all eating disorders including binge eating.”

No, Ms. Collins, it is your statement that is deadly … and horrifically incorrect.

First,  no studies have ever been released indicating the mortality rate amongst all eating disorders is ten percent (10%). It is mystifying from where that number was derived.

With regard to mortality rates among eating disorders, the latest peer reviewed, authoritative study was entitled, “Mortality in eating disorders – results of a large prospective clinical longitudinal study” and was published in the International Journal of Eating Disorders in April 2016. This study addressed Standardized Mortality Rates (“SMR”) with regard to eating disorders. SMR is a ratio  between the observed number of deaths in a study population and the number of deaths that would be expected, based on the age and sex-specific rates in a standard population. If the ratio of observed/expected deaths is greater than 1.0, there is said to be “excess deaths” in the study population.

For eating disorders, this study found the following SMRs:

1.      5.35 for Anorexia Nervosa;
2.      1.49 for Bulimia Nervosa;
3.      1.50 for Binge Eating Disorder, and;
4.      2.39 for narrowly defined ED-NOS

This study also found that patients with anorexia nervosa died earlier than patients with BN, BED, or ED-NOS all of which did not significantly differ.

This study concluded, “Mortality in AN is excessive and considerably higher than in BN, BED, and ED-NOS.” [emphasis added]

An Abstract of this Study is set forth below.

Research Study

To ignore this Study is reckless, foolhardy and irresponsible. Especially since the accuracy of this Study is cited with authority by one of the very experts whom F.E.A.S.T. showcased on this broadcast, Lauren Muhlheim. Ms. Muhlheim, quoted these very same statistics in an article she published on September 23, 2019 … just FOUR days after she appeared on this broadcast. Her article notes that it had been medically reviewed by a board certified physician.

Ms. Muhlheim’s article begins with the statement, “We often hear about the dangers of obesity, but we hear less commonly about the risks of eating disorders.”  Doesn’t this statement, along with the excessive SMR for anorexia contradict the very premise of the ill-fated broadcast?

According to Ms. Muhlheim, after citing the statistics in the aforementioned Study, she states, “In a study by Fichter and colleagues, individuals with anorexia nervosa experienced a standardized mortality rate of 5.0 – that is, they were five times more likely to have died over the study period than age-matched peers in the general population. Individuals with bulimia nervosa and binge eating disorder had a standardized mortality rate of 1.5 (were 1.5 times more likely to die than peers without eating disorders).”

Ms. Muhlheim’s article is set forth below.

Muhlheim Article

If that one study is not sufficient enough, we can consider findings from 36 other studies.

In 2011, a meta-analysis of 36 studies on mortality rates of eating disorders was published. The results? The SMR for eating disorders were as follows:

1.      5.86 for Anorexia;
2.      1.93 for Bulimia;
3.      1.92 for Eating Disorders Not Otherwise Specified

The Abstract from this Study is set forth below.

SMR Meta-Analysis

Ms. Collins’ statement, “It doesn’t seem to be more deadly” is contradicted by all of the relevant facts. It is contradicted by all of the research studies. It is contradicted by the very expert F.E.A.S.T. allowed on the broadcast.

Unfortunately, this misinformation was parroted by another presenter, Courtney Banks, a post-doc therapist at UC San Diego who stated, “ … I think … we are often times so … you know, confronted with this idea that anorexia has the highest mortality rate of any mental illness … which … you know … is not true.”

There are already far too many false mantras in the eating disorder community. This false premise is one that needs to be addressed and refuted. And refuted in the strongest manner possible. Especially since it is the strongest foundational pillar of F.E.A.S.T.’s Tough Topic Thursday broadcast. When that pillar falls, the rest of F.E.A.S.T.’s topic likewise fails.

Certainly not everything Ms. Collins said was inaccurate. With regard to the prevalence of anorexia, in 2017, the National Institute of Mental Health cited the following statistics:

1. The overall prevalence of binge eating disorder in adults was 1.2%;
2. The overall prevalence of bulimia nervosa in adults was 0.3%, and;
3. The overall prevalence of anorexia nervosa in adults was 0.6%.

So, yes, anorexia is not as prevalent in adults.

