Tag Archives: anxiety

The March 25, 2026 jury verdict in Los Angeles against Meta and Google, paired with the $375 million New Mexico verdict against the same companies the day before, mark a structural shift in how courts conceptualize harm arising from social media platforms. These cases do not merely expand liability. They reframe the legal ontology of digital platforms from neutral intermediaries into potentially defective consumer products.

In this article, we will explore what this means for the way in which we look upon eating disorders … and what therapists and clinicians should know.

For eating disorders, conditions already deeply entangled with algorithmic amplification, body image distortion, and compulsive engagement, the shift in liability for digital platforms is particularly consequential. The emerging litigation theory may provide for the first time a coherent legal pathway to attribute causation and duty in eating disorder related harm.

The recent Meta/Google verdicts succeeded because plaintiffs changed the theory of liability. The old framing was, “You allowed harmful content to exist.” Federal statutes provided immunity for this reasoning. Case dismissed.

The new framing is now, “You designed a system that predictably causes harm.” This is the doctrinal pivot. The plaintiffs were able to bring forth evidence that the platforms knew about harm (e.g., to teens, body image, ED risk) but continued optimizing engagement anyway. This evidence supports claims of negligence, recklessness and malice. This also strengthens the argument that the wrongdoing lies in corporate decision making not user content.

Why This Matters Specifically for Eating Disorders

Eating disorder harm fits the “Design, Not Content” model argued in courtrooms. Eating disorders are not typically triggered by a single post. But by repeated exposure, escalating comparison and behavioral reinforcement. These are clearly algorithmic phenomena.

Unlike traditional media, social media platforms can identify users engaging with dieting and body comparison content. This increases the likelihood of exposure. This frames a plaintiff’s argument that harm is not incidental. It is systematically intensified. There is also substantial evidence that social comparison leads to body dissatisfaction and repeated exposure leads to disordered eating behaviors

This makes it easier to argue that harm was predictable, foreseeable and safer alternatives were available but disregarded.

The recent verdicts are also significant not because they establish a medical causation of eating disorders, but because they elevate platform design and algorithmic exposure into the realm of foreseeable mental health risk.

In effect, the verdicts reinforce three propositions that are directly relevant to clinical practice:

  1. Digital environments can function as risk-amplifying exposures, particularly for adolescents;
  2. Algorithmic curation is not neutral, but can intensify engagement with appearance focused or psychologically harmful content; and
  3. Harm need not arise solely from user intent but may be driven by product design features.

From a standard-of-care perspective, these propositions are likely to influence what constitutes “reasonable” clinical conduct.

Even in the absence of formalized guidelines, foreseeability plays a central role in negligence analysis. As juries begin to recognize social media design as a source of mental health harm, clinicians may be expected to:

  • Screen for social media use with greater specificity (not merely duration, but type of content and engagement patterns);
  • Identify platform-related triggers (e.g., comparison behaviors, exposure to body-ideal content, reinforcement loops);
  • Incorporate digital environment management into treatment planning; and
  • Provide anticipatory guidance to patients and families regarding online risk factors.

Failure to do so over time may be framed as a deviation from evolving professional norms even in the absence of codified standards.

Evolution of Standard of Care Through Litigation Rather Than Consensus

In fields lacking clear clinical standards, the standard of care often evolves through case law, expert testimony, and institutional practice patterns.

The Meta and Google verdicts may accelerate this process by:

  • Providing a judicially recognized framework for linking platform design to mental health harm;
  • Encouraging plaintiffs to incorporate digital exposure into causation narratives; and
  • Pressuring professional organizations to issue more explicit guidance in response.

In this sense, the verdicts may function as de facto catalysts for standard formation even if formal consensus lags behind.

Clinicians and treatment programs that proactively integrate digital-risk assessment may therefore position themselves more favorably relative to an emerging baseline of care.

Implications for Causation Frameworks in Eating Disorders

Historically, eating disorders have been understood through a multifactorial model, incorporating genetic predisposition, temperamental traits, family dynamics, trauma and sociocultural influences. The recent verdicts do not displace this model. However, they may recalibrate the weight assigned to environmental and systemic contributors, particularly those mediated through technology. Importantly, this shift may influence not only clinical practice, but also the narrative frameworks used in litigation and public discourse.

Anticipated Expansion of Social Justice and Structural Etiology Arguments

One of the more complex implications of these developments is the possible expansion of social justice based etiological frameworks, including arguments that locate eating disorders within broader systems of oppression.

Within certain academic and advocacy contexts, eating disorders have increasingly been linked to:

  • Eurocentric beauty standards,
  • Fatphobia,
  • Structural inequities in healthcare access, and
  • Cultural norms associated with what has been termed “White supremacy culture” (e.g., perfectionism, control, individualism).

The Meta and Google verdicts may indirectly reinforce these perspectives in several ways:

1. Externalization of Harm

By attributing liability to platform design rather than solely to individual behavior, the verdicts support a broader shift toward externalizing causation. This aligns with social justice frameworks that emphasize systemic over individual factors.

2. Validation of Environmental Influence

The recognition of algorithmic amplification as harmful lends credibility to arguments that cultural and media environments actively shape pathology, rather than merely reflecting it.

3. Expansion of Duty Beyond the Individual

If platforms can be held liable for contributing to mental health harm, analogous arguments may be advanced that cultural systems, institutional practices, and dominant norms also bear some responsibility for shaping risk.

As a result, Plaintiffs may increasingly incorporate cultural and systemic critiques, expert testimony on media ecology and sociocultural pressure, and arguments linking platform content to broader ideological frameworks as part of causation narratives.

Tension Between Clinical Rigor and Expanding Etiological Narratives

While these developments may broaden the scope of inquiry, they also introduce tension. From a clinical and evidentiary standpoint multifactorial models require specificity and measurable variables and overly diffuse causation theories risk diluting analytical precision.

From a legal standpoint courts require evidence that is not only plausible, but attributable and proximate. Expansive social frameworks (e.g., “White supremacy culture”) may be more difficult to operationalize in a manner that satisfies evidentiary standards. Accordingly, while social justice perspectives may gain rhetorical and academic traction, their translation into clinical standards or legal causation will likely depend on the development of measurable constructs, empirical validation, and clear linkage to individual harm.

Increased Eating Disorder Liability

For eating disorder related claims, liability may no longer depend on identifying specific harmful posts.  Instead, plaintiffs can target recommendation algorithms, engagement loops (likes, scroll, autoplay) and behavioral reinforcement systems. This aligns directly with how eating disorder pathology operates; repetition, reinforcement, and escalation, not isolated exposure.

Historically, eating disorder related litigation struggled with causation; eating disorders are multifactorial (genetics, trauma, culture) and Courts viewed platform influence as too attenuated.

The recent verdicts suggest juries are now willing to accept alternatives. The Los Angeles case framed harm through addiction mechanics; compulsive use, reinforcement loops and diminished control. This maps closely onto eating disorder pathology; compulsive restriction, bingeing, or purging, reinforcement through comparison and validation and escalating behavioral cycles.

Unlike traditional media, social media platforms learn user vulnerabilities and optimize content delivery accordingly. For eating disorder claims, this enables arguments that platforms did not merely expose users to harmful content. They systematically increased exposure based on detected susceptibility.

This is a qualitatively different form of causation, not passive distribution, but active behavioral shaping.

Among potential harm categories, EDs are uniquely positioned for litigation success due to a high predictability of harm. There is extensive internal and external research linking social comparison to body dissatisfaction to disordered eating. We now know that social media platforms can track repeated viewing of weight loss content, thinspiration and calorie restriction narratives. This creates a potential evidentiary record of foreseeable harm combined with continued amplification.

Courts are especially receptive to harms affecting minors and failure to implement protective measures. Eating disorder onset often occurs during adolescence, aligning directly with peak social media usage and peak psychological vulnerability.

Long-Term Structural Changes

As a result of these cases, we may see an emergence of “Digital Duty of Care” particularly for minors. Social media platforms may be held to standards similar to product safety law and pharmaceutical risk disclosure.  Courts may formalize liability tied to predictive amplification of harm. And we may see potential legislation impacting youth specific design standards, limits on engagement optimization and/or mandatory transparency for algorithmic systems.

