Tag Archives: depression

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.

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.

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.

When Maladjusted Masquerades as Activism … Weight Stigma Awareness Suffers

Weight Stigma Awareness Week should be an opportunity to confront one of the most damaging forces in healthcare: bias against people in larger bodies. This should be a week for data, clinical rigor, and constructive collaboration. Done well, it can highlight evidence-based solutions, elevate medical leadership, and foster collaboration across disciplines. And families who are suffering are the ultimate recipients of this shared wisdom.

Next week’s agenda includes sessions that could help shape our response to stigma and patient care. For example:

  • Rebecka Peebles, MD, FAAP, DABOM, & Lauren Hartman, MD — “Healing Without Harm: Ending Weight Stigma in Healthcare.” Practical, evidence-based strategies for clinicians who treat real patients in real exam rooms. The goal is not slogans but practical training rooted in science.

  • Leslie L. Williams, MD — “Navigating Eating Disorder Risks in the Age of GLP-1 Medications: A Weight-Inclusive Clinical Approach.” With GLP-1 drugs reshaping public conversations about weight and health, the need for clear, medically sound guidance has never been greater. Families deserve facts, not fearmongering.
  • Abigail Pont, MD — “Anti-Fat Bias in Medical Education Through the Eyes of a Medical Trainee.” Change must begin with training. Reforming curricula to prepare physicians to treat all patients with dignity and competence is not optional — it is essential.

These are the conversations that deserve attention, funding, and follow-through. They are the ones that have the potential to save lives.

But here lies the danger: while some leaders are advancing medicine, others are actively working to undermine it. Instead of fostering collaboration, maladjusted activists reject it. Instead of engaging with science, maladjusted activists ignore and dismiss it. Instead of building trust between patients and the medical community, maladjusted activists sow division, reject science, reject collaboration, and replace patient-centered work with grievance theater.

The weapons they use are fatuous ideology and vacuous grievances void of real substance and merit. This leaves patients and families caught in the crossfire.

This is the dark side of the ledger: militant, maladjusted, angry activists, wallowing in such internal pain, who reject collaboration, denigrate clinicians, and weaponize grievance for influence. This sadly is not theoretical.

It played out in 2021 at the Legacy of Hope Summit — a convening of some of the field’s foremost experts intended to build consensus and advance patient-centered solutions. Instead of joining that work, some radical activists not only opposed it, both before and after, but they tried to burn it down.

The most vocal critic was Chevese Underhill Turner, co-host of Weight Stigma Awareness Week, who also serves on the Board of Advisors of Within Health and is “Queen of the Ashes.”

Regarding the Legacy of Hope, Turner wrote:

“The entire ED community is getting ‘upskirted’ by certain men and we cannot put our own FOMO aside long enough to see it. Instead, we attend these men’s meetings and give them power to continue their gaslighting and lack of any willingness to see the intersections affecting our field. I’d love for other women to join me (and a few others) in being difficult when it comes to these people.”

This was not a critique grounded in evidence. It was not a call for better data or stronger collaboration. It was a deliberate attempt to sabotage a convening of experts — through crude language, ad hominem attacks, and an open invitation to disrupt and destroy.

Turner’s misguided viewpoints do not end there. On various podcasts and in social media, Turner has attacked clinicians, mocks evidence, and replaces medicine and science with grievance politics.

Her own words make it clear:

“It bothered me that all the air was taken by a white perspective.”

“My heart is in the higher weight community, whether a person has an eating disorder or not.”

“I believe bodies are political.”

“Everything is political.”

“I came out of the womb as a political beast.”

“When I hear “marketing” in the context of ED services to marginalized communities I hear white folks not learning from colonization and slavery. We need to stand down.”

“We must also be centering and supporting BiPOC, LGBTQ+, fat therapists and professionals. This is no space for white, straight and thin folks to jump in.”

“When we constantly protect the feelings of those who are oppressing then we never actually get to the work needed to undo the oppression.”

Turner, in writing stated that she supported and was working toward the following: “ … 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; embracing and incorporating non-western treatment practices; providing access to Hormone Replacement Therapy.”

These extremist radical views come from ignorance and distrust of the medical community. In Turner’s own words:

“The DSM [Diagnostic and Statistical Manual of Mental Disorders], it is what it is … it’s not great.”

“Those of us who have done the work around our internalized biases no longer trust the medical establishment to actually help us.”

“That has only grown into a place where we are now. Body Positivity Movement. We don’t want to be judged on our looks and our size. The medical community said, ‘Ok. We’re going to judge you on your health.’”