Another item which Ms. Collins got correct was the need to talk about eating disorders as if it were more on a spectrum and that the “pie needs to be expanded and grown,” instead of shrinking down certain pieces.

Indeed, Ms. Collins briefly attempted to take the topic away from a Zero Sum Game but then, she and her guests jumped right back into the topic of attempting to lessen the attention given to anorexia so that more attention could be given to bulimia and BED. So, let’s attempt to answer the question presented by the topic as succinctly as possible.

“Why DO we talk more about anorexia?”

Assuming arguendo, this premise is accurate, we talk more about anorexia: (1). Because studies show that anorexia tends to get its deadly claws into our children at an earlier age, and; (2). Anorexia is nearly FOUR times deadlier than any other eating disorder! In fact, if you combine the mortality rates of bulimia and binge eating disorder, they still do not equal the SMR of anorexia!

To me, and to many others, the finality and heartache of the death of a beloved child is so much more significant than whatever “privilege” or “stigma” is being trotted out by the Social Injustice Warriors.

Along with Ms. Collins’ initial statement that anorexia gets too much attention and her false statement about mortality rates, she made additional statements of an equally troubling nature.

For example, she stated, “The thought that anorexia is special has caused us problems that we are having trouble unwinding.”

First, I am not sure how anorexia is “special” other than it claims the lives of significantly more victims than the other eating disorders and at a younger age. It is also unclear who the “us” is. Does Ms. Collins mean the militant HAES movement, the Eating Disorder Taliban or the Social Injustice Warriors? Also, it is unclear as to what the problems consist of referenced by Ms. Collins, or what trouble “unwinding” them refers to. However, what is clear is for any parent whose beloved child is suffering from anorexia, or who has died from complications from anorexia, this statement is certainly cause for concern. And is particularly insulting.

Ms. Collins also stated, “There’s a false sympathy that gets associated with anorexia and not with the other eating disorders.”

False sympathy? False sympathy pertaining to a deadly disease, a disease nearly four (4) times more deadly than the other eating disorders? False sympathy? I challenge Ms. Collins to approach any parent whose child has died from anorexia and initiate a conversation about false sympathy.

Ms. Collins also stated, “Why are they only doing research on anorexia?”

No, Ms. Collins. Again, this is inaccurate.

Attached below is a website listing twenty-six (26) clinical trials involving the study of bulimia nervosa:

Bulimia Research Studies

In addition, Drexel University conducted a six (6) year long study entitled, “Bulimia Nervosa: A Biobehavioral Study (The Eating Disorder Study) (TEDS). This Study concluded in May 2018.

Bulimia was specifically included in an extensive research project undertaken by UC San Diego in which over 5000 participants contributed information.

The University of Chicago conducted a study on adolescents with bulimia nervosa and their families and included participation in a 6-month outpatient treatment research study.

Stanford University conducted a 5 year NIH sponsored study examining the effectiveness of 3 outpatient therapies for bulimia nervosa (BN).

The Johns Hopkins Eating Disorders Program conducted a study which sought women 18-40 years old with bulimia nervosa interested in a research study funded by the Klarman Family Foundation. The study included a health assessment, blood testing, and pictures of the brain taken using a medical scanner.

In 2016, a team of researchers at the Stanford University School of Medicine sought adults with either bulimia or binge eating disorder to participate in a study assessing whether a new combination of medication lessens symptoms of these illnesses.

A list of these studies could go on page after page.

Ms. Collins continued to dig her grave ever deeper by also stating, “Weight stigma is an enormous part of our problem with the centering of anorexia.”

Again, who is the “Our” in “Our problem?” And the “centering of anorexia” is not justified since it only has the highest death rate by far? Further, what authoritative legislative, medical or corporate body has rendered the opinion that anorexia is being centered? However, this statement begins to show Ms. Collins’ true colors. Weight stigma may be your perception. The excessive mortality rate of anorexia and the fact that it impacts our children at an earlier age is the basis of the “centering of anorexia,” assuming that premise is even accurate.

She followed that statement with this remark, “Weight stigma, I believe to be an enormous part of why we like to talk about anorexia more than we are comfortable talking about the other eating disorders.”