We may also see evolving clinical implications for eating disorders. Eating disorders may increasingly be viewed not only as psychiatric conditions but environmentally induced or exacerbated disorders linked to platform design.

Clinicians should begin to document social media exposure patterns and incorporate platform use into diagnostic frameworks. This could strengthen litigation evidence and insurance coverage arguments.

In addition, eating disorders may be reframed as partially technology-mediated disorders. This parallels lung cancer (tobacco) and opioid addiction (pharmaceutical design and distribution).

The Meta and Google verdicts do not merely increase litigation risk, they signal a paradigm shift in how harm from digital systems is understood and adjudicated. For eating disorders, the implications are profound:

  • A viable legal theory now exists
  • Causation barriers are weakening
  • Platform design is becoming justiciable
  • Large-scale settlement frameworks are increasingly likely

Most importantly, these developments may redefine eating disorders not only as clinical phenomena, but as foreseeable outcomes of engineered environments optimized for engagement at the expense of psychological safety.

If this trajectory holds, the next phase of litigation will not ask whether platforms contributed to eating disorders, but to what extent, and at what cost.

THE DANGEROUS FICTION OF EATING DISORDER COACHES

The complexities of eating disorders require medical monitoring, psychiatric oversight, nutritional rehabilitation and clinical judgment. Eating disorders demand the highest level of expertise and professionalism from medical and mental health providers.

And yet, in a rapidly expanding corner of the wellness marketplace, they are being addressed by people who are not licensed, not regulated and, in many cases, not clinically trained at all.

They call themselves “Eating Disorder Coaches.”

There is no statutory definition of that role. No minimum education requirement. No mandated supervision. No governing board. No uniform ethical code enforced by law. It is merely a name. A brand. A vacuous title.

And no reliable mechanism to stop them if they cause harm.

Now make no mistake … there are “Eating Disorder Coaches” who are compassionate, intelligent professionals whose services are invaluable in working with a cohesive treatment team. But, in a community which rarely imposes consequences or adverse ramifications for reprehensible conduct, the danger of incompetent eating disorder coaches is far too real.

A Title Anyone Can Use

In most US states and in the UK, the title “eating disorder coach” is not protected. Anyone can adopt it. There is no state exam. No residency. No clinical hours requirement. No continuing education mandate enforced by a licensing authority.

A former state licensing board investigator describes the situation bluntly:

“From a regulatory standpoint, ‘coach’ is a marketing term. It does not confer legal authority, and it does not trigger professional oversight.”

If a licensed psychologist commits misconduct, a complaint can be filed. A board can investigate. A license can be surrendered, suspended or revoked.

If a coach commits misconduct, unless they also hold a license and the conduct falls squarely under licensed practice, there is often no comparable public accountability mechanism.

In practical terms, this means individuals with minimal training can advise medically fragile clients about food exposure, weight restoration, purging behaviors, exercise patterns and relapse decisions … issues that in clinical settings, are handled by multidisciplinary teams.

The danger is not theoretical.

A psychiatrist who specializes in eating disorders warns:

“Improper intervention can reinforce pathology. Poorly managed refeeding can have medical consequences. Missing suicide risk is catastrophic. These are not coaching issues. These are clinical issues.”

Yet the marketplace does not reflect that distinction.

The Coaching Loophole

The structural problem becomes especially stark when licensed professionals move into the unregulated coaching space.

Karin Lewis, an eating disorder clinician and founder of the Karin Lewis Eating Disorder Center in Boston, surrendered her Massachusetts therapy license while under investigation following two pending ethics complaints … including one filed by the therapist who began treating a former client after that client left Lewis’s care.

Separately, that client filed a civil lawsuit against Lewis for Lewis’ alleged unethical business practices. That case was resolved for an undisclosed payment.

However, Lewis’ licenses in New York and Rhode Island currently remain active… at least for the time being.

More recently, Lewis publicly presented herself on social media as an “Eating Disorder Coach.”

https://www.facebook.com/share/v/1DCba3vVBq/?mibextid=wwXIfr

The legal reality is striking: surrendering a license in one state does not prevent someone from operating as a coach. Coaching requires no license to surrender.  Instead, it is explained away as a personal and professional transition. In Lewis’ words, “I’m shifting to a coaching and consulting model.” Perhaps the rest of that sentence should have read, “Because I am prohibited from engaging in my chosen profession in my home state.”

Good Lord. From a profession where at least there is some oversight to a role that has no oversight, no requirements and no accountability. What could possibly go wrong?

Especially when you can belong to a community which will protect you no matter what so long as you hold the same idealistic, radical views espoused by others. Surrender your license? Not a problem. You can still serve on Advisory Boards of eating disorder treatment centers. No consequences. No accountability.

However, this is not a commentary on one individual alone. It exposes a systemic failure: professionals can exit regulated roles and continue working in adjacent, unregulated ones without a unified accountability framework.

This type of unregulated model is illustrated in a much larger context, that is, eating disorder board certification. [However, this article will not focus on certification. That is for a future date. It is only briefly included for context.]

Certification: The Illusion of Reform

Despite growing criticism, eating disorder certification programs have multiplied to an extent that would make rabbits blush. Like coaching, certification programs are unregulated, there is no oversight and anyone can create them. A person can include any private issue they like in a certification program … from Indigenous Person’s Land Use Acknowledgements to railing on White Supremacy Culture.

Project HEAL has expanded programming and provider networks while advocating for improved access to care. Inclusive Eating Disorder Education (IEDE) offers tiered credentials and training tracks. The Eating Disorder Institute (?) f/k/a The Institute of Contemporary Eating Disorder Education (ICEE) provides coursework and professional certificates. Iaedp’s certification program is undergoing broad changes because of litigation.

These initiatives often present themselves as raising standards in the field.

But certification is not regulation.

No state licensing board oversees these programs. No legislature defines their scope. No independent authority can revoke a certificate and legally bar someone from continuing to practice as a coach.

A healthcare policy scholar who studies professional licensure draws a clear line:

“A certificate means you completed a course. A license means the state has granted you legal authority to treat vulnerable people — and can remove that authority if you violate standards. They are fundamentally different.”

Certification programs may require coursework. They may encourage ethical guidelines. They may foster community norms.

But they do not create enforceable public protection.

And in some cases, critics argue, they risk compounding confusion.

“Consumers see badges, seals and credentials and assume oversight exists,” says a former hospital-based eating disorder program director. “But there is no disciplinary body behind most of these titles. It’s structural theater.”

These same issues exist with eating disorder coaching.

Coaching as De Facto Treatment

The most troubling development is not that coaching exists. Peer support has long played a role in recovery communities.

The problem arises when coaching becomes indistinguishable from treatment and therapy.

Coaches advertise meal plan guidance. Exposure support. Relapse prevention strategies. Accountability check-ins. Crisis navigation. Body image interventions.

These are not lifestyle adjustments. They are components of clinical care.

Eating disorders affect cardiac function, bone density, electrolyte balance and suicidality. Weight restoration can trigger refeeding syndrome. Purging behaviors can destabilize potassium levels to fatal effect.

In licensed treatment settings, these risks are monitored by medical professionals.

In coaching settings, oversight varies widely … and for the most part, does not exist at all.

A clinical ethicist frames the issue starkly:

“When someone markets themselves as capable of guiding recovery from a life-threatening illness, the absence of regulation is not an oversight. It is a policy failure.”

A Marketplace Built on Vulnerability

The expansion of coaching cannot be separated from systemic failures in access to care. Waiting lists are long. Insurance battles are common. Specialized treatment is expensive.

Desperate families look elsewhere.

The coaching industry has attempted to fill that void with polished websites, testimonials and social media authority. It operates largely outside insurance systems, outside hospital networks and outside state oversight.

In a traditional healthcare model, authority flows from licensure and statutory accountability.

In the coaching marketplace, authority flows from branding.

That shift should concern regulators.

As one former licensing official puts it:

“Regulation exists because vulnerable people cannot be expected to vet complex medical competencies on their own. When we remove regulation, we shift the burden of risk onto the patient.”

The Unanswered Question

Eating disorder coaching today exists in a regulatory grey zone that benefits providers more than patients.

Certification programs provide optics. Professional branding provides credibility. But neither substitute for enforceable oversight.

