LIVE OR DIES … Ai DECIDES

Your 18-year-old daughter, who is struggling with severe anorexia, desperately needs a higher level of care. Biologically, her organs are failing. You make a claim with your health insurance company. And you receive a denial.

You quickly research and then discover an Ai program utilized by the insurance company made the decision to deny saving your daughter’s life.

Welcome to the world in which we live. Where Ai programs may be making life and death decisions about your loved ones. That is the very harsh reality. So, let’s explore that reality.

First, what is “artificial intelligence?” The term itself is so vague as to be mystifying. What makes it artificial? The fact that human beings invented it? That it is silicone based instead of carbon based? Is the programmed intelligence, which is designed to learn at a rate far faster than humans can possibly comprehend, deemed artificial because it lacks a sentient existence?

Is Ai artificial because whereas it may “learn,” it does not experience the subtle nuances and life experiences which make us all unique? Does Ai have a soul? For that matter, do we?

Regardless, with Ai still being in an early stage of development, and with Ai’s developing interaction with humans, we must find ways to build guard rails so that Ai is not in a position where it could singularly make life and death decisions. Decisions which are often made by health insurance companies when deciding to pay, or not pay, for life saving surgeries or treatment. Or is it already too late?

Imagine if you will, an Ai program being utilized, without human interaction, to review and decide a claim or an appeal of a claim for a higher level of care, or to receive necessary treatment or to receive a life-saving procedure. An Ai program with no human experiences, no ethics, no soul, no subtlety, no morality. To leave our very existence in the hands of a machine, a machine that cannot love, cannot experience sorry, or joy, or happiness, or despair. And yet … that is happening. Today.

In 2020, UnitedHealth Group division Optum acquired naviHealth and its algorithm for predicting care, called nH Predict, which UnitedHealth uses and contracts out to other insurers, including Humana. Multiple industry sources estimate that Optum paid at least $1.1 billion dollars and when considering debt and related financial structuring—the purchase price is estimated to be as high as $2.5billion. When asked by the Guardian, a spokesperson for UnitedHealth Group denied that the algorithm is used to make coverage decisions. [Like when UBH denied it ran its guidelines through its accounting and finance departments?] 

UnitedHealth, Humana and Cigna are facing class action lawsuits alleging the insurers unethically relied upon Ai generated algorithms to deny lifesaving care.

One of the lawsuits alleges that Cigna denied more than 300,000 claims in a two-month period. This equates to spending approximately 1.2 seconds for each presumably physician-reviewed claim. Such a practice is aided by algorithms, the lawsuit alleged.

The Cigna lawsuit also alleged that nH Predict had a 90% error rate, meaning nine out of 10 denials were reversed upon appeal – but that vanishingly few patients (about 0.2%) appeal their denied claims, leading them to pay bills out of pocket or forgo necessary treatment.

Appealing denied claims means big business. The US Centers for Medicare and Medicaid Services estimate that when insureds appeal initial denials administrative costs for insurance providers exceed $7.2 billion annually.

According to a United States Senate Report issued in October 2024, UnitedHealthcare, CVS and Humana – the three largest providers of Medicare Advantage, together provide almost 60% of all Medicare Advantage coverage – but reject prior authorization claims at higher rates using technology and automation. That report can be found here:

To support the implementation of Ai, health insurance companies argue that Ai programs streamline claims processing, more effectively flag fraud, and promise greater speed, efficiency and cost savings.  They claim that by automating routine claims, Ai frees up human reviewers to focus on complex or borderline cases that require medical judgment and nuance. (For that matter, don’t all claims require medical judgment?)

Despite its alleged advantages in claims processing, Ai has faced fierce criticism, especially when its role extends to denying coverage or appeals for essential care. Ai is not immune to flaws, as its decisions depend on data quality and programming — both of which can perpetuate mistakes or systemic biases. Garbage in Garbage out.

Many Ai systems operate opaquely, leaving patients, providers, and even insurers unsure how specific decisions are made. This undermines trust and impedes meaningful appeals.

Numerous lawsuits allege that Ai tools prioritize cost-saving over medical necessity. In some cases, Ai has overridden physician recommendations, resulting in denials of rehabilitation, mental health services, or life-saving treatments.

There is a widespread perception—and often a harsh reality—that health insurers prioritize profits above the needs of their insureds. Ai tools, by automating denials or aggressively limiting coverage, can exacerbate this distrust, especially when decisions feel impersonal or unjust.

Critics argue that Ai systems are often deployed as “rubber stamps,” with little or no meaningful physician review—contravening legal and ethical obligations.

Meanwhile, states like California have moved to ban Ai-only coverage denials, signaling a wave of regulatory intervention.

As for those health insurance companies which utilize Ai alone to decide claims or appeals, the major issues focus on:

Risk of Profit-Driven Bias: Ai tools influenced by financial priorities may embed cost-saving incentives that override medical necessity, echoing problems revealed in the Wit v. UBH case.

Lack of Clinical Nuance: Ai lacks the ability to fully understand complex medical contexts or patient histories that human clinicians evaluate.

Transparency and Accountability: Patients have a right to clear explanations and meaningful appeals, which Ai-alone systems often fail to provide.

But that is where we are. Ai is being utilized by insurance companies to decide claims and appeals. Although the insurance companies may deny this fact, it is a reality. Especially since widespread use of Ai in denying claims and appeals will result in much greater profits for these companies.

To counter this reality, the future must be shaped by the following:

Stronger Regulatory Frameworks

States and potentially federal regulators are developing rules to ensure Ai complements—not replaces—human medical judgment. Requirements for physician involvement, transparency, and appeal rights are expected to expand.

Increased Legal Scrutiny

As lawsuits proceed, courts will clarify the legal boundaries of Ai’s role in coverage decisions, particularly under ERISA, Medicare Advantage rules, and consumer protection laws.

Pressure for Transparency and Explainability

Insurers may face mounting demands to disclose how Ai tools function, how decisions are made, and how patients can challenge automated denials.

Smarter, More Ethical Ai Development

Future Ai systems may incorporate safeguards to avoid wrongful denials, improve alignment with medical standards, and enhance explainability.

Ai’s exploding involvement, or interference in our lives will only increase. That is inevitable.

There is the potential that Ai can make health insurance claims processing faster, fairer, and more efficient—but only if deployed responsibly. It must address not only human fallibility but also the systemic distrust stemming from the reality that insurers prioritize profits over patients. Lessons from Wit v. UBH remind us that financial influence over clinical decisions can have devastating consequences, a cautionary tale for Ai implementation.

As courts, lawmakers, and the public demand accountability, the health insurance industry faces a pivotal choice: embrace Ai as a tool to support—not supplant—human expertise, or risk eroding trust and facing costly legal consequences.

The future of Ai in health insurance is not just a technological issue—it is a legal, ethical, and societal issue. Right now, the live of your loved one may very well depend on a machine. On Ai. A lifeless, soulless computer program devoid of all emotion, mercy and humanity.

That is our reality right now. Allow yourself to contemplate that reality and perhaps yes, be afraid. For our future depends on wisdom far greater than humanity has ever demonstrated. Our health depends on it. Our very lives depend on it.

COLLABORATE OR PERISH

June 2, 2025, was World Eating Disorders Action Day. (“WEDAD”) According to the organizers, “… over 300 organizations … stepped up—hosting events, launching social media campaigns and podcasts, conducting interviews, and working across borders and disciplines to make an impact on this one crucial day.”

Dra. Eva Trujillo, (whom I like and respect) was one of the drivers of WEDAD. Her quotes included:

“When we act together, our impact is stronger.   We are looking for new voices, perspectives, and passionate professionals ready to serve.”  

“Are we, as a field, ready to begin healing the divides within our own community? Or are we too overwhelmed trying to survive?” 