No, Ms. Collins. Had you done your research, you would know that families tend to talk more about anorexia: (1). because studies show that anorexia tends to get its deadly claws into our children at an earlier age, and; (2). anorexia is nearly FOUR times deadlier than the other eating disorders!

On September 19, at 2:01 p.m., the F.E.A.S.T. Facebook page contained the following language: “Anorexia nervosa is the rarest of the eating disorders but gets most of the attention: Why? What is the history? How can we change it?”

“Join F.E.A.S.T. for another Tough Topic Thursday live discussion to explore why anorexia nervosa gets the attention: the history, the controversies, the harms, and some interesting ways we can change this problem as a community.” [emphasis added]

I, along with the thousands of families who mourn the death of their beloved child from anorexia are unaware that drawing attention to a deadly disease was a “problem.” Those same families most assuredly are also unaware that a fringe element of the eating disorder community wants to change this. And beginning with F.E.A.S.T.’s broadcast and continuing during the subsequent Weight Stigma Awareness Week sponsored by HAES/NEDA this horrible “Parents’ Club of Death” claimed two more families.

Less than one week after F.E.A.S.T.’s Tough Topic Thursday live discussion to explore why anorexia nervosa gets too much attention, I was made aware of two more deaths … due to anorexia. Two, more beautiful daughters. Two more families who will be forced to live with the agony of overwhelming grief. Two more sets of parents left to endure pain that no parent should ever have to carry. I am sure these two families would have embraced the opportunity to join this tough topic discussion … to take F.E.A.S.T. to task for their ill-advised, irresponsible conduct. Instead, they are left mourning their beloved daughters being taken.

Nonetheless according to F.E.A.S.T., anorexia gets too much attention, which in and of itself, is a problem and it must be eradicated. It is incredible to believe that a responsible, parent based organization would hold such irresponsible thoughts to be true. It stretches the imagination that they would then attempt to support that false premise with blatantly incorrect statistics, statistics which were disproven by one of their very own panelists four (4) days after this event! 

Any rational person would hope that this article would make F.E.A.S.T. think twice before putting out any additional inaccurate and dangerous misinformation. But unfortunately, F.E.A.S.T. probably will never read these words. In the past year, Ms. Collins requested me to stop posting articles like this on F.E.A.S.T. social media sites. I send these articles to all of the leaders in the eating disorder industry and community especially when the topic of the article pertains to any specific leader.

Information and knowledge are power. And parents have a right to know everything that is going on in the industry. Nonetheless, I acquiesced to her request. Then, last week, Ms. Collins requested that I stop sending articles directly to her.  I understand that sometimes past articles have had an aggressive “tone.” But, the facts have been solid. And, I do meticulously research before posting. When I have been wrong, I have publicly stated I was wrong and printed a retraction and correction. Accurate information and knowledge are crucial.

And so, if the tone of the articles is displeasing to Ms. Collins, I make no apologies. The revelation that far more people are suffering from eating disorders than originally believed is a reality. More children are dying. Whatever the industry and community are doing is not effectively working. My beloved daughter is dead. Two more daughters of whom I am aware, were taken in the past month. Our beloved children are dying and parents have a right to know all facts which impact the community.

And F.E.A.S.T.’s “Tough Topic Thursday” did nothing but insult the parents of children who were ripped from life by anorexia and insult the very names, memories and legacies of our beloved children.

Finally, if you are a parent and your child is suffering from anorexia, you need to think very carefully about whom you support and who is standing up for you … and the life of your child … and who is not.  

On September 13, 2019, United Behavioral Healthcare through its servicing arm Optum (“UBH”) made a stunning announcement regarding new level of care guidelines for treatment of mental health disorders.

UBH’s Announcement

To this end, on its own website, UBH announced, “Optum is adopting the Level of Care Utilization System (LOCUS), the Child and Adolescent Service Intensity Instrument (CASII) and the Early Childhood Service Intensity Instrument (ECSII) for guidance on clinical criteria decisions for the treatment of behavioral health conditions across most Commercial and Medicaid membership.”

They also announced, “Please note, we will continue to use The ASAM Criteria, developed by the American Society of Addiction Medicine, as the clinician criteria for substance use disorder services.”