“Most of the country is at a higher BMI, but when you begin to talk about people above a 35 who are visually fat, the oppression increases — plenty of data on that. People in the 50, 60 etc (superfat) range experience even more oppression. These are the folks who are publicly chastised and harmed continuously by the medical profession. Oh, the stories I could tell. Public health in this country is getting it so wrong and there is a better way, but we need to be willing to actually listen to those being harmed.”

“There may be some things with eating disorders that are brain issues … I don’t know.”

Turner’s harmful, illogical, extreme points of view do not constitute insight – they are ignorance masquerading in cartoon regalia, strutting as wisdom. They demonstrate contempt for medical science disguised as activism, reckless to the point of sabotage. And yet, somehow, they earn you the golden ticket to co-host Weight Stigma Awareness Week. Turner’s very presence doesn’t elevate the cause; it cheapens it, hollowing the message until nothing credible remains.

In the past, Turner redirected organizational platforms away from patient-centered care and toward political crusades. As a former officer of NEDA, one of the largest eating disorder organizations in the country, she proudly declared, “We won’t be deterred in our social justice work.” Under her “leadership,” donors were encouraged to contribute to the Minnesota Freedom Fund — an organization later revealed to have posted bail for accused murderers, rapists, and other violent offenders.

Ask yourself: who benefits from public disruption? Certainly not patients. Nor families. Nor clinicians attempting to balance complex risks and benefits. Disruption for its own sake only produces a cacophony of racket instead of clarity. It produces division where we need partnership and collaboration.

And yet, Turner is annually trotted out as a co-host of Weight Stigma Awareness Week even though her message never changes. She is still handed the microphone. Still made co-host. Still rewarded.

Turner’s destructive, insidious pattern is consistent and consequential. When so called leaders prioritize ideological purity tests over rigorous science, they do more than dispute ideas — they undermine care. When organizational platforms are repurposed for partisan causes, and donors are steered toward politically charged funds with questionable implications, the field’s credibility erodes. When individuals who oppose expert collaboration are nonetheless rewarded with boards, speaking invitations, and opportunity, the message is clear: rhetoric is encouraged; results are irrelevant. And yet, that is the reality in the eating disorder community.

In any other professional community, such conduct would bring harsh consequences. Suspension. Banishment. In the eating disorder world, it brings greater influence and opportunity. But it does not have to be that way.

The way forward is clear but it requires courage and resolve:

  • Elevate science-first voices. Medical experts who ground their work in data and clinical care should be at the center of not just this week, but every week and this field.
  • Insist on collaboration. Medicine is not the enemy. Progress depends on partnership between clinicians, researchers, and advocates willing to engage constructively.
  • Enforce accountability. Organizations must set standards of conduct. Those who undermine collaboration with reckless rhetoric cannot continue to hold leadership roles.
  • Protect patient-centered care. Eating disorder treatment should not be a platform for partisan politics. The focus must remain on evidence-based approaches that save lives.

Patients deserve better than empty slogans. Families deserve better than spectacle and disruption. The eating disorder community deserves leaders who are accountable, collaborative, and grounded in science.

Weight Stigma Awareness Week should not be a stage for any one person’s hate filled ideology. It should be a platform for medical and science based workable solutions.

The choices confronting us are simple.

Evidence based treatment over drama and dysfunction.

Clinicians and researchers who do the hard work of translating evidence into care over charlatans who sell social justice snake oil.

Collaboration over spectacle.

Accountability over impunity.

Lives are at stake. Families are desperate for solutions grounded in competent, humane care. Patients cannot wait for ideology to sort itself out. If we allow disruption to replace discourse, we become complicit in the harm that follows.

And the escalating mortality rate.

When Social Justice Therapists Go Too Far …

Since prolific anti-semitism directed toward Jewish therapists by non-Jewish therapists is an appalling reality, it was predictable that the assassination of Charlie Kirk would reveal the worst in humanity … including of course, eating disorder therapists and family liaisons. More’s the pity.

When a loved one has an eating disorder, families are already living in a war zone. Every meal feels like a battlefield. Every doctor’s appointment feels like judgment day. And when parents turn to therapy, they are not looking for ideology, slogans, or someone’s Twitter feed come to life. They are looking for life saving help.

Eating disorders don’t care about politics. They don’t care about hashtags. Eating disorders only care about shutting down organs, hijacking minds, and killing people. But too many therapists, treatment centers, and professional organizations are importing America’s divisiveness into treatment. The result? Families are left paralyzed, distracted, and betrayed.