“It’s a question that haunts many of us, and it’s time we face it with courage and honesty. We can’t build meaningful change externally if we remain fragmented internally. This is a moment for us—clinicians, educators, researchers, advocates, sufferers, and caregivers—to come together—not in perfect agreement but in shared purpose.” 

“We must start connecting. Not by taking sides, but by building bridges, amplifying what unites us, listening more than speaking, and doing the hard work of healing, both within and beyond our professional circles.” 

An officer from another organization stated:

“So, how do we begin to heal our community?” 

“As organizations, we begin by reaching out to one another, recognizing each other’s strengths, sharing our own, and uniting our efforts to broaden services and support.” 

“Together, we are stronger.” 

Fine words. Grand words. But … just words. So, how do we put into action the concept behind those words and turn them into reality?

A few weeks ago, I attended ICED 2025 in San Antonio. [As an aside, ICED 2026 is scheduled for June 3 – 5 at … The Hague. And by wonderful coincidence, the Formula 1 Grand Prix in Monaco is scheduled for June 5 – 7! Can you say Bucket List? Super yachts in Monaco Bay. Black tie casino gambling. Incredible parties. But … I digress.]

Most of my time at ICED 2025 was spent darkening the Exhibit Booths, listening to a few presentations, swilling whiskey and having my tail handed to me playing chess in the hotel lobby.  But, in my wanderings, I noticed the following organizations did not have a booth, or for that matter, any presence: NEDA, iaedp.

They were not listed as sponsors. They were not listed as exhibitors. Their CEOs were not there. (or if they were, they kept out of sight).

Perhaps that is where we must start. Or does it go deeper than that?

Let us pose some questions which surely must be asked:

  1. Does the eating disorder community really need three (3) independent organizations, AED, iaedp and NEDA?
  2. If so, why? Especially since all three appear to be flailing if not failing.
  3. Isn’t it in the best interest of the families suffering from this illness that one unified, strong entity comprised of the best of those organizations be formed?

The problems and issues at each of the organizations are alarming.

iaedp is engulfed in a lawsuit which, if successful, will result in its demise and possibly the end of board certification. Iaedp also has a very large financial burden for past due taxes, penalties and interest. On its last F0rm 990, it showed a loss of $284,806.00. Since membership is no longer required to maintain board certification, its membership is dwindling. A number of iaedp individual chapters have dissolved. Its next symposium is being held in Baltimore … in the middle of winter. Iaedp’s “Members at Large” a/k/a Board of Directors is comprised of persons with no outside corporate or legal experience.

The issues at AED are also troubling.  From 2020 through 2023, AED reported a total combined loss of -$658,156.00. The cancellation of billions of dollars in NIH grant funding resulted in many university professionals unwilling and unable to attend AED’s ICED and not renewing their membership. A contentious relationship with international chapters plagues AED.

NEDA, unlike AED and iaedp, showed a profit on its last Form 990. On its 2023 Form 990, it showed net revenue of $1,836,601. However, in the three prior years, it showed three consecutive losses in a combined amount of $1,913,492.00. NEDA sold its telephone helpline to the National Alliance. But, besides conducting its fun walks and awarding some grants, (for which it should be commended), has time eroded NEDA’s impact in the community?

Therapists are intimidated by research professionals. Research professionals do not have the wisdom gained from being on the front lines, that is, in the actual therapy rooms. Medical clinicians are frustrated waiting for research findings to be released. Uninformed and misguided fat activists are just causing chaos. And the wheel turns round and round with little, if any progress being made.

Dra. Trujillo acknowledged the divides which exist in the community. So, where does progress start?

Perhaps we begin with transparency. An element so missing in the eating disorder community. No organization or person in the community is inventing a cure for cancer or devising the next generation of Ai/Robotics technology. Certainly, private organizations and companies generally do not disclose financial information or voluntarily broadcast future expansion or retraction plans. But we are dealing with a mental health illness with a high mortality rate. Families are severely impacted every day. It seems as if eating disorder organizations and entities have lost sight of that reality.  

And so, transparency and collaboration must start at the organizational leadership level. To start to accomplish this, accommodation and grace must be given.

Starting with iaedp’s next Symposium to be held in Baltimore in February 2026, iaedp must allow NEDA, AED, FEAST to have exhibit booths and have at least their three highest ranking officers to attend … at no cost. During the Symposium, the leaders from all organizations must meet to discuss all issues they have in common. Issues unique to each organization. The future is discussed. Planning is shared. Finally, at the end of the meeting, an open forum is convened both in person and via zoom. A forum that any concerned person can attend and ask questions, live or via the internet. The leaders share with everyone the topics of discussion and the plan of moving forward.

In 2027, at AED’s ICED to be held in Phoenix, Arizona, it is AED’s turn to host the other organizations utilizing the same format.

In 2028, these collaborative meetings may not be necessary. That is because by 2028, hopefully all major organizations will have realized that the tribal way they have done business in the past is not effective and does not work. In fact, the piecemeal, isolationist way each organization currently attempts to operate has failed. The six figure financial losses every year. Membership dwindling. As has been noted, people leading organizations have admitted that division exists in the community and needs to be healed. But these divisions cannot be healed singularly.

The old way of doing business has failed. The mortality rate worsens. The number of loved ones and families suffering continually increases. Each organization in their own way has failed and contributed to worsening the situation. So, how can we possibly proceed in the future?

The best way, the path which provides the greatest likelihood of success is to have these organizations merge into one entity. One large, collaborative organization. Therapists, medical doctors, research professionals, advocates all under one tent. Talking together in the spirit of professionalism and respect. Combining the greatest minds of different tracts to share knowledge, wisdom and ideas. Casting individual egos aside for the greater good. Bringing in corporate and legal experts to assist in reorganizing and providing many additional outlets for fundraising.

One large, all-encompassing yet diverse organization. An organization which would be able to lobby more effectively to address the true needs of the community. An organization which would be able to approach large corporations and foundations to engage their substantial resources for the purpose of working toward true breakthroughs in our understanding and treatment of eating disorders.

Now make no mistake. The obstacles are many and the challenges are great. There are those who will oppose this collaborative entity merely because it threatens their self-importance. There is a faction in the eating disorder community which actively fights against progress unless that progress exclusively involves their own pedantic points of view.

Nonetheless, the handwriting is on the wall. The commendable accomplishments of individual organizations in the past have been relegated to the past. The old way of doing business no longer works. It is not effective. That is shown by the deteriorating financial condition of these organizations, the deep divisions which exist in the community and most importantly, the number of our loved ones who continue to be taken.

Our loved ones who continue to die in ever increasing numbers.

That should be the first, middle, last and only concern of these organizations. The time is now. The future awaits. Collaboration beckons.

Sound Advice at Last.

In the past eight (8) years, I have seen various psychiatrists, psychologists, therapists, counselors, shrinks, shamans, witch doctors and a few exorcists. (It takes a special sentient being to understand the many flaws and quirks which exist within me.)

But finally, I located one whose advice was incredibly keen and insightful. It moved me so much that I got permission to record his advice and share it online.

Of course, the advice was centered on me, being a father whose 23 year old daughter died from anorexia after she fought it for many years. We explored the inevitable guilt and depressive feelings that any father would have under these circumstances.

This is the advice given:

https://www.youtube.com/shorts/0Zl4KjRFf5Q

The advice received from the many, past mental health professionals who attempted to meander through my psyche in an attempt to reach me on a deep level, pales in comparison to this advice. This advice was the most insightful, sound, strong and compassionate I received.

And then … things get strange … very strange.

What makes it strange is that the person in the above video is not a person at all … it is actually an Ai generated image. The advice? Word for word came from an Ai program. And not a program specially designed for mental health issues. But a generic ChatGPT program. The image at the start of this article? Ai generated.

Some undoubtedly knew that from the beginning. I am no impressario of Ai generated images. But other people are. People who design and perfect silicone based programs.

These programs are still in their infancy. Imagine what these programs will be like in 2 years … or 5 years … or 10 years.