The effective dates for the implementation of LOCUS, CASII and ECSII (“L/C/E”) are as follows:

“In the following states, the adoption of LOCUS will begin December 13, 2019, with CASII/ECSII becoming effective on January 31, 2020:

A copy of UBH’s announcement is set forth below:

UBH Announcement

UBH’s announcement was nothing short of remarkable. It was also done as quietly as possible with no major press release or media involvement.

UBH is implementing and presumably will be enforcing guidelines developed by third parties to guide payment/treatment decisions for their insureds. Every clinician and provider of mental health services who accepts UBH will have to develop a greater awareness of these standards and guidelines. Coverage for treatment of mental illnesses, be it admission standards, IOP and PHP standards, requests for on-going care will become more predictable if these guidelines are adhered to by UBH. The Peer Review process arguably will dramatically change since UBH’s internal and outside peer review professionals will now have to comply with objective criteria instead of criteria vetted by the financial and accounting departments at UBH. Certainly, good news. But, this announcement also opens the door to questions.

For example, if UBH is just now embracing these guidelines, what “guidelines” were they using before? Were their prior guidelines deficient? If payment for treatment was denied using their prior guidelines, does that open the door for reconsideration of prior claims which were denied using those guidelines? Does the fact that they are adopting those particular guidelines definitively establish them as setting the benchmark criteria for generally accepted standards of care?

They attempt to answer some of these questions on their FAQ page, a copy of which is attached below:

FAQ to UBH’s Announcement

According to UBH, they changed their prior level of care guidelines because the L/C/E “guidelines have been externally validated; that common language drives improved care and the six dimensions provide a more holistic view of acuity and chronicity of behavioral condition, thereby promoting more appropriate care for patients and a better overall experience.”

For some reason known only to God and broccoli, UBH failed to mention that they also presumably changed their guidelines because a federal court decision held their prior guidelines were grossly deficient if not outright fraudulent.

What this means for UBH’s insureds

As these guidelines are phased into UBH’s business structure, on the surface it could mean more objective, more certain, more reasoned decisions to pay for mental health treatment. It should result in fewer claims being denied. Treatment providers have direct knowledge of the guidelines being used to make payment/treatment decisions. They have their patient’s medical records and mental health condition at hand. Providers can assemble and present a more compelling case for treatment to UBH. This potentially means greater access to more life saving treatment being made available for their insureds.

On the surface.

Whether UBH will actually in good faith follow through with good faith evaluation of claims made under their new guidelines is another matter. Is it reasonable to believe that UBH received a message from God and now intends to comply with those objective guidelines and pay for life giving treatment whereas in the past, they implemented policies designed to not only evade the Mental Health Parity Act of 2008 but which inflicted actual harm upon their insureds?

The $64,000 Questions

UBH’s bad faith was exposed by the court in the Wit case. Are we now to believe that they have “turned over a new leaf,” and are ready to put the needs of their insureds over corporate profits? The answer to this question could lie in looking at the Announcement and the FAQ page on the Optum website.

To begin with, on UBH’s Announcement, it states, “Please note, we will continue to use the ASAM Criteria, developed by the American Society of Addiction Medicine, as the Clinician criteria for substance use disorders.” The problem is … the Court in Wit specifically found that UBH did NOT comply with the ASAM Criteria! The Court specifically held:

“UBH’s Guidelines deviate from these [ASAM] standards in a multitude of ways, as set forth above. This has been the case throughout the Class Period, including before and after the 2013 publication of the ASAM third edition. Indeed, in an internal UBH email exchange in 2012 with the subject line “Use of ASAM criteria poll,” one of UBH’s regional medical directors opined that the ASAM Criteria “usually will result in more authorization as they are more subjective and broader than our LOCG/CDGs.” See, Wit Order at paragraph 150.

UBH claims they are adopting the new guidelines because those guidelines have been externally validated, the common language drives improved care and, ” … The six dimensions provide a more holistic view of acuity and chronicity of behavioral condition, thereby promoting more appropriate care for patients and a better overall experience.”

In essence, UBH claims that these changes were done out of a magnanimous sense of obligation to their insureds. The insureds with whom they have a fiduciary relationship. The insureds with whom they have a duty of good faith and fair dealing. The insureds whom the Wit court found they betrayed. The insureds they lied to in their Announcement.