The core question remains unresolved:

Should individuals treating — or functionally treating — one of the most lethal psychiatric disorders operate without statutory accountability?

Until lawmakers address that question directly, through scope of practice laws, title protections or regulatory oversight, eating disorder coaching will remain what it is now:

A parallel system of quasi-clinical care, built on vulnerable populations, sustained by market demand, and largely immune from the guardrails that define the rest of healthcare.

And in medicine, immunity from oversight is rarely a virtue. It is a roadmap for catastrophic results.

Why we Acknowledge Awareness Week

It is Eating Disorders Awareness Week. A week in which organizations attempt to “raise awareness.” Presentations are made. The microscopically small niche on social media occupied by eating disorder advocates spout their messages using rote, familiar language while ignoring the most alarming statistic.

It is far easier to refine language than to examine outcomes. But outcomes are how we are judged. Outcomes determine our humanity. Our soul. Our fight for survival. And nowhere was this more apparent than in the incredible journey of Kaila Blackburn.

Everything I know about Kaila Blackburn I got from her strong, resilient, incredible mother, Debi and father, Tom. And what I read on social media.

Kaila was born on June 13, 1994, in Virginia, and on September 27, 2025, eating disorders took her life. Eating disorders took her from her family and her loving parents. But while she was with us, how she graced us with her strength.

Kaila was a natural student and athlete. She swam, dove, played softball, and ran with such breathtaking speed and grace that she earned the nickname “Flash.” Her dedication and talent carried her to Virginia Tech, where she proudly competed as a Division I runner.

From what I read, Kaila’s faith was the foundation of her life. From an early age, Kaila loved Jesus, and through her 31 years she remained steadfast, often teaching others through her wisdom and grace. Even in her hardest battles, she clung to her Savior with courage and unwavering trust.

Kaila’s parents wrote this about her, “We will not say that Kaila is “resting in peace.” Instead, we proclaim that she is Running in Paradise—whole, free, and forever embraced by the love of her Savior. That is exactly what Kaila would have wanted.”

I did not know Kaila. I never had the chance to meet her. But, I do take comfort knowing that my Morgan is probably showing her the ins and outs of the next plain of existence. And they are smiling, laughing and at peace.

This week, a Virginia television station did a story on Kaila. It can be found here:

https://www.wtvr.com/on-air/virginia-this-morning/observing-eating-disorder-awareness-week-kaila-blackburns-story

My heart goes out to Debi and Tom and her family. We belong to a horrific club that no parent should ever have to join.

Maybe this week, eating disorder awareness week, we should take just a moment, close our eyes, remember and honor those who have been taken. And in that moment of silence, perhaps we should reflect upon what our priorities should be going into the future.

As a parent who had a loving child taken by eating disorders, I hope and pray every day that Morgan’s life, that Kaila’s life, and the lives of many others, were not extinguished in vain. That perhaps the memory of them will inspire us all to do better. To set aside our petty differences. To pledge to strive forward together … with intelligence, wisdom, grace and collaboration.

So that in the future, there will be fewer Morgans and Kailas and Kellys and many others.

We parents remember. We mourn. We grieve. And yet, we continue to hope. And we continue to love.

And love should be the overriding message of awareness week.

The Illusion of Normal: Why Eating Disorder Mortality Remains the Quietest Fact in the Room


The most recent iteration of the iaedp symposium just concluded in Baltimore. Speakers, many of whom are the same familiar faces appeared giving similar presentations as in years past. And many people will go back to their practices secure in the feeling of a job well done. And the normalization continues.

We know that eating disorders are among the deadliest psychiatric illnesses in medicine. That is the uncomfortable truth that very few are willing to discuss.

That is not debated in the literature. It is not speculative. It is not marginal data. And yet the urgency one would expect around a lethal psychiatric disorder is conspicuously absent from the professional culture that surrounds it.

There are no sustained national funding drives proportionate to mortality risk. Federal research allocations remain disproportionately low compared to other psychiatric and medical illnesses with lower fatality rates. The disparity between lethality and attention is measurable.

So is the normalization.

Inside treatment systems, the language feels technical and reassuring:

Levels of care.
Step-down programming.
Compliance metrics.
Utilization review cycles.
Coverage determinations.

The vocabulary signals coordination. It implies rigor. It suggests that decisions are anchored in standardized expertise. How wrong that is.

On the surface, the system does not appear malicious. It appears procedural. Structured. Measured. Confident. Each provider can justify decisions within guidelines. Each insurer can defend criteria. Each organization can cite consensus statements.

The illusion is not cruelty.

The illusion is normal.

Normal treatment duration.
Normal discharge criteria.
Normal reimbursement ceilings.
Normal consensus frameworks.

Individually, nothing appears aberrant. Collectively, the structure produces outcomes that mortality data have been warning about for decades.

Which raises an uncomfortable question:

If eating disorders carry one of the highest mortality rates in psychiatry, why is that reality not the organizing principle of our professional gatherings?

The Silence Around Mortality

At major symposiums, such as the recent iaedp symposium in Baltimore, the agenda is full. Panels are polished. Continuing education credits are awarded. Networking flourishes.

Eating disorder awareness week is upon us. It will be acknowledged by a crowd measuring in the tens. Some media outlets will pay lip service to it. Again, the same faces will talk about the same messaging. Events will be broadcast on social media attended by the same people, again, measuring in the tens. At the end of the week, the community will pat itself on the back and go back to bickering about social justice issues being allowed in treatment rooms.

But where is the sustained, central, data-driven reckoning with mortality?

Where are the plenary sessions that open with longitudinal survival curves?

Where are the transparent discussions of long-term relapse and death rates across levels of care?

Where are the public audits of whether treatment durations align with neurobiological recovery timelines rather than insurance reimbursement windows?

Mortality is referenced, occasionally acknowledged, sometimes framed as a reminder of seriousness. But it is rarely dissected structurally.

Why?

Because a full confrontation with mortality data does not just indict illness. It forces scrutiny of systems.

It forces questions about whether reimbursement structures shape clinical standards, whether “medical necessity” criteria are actuarial compromises rather than survival-based thresholds, whether discharge decisions are tethered to coverage limits rather than durable recovery, and whether professional consensus has been influenced by economic sustainability of treatment centers.

Where are the public questions and demands about how a credit card company is now going to oversee and operate an eating disorder residential treatment center? And how is that even legal? Let alone in the best interests of our families.

Those are not comfortable conference topics.

For that matter, why wasn’t that topic discussed at the REDC meeting which took place in Baltimore in a public forum with families who are suffering ? What matters more? Families and the mortality rate? Or protecting one of your fellow REDC members from public scrutiny? Profit margins or saving lives?

It is far easier to discuss innovation in therapeutic modalities than to ask whether overall mortality has shifted meaningfully in decades.

It is far easier to host panels on emerging frameworks than to ask why families still encounter rationed care for a disorder with documented lethal risk.

It is far easier to refine language than to examine outcomes.

If symposium speakers are drawn repeatedly from the same professional circles, presenting iterations of the same frameworks year after year, the ecosystem becomes self-reinforcing.

Professional consensus carries weight. But consensus is not formed in a vacuum. It is shaped by committees, insurers, funding realities, dominant voices, and organizational politics.

If dissenting clinicians, particularly those who challenge reimbursement norms or treatment duration standards are marginalized rather than platformed, scrutiny narrows.

If social positioning and internal professional politics consume oxygen that should be directed toward structural reform, then optics begin to substitute for outcomes.

Meanwhile, mortality remains stubborn.

And rarely centered.

The most powerful stabilizing force in the treatment ecosystem is not bad intention. It is normalization.

If revolving door admissions are normal, no one is failing.

If truncated treatment is normal, no one is responsible.

If mortality is described as “multifactorial or complex” urgency diffuses.

But when a system designed to treat a known lethal disorder operates for decades without materially altering lethal outcomes, and that fact does not dominate its most visible professional forums, something deeper is occurring.

The silence itself becomes data.

How is it possible that a field organized around a disorder with one of the highest psychiatric mortality rates can gather annually without centering that mortality as the primary measure of success or failure?

If mortality is not the headline metric, what is?