As a society, we believe that these programs can never have human empathy or life experiences so they will never be as insightful as person-to-person interaction. But that also means these programs will never have issues with countertransference or the incompetence or inherent failings of human beings. Go back and listen to the words being used. This silicone based program used words we associate with compassion, with caring, with concern.

Human generated therapy software programs are here to stay. Generated images improve in depth and quality seemingly every day. Therapy software programs are evolving as they continue to expand and learn.

The question that our mental health professionals need to be asking themselves at this point should not be, “should I be incorporating these programs in my practice in some way …”

But rather … “how am I going to incorporate these programs in my practice?”

The future is here.

Your choice is to embrace it … or be left behind.

Research Grants, DEI and the Future

On February 7, 2025, in accordance with the Trump Administration’s mandate to eliminate waste in federal spending, the National Institute of Health (“NIH”) announced it was capping “indirect costs” on federal research grants at 15%. In addition, a number of research projects, both current and future were terminated.

Indirect costs are used to cover research expenses such as equipment and facilities maintenance, IT services, and administrative support. Indirect costs are itemized separately from direct research costs and are often expressed as a percentage. For example, an indirect cost rate of 50% means that for every dollar awarded as part of a research grant for eligible direct costs, the institution would receive an additional 50 cents to cover indirect costs.

But indirect costs are also used to fund another very important aspect of research.

Every university-based study has to go through a rigorous ethics process. All animal studies go through IACUC (Institutional Animal Care and Use Committee). All human studies through an IRB (Institutional Review Board.)

Not only are studies submitted for a full ethics board review at the beginning of the study, but they must be renewed every year and any deviation from protocol, adverse event or other unforeseen result must be resubmitted and reviewed by the board. These committees include faculty members who receive a minimal salary for their time and include lay members from the community (who are also remunerated).

The review involves a substantial amount of work and basically ensures that animals used in research are being treated humanely and that people are (being treated like animals?). No, that people are treated ethically. The documentation and regulatory aspects are so complex that many universities now have a Regulatory and Compliance Officer to assist in the tracking of all aspects of these research grants.

Without the IRB and IACUC there can be no research. If the university administration decides to “break” the current indirect system, the ethics structures would also break, and this would be another way in which research would screech to a halt.

So, the question must be asked, how did we get here?

In 2023 the NIH invested $35 billion in research through 50,000 competitive grants to more than 300,000 researchers at 2,500 universities/research institutions. Of the $35 billion, $26 billion was for the ‘direct cost’ of the research and $9 billion (26%) was for indirect costs.

In its February 7, 2025, announcement, the NIH said its 15% cap on indirect cost could save $4 billion annually. On the surface, this cap may seem reasonable.  

So, why is the 15% cap causing such turmoil in academia?

First, it came from the Trump Administration. Since many people in academia look upon President Trump as evil, or the anti-Christ, or a Fascist or Hitler incarnate, they look upon anything he does as bad for the Republic.

Undoubtedly part of the angst was also caused by the heavy-handed manner in which the announcement was made, and the cuts implemented. Giving universities only one weekend to absorb the news, conduct meetings and conferences, and undertake a search to locate and receive other sources of funding is patently unreasonable. Budgets had been set, scholarships and employment for university professionals had been scheduled in part based on the indirect grant costs. To presume that universities could undertake all actions necessary to continue research projects in the span of 48 hours is unrealistic.

But there are two sides to a coin and two edges to every sword.

So, why did this happen?

Some pundits speculate that DEI is the underlying culprit. And the heavy-handed manner in which DEI has been foisted upon the American public.

DEI is an incredibly nuanced, complex, multi-faceted topic. At its core, it attempts to address the manner in which we, as a just and fair society can and must stride forward into a bold future. A future filled with hope for all. When properly implemented, DEI provides greater opportunities for those who have been traditionally overlooked.

Microsoft created a neurodiversity hiring program targeting individuals with autism and other neurological differences.

Johnson & Johnson invested in a supplier diversity program to support owned by minorities, veterans and people with disabilities.

When implemented by diverse, intelligent persons from both ends of the political spectrum, DEI can be intelligently utilized to provide greater opportunities. That requires collaboration by people of differing opinions and backgrounds.

That is one of the ways where Academia fails.

Academia pushes an identity-based approach to DEI encouraging people to define themselves by race, gender and victimhood rather than by merit and responsibility. This mindset focuses on resentment instead of ambition.

Regarding DEI and equality, Academia and liberals tend to focus on equality of outcome (does everyone have the same things?).

Corporations and conservatives tend to focus on equality of opportunity (is everyone treated the same?).

The undeniable reality is that on its surface and as utilized by Academia, DEI is fundamentally discriminatory. DEI asserts that representation must be based on an end product or result evidencing broad based inclusion regardless of merit. This attempts to address the horrific scourge of past discrimination by engaging in horrific acts of future discrimination.

Under the Biden Administration, DEI and research grants flourished.

However, a society which distorts history is not advancing. It is regressing. One of the great failures of multiculturalism is its rejection of assimilation. The process by which different cultures blend into a shared identity rather than remaining separate factions. We must focus on merit and opportunity. Not grievance.

So, what must be done now? 

The old system of applying for and pursuing grants is over. Quite frankly, it should be. The eating disorder research community has suffered far too long at the hands of a radical element which places their social justice and political views over families. Those people who have ignored and derided the medical community in order to showcase their own dysfunctions and inner turmoil.

Tragically, it is now the university research professionals who are paying the price for this ignorance as their research funding has been reduced or eliminated.

In the short term, there is not much the university-based research professionals can do.  Except pray that the various pending lawsuits result in favorable outcomes.

Certainly, GoFundMe accounts are not the answer. Unless hundreds of thousands of dollars are contributed through GoFundMe accounts, those GoFundMe efforts approach questionable ethical boundaries. A few thousand dollars will do nothing to replace the lost funding.  They are symbolic at best.

But the long term?

First universities and researchers must have a greater understanding of the possible return of investment for grants. Universities must become more like the private sector.  They must have vision as to how research is applicable to the understanding and treatment of illnesses in the real world. Not social justice issues. Not radical political issues.

As such, universities must mandate that the focus of research be applied to medically based, science supported issues. A commonly cited factor for NIH allocation decisions is scientific opportunity. Universities and institutes are typically looking for the best and most innovative research.

However, an important question is whether research on the same diseases remains on the forefront of discovery for many years. It is difficult to accept, given the constancy of funding across diseases, that the relative likelihood of scientific breakthroughs varies in the same way across diseases now as it did 10 or even 20 years earlier.

Disease-specific advocacy also plays an important role in NIH funding. Although advocates’ success in garnering congressional support for research can lead to higher overall NIH budgets, most advocacy groups focus on specific diseases. Some of the extra funding that certain diseases obtain could be the result of these efforts.

This means that medical and scientific aspects of an illness must be emphasized and placed at the forefront of a study. Research which involves social justice issues or denying science not only will not get funded, but they cause harm to the community.

Private foundations and large corporations want to know exactly how your research study will improve the lives of their employees or the people their foundation supports.

University professionals must determine the manner in which emerging technologies and synthetically created intelligence platforms will become involved in the subject about which their research addresses. Ai is not just here to stay, but it is growing and learning at an alarming rate. If a researcher does not have a firm grasp on emerging creations and technologies and how that impacts his/her study … they are wasting their time.

Universities can partner with research and development liaison organizations. Those organizations can find suitable collaborative outside entities who will invest money to cover in part, those indirect costs. A failure to do will result in overall failure.

For that matter, there are a number of private equity companies and a few publicly traded companies which own hundreds of mental health treatment centers across the United States. These entities have literally billions of dollars of assets and resources at their disposal. Imagine the epic advances and increased knowledge of eating disorders, including state of the art treatment protocols which could be discovered and implemented through … collaboration. This type of collaborative effort would not only lead to breakthroughs in treatment resulting in a legion of lives being saved, but as another benefit, would result in increased profits for those companies.