In the last day, I have spoken with a number of people insured by UBH. I asked if they have heard of, or received anything from UBH about this incredible advancement. Each person said “no.”

If this decision was made solely because it was in the best interest of their insureds, that UBH was only thinking about the mental health of their insureds, isn’t this news that UBH would trumpet on all social media sites? With the PR machine that a multi-billion dollar conglomerate like UBH owns and controls, you could have news stories in every major newspaper and on every major network. Imagine the positive press you could engender from this type of announcement. And yet, nothing. Nothing reported on the Optum social media sites. Nothing on the UBH social media sites. No news stories. No internet stories. Just one story on UBH’s own website. Why? Don’t your insureds have a right to know this information? Don’t the doctors and treatment professionals fighting with UBH’s peer review doctors on a daily basis have a right to know this information?

UBH certainly did not simply undertake this change and unprecedented conduct out of the goodness of their hearts or for philanthropic reasons. So, why did they undertake this action and why now?

The obvious answer is that their conduct came about because of the Wit case.

A Brief Recap of Wit

On March 5, 2019, Magistrate Judge Joseph C. Spero of the United States District Court for the Northern District of California [San Francisco] issued a 106 page Findings of Fact and Conclusions of Law [Judgment] in the case of David Wit, Individually and on Behalf of Others Similarly Situated, et al v. United Healthcare Insurance Co., et al, Civil Action No. 3:14-cv-02346.

Judge Spero eviscerated United Healthcare not only for the manner in which it operated its guidelines, policies and procedures, but the very manner in which it formulated those guidelines. Each of United Healthcare’s expert witnesses were deemed not credible or only partially credible.

In determining the generally accepted standards of care, the court in Wit relied upon the following criteria:

1) The American Society of Addiction Medicine Criteria (“ASAM Criteria”) [now adopted by UBH];

2) The American Association of Community Psychiatrist’s (“AACP”) Level of Care Utilization System (“LOCUS”) [now adopted by UBH];

3) The Child and Adolescent Level of Care Utilization System (“CALOCUS”) developed by AACP and the American Academy of Child and Adolescent Psychiatry (“AACAP”), and the Child and Adolescent Service Intensity Instrument (“CASII”), which was developed by AACAP in 2001 as a refinement of CALOCUS, and [CASII now adopted by UBH];

4) The Medicare benefit policy manual issued by the Centers for Medicare and Medicaid Services (“CMS Manual”).

Is it a mere coincidence that UBH announced it was going to utilize LOCUS, CASII, ECSII and ASAM? These are the very criteria relied upon by the Court in Wit in determining generally accepted standards of care. Only after being pushed against the wall did UBH finally acquiesce and undertake conduct which should have been taken many years ago.

Generally accepted standards of care for mental health. Objective third party criteria establishing generally accepted standards of care for the treatment of mental illnesses. Adopted by a federal court and now being adopted by the United States largest provider of payment services for mental health claims. The importance of this announcement and its ramifications cannot be understated.

And yet, something is missing. What about eating disorders?

The Eating Disorder Industry’s Lack of Generally Accepted Standards

We previously set forth that in the international eating disorder industry, seven (7) different organizations had published seven (7) different standards in seven (7) consecutive years. So, which of the (seven) 7 various standards did the Court adopt?

None.

Now, consider the lost opportunity. Had the eating disorder industry put aside its collective egos, and silo mentality, and ivory towers, and insular private equity financial reality, standardized criteria leading to generally accepted standards of care could have been thoroughly vetted and adopted by the industry. In all reasonable likelihood, the Court would have adopted these standards and guidelines. And it is likely that UBH would now be adopting those standards as well. But now?

It very well could be that the Court, through the Special Master it appoints may take the position since the eating disorder industry could not get its collective act together, it will appoint its own experts and devise its own standards and guidelines for eating disorders and enforce those.

And if that happens, and those guidelines are drafted and adopted by the Court and enforced against UBH, the ramifications for the eating disorders industry could be extreme. Assuming this fact scenario comes to fruition and the case survives the inevitable appeals including through the United States Supreme Court, the eating disorder industry would then be faced with the reality that its generally accepted standards of care were drafted and implemented without input from some of the greatest minds in the eating disorder industry.

