Tag Archives: depression

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

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

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

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

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

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

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

Ok… so that may be a bad example.

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

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

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

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

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

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

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

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

Unless … there is a shred of truth in it.

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

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

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

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

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

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

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

But … it may be in the same zip code.

AWARENESS WITHOUT ACTION EQUATES TO FAILURE

Awareness.

Awareness.

Have you ever wondered what comes after awareness?

In any event, once again it is Eating Disorder Awareness Week 2025. Almost all eating disorder organizations and treatment providers will be mentioning this on their social media outlets.

Some buildings will be lit in the blue and green colors adopted by NEDA. This is the St. Louis Planetarium complete with statue in the shape of what society deems an anorexic body type:

Did I just body shame a statue?

Some therapists and advocates, treatment centers and organizations will hold special “virtual” sessions highlighting their pet eating disorder interest. People self-identifying as experts will pontificate on many and varyed aspects of eating disorders. The same radical tired voices will repeat the same radical tired messages to the same radical tired crowd measuring in the tens of people.

As in year’s past, the eating disorder community will feel good about itself for the week, will pat itself on the back and then … will slink back to its customary irrelevancy in the medical and mental health fields. Next year will be rinse and repeat. Or as Herman’s Hermits once sang, “Second verse same as the first.”

However, this year is different. For a number of reasons. These reasons threaten to not just shake but could very well crumble the very foundation of the eating disorder community. Not surprisingly, these reasons and issues will not be discussed this week and the community will ignore its awareness of these issues.

These issues will not be discussed in part because the issues are just too difficult. They are uncomfortable. In addition, the firmly entrenched corruption and rot in the community will mandate that some of the issues be ignored. When for a price, even the most reprehensible predator can buy a place at the table.  Regardless, the issues are incredibly serious and require serious people with serious IQs to ponder and then take rational, serious action.

Let’s review some of these serious issues.

NIH funding collapsing

On Friday, February 7, 2025, the National Institute of Health (“NIH”) announced it was pausing all grant funding pending review and placing a 15% cap on funding “indirect research costs.” Indirect costs, also known as facilities and administrative (F&A) costs, are used to cover research expenses such as equipment and facilities maintenance, IT services, and administrative support.

The freeze has impacted the funding of all continuing grants at NIH. These grants fund ongoing research, including many studies involving human subjects in clinical trials. Universities are already reacting in a manner consistent with believing that those funding grants will not be reinstated. Some universities have already frozen hiring and taken other budgetary measures. These measures include a spending freeze on travel, procurement, capital projects and events.

So, how will this impact the eating disorder community? University based eating disorder professionals are likely to have their budgets slashed making travel to conferences unlikely. This includes travel to San Antonio for the ICED conference. This could also include a reduction in membership in AED. With AED’s financial woes already being very deep, a steep decrease in membership and low attendance at its ICED event could be the death knell for that organization.

But more importantly, this issue means that there will be significantly less research conducted into our understanding of the biological and genetic aspects of eating disorders. Possible state of the art treatment requiring a research basis will not be experimented upon and implemented. “Evidence-based” will become an even greater cartoon slogan.

Which will result in the mortality rate continuing to climb.

At least we now have awareness on that issue.

Iaedp

Iaedp’s many issues and problems have been highlighted for over a year. Tax fraud. Forgery on official documents. An overall lack of transparency. Possible violations of antitrust laws regarding the certification process. I understand that attendance at the recently concluded Symposium was disappointing.

A class action lawsuit hanging over its head.

A number of chapters have dissolved.

Rumors that the 2026 Symposium will be virtual.  Perhaps because of a lack of funds? After hosting an in-person conference for a number of years, a virtual conference means virtually nothing.

All of which makes iaedp’s continued survival problematic. And if iaedp does not survive, what of the certification process? Would that mean we are left with another certification process which starts out with an idiotic Indigenous Persons land use acknowledgement? Because nothing says “eating disorders and the highest quality certification process” like an Indigenous Persons Land Use Acknowledgement!

At least we have awareness on these issues now.

Residential Treatment Center issues

The great eating disorder residential treatment center experiment appears to be floundering.

Recently, Castlewood (Make no mistake, it was Castlewood all along. Alsana was merely its pasteboard mask.) closed its operations in the State of Missouri … where it all began. Now, Alsana may find itself having issues with the California Medical Board for the unauthorized practice of medicine in that state.

