Tag Archives: anxiety

Consequences and Ramifications?

On October 25, 2024, Acadia Healthcare is hosting and presenting the event, the 20th Annual Renewed Eating Disorder Conference in Nashville, Tennessee.

First, by all accounts, the organization, “Renewed, Eating Disorders Support” does good work in the State of Tennessee. No vitriol is directed at them … other than addressing their host and presenter of the event at issue.

The event’s keynote address is entitled, “Adventures in Treating Eating Disorders: Sharing Wisdom from a Cumulative 75 years of Practice.” The overview of this talk includes: “The overall goal of this presentation is to provide eating disorder practitioners from all disciplines and all levels of experience valuable knowledge and insight to enhance their effectiveness.”

So, with that in mind …

Is this the talk where practitioners from all disciplines learn that raping and/or sexually abusing patients is a bad thing?

Or is this the talk where practitioners from all disciplines learn that residential treatment centers can employ persons who allegedly commit rape and/or sexual assault but so long as the bottom line is not negatively impacted, you can ignore the rape and/or sexual assault and not be transparent about it?

Or is this the talk where practitioners from all disciplines learn that treating eating disorders is expensive because it demands the highest level of skill from experienced treatment providers? But since that impacts the bottom line too much, you get out of the eating disorder treatment field and adopt an addiction focused regiment which is far less expensive to implement?

Or is this the talk where practitioners from all disciplines can learn that even though a scathing Senate Committee Report was published which eviscerates your organization, so long as it doesn’t impact you from a financial standpoint, that Report is simply not material?

With all of the recent controversies and issues surrounding Acadia, aren’t we justified in believing that reputable eating disorder organizations would shy away from sponsoring or supporting any event in which Acadia is involved? After all, there is precedent. In 2019, after the Timberline Knolls – Jacksa abusive misconduct came to light, NEDA returned a $10,000 donation Timberline Knolls had made. Surely, because of Timberline Knolls and Acadia’s recent issues, in order to show support for the victims of misconduct and criminal behavior and to make a loud statement against grossly negligent entities, organizations would withdraw their sponsorship and pull out of that event.

Instead, let’s look at the sponsors listed for the October 25th event:

Within

ACUTE Center for Eating Disorders and Severe Malnutrition


Alsana


Blue Ridge Eating Disorder Care Center


Center for Change


Eating Recovery Center and Pathlight Mood & Anxiety Center


Equip


Focus Treatment Centers


Healing at Hidden River


Koru Spring


Laureate Eating Disorders Program


Monte Nido


Odyssey Eating Disorder Network


Rogers Behavioral Health


SunCloud


The Emily Program


The Renfrew Center

Like Captain Renault’s quote in the movie Casablanca, “round up the usual suspects,” we see the usual list of corporate entities in the eating disorders field.  

It would appear as if no one … absolutely NO ONE … demands accountability or seeks to impose consequences for reprehensible conduct. So long as money continues to be the primary motivator for the owners of treatment centers, apparently there will be no demand for repercussions for bad behavior. And as a result, the families who are suffering are further victimized. Patients, loved ones, being sexually abused and/or raped by employees. Our most vulnerable population being preyed upon.

And all we hear is silence.

Where is the integrity?

Where is the dignity of human life?

Where is the placing the needs of the patient and families who suffer from this illness first and foremost?

I don’t think I have ever been more disgusted with the eating disorder community. So, some people may wonder why don’t I just leave then?

I don’t have much of a choice.  In 6 days, I will mark 8 years since my daughter, Morgan died.  That personal tragedy put me on this path … this macabre journey which has exposed corruption and dysfunction far greater than any I exposed or experienced in 40 years of practicing law.

I also strongly believe the memory of my daughter, and the memory of others who have died from this insidious illness have been soiled by not just the bad actors in the community, but those who refuse to stand up against the bad actors in the community.

By those who refuse to take a stand. By those who just conduct business as usual. By those who refuse to draw a line in the sand and say, “No more will we stand with those who hurt our most vulnerable population.”

Until then, the message being sent by this community is … a healthy return of investment to Acadia’s shareholders is far more important than providing life-saving care and preserving the dignity of life.

If you are not disgusted and sickened, you should be.