There are solutions. Ready solutions. However, finding the right solution can be difficult and confusing.

In order to discover a brave new world, we must embrace strength, resolve, intelligence, collaboration and faith. Without those qualities, we will remain lost. And knowledge and advancement will be stifled.

ADDRESSING DIFFICULT TOPICS THROUGH SHARED WISDOM AND COLLABORATION

We exist in a perpetual moving cycle of life, death and rebirth. In that cycle, we may be given the opportunity to discover and if we have the wisdom, to embrace a greater understanding of ourselves. And maybe as well, we will receive a brief glimpse of our soul’s purpose on this plain of existence.

Life. Death. Rebirth.

Questioning what awaits us. Exploring the unanswerable questions of … do we have a soul? And, what awaits us after we leave this existence?

Life. Death. Rebirth.

Fewer things frighten people as much as the belief that death is the end. It is eternal. It is darkness. It is final and everlasting. For so many of us, we fear the great unknown. We do not understand it. For many of us, we do all we can to delay the inevitable. If we are bestowed with the gifts of logic, reason and wisdom, we understand that each day of life brings us closer to our last day of life.

And so, we are afraid.

Three years ago, when Dr. Jennifer Gaudiani and her colleagues wrote a paper on “Terminal Anorexia,” she brought to the forefront of our consciousness the great unknown.  Our greatest fear. Our mortal existence. When confronted with a difficult topic which is controversial or which stirs deep emotions, more often than not, people react with fear. With anger. With what they believe is righteous indignation.

I was certainly the Grand Master of that parade of indignation.  Filing complaints with medical boards. Writing scathing articles. Calling her “Dr. Death.” Certainly, the death of my beloved daughter clouded my vision on this issue. In addition, death visited me far too often in a very short time frame.  Within thirteen (13) months, my father, my mother and my older brother were all taken.

And so, my logical, reasoning brain took a holiday. This was a crusade. A righteous mission. And then, life happened.

I was afforded the opportunity to meet with Dr. Gaudiani and look her in the eyes. To ask questions. To challenge her. It was an opportunity to spew forth my views on death, and the soul, and our existence. By God my righteous indignation was going to be heard!

But inexplicably, I experienced a soul. A person in pain. A person in fear. A person who desired to be heard on this most difficult issue. And so, I listened. And learned.

And, I found a person of compassion. I also discovered that perhaps Dr. Gaudiani reasoned that what awaits us after this existence is not something to be feared but instead, is a release from pain. A new beginning. A transition to a higher level of consciousness. Bringing us one step closer to a greater understanding of our soul. A step closer to the Divine.

In the past few months I also discovered at the time the paper on “Terminal Anorexia” was being written, one of her co-authors, Dr. Joel Yager, was battling for his own life. Cancer had sunk its insidious claws into Dr. Yager. It finally claimed his life at 83 years old on December 22, 2024. Imagine if you can, that as you are fighting for your own life, as you are facing the greatest fear of all, you are contributing to this controversial issue. What incredible courage and strength that must have taken. And another life lesson was learned.

One of the more admirable qualities a person can have is the ability to look at themselves, acknowledge past mistakes, own those mistakes and then, take steps to rectify those mistakes.

That journey is so incredibly difficult. It requires a person to be vulnerable. To be open to the gift of being able to listen to learn. To her immense credit, Dr. Gaudiani did exactly that.

She reached out to people who not just strongly disagreed with her, but who sought to end her career. She hosted a summit in Denver in which persons who both agreed and disagreed with her views were granted the opportunity to state their opinions and points of view. To talk. To start a journey of greater understanding and cooperation.

Dr. Gaudiani admitted her mistakes. And desired to listen to those who disagreed with her. Those who sought collaboration.  That journey was not always smooth and trouble free. But most persons persevered. She actively sought professionals who disagreed with her views. And from those discussions and meetings, an evolution began to happen.

An evolution of not just the thinking about end of life, but an evolution of the heart. An evolution of the soul. An evolution of substance.

This past week, the Journal of Eating Disorders published an article written by Dr. Gaudiani. That article is embedded here:

https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-025-01279-x

I strongly believe that had this article been written first, Dr. Gaudiani would be looked upon as a pioneer in how we care for the sickest of the sick. There is intelligence, compassion, testing boundaries, a firm, resolved commitment to her patients expressed in the article.  And it would set the foundational standard upon which intelligent discourse and future collaborative conduct could have been built.  And hopefully … that is what happens now.

There will always be those who oppose and seek to denigrate Dr. Gaudiani. Not just her viewpoints and medical opinions. But her as a person. These people tend to personalize an issue. More often than not, because their identities become the very topic at issue. The world to them is black and white. They cannot separate the professional from the opinion. And they languish in their own fear.

I still strongly oppose medical aid in dying for anorexic patients. A society struggling with how we keep alive our loved ones afflicted with this illness is light years away from being able to intelligently and compassionately implement a protocol which assists our loved ones into their next plain of existence. We know so very little about this illness. What we do know, our knowledge, wisdom and understanding have been clouded by tribal idiocy.

Dr. Gaudiani and I have communicated on a frequent basis. Our communications have gone from initially hesitant, respectful, and perhaps a bit distrustful to … sending each other family photos on holidays. Dr. Gaudiani was gracious enough to take a call from my sister who was struggling with a severe gastrointestinal issue.

Whereas I strongly believe that medical aid in dying should not be utilized for anorexia nervosa, I just as strongly believe that this topic, no matter how uncomfortable it may be, should and must be discussed among professionals. Opinions, research and experience must be shared.  We cannot possibly make progress if we are unwilling or unable to meet with fellow professionals, set aside our personal animus, and explore all options.

Finally, I believe that Dr. Gaudiani has a right to be very proud of this article. Mostly because of the substance behind the words. She has found a way to “humanize” very deep emotions and given grace and a platform to allow intelligent discussion on one of the most complex riddles which faces humankind today … our very existence.

I hope and pray that as a community, we can utilize a hopeful message as a rallying cry for unity. Society and our culture will not allow us to reach an accord on all points of disagreements.  Our fear will not allow us.

That is not important. But, collaboration, respect and giving grace. Aren’t those the qualities which bring us wisdom and insight? Aren’t those the very qualities which bring us closer to the Divine?

THE VICTIMS … THEIR FACES

I was recently advised that articles about IAEDP and Acadia were getting redundant.

So, why continue ?

Regarding Acadia, the answer is quite simple.  Because its systemic corruption continues seemingly unabated and its vapid denials and inane posturing have reached an absurd level.

But before going into the most recent damning New York Times investigative article on Acadia, let’s look into the eyes of some of their victims:

Christopher Gardner

Five year old Christopher was left for 8 hours in a transport van at a West Memphis, Arkansas daycare facility owned by Acadia. Workers tried to cover up their gross negligence by signing documents showing that Christopher was taken inside the West Memphis day care center, even though he remained on the van. At least one media outlet reported the temperature in that van rose as high as 141 degrees. Christopher died in that van.

Deborah Cobbs

In May 2024, 20-year-old Deborah Cobbs, died after she threw herself down a staircase. At Timberline Knolls. Police reports indicate that she attempted to run away from the campus twice that very day. Which makes it quite curious as to why she was not being closely supervised.

Tiley McQuern

In January 2023, Tiley McQuern, 50, was found dead in her bed at Timberline Knolls after swallowing too many pills.

Those are just three of the many Acadia victims. Look at their faces.  Never forget their faces. Because the faces in those photos are all that is left for their loved ones.

On April 22, 2025, the New York Times published an article about Acadia’s now shuttered and infamous facility, Timberline Knolls. It is entitled, “Suicides and Rape at a Prized Mental Health Center. Timberline Knolls, a mental health center owned by Acadia Healthcare, skimped on staff. Then came a series of tragedies.