Acadia shuttered Timberline Knolls after numerous issues and abuse came to light.

Cielo House.  Shoreline Center. Fairhaven. Evolve. All closed.

Some of the residential treatment centers which remain open seem to be exploring adopting an addiction treatment model.

Accanto Health’s CEO, Dr. Tom Britton is the former CEO of American Addiction Centers. Accanto Health owns the Emily Program. Information has been circulating that medical doctors at Accanto Health/Emily Program have been laid off or asked to take lesser roles.

Virtual treatment programs, with no independent, third-party studies supporting their efficiency have sprung up and their growing presence cannot be denied. They are less expensive to operate. Purportedly, the growing influence of virtual programs is impacting attendance at residential treatment centers.

At least we have awareness of these issues now.

Acadia Healthcare

Then, there is Acadia Healthcare.  I once wondered why treatment centers and organizations were not incensed at the harm being perpetrated by Acadia. Why they did not stand up for the vulnerable and hold Acadia accountable. Of course, the answer is obvious.

They have accepted money from Acadia Healthcare. They are bought and paid for consorts for Acadia.

Since iaedp did not have enough troubles, at its recent symposium, one of its primary sponsors was Acadia Healthcare.

The National Alliance on Eating Disorders lists Acadia Healthcare as one of its “Diamond Supporters.” [its highest level]

Montecatini, McCallum Place and Carolina House are not going to stand up. They live on their knees subservient to the whims of its overlord and master, Acadia.

Acadia, knowing the eating disorder community is long on radicalism and short on common sense, embedded itself by throwing money around. It was an effective strategy. And it still is.

And to think at one time, AED would not accept money from any pharmaceutical company or health and wellness company because of concerns about conflicting interests.

Sadly, when an organization accepts dirty money, it acquiesces to whatever heinous acts are being perpetrated by the predator.

And so, we have that awareness now too!

Many other issues about which we need to be aware

Many other serious issues exist which plague the eating disorder community.

No generally accepted standards of care. 

No collaboration with any medical or mental health communities to speak of.

No collaboration within the eating disorder community.

When was the last time NEDA, iaedp, AED and the other entities got together and stated, “Enough is enough. We are going to hold a joint conference. We are going to collaborate. We cannot have true progress if we remain separate and instead, we must collaborate. But, egos prevent that.

Ai is to be feared and cancelled.

Eating disorder legislative bills to increase research funding?  Nope.

Then there is the beating of the drums by the Militant Fat Activists who have been allowed to poison the community with their own unique brand of craziness.

How many times have we read or heard that pediatricians, medical doctors and other medical professionals do not understand eating disorders and do not know what to look for? That lack of awareness falls on the shoulders of the eating disorder community.

The eating disorder community has had over ten (10) plus years to accomplish that! Instead?  They failed. Completely. Miserably.

So, we go back to awareness?  Awareness of what? Our own failures?

A focus on awareness has only resulted in failure. And this failure is measured by the lives of more children, adolescents and loved ones being taken.

The next step in awareness is … taking action. Since awareness without action is only cowardice and ignorance.

Ordinarily I would hope that at this time next year, we will be embracing Eating Disorder Action Week. But when as a community you instead embrace the known predators in the community, you have destroyed the hope which must exist within families.

So, ring in the new year. I am sure Eating Disorder Awareness Week 2026 will be the same vacuous song and dance.

The same radical tired voices will repeat the same radical tired messages to the same radical tired crowd measuring in the tens of people.

As the predators increase their profit margin, our children will continue to die.

Happy Eating Disorder Awareness Week 2025.

Why HAES is Dead in the Eating Disorder Community and … Crossing a Sacred Boundary.

Why is HAES dead in the eating disorder community? Because the ASDAH wanted it that way by taking HAES in a different direction.

Some people opined that ASDAH does not involve eating disorders. And yet, weight stigma and individualized eating are certainly part of the eating disorder realm. So, to that extent, yes ASDAH was formerly involved in the eating disorder community.

Some people attempted to argue that HAES was not part of the eating disorder lexicon. And yet, there are therapists, marketers and third parties who naively seek, “HAES aligned doctors, therapists, nutritionists” for people who suffer from eating disorders.