Et tu AED?

The Academy for Eating Disorders (“AED”) announced its annual international conference (“ICED”) will be held in San Antonio, Texas from May 28, 2025, through May 30, 2025.

The announcement for ICED 2025 can be found here:

https://www.aedweb.org/aed-events/iced-2024881

I will quote the most naïve, divisive, lunatic language:

“While Board members were excited at the opportunity, there was much concern for the comfort and safety of our attendees considering the political climate in the state of Texas.” 

“We understand and respect that some of you will make the decision not to attend ICED 2025 due to its location. We hope that you will continue to support AED, and perhaps consider a donation to one of the many grass roots organizations in San Antonio fighting for equality. Thank you.” 

Good Lord.

Comfort and safety of our attendees? Really?

Not attending because of its location? Really?

I guess the master plan of the ultra-right wing conservative people was leaked! This plan consists of as soon as anyone on the left of the political spectrum retrieves their luggage at the San Antonio airport, the “tree hugging, Birkenstock wearing, granola eating person” alarm will immediately and loudly sound out. Five white men in white dress shirts and jeans, will approach you, surround you and escort you to a nearby Ford 650 XL pickup truck.

From there you will be driven to Billy Bob’s Church for the Reclamation of Lost Souls.  Upon being escorted into the 25,000-seat sanctuary, you and your fellow “libruls” will be restrained in your seats.  Then, “Clockwork Orange” style, you will be forced to watch endless hours of Bible studies, religious movies and other right-wing propaganda until you are completely brainwashed.

You will then gladly become members of the church, enter into an agreement wherein you agree to tithe 20% of your gross revenue in perpetuity. Only after all of this, you will then be escorted to the hotel.

“Comfort and safety of our attendees …”

I cannot begin to fathom the insipid mania nor the superficiality of the intellect and the lack of soulfulness of people who are so entrapped by their political views that they are willing to compromise their education and understanding of eating disorders. That their radical leftist tribe means more to them than the people and families who are suffering from eating disorders. Isn’t that the ultimate act of betrayal?

For that matter, for many of those AED research professionals, how many have even been exposed to that type of suffering? Or do they merely sit in their faux ivory towers, applying for grants that very few receive? They publish a paper every three years … a paper widely read by an audience of maybe nine (9) people before it disappears into that vast gap wasteland. And they cling with quiet, and yet overwhelming desperation to the hope that “they matter” knowing all the while that they must toe the radical, “librul” company line or risk being ostracized and cancelled.

Well, here is an idea. For even one week every year, get out of your Styrofoam tower, contact a reputable clinician and then shadow them. Look into the eyes of families, of people who are suffering from eating disorders. Look at their pain. Look at their anguish. Look at their fear. And yet, we know they won’t do that.

That is because they are driven by their own fear. They do not grasp that fear is illogical and unreasonable. It is a function of our own ego. The only place that fear can exist is in our thoughts of an unknown future. It is a product of our imagination. It requires us to consider things, events that do not currently exist and may not ever exist. Fear is a choice. And yet, fear defines them.

“Comfort and safety of our attendees …” Good Lord.

Fear has become their master. And in becoming their master, failure becomes an inevitability. Fear prevents them from growing. Fear shackles them in chains of cruelty and oppression and prevents them from embracing a brighter future.

With whatever integrity, if any, they have left, AED as an organization should just announce that henceforth, their members will only conduct research applicable to the librul mindset. That they will only support clinical treatment aimed toward the librul mindset.  That they will only hold their future conferences in librul cities like Berkeley, Seattle, Boston, or San Francisco. Where all members can be safe and comfortable among their fellow tribespersons. And they need not interact with anyone who remotely disagrees with them. They can remain safe and comfortable. Because that is working out so well for them.

After all, who cares that on its last Form 990, filed for 2022, AED showed revenue of $584,436 and expenses of $858,402 for a net income loss of -$273,966.00? Who cares that AED paid a management company, Virtual Inc. $382,358.00?  That this management fee constitutes 65.4% of its gross revenue?

In 2021, AED showed a loss of -$118,334.00.

In 2020, AED showed a loss of -$200,058.00.