Although behind the New York Times paywall, the good people at the Salt Lake Tribune published the article in its entirety here:

https://www.sltrib.com/news/nation-world/2025/04/22/timberline-knolls-owned-by-acadia/

Some of the statements in the article include:

“But dangerous conditions persisted for years at Timberline Knolls, an investigation by The New York Times found, in part because of pressure to enroll more patients without hiring enough employees.”

“Two former residents sued Timberline Knolls last year, claiming that an aide had raped them. Acadia had hired the aide despite a criminal record that included domestic violence and gun charges.” [emphasis added]

“Another resident — a child who was a ward of the state — nearly died after she overdosed on medication that had been left out in a common area, according to former staff members. And two other women died by suicide after being left unsupervised, a rare occurrence at mental health facilities.”

“We were extremely understaffed,” said Cecilia Del Angel, who worked as a behavioral health aide at Timberline Knolls until last July. Several other former employees echoed that sentiment. The patient deaths, Ms. Del Angel said, were “entirely preventable.”

“Illinois regulators had not looked into the suicides. A spokesman for the state’s health department said it did not regulate Timberline Knolls, and the state’s Division of Substance Use Prevention and Recovery had not visited the property since 2019.”

“The problems at Timberline Knolls were part of a nationwide pattern of lapses at Acadia, one of the country’s largest for-profit providers of mental health services, with more than 260 facilities in 39 states, The Times found.”

“Acadia has closed facilities over the past decade after reports of sexual abuse. More than a dozen patients reported sexual assaults at an Acadia psychiatric facility in Utah. At a youth treatment center in New Mexico, patients claimed that staff had sex with them and pushed them to participate in “fight clubs.” And in Michigan, three women said they had been sexually abused by a supervisor at a youth treatment center.”

“In the summer of 2018, patients complained to Timberline Knolls employees that a therapist, Michael Jacksa, had sexually abused them on Timberline’s campus. The facility waited more than three weeks to call the police, doing so only after the patients complained to the state’s substance abuse agency, court records show.”

“Timberline’s leader at the time, Sari Abromovich, said an Acadia executive had told her not to alert the authorities, according to a deposition she gave in a lawsuit later filed by one of the women who was raped.”

“Ms. Abromovich, who was fired in 2018, said she was under daily pressure from corporate managers to fill beds and keep expenses low by skimping on staff.”

“Patient enrollment fell with the news of Mr. Jacksa’s arrest. In the ensuing years, Acadia pressured staff to find new ways to fill beds, according to eight former employees, who spoke on the condition that The Times not publish their names because they still work in the mental health industry.”

“Staff struggled to prevent patients from fighting, harming themselves and escaping the facility. In 2020, the Lemont police were called to Timberline Knolls 222 times, police said. By 2023, that number had soared to 519. No one else in Lemont made more emergency calls.”

“In a brief telephone call with The Times, Eiliana Silva, the director of J.P.’s [rape victim] residential unit, acknowledged that she had heard concerns from staff about Mr. Hampton [the rapist/employee] but said she could not properly supervise him because she was one of only two directors overseeing five lodges. As soon as she heard about J.P.’s complaint, she said, she relayed it to Timberline Knolls’ leadership.”

“At the time Timberline Knolls’ leadership heard the accusations against Mr. Hampton, the staff was still reeling from three other disasters.”

“In January 2023, Tiley McQuern, 50, was found dead in her bed after swallowing too many pills. A staff member told police that although employees were supposed to check on patients, those checks were “not thorough,” police records show.”

“Seven months later, a child, who had been placed at Timberline Knolls by the state’s child welfare agency, was rushed to the hospital after overdosing on medication that a staff member had left in a common area.”

“Then, in May 2024, another resident, 20-year-old Deborah Cobbs, threw herself down a staircase while no one was supervising her and died. She had tried to escape Timberline twice that day, police records show. Ms. Cobbs had also told several people that she was feeling suicidal, according to former employees who worked there at the time.”

So, what was Acadia’s response to this legion of corruption and harm to those entrusted to their care?

“Tim Blair, a spokesman for Acadia, said in a statement that the company had a zero-tolerance policy for behavior that could put staff or patients in danger. “We reject any notion that we put profits over patients,” he said, adding that “complaints and incidents are investigated and addressed.” 

“Mr. Blair denied that Timberline Knolls had dangerous conditions and said it had adequate staffing levels.”

Another unidentified Acadia spokesperson said, “The recent New York Times story about Timberline Knolls, a closed Acadia facility, includes material inaccuracies and cherry-picks and conflates historical incidents to paint a false and inaccurate picture of the safety and quality of the care our facilities provide.” 

Acadia’s corruption is vast. A report by the National Disability Rights Network detailed allegations of inappropriate physical restraints, sexual abuse, and emotional abuse at for-profit treatment centers, citing examples at Acadia facilities including an incident where a 9-year-old was injected with antihistamines as punishment at an Acadia facility in Montana.

In March 2025, three adolescents filed a lawsuit against Detroit Behavioral Institute, LLC and its owner, Acadia. The plaintiffs allege widespread sexual, physical, and psychological abuse inflicted on dozens of children. In fact, more than 35 people have come forward after they were reportedly abused as children at the Detroit Behavioral Institute between 2005-2022. The lawsuit alleges that the children were groomed, sexually assaulted and those that spoke out were retaliated against.

Naturally, Acadia closed the facility in 2022.

https://www.clickondetroit.com/news/local/2025/03/11/trapped-in-a-jail-of-horrors-juvenile-detroit-facility-accused-of-abuse-cover-ups/

Acadia’s response to that lawsuit? “The well-being of all patients is of the utmost importance to Acadia Healthcare and its affiliated facilities. We take these allegations seriously. While we can’t comment on specific allegations and patient situations due to privacy regulations, the picture being painted of Acadia and the quality of care provided by our facilities is inaccurate. We intend to defend this case vigorously.

It is enlightening that Acadia’s public response to both the Timberline Knolls scandals and the horrific allegations against Acadia’s Detroit facility utilize almost identical language … “the picture being painted of Acadia and the quality of care provided by our facilities is inaccurate.

In addition, the same day the New York Times published its story, Acadia released its own statement entitled, “Setting the Record Straight: Acadia is A Leader in Quality, Safe Behavioral Healthcare.”

That statement can be found here:

https://quality.acadiahealthcare.com/setting-the-record-straight-acadias-a-leader-in-quality-safe-behavioral-healthcare/

It should come as no surprise that Acadia once again uses its old stand by line, “Regrettably, a recent media report cherry picked and conflated historical incidents at a closed Acadia facility to paint a false and inaccurate picture of the safety and quality of the care our facilities provide.”

So apparently, medication overdoses causing death while under the watchful eyes of Acadia, two suicides in the facility within a year, a minor taken to a local hospital because of a drug overdose, numerous young women being sexually assaulted and raped, five hundred nineteen (519) 9-1-1 calls within one year all fall into the category of “false and inaccurate picture of the safety and quality of the care our facilities provide.”

So, painting an inaccurate picture? Like this?

Or is the painting inaccurate because it does not nearly portray the numerous additional instances of abuse, misconduct and neglect perpetrated by Acadia?

It seems as if Acadia anticipates these lawsuits and issues the same trite defensive language dripping in lawyer ick. For Acadia, it is merely the cost of doing business with our loved ones being nothing more than corporate commodities.

Acadia’s profiteering at the expense of its patients results in the dirtiest kind of money. And yet, our eating disorder organizations continue to close their eyes and continue to accept Acadia’s dirty money. In February, it was iaedp at its annual symposium.