Attendance numbers?
Program growth?
Expanded diagnostic inclusivity?
Brand alignment?

Those may matter. But survival matters more.

Progress should be visible in survival curves.

Progress should be reflected in transparent long term remission and mortality data published without marketing filtration.

Progress should include open debate about reimbursement models, discharge standards, and treatment duration norms.

Instead, the field risks mistaking activity for advancement.

The same speakers.
The same frameworks.
The same consensus language.

And the mortality rate remains among the highest in mental health.

How Is That Progress?

If a system repeatedly fails to prevent lethal outcomes and still considers itself structurally sound, normalization has replaced urgency.

The institutions may be populated by compassionate individuals. Many clinicians care profoundly. But compassion operating within a misaligned architecture cannot compensate for structural design.

When families trust that care is calibrated toward survival, and insurers trust that criteria are defensible, and professional organizations trust that consensus equals correctness, scrutiny diminishes.

And when scrutiny diminishes, reform stalls.

The question is not whether people inside the system intend harm.

The question is whether the system is calibrated toward survival … or toward its own stability.

Until mortality is treated not as a sidebar statistic but as the central accountability metric, at symposiums, in reimbursement negotiations, in guideline committees, the illusion of normal will persist.

And children, adolescents, women, and men with eating disorders will continue to face a lethal illness inside a system that rarely speaks about death loudly enough.

That is not progress.

It is normalization of unacceptable outcomes.

DSM Steering Committee Proposal

The DSM Steering Committee is recommending changes to the severity specifier levels of anorexia nervosa, bulimia nervosa, and binge eating disorder. The changes are intended to emphasize the importance of symptom severity, functional impairment, and illness-related medical complications rather than relying on a range of BMI levels (anorexia nervosa), episodes of inappropriate compensatory behaviors (bulimia nervosa), and episodes of binge eating (binge-eating disorder). The updated severity levels will also be more comparable to the severity of other disorders in the DSM.

The recommended changes can be found here:

https://www.psychiatry.org/psychiatrists/practice/dsm/proposed-changes#:~:text=Description%20of%20Proposed%20Change:,other%20disorders%20in%20the%20DSM

So, what does this actually mean?

First, the American Psychiatric Association has not yet agreed to change the DSM severity criteria for anorexia, bulimia, and binge eating disorder. This is a proposal, not an adoption.

Let’s review what the APA adoption process looks like.

Proposals are submitted: Changes to diagnostic criteria, additions, deletions, etc., are submitted by clinicians and researchers through the APA’s DSM proposal portal.

Next comes the Steering Committee Review. The DSM Steering Committee and specialized Review Committees assess the proposals for scientific evidence, clinical utility, and reliability. If the Steering Committee finds a proposal promising, it is posted for public comment.

The next step is the Final Steering Committee Recommendation. The Steering Committee issues a formal recommendation (either for approval or rejection/modification).

Finally, Steering Committee recommendations must then be approved by the APA Board of Trustees and Assembly before changes are incorporated into the DSM or DSM-5-TR.

With this review procedure in place, let us now look at how often proposals are rejected.

First, I could not locate any websites which show a published rate of rejection. But empirical examples from analyses of the initial iterative revision experience following DSM-5 publication exist.

In a report on the first 3 years of the iterative revision process twenty-nine (29) proposals were received.

These proposals resulted in a few successful changes: addition of prolonged grief disorder, modifications to existing criteria (e.g., ARFID), and inclusion of new codes.

One proposal was explicitly rejected by the APA Board.

17 proposals were returned to the submitters with requests for additional supporting data but not adopted as submitted.

Two proposals were rejected without further review due to conceptual issues.

Others were deferred or still under review.

Therefore, of the 29 proposals in the first three (3) years, it appears as if at least twenty (20) were not approved for inclusion in the DSM-5 or DSM-5-TR. While not a formal percentage, a substantial proportion of proposals (in this case, more than half of those submitted) did not directly result in adopted changes in that period — either rejected outright, deferred for more evidence, or modified significantly before acceptance.

Key points to understand from this process are approval is multistage. Even if the Steering Committee recommends a change, it still must pass approval by the APA Board of Trustees and Assembly. Importantly and statistically, the greatest impediment appears to be lack of data. The majority of proposals are returned for additional evidence rather than adopted, showing how stringent the criteria are on empirical support. Finally, the iterative process means ongoing evaluation: The APA’s current model for DSM revision is deliberately iterative and evidence-driven, which tends to minimize adoption of weakly supported proposals.

Also, the DSM is just a general guideline tool. APA’s practice guideline includes a “Statement of Intent” “… that the guideline should not be considered a statement of the standard of care and does not mandate any particular course of medical care and is not a substitute for independent clinical judgment.”

The DSM guidelines are NOT a generally accepted standard of care. In fact, there is no generally accepted standard of care (“GASC”) for eating disorders. This is a huge negative factor which has been haunting the eating disorder community for years.

That factor was decisive in the Wit v. UBH case.

In Wit v. United Behavioral Health, the district court held (and the Ninth Circuit largely left intact for this purpose) that:

An insurer’s internal guidelines are enforceable if they do not conflict with generally accepted standards of care.

Crucially, Wit did not require insurers to mirror professional association guidance, nor did it require guidelines to be optimal or patient-favorable … only that they not contradict the GASC.

This creates a binary inquiry:

If GASC exists and the insurance guideline contradicts it → unenforceable

If GASC is absent, unsettled, or heterogeneous → insurer discretion survives

That premise is decisive for eating-disorder claims. Unlike many medical conditions, eating disorders suffer from persistent standard of care fragmentation. There is no universally accepted level-of-care criteria. There are competing frameworks (APA, AACAP, SAHM, insurer-developed tools, proprietary LOC criteria). There is variation in reliance on: BMI; % expected body weight; Vital sign instability; Functional impairment; Psychiatric risk; Trajectory vs. snapshot severity.

Because no unified GASC exists, insurers can plausibly argue, “Our guideline does not contradict generally accepted standards—because no single standard exists to contradict.”

That argument has been repeatedly successful in eating-disorder denial litigation.

On a positive note, the Steering Committee proposal would reframe DSM severity specifiers for AN, BN, and BED. It would emphasize: Functional impairment; Symptom severity; Medical complications; Explicitly de-emphasize single-metric severity determinations (BMI/frequency counts).

However, and importantly:

It does not eliminate BMI for insurance company consideration;

It does not establish level-of-care rules;

It does not declare BMI-based criteria invalid;

It does not override APA’s SOC disclaimers.

So even if adopted, it would be diagnostic and descriptive, not prescriptive advisory nor normative.

Under Wit v. UBH, the DSM Steering Committee’s proposal, while clinically significant, would not materially constrain insurer claim handling absent a broader, enforceable consensus standard of care for eating disorders, which still does not exist.

Regarding the Steering Committee Proposal, there is a one-month public comment window [Until January 9, 2026]. It is critical that the APA hears from intelligent voices. Voices which supply objective data, medical evidence and information, independent authoritative research studies.

Undoubtedly, activists will also be submitting their lived experience stories claiming they are dispositive. And whereas they are certainly a part of the equation, collaborative messaging which shows unity and a collective strong voice is more important than ever before.

If you are struggling with the substance of the comments you wish to make, The International Federation of Eating Disorder Dietitians on its website has suggested comments. This page also has extensive background on the evolution of this initiative. (And yes, thanks to Jessica Setnick should definitely go out!):

IFEDD Advocacy Initiatives

That is the only way in which true evolution and change are possible.

Board Certification Chaos: How Disunity and Private Equity Diluted the Community

Few areas of mental health care illustrate dysfunction as clearly as the eating disorder board certification industry.

What began decades ago as a grassroots movement of passionate clinicians, dietitians, and advocates has metastasized into a labyrinth of overlapping credentials, proprietary “certifications,” and glossy corporate training programs.

Today, the United States alone boasts well over one hundred distinct eating disorder related certifications. This is more than that which exist for all other major psychiatric conditions … combined. For schizophrenia, there are fewer than a dozen. For depression, arguably the world’s most common mental illness, maybe two dozen. For autism, a total of ten programs. For eating disorders?