But there’s nothing to see here. Move along. Move along. AED must keep pursuing their librul agenda at all costs even to the extent of suggesting that instead of making donations to worthy eating disorder causes and organizations, its more offended members should donate to organizations in San Antonio fighting for equality.

After all, it’s not like eating disorders is serious or has the second highest mortality rate amongst all mental illnesses.

“Comfort and safety of our attendees …”

Good Lord.

Medical Aid in Dying or Physician Assisted Suicide?

Words matter. Words are one of the strongest ways in which we communicate. We use words to express every human emotion. When words are used passionately and honestly, they can inspire us to greatness. Motivate us to dare mighty deeds. To, in the name of humankind, be open to exploring the greatest mystery facing us, that is, our very existence.

Close your eyes. Now, embrace the rapture you feel when the most special person in your life holds you in his/her arms, looks you in your eyes and says, “I love you.” Revel not just in those words, but the feelings and emotions they evoke.

Contrarily, words can also be used to inflict the deepest, darkest scars on a person’s soul. Words can cause such pain, such rage … such defeat, that they can push us prematurely closer to our graves.

Again, close your eyes. And try to imagine how you may feel when the most special person in your life looks you in the eyes and says, “I do NOT love you.” One word. One small word. One word changes everything. It changes feelings, emotions. That one small word changes … life.

Recently, end of life issues in the mental health community have come to the public’s attention, not just domestically, but internationally. Are physicians in the Netherlands prescribing death-inducing medications for autism? Is the UK government allowing life support measures to be removed from a child against a parent’s and their doctor’s wishes? Canada’s recent decision to delay until 2027, end of life measures for persons whose primary diagnosis is a mental health issue. And of course, here in the U.S., end of life options for persons suffering from severe and enduring anorexia.

And yet for these great emotional debates and issues, we cannot even agree which term of art to use … Medical-Aid-in-Dying (MAiD) or Physician Assisted Suicide (PAS). Each phrase engenders very different thoughts and feelings. Granted, this was not much of a debate when MAiD was first being considered for biologically based diseases for which the medical community did not have viable cures. It is now.

Dr. Matthew Wynia, director of the University of Colorado’s Center for Bioethics and Humanities, states: “There is a significant, a meaningful difference between someone seeking to end their life because they have a mental illness, and someone seeking to end their life who is going to die in the very near future anyway.”

As Lee Corso, a college football pundit and legend is fond of saying, “Not so fast my friend!”

Now, a once relatively clear line is being blurred.

In the United States, ten states and the District of Columbia allow patients to receive life ending medication. However, among these states, I could locate no provision specifically including, or excluding mental health issues. 

Instead, the statutory language focuses on the requirement of a “competent, terminally ill patient.” A vague, ambiguous term. When a person’s life hangs in the balance, there are few things as egregious as including terms which are vague, subjective to numerous interpretations and which are not readily definable.

So, what is the difference, if any, between MAiD and PAS?

Some health advocates and medical professionals insist that a terminally ill patient with a recognized, biologically based, somatic disease taking medication to hasten the end of their life is doing something fundamentally different than suicide. The term “medical aid in dying,” they say, is meant to emphasize that someone with a terminal diagnosis is not choosing whether to die, but how to die. Their death is immediate and inevitable.

Anita Hannig, an anthropologist at Brandeis University and author of the book, “The Day I Die: The Untold Story of Assisted Dying in America,” stated, “A phrase like “medical aid in dying” would reassure patients that they were taking part in a process that was regulated and medically sanctioned. Medicine has that legitimating power, like it or not, that really removes a lot of the stigma.”

Now, look at the language used by Ms. Hannig.

A process that was regulated.

A process that was medically sanctioned.

I would add, a process focused on a biologically based, somatic diseases, thoroughly researched and studied. Diseases in which relatively objective findings, treatment regiments and outcomes had been thoroughly vetted and are considered reliable. A disease, which in an advanced state, medical science cannot effectively combat nor cure.

For this, yes, Medical Aid in Dying may very well be accurate, understandable and compassionate.

But for circumstances in which a mental health issue is the primary diagnosis? Particularly, Severe and Enduring Anorexia? A legion of questions abound.

When did Anorexia become terminal? Does the medical community even have a remotely accurate understanding of the manner in which eating disorders impact the brain? And if so, why haven’t effective, biologically based treatments been researched, studied and implemented?