Next month in San Antonio, it is AED’s turn to turn a blind eye and accept Acadia’s dirty money. In doing so, AED arguably becomes complicit in the following odious, reprehensible acts perpetrated by Acadia and its feckless employees:

  1. Multiple rapes in their treatment facilities located in a number of states;
  2. Multiple sexual assaults in their treatment facilities located in a number of states;
  3. Multiple attempted suicides in their treatment facilities located in a number of states;
  4. Multiple successful suicides in their treatment facilities located in a number of states;
  5. Having your lack of oversight result in the death of a 5 year old child left under your care;
  6. Acadia’s officers and Board of Directors engaged in a scheme to defraud and mislead investors concerning patient care, staffing levels and legal compliance issues;
  7.  Acadia and its employees submitting false claims for payment to Medicare, Medicaid and TRICARE for inpatient behavioral health services that were not reasonable nor medically necessary;

There are many other woeful, reprehensible, unethical, illegal and criminal acts being perpetrated by this rogue organization.  But even all of this is not enough to make eating disorder organizations take notice, stand up, and say enough, no more, no longer will we permit you to abuse the most helpless, vulnerable people in society. We refuse to be part of your misconduct.

Instead, like a common street walker, these organizations stand by with their hand extended willing to participate in any act no matter how vile, demeaning or degrading for its 30 pieces of silver.

Deadly Heart Conditions and Grandbabies … like Peas and Carrots

For Christians, especially the 1.4 billion Catholics across the globe, Easter weekend is the epitome of the Circle of Life.

Christ dying on the cross on Good Friday. T.S. Elliott once wrote, “The dripping blood our only drink; The bloody flesh our only food; In spite of which we like to think that we are sound, substantial flesh and blood — Again, in spite of that, we call this Friday good.”

With that backdrop, two days later, we rejoice His resurrection.  Craig D. Lounsbrough wrote, “Easter is a time when God turned the inevitability of death into the invincibility of life.”

The Circle of Life.  This year, made even more poignant with the passing of Pope Francis just mere hours after Easter Sunday passed.

Life and Death. Light and Darkness. Hope and Despair. All inextricably linked.

For me this past weekend, the bittersweet reality and memories of tragic events four years ago reared its head once again. And was made manifest in the present.

But first, we must flash back four years ago.

On the evening of November 6, 2020, my son Hanford advised me that he and his wife were on the way to the hospital. The same hospital in which both my beloved daughter and loving father breathed their last. But this time it would be different. This time, new life awaited!

At 7:42 a.m. the next morning, I received a Facetime message.  I immediately see the smiling face of my son, Hanford, the exhausted but glowing face of his incredible bride, Rebeca, and … the hope and promise of a better world in Riley Emily Dunn. Born just six (6) minutes before. Tears fill my eyes as I watch the parents so filled with love that they can barely communicate holding the miracle they brought into the world. And for a moment in time, that huge hole that exists within my heart felt a little smaller.

But, that was to be short lived.

Sunday evening, November 8, 2020, about 8:00 p.m., I was told that my older brother, Chuck, an American Airlines pilot, adventurer and the picture of health, was being rushed to a hospital. Whether it was a heart attack, a heart aneurism, or severe stroke, we did not know at the time. 

And so, the very first time I held my granddaughter in my arms, I had to tell my son that my brother’s life was essentially over … that I was flying to Florida the next day to tell the medical professionals to end the procedures keeping his heart pumping.

The seconds of your life tick away. Endlessly. The sands of time pouring through an hourglass. Which may cause one to wonder how many grains of sand are left.

Afterwards, we tried to go back to our daily lives …while we picked up the pieces from the carnage that death had taken. At year’s end, we tried to believe the worst was behind us. We tried. And before 2021 was even one week old, the spectre of Death tried to revisit us, mocking us, grimly laughing at us, taunting us with, “Hold My Beer.”

Almost two months to the day when I got that phone call from my older brother’s now widow, on Tuesday January 5, 2021, I received a call from the wife of my younger brother, James. His wife called to tell me that, “Jim has had a massive heart attack. He’s in the hospital in surgery right now.”

So, yes, my younger brother, almost 2 months to the day my older brother died of a heart condition, had a major heart attack known as “the widowmaker.” I was told he had 100% blockage in one heart ventricle.

But survive he did.

Which brings us to the present.

Once again, my son and his wife were expecting their second child.  A boy. My first grandson. His due date was supposed to be around April 12. The joy! The expectation. Even though they shot down my suggestions for names. I could not understand why they did not think that “Worthington Winthorp” was not a good name.

Now young Logan (the name they chose) was becoming the size of a Mack truck.  So, a C-section was scheduled for April 7. The birth went without a hitch. 9 lb. 12 oz, 21 ½ inches long.  Welcome to the world Logan!

And then once again, the macabre hand of fate intervened.

My younger brother James was scheduled to fly to Croatia to meet his daughter, Avery.  Avery is taking a gap year going on a global adventure. But a day or two before he was supposed to go, on Wednesday, April 16, 2025, James began to feel a stronger fluttering of his heart.  The prior two weeks, he had worn a heart monitor as medical professionals tried to learn more about his health. So, on that Wednesday, he cancelled his trip and set up an appointment with his heart specialist.

On Good Friday, April 18, 2025, he was scheduled to go in to have a stent or balloon inserted to clean out his arteries. But… not so fast my friend. His physical health was far worse than believed.  95% blockage in one artery. 99% in another. Which leads us to … open heart surgery.

Much to his chagrin, the medical professionals would not allow him to leave the hospital. In fact, he was transferred to another hospital so the procedure could be performed.

So, while the Easter Bunny was merrily hop, hop, hopping into our homes, James was in a hospital… waiting. With only time to think.

Open heart surgery, with all of its complications and uncertainties was scheduled for Monday, April 21, 2025.

And so…

As I anxiously awaited the news, I pondered life and death. Light and darkness. Hope and despair. The fates bringing one new, incredible life but at what cost? Would there be the ultimate price to pay? A zero-sum game. Quid pro quo. What cruel joke was this?

In the Game of Thrones series, among the many poignant lines, the following takes place …

So today we tell death … Not today.

The normal 4 hour surgery took only 2 hours. But, it was not his time. Not today. But for another?

Sometimes Death is not to be denied. On that same Monday I was told that the grandmother of Rebeca (my son’s wife), had passed away in her sleep on Easter Sunday. Rebeca’s last grandparent.

So as we remain thankful for life, we remember those who have transitioned to their next stage of existence.

My brother’s recovery will be long and difficult.  But there is life.  The life that flows through my brother and my grandson, Logan. The life that flows through me. The life that flows through all of us.

Life … Light … Hope.

That is a future worth embracing.

MEDICALLY INDUCED COMA FOR ANOREXIA?

There are numerous quotes about being in a “coma” scattered throughout Hollywood movies.

“Paralyzes him, puts him in a coma, then keeps him alive. Now what the hell is that?

 Alien

“Her heart. Can you give her something? – She’ll go into a coma.”

Exorcist

“Unless they’re completely supplied with lysine by us, they slip into a coma and die.”

 Jurassic Park

“He’s in a coma. – Then bring him out of it. I want to talk. Now, doctor.”

 Green Hornet

“When he arrived here, he was very ill, in a coma, not likely to live. And yet in a matter of ten days, his body is fully recovered.”

 36th Chamber of Shaolin

“We don’t know what the hell to do at this point. So, let’s put her in a medically induced coma and tube feed until she gains 20 pounds. That should fix things right up!”

 The Marx Brothers in Medical School [Ok, not a real movie.]

Apparently, in the UK, a recent Telegraph investigation revealed that NHS hospitals authorized at least six young women with anorexia to be placed into comas in order to restore their weight.

https://www.dailymail.co.uk/news/article-14503651/Anorexic-girls-coma-NHS-hospitals-force-feed.html

Doctors attempt to argue that this hair-brained plan … err, I mean, that intervention is necessary to prevent death. However, reputable professionals and specialists caution it is a high-risk intervention with no medical precedent and that safer, evidence-based alternatives exist.