This is a table listing eating disorder related certifications:

The eating-disorder field, serving a far smaller patient population, is drowning in certificates, credentials, and branded “specialist” designations. And more are seemingly arriving every month.

This glut is not a sign of progress. To the contrary. It is the predictable outcome of a profession with no unified standards, no central accrediting authority, no ethical oversight, and an increasingly privatized treatment economy driven less by patient outcomes than by returns on investment and profiteering perpetrated by individuals and their egos.

The Great Credential Free-for-All

Unlike psychiatry or psychology fields with centralized boards and accreditation bodies, the eating disorder community has no single regulatory anchor. Instead, numerous competing organizations (IAEDP, AED, NEDA, ANAD, APT, and others) define “competence” differently and seldom recognize each other’s credentials.

The result is a credential arms race. Clinicians seeking legitimacy often accumulate multiple certifications, not because each adds new expertise, but because no one can agree which ones actually matter. Every theoretical school, CBT-E, DBT, FBT, ACT, somatic, trauma-informed, HAES®, intuitive eating, and more has spawned its own “certifying institute.”

With no governing framework, anyone can create a credential. And many have. Do you want to include social justice and political issues? Blame White Supremacy Culture? Blame the white man for all mental health issues? Create a certification program which does not include any information on ethics, or state-of-the-art medical and biological treatment? No involvement of diverse persons in creating a certification program? Extensively utilize information that is well known and has been in the community for many years? Sure! Why not? Who is going to say you cannot?

When Certification Becomes a Branding Exercise

This fragmentation might have remained a benign inconvenience if not for a second, more corrosive force: monetizing eating disorder certification through the rise of private equity.

Over the last decade, investment firms have used their monopoly power to control the narrative and then, consolidated the treatment landscape. In doing so, they squeezed the very life out of the field one dollar at a time. Large PE-backed treatment centers now own a majority of residential and intensive outpatient programs in the United States. And yet, at least one CEO of private equity owned treatment center testified in a sworn affidavit that the private equity owners prioritized profit over patient care. And patient care was compromised.

Private equity’s influence reshaped everything, from staffing ratios to program philosophy, but nowhere is the shift more visible than in education and credentialing. Under investor ownership, training is no longer an act of professional stewardship; it’s a marketing opportunity. Corporate chains launch internal “training academies” that sell branded certifications to staff and outside clinicians. Certification has become the new advertising … a low-cost, high-margin product that projects authority and generates revenue.

The loans to the investors are not simply going to pay themselves. Additional streams of revenue must be found to meet the financial demands.

Disunity as a Business Model

Eating Disorder organizations have failed to coordinate standards because fragmentation serves their financial interests. Each group has its own alleged proprietary curriculum, fees, and renewal dues. Collaboration would mean shared intelligence, information, revenue and control. Research and data would be collaboratively shared. For the first time the term, “evidence-based” would have substantive merit instead of simply being a vacuous catch phrase without any real meaning, without definition and without regulation.

Private equity masterfully exploits this vacuum. Without a single regulating body to enforce quality benchmarks, PE-backed centers can market themselves as the “gold standard” simply by aligning with whichever certification best fits their brand narrative. Or better yet, simply create your own standard of demonstrating expertise. No matter how many patients are abused, groped, or treated as if they were mere grist ground down by the mill of greed and incompetence, any treatment center can claim they are the “gold standard.”

Since they are privately owned, they can operate in the shadow of secrecy with information, which at best may be shared with their fellow PE owned overlords at quarterly meetings. Meetings which are conducted clandestinely, never to be disclosed to the families which need the highest level of care.

The Human Cost of Credential Inflation

For patients and families, the consequences are not academic, they’re life-altering. A parent searching for specialized care for a child with anorexia may encounter a clinician advertising six or more “certifications,” yet none of those credentials guarantee the provider has completed supervised ED training, worked within a multidisciplinary team, or met any validated competency benchmarks.

This blurring of standards enables underqualified practitioners to enter the field under the guise of expertise. Genuine experts are forced to buy legitimacy through redundant credentials simply to remain competitive in a marketplace driven by SEO and optics rather than outcomes.

The Wellness Economy and the Collapse of Accountability

The eating disorder arena overlaps with the $5 trillion wellness industry, which thrives on micro-credentialing. Nonclinical players, nutrition coaches, yoga instructors, and social media influencers alike obtain “eating disorder informed” certifications online, sometimes in less than a weekend.

Education has been replaced by branding. Evidence based care is replaced by radical social justice brain washing. If a person is offended by society, they need only slap an inflammatory label on the issue and not worry about its nuances. Congratulations! You have just become certified as an “Inclusive” board certified expert. The result is a field saturated with worthless credentials but starved for accountability.

Questions which should be asked are not being asked. For example, what new information does your certification program provide that was not already public knowledge in the community? Did, and does, your certification program include research professionals, medical doctors, dietitians, mental health experts, or even any men on its advisory board? Did you collaborate with any organizations or treatment centers when you were creating your program? What specialized knowledge does your organization have which other organizations do not possess? Do you have any agendas outside of providing necessary care for families suffering from eating disorders? How is your certification program going to lower the appalling mortality rate of eating disorders? Objectively speaking, how and why is your certification program an improvement over that which is already in the public domain?

Without substantive answers to these questions, professionals are left with a meaningless diploma … and simply more innocuous initials to put after your preferred pronouns.

A Perfect Storm of Profit and Disunity

Disunity and privatization feed each other. Lack of collaboration creates a vacuum; private equity monetizes it. The proliferation of proprietary programs generates revenue and brand differentiation but erodes professional credibility. Without regulation, there is no penalty for low standards, only rewards for market dominance.

The tragedy is that eating-disorder professionals entered this field to help patients including those most often marginalized by healthcare systems and diet culture. Yet through disunity and commodification, the field has allowed itself to become a marketplace rather than a discipline. Every new certification minted without oversight or accountability is another crack in the foundation of public trust.

Until collaboration replaces competition, and professionalism and the priority of patients triumph over profit, the eating disorder treatment industry will remain a cautionary tale: proof that when market logic outruns moral logic, vapid expertise becomes just another product for sale.

Nine Years Beyond the Darkest Night: Grief, Truth, and Hope for Greater Tomorrows

On October 30, 2016, my beloved daughter Morgan died after battling eating disorders for seven (7) long years. She was 23 years old when she was taken. At the moment of her death, when a daddy hears those dark words, “She’s gone” though he may not know it at the time, the better part of him is also ripped away.

Morgan was brilliant, kind, and fiercely determined to get well. She thought of others, often before her own needs. Her own words, “I can seem to help everyone else … I just can’t help myself” is her legacy. And yet, those very words still haunt her daddy every day.

When those words and the reality of a loss no parent should ever have to suffer are combined with the state of the eating disorder community today, you realize that there will be many more of our loved ones condemned to share the same fate which took my daughter… unless a seismic change is forthcoming.

A System Without a Compass

Even at that time, the system that claimed to know how to help Morgan had no map, no unity, and tragically, no accountability. Nearly a decade later, the eating disorder community is in even greater disarray. There are still no generally accepted treatment guidelines … no consensus on what works, no uniform standards for care, no consistency from one program to another and no accountability nor consequences. If you send your child for treatment, what happens next depends less on science and more on which center you happen to find, and what ideology dominates that space.

The Vanishing of Science and the Rise of Ideology

The dire crisis in the community has worsened as grant funding for research dries up. Federal and private funders have largely turned their attention to other mental health priorities, leaving eating disorder research chronically underfunded. Few new studies are being published, and the next generation of researchers is dwindling. Research professionals and medical clinicians on the front lines rarely collaborate. In this vacuum, ideological movements have filled the void … often louder, more absolutist, more absurd and less accountable to data or outcomes.

Militant factions within the “body liberation” movement now control far too much of the public conversation in the community. They label professionals, clinicians and even families in a gross, inflammatory manner. Anyone who speaks about weight restoration or malnutrition is labeled as “fatphobic.” White Supremacy Culture. Invasive species. Utilizing every “ism” word possible. Complex medical and psychiatric illnesses are reframed as political identity issues. The result? A silencing of nuance and a dangerous confusion between eating disorder treatment and radical social activism. Inflammatory labeling has become the substitute for reasoned professional, collaborative communication. And our loved ones suffer.