For that matter, regarding eating disorders, we also know the following:

There are no generally accepted standards of care. The “experts” in the community cannot even agree about the most effective medical and mental health interventions to treat this deadly mental health illness. For that matter, should anorexia even be classified primarily as a mental health illness?

There is no effective collaboration with any other medical or mental health community.

Private equity companies have been allowed to dictate residential “standards of care” and the way this mental health illness is treated. Emphasizing profits over patient safety. Even a former CEO of a residential treatment center is now admitting to this reality.

There are no pharmaceutical drugs which have been specifically researched, trialed and then approved to treat eating disorders. The drugs being used today were all designed to be used for other mental health and medical issues.

If the statistics can be believed, the mortality rate for eating disorders is worsening.

It is with this background, despite these harsh facts, that some people are attempting to legitimize end of life options for Severe and Enduring Anorexia.

Seriously. What criteria and protocol would be utilized to establish that which constitutes the highest level of treatment care before patients are welcomed into the warm embrace of death? Some pro PAS professionals may even look upon death as not being a failure or even a bad outcome.

How many years would a patient have to be afflicted with Severe and Enduring Anorexia before a death protocol is appropriate for them?

What objective testing exists to determine brain atrophy? Testing which would give more objective evidence showing that a patient either has or does not have the capacity to make life and death decisions?

As it is, no state has set forth any minimum, objective biological standards which must be met before a death protocol is made available for patients suffering from mental health issues.

With many biological based, somatic diseases such as cancer, objective testing and decades of research support a medical finding that death is inevitable. And as a compassionate society, Medical Aid in Dying, with effective oversight and clear protocols, very well may be in humanity’s best interest.

However, with Physician Assisted Suicide for mental health issues, because of the dearth of medically objective criteria, the diagnosis of “terminal” is based not so much on whether a patient will die, but how they will die.  

That patient’s death may not be pending, may not occur soon and may not be inevitable. That is the heart of Physician Assisted Suicide. Besides subjective criteria experienced by some mental health providers, there appears to be no medically recognized protocols or standards supporting those person’s views.  That is not and should not be acceptable.

For the treatment of Severe and Enduring Anorexia, the brightest and the best medical and mental health doctors cannot collaborate and come up with treatment standards utilizing the latest technological and science-based knowledge and innovation. There are no protocols to preserve life.

When the community cannot come up with and implement a legitimate, generally accepted protocol for life, how can anyone seriously consider a protocol for death?

The Old Gray Lady and Assisted Suicide

The New York Times was founded in 1851. In its long and storied history, it has been at the heart of important legal decisions pertaining to journalism and the freedom of the press. Since 1896, its slogan has been, “All the News That’s Fit to Print.”

For many Americans, the Times is at the forefront of their consciousness regarding the journalism industry. It is a major news outlet in the United States’ most prominent city. The Times often sets this nation’s news agenda.  All of which makes it that much more surprising when the Times lowers itself to publishing an outdated, tag along storyline devoid of substance and not current on the latest events on a crucial topic.

In this case, the January 3, 2024 article entitled, “Should Patients Be Allowed to Die from Anorexia?” To say that this article fell down the deepest well far below the Times usual standards would be charitable. In fact, this article could have jeopardized on-going debates, discussions and interactions which are currently taking place among mental health professionals on the highly controversial topic of assisted suicide and mental health, particularly anorexia nervosa.

The Times Article attempts to frame issues designed to draw the reader away from one of the most complex issues we as sentient beings face … our very mortality … and simplify it to a plug and play game devoid of any nuance, substance and morality.

The manner in which the Times article fails is legion. So, let’s address just some of its shortcomings.

First, the Times article comes across as a less informative follow up piece to the outstanding article written by Abby Ellin and published in the Washington Post on November 1, 2023. Ms. Ellin’s article was obviously thoroughly researched, and included information from doctors, research professionals, mental health advocates, families and people who have been directly impacted by anorexia’s deadly nature. It explored both sides of this highly volatile issue. Ms. Ellin’s article endeavored to stay current with the rapidly evolving events on this topic.  All of which are missing from the Times article.