Before jumping into this fray, I should note that about three years ago when a previously untested and untried end of life option which shall not be named (thank you Harry Potter) [but, it rhymes with “Perminal Plannoplexia!]

was brought into the public consciousness, I went full blown nuclear from day one, filed ethics and board complaints and was considered (by some) very ugly in published articles.

Well, I learned my lesson. This time I am going to be more measured. More reasoned. More compassionate. Kinder, Gentler …

Before we delve into this latest Marx Brothers like Clown Show, let’s review the numerous criticisms of NHS hospitals in the UK.

A health ombudsman in the UK made the following remarks about the treatment of eating disorders in NHS facilities:

“Urgent action is needed to prevent people dying from eating disorders, the parliamentary and health service ombudsman for England has warned, as he said those affected are being “repeatedly failed”.

“The NHS needs a “complete culture change” in how it approaches the condition, while ministers must make it a “key priority.”

“Little progress has been made since the publication of a devastating report in 2017, which highlighted “serious failings” in eating disorder services.”

“Lives continue to be lost because of “the lack of parity between child and adult services”, and “poor coordination” between NHS staff involved in treating patients. There remain issues with the training of medical professionals.”

“Eating disorders are enormously complex, and those on the frontline treating people have a tremendously difficult job to do. This [is] not helped by a lack of a sense of urgency to address the scale of the problem. Clinicians need better support to do their job of protecting patients.”

“It is heartbreaking to see repeated mistakes and tragedies happening again and again. We need to see a complete culture change within the NHS, where there is a willingness to learn from mistakes.”

“The government also needs to fulfil its promise to treat eating disorders as a key priority so that we can see meaningful change in this area and make sure patients receive the quality of care they deserve.”

Tom Quinn, the director of external affairs at Beat, an eating disorders charity, said it was “appalling” that vulnerable patients were not getting the treatment that they desperately need.

NHS figures evidence the number of children being treated for eating disorders more than doubled from 5,240 in 2016-17 to 11,800 in 2022-23.

Doctors and charities warn limited access to community services means both children and adult patients are not able to access treatment quickly enough, which has led to many becoming so ill that they need urgent hospital care.

Ok, I think we got it.

A lack of urgency. Governmental ambivalence. Not learning from past mistakes.  Repeated tragedies. Lack of support. Poor coordination. Insufficient training of professionals. Little progress addressing past serious failings. Exploding number of eating disorder patients. Limited access to care.

And the NHS’ solution is … let’s put “em in a coma!” Blimey! And Bob’s your Uncle!

Cue the Benny Hill yakety sax music …

Let’s put the patients “on ice,” tube feed them until they gain 20 pounds, have Prince Charming come along to give them “love’s first kiss to wake them up,” [No wait… Prince Charming was a creepy stalker!]. Ok, A rebellious, hoody wearing bandit named Jonathon comes along, kisses Snow Woke, she wakes up from her coma and along with his bandit friends, they storm the Bastille and live happily ever after. Back to reality now.

A medically induced coma …

Being placed in a coma and hopefully waking up with no resulting physical harm is wrought with peril. There is the increased risk of lung infection. The possibility of damaged lung tissue. Blood clots could develop in the legs possibly leading to a pulmonary embolism. Muscle breakdown and nerve damage. Possible memory loss and seizures. Weakened immune system. Dangerously low blood pressure. And of course… death.

Medically induced comas are too high risk for psychiatric treatment and are reserved for brain protection in life-threatening cases.

One can’t help but wonder if the NHS doctors in the UK first attempted rTMS. Or a ketamine regiment. Or Deep brain stimulation. Or responsive neurostimulation.  The facts indicate otherwise.

In 2024, the NIHR Maudsley Biomedical Research Centre reported that it completed its first clinical trial of repetitive transcranial magnetic stimulation to the prefrontal cortex in patients with severe enduring anorexia nervosa.

Last year. The first clinical trial of rTMS… 2024.

Ketamine? Yeah… No.

On April 4, 2024, it was reported that King’s College researchers were awarded £1.45 million from the MRC Developmental Pathway Funding Scheme to run a randomised controlled feasibility trial of oral ketamine vs placebo in people with both anorexia nervosa and treatment resistant depression, marking the first time that ketamine has been used in a trial of this kind.

Last year. The first clinical trial of ketamine … 2024.

Seeing how according to the literature, rTMS and ketamine were not clinically trialed until 2024, it is very unlikely that these treatment regiments were first attempted.

And so instead, the NHS solution was to put these young women into a coma and then tube feed them.  One can’t help but wonder if they first at least tried leeches or attempted to bleed the bad humours out of their blood. Trepanation? Tobacco smoke enemas?

There is certainly enough medical literature detailing the use of forward thinking medical treatment for anorexia nervosa. Were these treatments even first considered?  Were they utilized? [from the UK literature, that would be highly unlikely.] I think we all know the answers to those questions.

Instead, we are left once again with the reality that universally we do not know nearly enough about eating disorders. Globally, medical providers have not found a way, nor the ability to collaborate, share knowledge, consult with professionals from different backgrounds and countries and to come to the realization that collective knowledge exceeds individual knowledge.

Which results in medieval type, untested and untried experimentation on guinea pigs. Except they aren’t guinea pigs. They are our loved ones.

Loved ones being treated by Groucho, Chico and Harpo.

We deserve better.

Ai, ChatGPT, and the Future

Silicone based intelligence software programs are not only here to stay, but they are our certain future. The discovery of new technology replacing humankind has always been part of our past.

Pin boys who replaced bowling pins by hand; human computers (remember the term used in the movie, Hidden Figures); switchboard operators, cashiers; some factory and warehouse workers; bank tellers, travel agents.  All jobs/careers significantly reduced or rendered obsolete by technology.

Now, silicone-based intelligence software or “Ai.” No matter what job or career you may have, in the future you will be impacted, if not replaced, by Ai. My genius friend/neighbor “Ze” [who got a PhD in Molecular Evolutionary Genetics from that little school in Cambridge MA] and who is working with coding for Ai software believes that Ai will eventually replace all human careers leaving us to enjoy a lifetime of nothing but pursuing leisure.

Ai will certainly become a greater reality in the understanding and treatment of mental health issues. Some people do not understand the push for virtual therapy is building a stronger foundation for utilizing Ai therapy in the future. [As an aside, the Cambridge English dictionary in part defines “virtual” as, “almost a particular thing or quality,” and “created by computer technology and appearing to exist but not existing in the physical world.”] (That gave me warm fuzzies.) In short, we are building our own obsolescence.

Even now, Ai can tell the world about who you are. Recently, I conducted a ChatGPT inquiry about myself.  The inquiry was simply, “What impact has Steven Dunn had in the eating disorder community?”

This was its response:

“Steven Dunn, a Dallas-based attorney, has made significant contributions to the eating disorder community through advocacy, education, and legal action. Following the tragic loss of his daughter, Morgan, to an eating disorder in 2016, Dunn redirected his career to focus on combating these illnesses. He established The Morgan Foundation, aiming to raise awareness and support for individuals affected by eating disorders.  

In his efforts to educate the public, Dunn delivered a TEDx talk titled “Empowered Treatment of Eating Disorders,” where he challenged societal misconceptions about these conditions.  Additionally, he has shared his personal journey and insights through his blog, “A Dad’s Journey with Eating Disorders,” discussing mental health and critiquing aspects of the eating disorder treatment industry.  

Dunn has also engaged in legal advocacy to address issues within the eating disorder treatment community. He has been involved in class-action lawsuits against organizations such as the International Association of Eating Disorder Professionals (iaedp) and the National Eating Disorders Association (NEDA), representing clinicians and advocating for systemic change. 