Private Equity and the Hollowing Out of Care

At the same time, private equity–owned treatment centers, once the great hope for scaling access, are collapsing under the weight of their own failed business models. Many have failed outright or are surviving only by slashing costs: laying off medical doctors who served as full time employees, replacing them with part time independent contractors and inexperienced working staff. Running skeletal programs that cannot provide the continuous, multidisciplinary care our loved ones require. The result is a race to the bottom: more marketing, fewer doctors, more “coaches,” less medicine. No accountability nor consequences.

Families are left navigating glossy websites and sales teams instead of evidence-based programs. If a family wishes to speak with the medical director of a program before entrusting their child to that program … good luck. Insurance denials come faster than ever. Inpatient stays are shorter. Step-down programs are often nonexistent.

When Morgan was fighting for her life, I wondered whether the lack of care was a failure of coordination. I no longer wonder. It has never been clearer that it was and continues to be, a failure of values.

A Community in Financial and Moral Crisis

The largest eating disorder nonprofit organizations, long believed to be the moral anchors of the community, are collapsing financially some losing more than $200,000 per year. Echo chamber thinking and associated conduct have replaced outreach to professionals who respectfully disagree with their view. Where at one time, these organizations were led by persons of vision, true giants of the community, now with very few exceptions, they are led by boards who shrink away from transparency, oversight and responsibility. These organizations host conferences and awareness campaigns, but their impact is negligible at best and failing at worst.

Their messaging has grown vacuous and timid, shaped more by the politics of social media than the needs of our loved ones. Once they were advocates for treatment access and medical rigor; now too often, they stand meekly on the sidelines … mere bystanders to the on-going carnage.

The Human Cost

The price paid for the wholesale failure of the community is measured by the dearest blood possible … the lives of our loved ones. The mortality rate for eating disorders, already the highest among psychiatric illnesses [apart from opioid addiction] has worsened. Suicide and medical complications are climbing. The promise that “recovery is possible” rings increasingly hollow to families who can’t even get a proper diagnosis, let alone a full course of the highest quality medical and mental health care. Which results in:

Behind every number is a person, a victim. Behind every person is a family like mine, standing outside a treatment center, a hospital, a counselor’s office, desperately holding on to the only thing they can … that is, the fading hope that this time will be different.

Where Do We Go From Here?

Families are entitled to transparency. Accountability. Honesty. From our doctors, clinicians, and counselors. Families should demand nothing less. But, to accomplish this reality, we not only need an evolution of thought and wisdom … we require a bold reckoning. The eating disorder community must reclaim science, ethics, and accountability. The community can only provide those necessary qualities by demanding:

  • The adoption of national treatment guidelines grounded in evidence, not ideology.
  • Federal, state and philanthropic investment in clinical research and longitudinal outcomes.
  • Oversight of private treatment companies that market medical care that is not forthcoming as it  sheds experienced medical practitioners and licensed staff.
  • Strong, bold, new leadership in nonprofit organizations that prioritize patients over politics.
  • Measured inclusion of all reasonable, rational, intelligent viewpoints and persons.

But these steps require a courage of conviction… conviction which is sorely lacking.

Not just Morgan, but all those who have died from eating disorders cannot die in vain. But until we admit that this system and community are broken, until we expose the silence, the failures, the charlatans, thed fraud and the fear … we will keep losing more daughters, more sons, more loved ones, more years of life.

The eating disorder community once promised healing. Today, it must fight simply to survive. For survive it must. But in an evolved, intelligent, collaborative manner.

The very lives of our loved ones depend upon it.

EQUITABLE MENTAL HEALTH CARE AWAITS

Two of the more troubling topics confronting mental health communities are: (1). Lack of Minority Representation in the Mental Health Workforce and (2). Limited Accessibility of Mental Health Care in Minority Communities.

We will be focusing on exploring real world, workable solutions instead of using inflammatory labels, pointing fingers and embracing the litany of “isms” being cavalierly thrown around.

Any solution necessarily begins with starting and having open, collaborative conversations. While recognizing that a start is just that … a start and not a solution. And yet, from that start perhaps seeds are planted from which bold, forward-thinking initiatives grow which could ultimately result in a better world.

Increasing Minority Representation in the Mental Health Workforce

No one disputes that minority representation in the mental health workforce is grossly lacking. So, let’s address some of the issues which produced this inequity and explore possible solutions.

1. Financial Pathway Support

Problem: The cost and duration of training (graduate degrees, licensure) are major barriers for minority students.

Possible Solutions:

  • Targeted scholarships and loan repayment programs for minority students in psychology, psychiatry, counseling, and social work (e.g., HRSA’s Behavioral Health Workforce Loan Repayment Program could be expanded or localized).
  • Paid internships and residencies in community-based organizations serving minority populations.
  • Employer-based tuition reimbursement tied to post-graduation service commitments in underserved areas.

2. Pipeline Programs (High School → Graduate School)

Problem: Minority students are underrepresented early in the pipeline.

Possible Solutions:

  • Create “Grow Your Own” mental health workforce programs in high schools and community colleges — exposure to mental health careers, mentorship, and clinical shadowing.
  • Partner with HBCUs, HSIs, and Tribal Colleges to create joint degree or accelerated pathways into counseling, psychology, and psychiatric nursing.
  • Establish bridge programs for paraprofessionals (e.g., caseworkers or peer specialists) to obtain advanced clinical credentials.

3. Licensure and Training Reform

Problem: Licensure barriers disproportionately impact minority and bilingual professionals.

Possible Solutions:

  • Reciprocity agreements among states to ease cross-state licensing for clinicians serving telehealth clients.
  • Allow supervised hours to include culturally competent community-based or telehealth work, not just traditional clinical settings.
  • Bilingual competency credits or pathways for professionals providing care in multiple languages.

4. Mentorship and Professional Networks

Problem: Isolation and lack of role models lead to attrition.

Possible Solutions:

  • Fund minority mentorship programs through professional associations (e.g., APA, NASW, NBCC).
  • Develop online professional communities for peer support and continuing education focused on serving minority communities.

There are no “zero sum game” arguments. No white people must step aside. No looking backward as to what was previously done wrong. No obsessing on the past.

Simply a possible roadmap to start discussions to increase minority mental health providers.

This is going to become even more important in the future as research scientists increasingly discover additional biological links between the brain and mental health issues. We could be at the genesis of a bold new frontier regarding how mental health issues are studied, researched and treated. We need all persons to be involved in this process.

With this reality facing us, how do we increase accessibility of mental health care?

Increasing Accessibility of Mental Health Care to Minority Communities

Mental health care providers, resources and treatment centers must become more available and accessible in minority communities. Let’s explore how we can start to address this issue.

1. Community-Based and Culturally Anchored Services

Problem: Mainstream clinical settings in minority communities are few and far between and when they do exist, can feel unwelcoming or irrelevant.

Possible Solutions:

  • Fund community-based organizations, churches, and cultural centers to offer embedded mental health services (e.g., co-located clinics).
  • Recruit faith leaders, barbers, and cultural ambassadors as mental health liaisons trained in Mental Health First Aid or peer support.
  • Support mobile crisis units staffed with culturally and linguistically matched professionals.

2. Telehealth Expansion and Equity

Problem: Digital divides and lack of culturally competent telehealth platforms persist.

Possible Solutions:

  • Subsidize broadband and devices for patients in rural or low-income minority areas.
  • Require telehealth platforms to support multilingual access and easy interfaces.
  • Train clinicians in telehealth cultural competence (e.g., cross-cultural communication online).

3. Insurance and Reimbursement Reform

Problem: Minority-serving clinics often cannot sustain services due to poor reimbursement rates.

Possible Solutions:

  • Equal reimbursement for behavioral health and physical health under parity laws (and enforce it). [This requirement is already provided by federal law. Insurance companies have found ways to avoid or get around this requirement.  These loopholes must be closed by legislative bodies.]
  • Expand Medicaid coverage for peer support specialists and community health workers.
  • Incentivize integrated care models (behavioral + primary care) in federally qualified health centers (FQHCs) and minority-owned practices.

4. Public Awareness and Trust-Building

Problem: Stigma and mistrust are major deterrents.