And yet, because they survived judicial challenge and were enforced against the largest behavioral health insurer in the United States, the treatment centers, doctors, counselors, and organizations will in essence be forced to adopt those same guidelines. Failure to do so could result in accusations that the generally accepted standards of care are not being followed and as a result, malpractice claims will spike and centers which do not comply will be looked upon as “rogue” clinics placing their own confirmation bias above the needs of the patients as defined by the generally accepted standards of care.

That is the reality the eating disorder industry faces today. The clock is ticking. The Hering case filed in Florida tracks the Wit case and if it proceeds like the Wit case, the court in Florida could, and in all legal probability, will adopt and enforce the rulings from the federal court in San Francisco.

The clock is ticking.

The eating disorder industry can no longer hide and play the safe, wait and see game. Universal guidelines will be adopted in the very near future. The biggest question the eating disorder industry faces is, “Will we bit a part of it?”

J.D. Ouellette is a bleeding-heart, tree hugging, egghead liberal. We disagree on practically everything … education, the extent of gun control, school prayer, defense spending, taxes, political issues and many aspects of the eating disorder industry.

(JD [far left… how fitting!] on Nancy Pelosi’s office balcony.)

And yet, there are very few people in the eating disorder community whom I respect more.

To those who may be mystified by this statement, one need only review the close friendship which existed between Supreme Court Justice Ruth Bader Ginsberg and the late Supreme Court Justice Antonin Scalia.

During their time together on the United States Supreme Court, Justice Scalia, a staunch conservative, and Justice Ginsburg, a staunch liberal, rarely found themselves on the same side of controversial issues. More often than not, their written rulings were polar opposites since they looked upon application of the Constitution to our laws through very different lenses. However, even this brought a greater depth to their friendship, as they were known for their respect, deep admiration, and mutual exploration. 

Often standing on opposite sides of arguments, Justice Ginsburg admitted that she “disagreed with most of what he said” but “loved the way he said it.” More importantly, Justices Scalia and Ginsburg demonstrated that it is possible to separate a person from his or her ideology or political views.

Today, that sort of mature professionalism and respect seem to be sorely lacking in the eating disorder community. Division on professional and intellectual issues rapidly denigrate to a division on a personal basis which drive people and organizations apart. Needlessly so.

 I first got to know Jennifer Denise after my daughter Morgan died and I began to get more involved in the eating disorder community. Through groups on Facebook and other social media, JD posted her strong opinions. I remember reading some of the posts on her Facebook wall and thinking, “this woman has a crazy gene coursing throughout her body!” But, I continued to read. Then, I began to respond, more often than not, disagreeing with her post.

This led to our first telephone discussion. I remember this call distinctly because JD talked, uninterrupted for 44 minutes straight. After the call concluded my thoughts were, “I like this person. And, I admire her passion.”

I discovered that JD’s involvement in the eating disorder world was cemented due to her family’s circumstances. In 2012, the youngest of her four children, while a senior in high school had anorexia nervosa enter their lives. She experienced this disease first hand as a mother. She studied voraciously. And her daughter survived and is on a good path. And so too, JD’s path was set.

We continued to have communications and a greater understanding between us began to emerge. I saw her in Chicago at the ICED 2018 Conference held by AED. Then, in October 2018, the Morgan Foundation held a screening of the documentary, “Going Sane.” This documentary features Joan Riederer and her daughter Erin’s story. The producer of the documentary, Lisa Sabey graciously agreed to come to Dallas to talk after the screening. Elissa Myers, the Executive Director of AED likewise appeared. JD reached out to me and stated she would love to attend and appear as well. When I stated that funds for the Foundation were still very tight, she said she would appear at her own expense.

JD appeared and spoke to the attendees that night. She took time from her busy schedule to fly to Dallas and support my family, a family who forever will suffer the scars inflicted by eating disorders. And that is a special gift that will be cherished.

Since that time, JD and I continued to disagree on many topics. But once again, her character and strength were demonstrated this past year. The college at which she was an administrator abruptly closed. And so, facing an uncertain future, JD boldly persevered. I am not surprised by this perseverance.