More and more therapists and family liaisons are peddling something else: politics disguised as treatment. Some wave the flag of “Free Palestine” with militant zeal. And yet, most could not even remotely explain the complex nuances of Middle East politics going back thousands of years. When the phrase, “From the River to the Sea,” is spewed forth with all the hatred and horror which exists within the soul, many therapists and activists cannot even identify which river or which sea is being referred to, let alone identify the dark significance of that phrase.

These militant therapists and family liaisons sneer that the death of Charlie Kirk, a conservative commentator was deserved, and in their ignorance and room temperature IQs, slap “ism” labels on him and then rejoice that his life was tragically cut short. These providers and activists are intentionally obliterating the line between activism and care. Families should take this as the clearest possible warning sign: walk away. As fast as you possibly can. Do not trust those people or their organizations.

It is bad enough that families seeking help often find therapy rooms that sound more like activist seminars than clinical spaces. Instead of guidance on food and recovery, they get:

  • “Diet culture is colonialism.”
  • “Anorexia is a symptom of white supremacy.”
  • “Thin privilege is the real disease.”

These are not treatment strategies. They are slogans, ripped from Twitter and recycled in therapy sessions. When families should be hearing about family-based treatment (FBT), CBT-E, or medical stabilization, they’re handed culture-war scripts that do nothing but fracture trust.

Eating disorders thrive on chaos and division. They feed on families who are fractured, therapists who are distracted, and organizations that are broken. Every minute spent arguing over slogans is a minute not spent on saving a life. Every resource squandered on activism is a resource stolen from recovery.

Therapy is supposed to be a sanctuary from the chaos of the outside world. It is supposed to be a space where pain is met with compassion, not political litmus tests. Injecting social justice battles into that space doesn’t just distract — it actively harms.

Here’s how:

  1. It replaces healing with indoctrination. Patients and families arrive desperate for answers about food, weight, fear, and survival. Instead, they may be handed lectures about geopolitics, race, or privilege. The family’s suffering becomes a prop for the therapist’s personal crusade. That is gross exploitation, not care.
  • It breeds division when unity is essential. Eating disorders tear families apart. Recovery depends on pulling together. A therapist who filters everything through activism risks turning family members against each other based on political or cultural identity. That kind of manufactured division is gasoline on the fire.
  • It signals contempt for dissent. A therapist who proudly mocks the death of someone they dislike politically is broadcasting one thing: if you disagree with me, I do not respect you. How could any family trust such a provider to respect their child, their family bond, or their values? Trust collapses before therapy even begins.
  • It encourages rigidity instead of curiosity. The most effective therapists know they don’t have all the answers. They ask, they listen, they adapt. But the activist-therapist thrives on certainty: oppressors vs. oppressed, good vs. evil, us vs. them. That rigidity suffocates the flexibility patients desperately need for recovery.
  • It undermines professional ethics. The ethical codes of every counseling profession warn against imposing personal beliefs on clients. Therapists who cannot resist bringing their political militancy into the room have already failed the most basic test of professionalism.

Let’s be clear: cultural awareness and respect for diversity are good things. But respect is not the same as ideology. Sensitivity is not the same as indoctrination. Families need therapists who can meet them where they are, not therapists who drag them into battles they never signed up to fight.

Eating disorders are the second most lethal mental health illness, outpaced only by opioid addiction. This is life-or-death work. Families should demand nothing less than evidence-based treatment, humility, and compassion. When a therapist instead advertises their political rage as part of their practice, they are showing you what matters most to them — and it isn’t your child’s recovery.

The therapy room should be sacrosanct and must never be allowed to become another front line in America’s political battles. Families: if your loved one’s treatment starts to look like activism instead of medicine, get out. Your child’s survival depends on science, unity, and clarity — not the noise of a broken country bleeding into a broken field.

THE VICTIMS … THEIR FACES

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

So, why continue ?

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

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

Christopher Gardner

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

Deborah Cobbs

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

Tiley McQuern

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

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

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

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

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

Some of the statements in the article include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Naturally, Acadia closed the facility in 2022.

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

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

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

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

That statement can be found here:

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

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

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

So, painting an inaccurate picture? Like this?

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

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

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

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

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

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

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

MEDICALLY INDUCED COMA FOR ANOREXIA?

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

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

 Alien

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

Exorcist

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

 Jurassic Park

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

 Green Hornet

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

 36th Chamber of Shaolin

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ok, I think we got it.

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

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

Cue the Benny Hill yakety sax music …

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

A medically induced coma …

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

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

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

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

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

Ketamine? Yeah… No.

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

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

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

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

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

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

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

Loved ones being treated by Groucho, Chico and Harpo.

We deserve better.