Through these multifaceted efforts, Steven Dunn has played a pivotal role in raising awareness, challenging existing paradigms, and striving for improvements within the eating disorder community.

https://www.cbsnews.com/texas/news/dallas-attorney-shines-light-on-eating-disorders-after-daughters-death/?utm_source=chatgpt.com#:~:text=Steven%20Dunn%20is-,walking%20away,-from%20a%20successful

Wow!  Thanks, ChatGPT! To whom do I send my bribe money for that response?

Obviously, ChatGPT chose to not talk to my many, many, many detractors. Nor the militant fat activists. Nor the perpetrators and enablers of the Clown Show mentality present in certain aspects of the eating disorder community. Nor those people who either choose to not listen to voices which are different than their own, or voices of people who frighten them. It ignored my many character flaws.

Whether you agree or disagree with ChatGPT’s response, you are left with one inescapable conclusion. ChatGPT’s answer which excludes the frailties, emotions, weaknesses and bias endemic to the human condition is what is left after it analyzed the facts and information it discovered.

To demonstrate how advanced (even in its parochial development), Ai generated images are, click on this link and play the test.  How many did you get correctly?

https://www.whichfaceisreal.com/index.php

Isn’t it a matter of time before Ai generated images are combined with the vast knowledge of the internet, including all known information on mental health issues, and an Ai therapist is a reality. An Ai therapist who does not prattle on ad infinitum about “privilege,” or “white fragility,” or spelling obesity without the “e.” A therapist that any patient will be able to select that therapist’s race, age, background and life experiences.  A therapist upon whom that a patient has direct input. To establish an emotional link, a trust right from the start. A therapist who remembers everything about their patient and pulls on an infinite library of information and knowledge. The perfect therapist for them.

For that is certainly the reality.  That is the future.  That is coming in our lifetime. In fact, in some ways, it is already here:

https://www.nbcnews.com/tech/ai-companions-friendship-rcna194735

Actual emotional bonds are being formed between carbon-based life forms (us) and silicone based programmed entities. That is the reality. That exists in the here and now!

So as the radical loons go on and on and on about their social justice issues and demanding more, if not numerically equal or superior therapists, doctors, counselors, and research professionals, not surprisingly, they are missing the target.

That dark cloud on the horizon is the inevitable takeover of the mental health communities by Ai entities. Entities which are capable of gauging and reacting to human emotions without their own counter-transferred needs interfering and causing more harm. DEI is so forty years ago. Ai is here. Ai is the present. Ai is the future. It is here to replace you.

In the meantime, go do a ChatGPT search on yourself. Let yourself feel good. Have some fun! That is … until you are replaced. Until you … are obsolete.

Hannibal Lecter, Frazier Crane, Dr. Blane … and You!

Therapists are on the front lines of mental health. They are in the trenches. They are the professionals upon whom we rely to reach down into our darkness of despair and lift us into the sunlight. To show us a bold new future filled with hope and joy. To have the strength and resiliency to not just help us fight our own internal struggle toward mental wellness, but who are able to maintain their own sanity. They must be intelligent, courageous, self-aware and in order to meet the broadest range of patients possible, they must possess an open mind regarding culture, society, life and yes … even politics.

[I understand at this point the 4 remaining therapists who may still read my missives may be pressing the block/ignore button. That’s ok.  After all, we can’t have a man (or person who identifies as a man or a person who is not in our tribe) be allowed to have any type of voice which may disrupt their echo chamber!] … But as usual I digress.

Seriously, what an incredibly difficult job. As patients, we spew forth our anger, our guilt, our sorrow, the rawest of our emotions and we trust that our therapist can help guide us to the genesis of enlightenment, a path of wisdom … Or at least give us a break on their hourly fees after we have been seeing them for one year. Whichever … Whatever!

And yet, Hollywood and the television and movie industries trend toward casting doubt upon that premise. Those bastards!

So, let’s look at a few series in which therapists were prominently featured as we attempt to understand Hollywood’s seemingly negative portrayal of therapists.

First, the series “Hannibal” featured everyone’s favorite cannibal psychiatrist, Hannibal Lecter. If he wasn’t helping his patients resolve their issues, he was dining upon them… with some fava beans and good chianti.

Ok… so that may be a bad example.

There was everyone’s favorite radio psychiatrist, “Frasier” who when he wasn’t doling out McTherapy on his daily radio show, he was struggling with his own many personal issues involving family and friends. And he went through a legion of failed relationships ad infinitum.

The “Shrink New Door.” This limited series is a dark comedy starring Paul Rudd as Dr. Isaac Herschkopf – a charismatic yet manipulative therapist who exploits his relationship with patient Marty Markowitz (played by Will Ferrell). This show delves into themes of power dynamics, boundaries, and ethical dilemmas within the context of therapy while providing audiences with a unique cautionary tale about misplaced trust.

“Gypsy” was a brief series starring Naomi Watts as therapist Jean Holloway. It delved into themes surrounding boundaries, ethics, and personal relationships within the profession. Jean becomes increasingly entangled in her patients’ lives outside her office – blurring lines between professional responsibility and personal desire.

Then there is Loudermilk. A comedy about a recovering alcoholic, Sam Loudermilk, who works as a substance abuse counselor. Despite sometimes helping the people he works with, Sam’s defining characteristics are being uncaring, sarcastic, and self-centered.

A recent series, Shrinking just completed its second season on Apple TV with a third season to come. Shrinking is a comedy bundling the elements of friendship, love, kindness and dysfunctionality with an underlying theme of grief. The characters are bound together by their support and love for each other. And yet, their own struggles and dysfunctions define each character, their very existence. And give an alarming glimpse into the reality of countertransference.

Finally, there is YouTube sensation, “Dr. Blane.” Dr. Blane should best be watched instead of described:

What do those series, and numerous other series not cited have in common? They all depict counselors, therapists, those people upon whom we rely to help us, as being inherently flawed, emotionally needy and dysfunctional. A person who should be receiving therapy instead of doling it out.

Now, I did not write nor produce these series. And yet, they all portray therapists/counselors in less than a flattering light.  Aren’t we justified in wondering why that is? Keep in mind this is Hollywood.  The place from where the messaging seems to be, “we invented extreme, radical leftism, we hate everyone who does not agree with us, we are looney toons.” So, other than a belief that comedic dysfunctionality sells, why would the very left of the leftists portray therapists/counselors in an unflattering way?

Unless … there is a shred of truth in it.

Which brings us to the aforementioned countertransference. Therapists know that countertransference occurs when a therapist lets their own feelings shape the way they interact with or react to their client. In a therapy session, a client might remind the therapist of someone or something from their present or their past. As a result, the clinician might unconsciously treat the client in an emotionally charged or biased way.

Therapists trying to heal themselves through their patients. While inflicting their own views of cultural and societal liberalism upon those whom they are tasked to help and thereby bastardizing the therapy process.

Those therapists are fairly easy to spot.  Most have social media posts replete with cut and paste posts on how all Republicans and/or President Trump are evil. He is the Anti-Christ! The world is coming to an end!

These therapists/counselors drag this pablum into the therapy room. In fact, there are counselors who openly admit they do exactly that! And to those counselors, I ask, do you honestly believe that there is space in the therapy room for your own mania? Is it ever appropriate to bring your own biased political views into a therapy session and attempt to infuse them into your patient? Especially with eating disorders where other mental health concerns are more often than not, inextricably intertwined?

Especially since there are so many complexities with eating disorders. Isn’t a counselor’s time better spent studying how and why the malnourished brain does not operate? Learning what parts of the brain are impacted? Looking at the genetic components of eating disorders? Or what you know about RTMS? Or ketamine regiments? Or Ai interactions? Or brain implants?

Your patients … our loved ones deserve the very best from you. This is not your special opportunity to heal yourself.

Now, make no mistake, there are many incredibly intuitive, intelligent, and insightful therapists.  Those who make a difference.  This is not a case of Diogenes the Cynic holding a lantern wandering the Greek countryside looking for one honest man.

But … it may be in the same zip code.