Possible Solutions:

  • Fund anti-stigma campaigns featuring diverse community voices and lived experiences.
  • Partner with trusted local messengers (e.g., influencers, pastors, tribal elders).
  • Offer mental health literacy programs in schools and workplaces, especially in minority-majority areas.

Of course, all of this is not probable unless there is greater policy, corporate, institutional and legislative support. This support could resemble the following:

Policy and Institutional Support

  • Data collection and accountability: Require reporting of workforce demographics, service access, and outcomes disaggregated by race/ethnicity.
  • Federal and state grants: Prioritize funding for programs demonstrably improving minority recruitment and retention.
  • Cross-sector collaboration: Involve education, housing, and criminal justice systems in joint mental health equity initiatives.

An “Integrated Implementation Model” could be structured as follows:

Minority Mental Health Workforce Accelerator (state-level example):

  • Provides full scholarships and living stipends to minority students pursuing behavioral health degrees.
  • Requires 3–5 years of post-graduation service in designated shortage areas.
  • Operates mentorship and continuing education programs led by culturally competent practitioners.
  • Partners with community-based agencies that receive reimbursement incentives for hosting trainees.

The mental health field, particularly the eating disorder community, talks of the need to increase minority mental health providers and the necessity of having greater access to mental health care for minorities. The community is absolutely correct. But that is as far as rational discussions go.

More often than not, discussions take place in an echo chamber. The community points fingers at the patriarchy, white supremacy culture, the diet culture and apply many other inflammatory labels … and nothing is accomplished. The community is defined by the past. A failed past. Instead of embracing a bold future.

Solutions to provide mental health care for our minority population can only be found by looking to the future. A future filled with hope and unlimited possibilities.

Inflammatory Labeling = No Progress

The mental health system in the United States is inundated with inequities and is hindered by limited access to care. Universal complaints about mental health include gross underfunding of services, provider shortages, fragmented care between mental and physical health, inadequate insurance coverage and widespread stigma that creates policy and opportunity barriers for people with mental illness. No one disputes that reality.

When significant cultural issues confront us and change is demanded, generally there are two types of people.

There are those people who lead, who are people of vision. They recognize and identify the problems and then commit to explore workable, rational, obtainable, collaborative solutions. These people who will negotiate with Satan himself if it leads to more people receiving the help they so desperately need.

Then there are “the ROYS.” In Texas, that acronym stands for “Rest of Y’alls.” This constitutes the vast majority of people. Those who are content with only complaining about the problems without being willing to invest in finding a rational, reasoned, collaborative solutions. When facing those issues, they immerse themselves deeper in their tribes safely ensconced in the comfort of their echo chamber. They are satisfied with whining and applying inflammatory labels to the issues. Their egos and fears drive their lack of vision. They refuse to interact with anyone who does not agree with them.

With that backdrop, how may we presume the eating disorder advocacy/therapist community responds to the daunting issues confronting mental health in general, and eating disorders specifically?

In the past few years, I have spoken with research professionals, medical doctors, therapists and advocates about the state of the eating disorder community. All seem to be unanimous in their view that things have never been worse in the eating disorder industry and communities.

As such, it should come as no surprise that the community seems largely content to address daunting, societal mental health issues by fostering divisiveness through utilizing inflammatory labels on their websites, publications and even a purported certification program. In general, inflammatory labels are cavalierly directed toward other people in the community, but only from a person’s keyboard.

So, what is inflammatory labeling? Inflammatory labeling is just as it sounds. It is when we assign highly negative or even cruel labels to people or organizations.

Focusing on inflammatory labels instead of solutions in social justice movements, or for that matter in any context, hinders progress by reducing complex issues to oversimplified caricatures. This practice intensifies social divides, alienates potential allies, and prioritizes outrage over tangible reforms. While rhetoric is central to advocacy, the way it is framed can either drive constructive dialogue or deteriorate into unproductive polarization.

Studies on social movements have found that extreme or inflammatory rhetoric, including labeling, tends to decrease public support for a cause. This is because such tactics reduce the average person’s sense of identification with the movement, making it difficult to find common ground. Inflammatory labels simplify people into negative stereotypes, making it harder to recognize their full humanity.

This reflects the sociological concept of “labeling theory,” which posits that assigning a negative label can lead to a self-fulfilling prophecy and further entrench deviance. Labeling opponents with charged terms can create a binary “us vs. them” mentality, making it difficult to challenge ideas through reasoned debate. Instead of addressing the complexities of an issue, discourse devolves into a culture war of labels, name calling, and finger pointing all of which obscures real policy solutions.

By way of example, radical eating disorder activists casually throw out inflammatory labels like:

There are so many others: White Privilege, Whitestream Research, toxic masculinity. These inflammatory terms of derision are directed at anyone who does not agree with their viewpoints as well as the mainstream medical and mental health communities. In addition, the term “invasive species” is even being used to define or refer to the same White Supremacy Culture and people and organizations which fall under that umbrella. And that is supposed to be productive?

As for any proposed practical, realistic collaborative solutions to address the inequities in mental health care? They propose none.

A few years ago, a small group of people published a letter directed at eating disorder organizations and treatment centers. Amongst the demands made in the letter included: providing reparations to Black People, Indigenous people and People of Color, (“BIPOC”) especially queer and transgender BIPOC; hiring a transgender consultant to revise your marketing material; establishing sliding fee scales for BIPOC, transgender and gender diverse clients; redistributing wealth from the for-profit ED treatment world; providing access to Hormone Replacement Therapy.

Other radical activists equate mental health research and treatment as a zero sum game. That BiPOC, LGBTQ+, fat therapists and professionals must be centered and that there is no space for white, straight and thin people to jump in. Or that white, liberal female therapists should focus more of their attention on social justice issues and political reform in all they do.

Of course, in the unlikely event the latter ever happened, those therapists would then be labeled as White Saviors and would be publicly eviscerated in the town square ala Lindo Bacon.

There must be a way. Other than inflammatory labeling, whining and complaining, what possible solutions exist which could be explored to address some of the inequities in mental health care systems?

Inequities which include far too few medical doctors, therapists, counselors and other medical and mental health professionals who are BIPOC. Minority and BIPOC communities are far underserved. Medical school training largely ignores eating disorders and BIPOC issues. Far too few BIPOC persons receive mental health care. Access to meaningful mental health care is severely limited for BIPOC persons. Research has not included significant BIPOC participation. Mental health care can be prohibitively expensive.

These complex, daunting issues require collaborative wisdom. And when progress is made on these issues, as they surely must be, this necessarily will result in a more enlightened society. So, the question must be asked again … how are name calling, tribal mentality and inflammatory labeling going to be remotely effective in addressing these serious issues? Answer … they aren’t.

A roadmap does exist for systemic mental health reform in the U.S., prioritizing enforceable, high-impact interventions first while building toward longer-term initiatives. The roadmap assumes some federal and state collaboration, leveraging funding, licensing, audits, and measurable metrics. But it is possible. It will not be easy. It will require participation, wisdom and sacrifice from society as a whole. It will require us looking past our human frailties and being bold and forward thinking. But it is possible.

And so, we will address that roadmap next.

RIGHTEOUS INDIGNATION ?

Recently, after expressing my views on the eating disorder community and its many dysfunctions, I was informed by an “eating disorder advocate” that I only had “righteous indignation.” In the past, this same person also opined that I was in the eating disorder community solely to make money.

Righteous indignation? Solely to make money? Let me answer both plainly: my anger is earned, and my motives are grief-forged — not mercenary. I paid my entry fee into this dysfunctional community with the dearest blood possible: my daughter’s. I did not come here to be liked, or to join the chorus of vapid, comfortable, egomaniacal voices. I came because someone I loved was ripped from life. Silence would be complicity.

Make no mistake, there are some incredible, soulful, intelligent, compassionate souls in the eating disorder community. Unfortunately, they largely remain silent, on the sidelines. Fearful of being ostracized or cancelled by the hate filled, social justice warriors.

I wish with every fiber of my being that I was not in this decaying eating disorder community. I wish that I did not know even one person in this horrifically comical, appalling community. For that would mean my daughter, Morgan lived. But since she died, I will allow my “righteous indignation” to illuminate what having a beloved child ripped from life is like.