Just before she decided to stop applying for jobs and open her own peer coaching practice, she applied for her dream job as a Program Manager for the UC San Diego Extension School running their Lactation Educator workshops.  When she did not hear back from the university for some time, she embraced that soulful quality which points us in the direction our lives are intended to journey. She started the process to utilize all of the experience she had learned and began to form a peer coaching practice. But again, life happened.

UC San Diego offered the position to her, a dream job. And undoubtedly, sleepless nights ensued as she wrestled with a life altering decision. Naturally, I again was not surprised when she chose the most difficult path of …

She negotiated the UC San Diego position to twenty (20) hours a week which she could do while building her own peer coaching practice.

One may very well wonder how she is handling an overwhelmingly busy schedule. So, in her own words, JD lets us know:

“I am loving life! The coaching business is really amazing – helping support my family by helping other families is so fulfilling. I am developing a niche in working with families to get young adults to “voluntarily” admit and so far I am batting 100%. Working with parents and then parents and child on Skype and with shared documents to collaborate on plans is so helpful. I’ve had 3 young women tell their parents I make them feel safe and hopeful – can’t ask for more than that.

She also stated:

“Fighting an eating disorder is a fearsome task; you are literally fighting to save your loved one’s life. For me, it was the hardest thing I have ever done and it rocked our family to the core; the overwhelmingness of it is huge, and that was when our experience included the best treatment possible, almost immediately. It taught me much about what is needed to get a loved one well and the awesome power of cutting edge education for parents plus specific skills training and support.

I can provide that via Skype, phone, and text. I believe having a trained peer support coach/mentor will save you time, energy, money and quality of life as you navigate this as my testimonials support. I look forward to connecting with and helping you.

As an informed, educated, experienced international peer support provider, I understand the spectrum of hurdles a family faces and the variations among systems and with insurance, as well as being cognizant of cultural norms. I have dealt with many iterations of family dynamics and diagnoses and co-occurring conditions, and I have a personal library of books, articles, videos, and podcasts I curate and add to daily so I can target your resources to your individual needs. I have connections with professionals and peer supporters and advocates across the world who are as eager to help families as I am.

I use a lot of analogies and visualization in my coaching, so think of yourself as learning to ride a bike with my help – I am going to explain to you how a bike works, spend some time running alongside you holding onto the handlebars and seat, cheer you when you take your first wobbly solo spins around the parking lot, help you dust yourself off if you fall, and be available if the bicycle needs a tune-up.”

Strong, intelligent, independent and fiercely passionate. All that and she is a bleeding-heart, tree hugging, egghead liberal!

At the funeral for Justice Scalia (whom Justice Ginsberg at times referred to affectionately as “Nino”) Justice Ginsberg stated, “Once asked how we could be friends, given our disagreement on lots of things, Justice Scalia answered: “I attack ideas. I don’t attack people. Some very good people have some very bad ideas. And if you can’t separate the two, you gotta get another day job … How blessed I was to have a working colleague and dear friend of such captivating brilliance, high spirits, and quick wit.”

How blessed indeed. And what high praise.

As for praise regarding J.D., if anyone ever posed the following question to me, “If my daughter were still alive, would I be comfortable with J.D. being a mentor to her?”

My response? “Damn straight I would.”

J.D. lives in the San Diego, California area and can be found at http://www.jdouellette.com

On September 19, 2019, Chase Bannister, the President of the Board of Directors of the Eating Disorders Coalition (“EDC”) appeared before the National Institute of Mental Health National Advisory Mental Health Council. This was an open policy session.

Some of Mr. Bannister’s more poignant remarks were as follows:

“This mortality rate underscores the severity of this illness, as it is common for individuals with eating disorders to have co-occurring medical and behavioral health conditions, increasing the complexities of proper intervention and treatment.”

“And these disorders seem to be on the rise, both here and around the world.”

“Proper intervention and treatment for any condition requires an investment in research.”

“Amongst all psychiatric conditions, … funding for eating disorder research remains among the most discrepant from the burden of illness they represent.”

“Meaningful progress in eating disorders treatment and intervention will only by realized to the extent we meaningfully invest in its science.”