The Times article was not current regarding events which have transpired on this issue since June 2023. It did not address retraction of certain articles, medical complaints being withdrawn, or the fact that a broad-based summit occurred in Denver, Colorado on November 17, 2023, or the fact that perhaps our mental health professionals are looking at new ways to address controversial topics. Instead of engaging in seemingly endless academic articles ping-ponging back and forth, face to face respectful engagement took place. Professionalism. Mutual respect. All this important information was missing from the Times Article.

The Times Article focusing on Naomi’s story was understandable. Her story is compelling. How can we not sympathize with her? Her story touches our heart. Her story and the extreme issues and measures she has faced in her life are designed to attract readers and perhaps gain support for assisted suicide for mental health issues. And yet, her story is not representative of the millions of people suffering from anorexia nervosa. There was no counterbalance showing those people who are greatly suffering and yet who are still scratching, clawing and fighting for life.

Now make no mistake. Palliative psychiatry is a topic that has arisen as an important topic of discussion and worthy of studied research and contemplation. However, the Times Article takes this topic and renders it fodder for click bait. If people are looking for substantive information on this topic, the article fails. No mention of criteria or guidelines. No mention of studying biological or more objective signs of mental impairment.

The Times Article also failed in that it did not address the ever evolving understanding of possible biological causes of anorexia nervosa. It did not address the fact that we do not completely understand the biology and neurobiology of anorexia nervosa and accordingly no treatments have been developed, tested, and approved that specifically target the underlying biology. Genetic factors? Nothing. The Times Article also does not address recent research indicating prolonged starvation damages the gastro system and impoverishes the microbial ecology making recovery more painful and more difficult.

The Times Article did not address alternative and evolving medical measures being utilized to treat anorexia.  For example, Ketamine, Psilocybin, ECT: (electroconvulsive therapy), TMS: (transcranial magnetic stimulation), tACS: (transcranial alternating current stimulation) DBS: (deep brain stimulation). After all, don’t our medical and mental health professionals have the duty to explore all viable treatment options before beginning that journey which leads to the end of life? The article failed to explore this issue.

The Times Article unfairly portrayed Dr. Joel Yager in an unflattering light. Dr. Yager virtually attended the November 17, 2023, summit. He heard inspirational stories of heartache and resiliency from Linda and Jack Mazur and heartfelt apologies from Dr. Gaudiani to those who may have been hurt. He not only heard from but collaborated with some of the leading eating disorder experts in attendance that day. He heard the term “Terminal Anorexia” is being abandoned. He heard the commitment from all in attendance to preserve, to work together, to address this volatile topic in a compassionate, intelligent collaborative manner. As such, we are certainly justified in questioning why Dr. Yager was portrayed in such a cynical manner. Was the Times Article accurate in asserting Dr. Yager questioned the ethics and competency of other psychiatrists?  Whether they had become “zealots for the model.” Whether Dr. Yager was ambivalent and equally accepting whether Naomi lived or died. Whether Dr. Yager stated, “Yager told me that he does not regret what he wrote. ‘The main point is that some people die from the disease,’ he explained.” I believe that type of cynicism could not be generated from the Dr. Yager who participated in the November 17, 2023, summit.

The Times Article did not include information about the plenary panel session to be conducted at the International Conference of Eating Disorders in mid-March in New York City. This panel includes Dr. Gaudiani, Dr. Westmoreland, and others, with all sides of this topic to be discussed in a professional, open forum. This highly volatile, emotional, potentially divisive issue which touches our very existence deserves our highest compassion, intelligence and collaborative work. The Article failed in addressing this.

The New York Times is sometimes referred to as the “Gray Lady,” or the “Old Gray Lady.” Initially, the Gray Lady was a term of affection, meaning that the Times was deserving of respect, of measured intelligent thought. This article was the antithesis of the Times past standard.

With at least one of its photos in the article deserving of both a “trigger warning” or inclusion in the National Enquirer, this article was not worthy of being called investigative journalism. The Article took a complex, emotional issue … life or death, and relegated it to a lurid standard that makes “yellow journalism” appear erudite. Even the birds in my birdcage would be offended if I used this Article to line their dwelling.

Perhaps showing that the Old Gray Lady just ain’t what she used to be … many long years ago.