Sunday nights in an intensive care unit in a hospital in a large city can be very quiet.  But, not for you. You hear the ear shattering blaring of alarms, screaming out “Code Blue.”  Death is sounding for your daughter. Death has come for you!

With panic in your eyes, you look into her room and cannot even count the number of hospital employees trying to bring her back to life. For at that moment, she is dead. Her heart is not beating. And you feel nothing at that point.  The greatest fear a parent can face has you in its powerful, icy grip. Your brain has stopped working. You are not aware of anything… except the frantic efforts to bring her back to life. Finally … they detect a faint heartbeat after nine excruciating minutes.

Do you know what it’s like to have your child dead for 9 minutes while you look on helplessly? It is a lifetime. You are drenched in sweat. You are aware of nothing. Except … for the briefest of times, she is living again.

Until once again … she dies … and you again hear those horrific alarms of death. Again … her room is filled with employees doing all they can to bring her back. You are numb. Your entire world is in that room … on that incredibly dark night. And once more … they briefly bring her back.

That is when the doctors pull you aside and tell you … each time it is more difficult. You ask if she feels any pain. They cannot give you a straight answer. They tell you that in all likelihood, there is already substantial brain and organ damage. You ask them if there is truly any hope.  They cannot look you in the eyes and are mumbling non-answers. And you know. You know. You are faced with the most difficult decision any person will ever have to make.

You remember one time in the past, your beloved daughter saying … “Daddy … don’t let me die.” And you know, you know, for an absolute certainty … that your life will never be the same. You wonder if you can ever forgive yourself for betraying those sacred words.

There is nothing performative about that grief. It is not a credential.

You slowly nod your head and quietly, while tears are pouring down your cheeks, say … no more alarms. No more bells. She will go in peace.

You sit next to her, holding her hand, praying for a miracle … knowing that one will not come. Finally, you hear those words which rip the heart from any parent … “She’s gone.”

You slowly walk down the dark hospital hallways. Sunday nights can be quiet in a hospital. You go to a waiting room where your daughter’s mom is waiting with friends.  You can’t say the words… only shake your head. And you hear that heart wrenching scream of anguish. And yet, you feel nothing.

Your life as you knew it … is over.

You live in a fog. Making funeral arrangements, service arrangements. You feel nothing. Food has no taste. Your soul is numb. You wonder if you even want to wake up.

But you find a way, some way, to wake up and to keep living. Now, imagine that for most of your professional life, you had been a shallow, superficial, asshole. An attorney without a soul. But something has awakened within you. You begin to feel driven. Perhaps for the first time in your life, you are aware of something far greater than you.

In your daughter’s name, you only want to make a difference. You want to help others. But you are so broken. You make mistakes. You live in a constant state of guilt and shame. Nonetheless, you pledge to help others. And so, you try.

You then discover in the eating disorder community, children’s lives are being reduced to talking points, a and mortality is sidelined in favor of crowd-measuring. You read that this is no place for thin, white people to jump in. You realize that families are being betrayed by radical activists who only wish to parade their own ignorance and internal pain. Nonetheless, you continue to try. You try to serve.

You give two TEDx talks on eating disorders.

You organize and with a medical doctor, present a talk to Apple … and its 150,000 employees. The talk was broadcast on Apple’s North American network.

You organize and with that same medical doctor, present a talk to Raytheon … and its 75,000 employees. Also broadcast on its national network. This talk was so informative and compelling that the Raytheon office hosting it won a national corporate award for collaboration with the community.

You organize and present a 30-minute segment every week on a local radio station entitled, the Mental Health Moment. You have national experts on mental health appear on your show.

You appear on the local CBS and Warner affiliates talking about eating disorders.

The methodist church you belonged to does a video on your daughter and her struggles. With over 300,000 views, no other videos this church has done comes even close.

You speak to school district’s counselors and nurses. You organize presentations to communities. You visit young people in treatment programs. That is still not enough.

You are still living in a twilight that knows not joy, nor love, nor happiness.

Because you do not check the correct political and social boxes, because you frighten people, the eating disorder community turns on you. Have you made mistakes? Hell yes.

But it gets worse. Just five years ago, your father, your mother and your older brother all die within 14 months of each other. Your brother was the picture of health. And he only trusted you to tell the doctors to end his bodily functions. Imagine that much death in such a short period of time.

At that moment in time, your son and his wife have a baby. Imagine the very first time you hold your granddaughter in your arms, you have to tell your son you are flying to Florida the very next day to tell doctors to remove life sustaining equipment from your brother.

You know the eating disorder community doesn’t care. You frighten them because you do not play their pedantic games. You care about life and death not social justice and political statements.

And so, your mindset begins to evolve. You see the vile, on-going corruption in the community. You see the illness which claimed your daughter’s life being used as a platform to spew forth the community’s social justice and political viewpoints. And you reach a point where you say … enough!

Donors to NEDA come to you so angry that NEDA is being turned into a social justice and political side show by Chevese Turner and her social justice warriors. You have the ability and skill to take action. But first, you give NEDA almost 20 opportunities to talk before you file suit. An expeditious settlement is reached, a settlement which also financially benefits research into the genetic aspects of eating disorders. And yet, the very person who attempted to destroy NEDA’s purpose, skates by with no tangible consequences. She knows that her minions and cohorts in the community will continue to breathe life into her. Consequences and ramifications are foreign to the eating disorder community.

Undeterred, you go after more inappropriate conduct in the community. You see the specter of death appear in the words, “Terminal Anorexia.” Like many others, you are horrified. University-based professors write neatly composed articles opposing it, articles which accomplish nothing. Nothing tangible is being done.

So, you take action. You file a number of medical board complaints. That changed everything. You meet Dr. Jennifer Gaudiani and look her in the eyes. Much to your surprise, you do not find a monster. Instead, you find a professional. A soul. A human being. A person then in pain. You talk. And then collaborate with many others. What grew from that hard work was not triumphalism but human connection: colleagues turned collaborators, pain turned toward repair. And maybe … just maybe, you find through adversity a greater understanding about life and death. You realize that the manner in which we face death is just as important as the manner in which we face life.

Then, there is iaedp. The corruption and stupidity in that organization were and are legion. And the eating disorder community DID NOTHING. It cowered. The rot there was obvious and long tolerated. You initially do not pursue headlines and seek to meet and resolve all issues privately. That outreach is rejected. So, professionals in the community request action. The result: past due taxes, penalties and interest in the hundreds of thousands of dollars are being required to be paid. Board certification is being reformed and made more affordable. Individual chapters are gaining their independence. Thousands of therapists are now being spared needless expense. The community has improved — slightly, imperfectly — and for that action, very, very few people have said thank you. Predictable.          

You are not finished. Not nearly. You expose how Chevese Turner and others of her ilk took down the Legacy of Hope. And for their misconduct, they have been rewarded and still have a voice. The community blindly accepts those who think like they do. Contrarily, you continue to exist. Living with the greatest heartache possible.

No matter how many times textbooks say, “it’s not a parent’s fault,” or some vacuous therapist tries to convince you of that, they fail. They haven’t lived it. They don’t live with the daily pain, the heartache. The anguish.

I do. Every … single … day.

I have made mistakes, and I will make more in the future. Grief is not a moral compass. But the stubborn refusal to confront corruption, the eagerness to defend the performative rather than the practical, that is the real moral failure. When children’s lives are reduced to talking points, when mortality is sidelined in favor of crowd-measuring, the community betrays the very people it claims to serve.

So — righteous indignation? It is paid in blood and sleepless nights. It is the only honest response left when an industry cloaks politics in the language of care and ignores the medical science in front of it. If you are offended by my anger, consider why the community has earned it.

I do not wish to be part of this community. I wish — every day — that I did not know anyone in it. I wish my daughter, Morgan, were alive. I mourn her constantly. My activism is not grandstanding; it is grief turned toward accountability, toward saving the next life.

If you call that righteous indignation, so be it. I am guilty as charged. And I will keep speaking and acting until this feckless culture chooses truth over theater.

So … righteous indignation?

A brilliant light was extinguished in Dallas on October 30, 2016. That tragedy is the ledger against which I measure every day. Righteous indignation is paid with the dearest blood possible — and I will not apologize for the balance I keep.