“On behalf of our 56 member organizations and the millions of Americans we serve, I urge the Council to advise NIMH to increase research funding for eating disorders.”

That same day, the Eating Disorder Coalition issued its press release which quoted Mr. Bannister in material part, as follows: “For too long, research funding for eating disorders has been an order of magnitude away from what’s necessary. Meaningful progress in eating disorders treatment and intervention will only be realized to the extent we meaningfully invest in its science. We call upon NIH – and all who make or shape policy – to invest in eating disorders research. To do what’s necessary.”

Strong, noble words. Words worthy of concerted action. Words for which one should be held accountable.

I wholeheartedly applaud Mr. Bannister for these sentiments. I agree with the substance of these statements. Truly for progress to happen, for lives to be saved, we must emphasize investment in scientific research. This is the true life blood which will result in improved treatment protocols, in establishing industry-wide generally accepted standards of care and in saving many, many lives.

With such noble, strong words, let us explore how Mr. Bannister, the Eating Disorder Coalition and the other eating disorder organizations which help shape policy and which have a presence on Capitol Hill are backing up these words with equally bold, affirmative action.

It is unfortunate that no written expression is as effective as the sound of crickets in the background to fill those times of awkward silence. For that is the most accurate description of the inaction undertaken by the eating disorder industry on this critically important issue. No action at all.

The three eating disorder entities paying a lobbyist on Capitol Hill are the EDC, our friends at the Residential Eating Disorder Consortium (“Consortium”) and the HAES Movement f/k/a the National Eating Disorder Association (“NEDA/HAES”). Using EDC’s own words, these three organizations are entities which clearly, “… make or shape policy.” They collectively employ a small lobbying group named “Center Road Solutions.” And they pay that lobbyist very well.

In 2019, the EDC has paid Center Road Solutions $60,000.00.

In 2018, the EDC paid Center Road Solutions $120,000.00.

In 2017, the EDC paid its former lobbyist $120,000.00.

In 2019, the Consortium has paid Center Road Solutions $80,000.00.

In 2018, the Consortium paid Center Road Solutions $140,000.00.

In 2017, the Consortium paid its former lobbyist $70,000.00.

In 2019, NEDA/HAES has paid Center Road Solutions $40,000.00.

In 2018, NEDA/HAES paid Center Road Solutions $80,000.00.

In 2017, NEDA/HAES paid its former lobbyist $70,000.00

This combined total is $780,000.00.

So again, Mr. Bannister’s own words, “Meaningful progress in eating disorders treatment and intervention will only be realized to the extent we meaningfully invest in its science,” provide ample justification to speculate as to the amount that that $780,000.00 was utilized to pursue scientific research on new eating disorders bills in Congress. These three entities clearly help shape policy on eating disorders. Pursuant to a public statement made by Mr. Bannister, the president of one of those entities, they have the duty to seek funding for scientific research since this is the only manner in which meaningful progress in eating disorder treatment will be realized.

And yet, how much of that $780,000.00 was utilized to introduce new bills establishing Centers of Excellence in Eating Disorders? How much of that $780,000.00 was utilized to introduce a bill which addressed the need to establish and define the most effective, scientifically based treatment for eating disorders? How much of that $780,000.00 was utilized to establish a collaborative academic and corporate based center where generally accepted standards of care based on scientific and clinical evidence could be established?

It is unfortunate that no written expression is as effective as the sound of crickets  in the background to fill those times of awkward silence. For that is the most accurate description of the answers to those questions. That is, none.

The only thing that saved Mr. Bannister from public humiliation was that no one on the National Institute of Mental Health National Advisory Mental Health Council had conducted sufficient research on this issue. If so, the following question surely would have been proffered:

WHY SHOULD THE NATIONAL INSTITUTE OF MENTAL HEALTH INCREASE SCIENTIFIC RESEARCH FUNDING FOR EATING DISORDERS WHEN YOUR INDUSTRY’S OWN ORGANIZATIONS RESPONSIBLE FOR THE DIRECTION OF ITS LOBBYISTS ARE NOT PURSUING THIS SAME FUNDING?

Why indeed.

Sometimes, the sound of crickets can become a mighty cacophony of noise drowning out all other sound … even the sound of awkward silence.