Certainly, the abandoned HAES principles align with some aspects of the eating disorders community. These principles included:

  1. Weight Inclusivity– Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
  • Health Enhancement– Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
  • Respectful Care — Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
  • Eating for Well-being — Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
  • Life-Enhancing Movement — Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

When viewed through an intelligent, rational lens, who can argue with those principles? I certainly agree with them.

If HAES still embraced those noble principles and was being conveyed in an intelligent manner, there would be far fewer issues and HAES would be further on its way to being respected, if not adopted by more medical and mental health professionals. Sadly, it is not.

In 2022, ASDAH (the entity which owns the HAES trademark) had a seismic shift in its vision and mission. As was its right. Now, ASDAH is attempting to redefine health through a sociopolitical construct and is openly stating that it is aligning with other social justice movements. [their words] Again, any organization has the right to pivot in the direction it deems best for its members and donors. But as it pivots, to the extent that ASDAH and HAES were once part of the eating disorder narrative, they no longer are. With regard to eating disorders, HAES is dead.

ASDAH seeks to “dismantle the medical industrial complex.” [their words] ASDAH does not say how it intends to undertake this dismantling or what it seeks to substitute in its place.  ASDAH also states, “One of the main roots of the current Health at Every Size® community was a group of fat activists known collectively as the Fat Underground who began questioning their healthcare experiences and the advice they received from healthcare professionals.”

ASDAH also states, “We remain committed to the ongoing learning from liberation thought-leaders in Black liberation, fat liberation, crip/disability justice, queer liberation, womanism, intersectional feminism, and many more known and not-yet-known movements working towards the liberation of all people.” [Nothing about eating disorders.]

That is truly what ASDAH is about. Fat activism. The liberation of all people who it perceives as being victimized. Social justice issues. So long as ASDAH stays out of the eating disorder community, I say, “Best of luck to you, knock yourself out and do what you believe you must do.”

Especially since I agree that lack of access to medical and mental healthcare for minorities, the poor, the disenfranchised is a huge societal issue and needs to be addressed. We clearly do not have enough people of color who are medical and mental healthcare professionals. Research studies in the past have disproportionately focused on white persons. BMI as an accurate, modern measure of health is lacking. Medical and mental healthcare providers in minority communities are grossly lacking.

But what is also lacking are workable, logical, fact and science-based solutions to these very real problems.  ASDAH is not providing them. HAES activists are not providing them. Real life workable solutions, with greater knowledge and wisdom of medical and mental health care issues are not being proposed nor debated.

It is one thing to illuminate issues to be addressed. It is something very different and far more complex to illuminate workable solutions to those problems which do not violate the Constitution or require wholesale revolution and overthrow of the US government.

Nonetheless, with its pivot exclusively to social justice activism leaving eating disorders behind, there are still some therapists and third parties who continue to use the now outdated term, “HAES aligned.” Third parties do not have the luxury of using the term “HAES” to fit whatever narrative they wish to use. In fact, should you wish to utilize the trademarked term HAES in a way that does not align with ASDAH’S militant vision, it has the right to demand you cease and desist from further use of this term. ASDAH has the right to protect its trademark to ensure it is being used in compliance with its extremist vision. In fact, if it does not protect its trademark, it can waive its rights to exclusively use the term HAES. ASDAH can legally prevent any mental health provider from utilizing the HAES trademark if that provider does not adhere to ASDAH’s current vision and mission.

Based upon some of the past tactics utilized by the ASDAH Militant Fat Activists and their cronies, ASDAH will undoubtedly resort to that tactic.  Its current tactics include excessive bullying on social media directed against therapists and others who disagree with their views on Palestine and other ASDAH mandated issues. Harassment. Making those who disagree with them feel afraid, unsafe and minimized.  There can be no rational debate. No intellectual exchange of ideas or views. They bully those who they perceive are weaker than them. But they are cowards.  They will not directly and openly confront those who oppose them. Those whom they perceive are stronger than them. They hide behind their keyboards.

But then they erred. In the most egregious manner possible. After my last post on this issue, on the Facebook page of one of their advocates, they came after me.  Oh, certainly not directly since it is far easier to block those who disagree with your views and as such, live in an echo chamber. All manner of slurs and slanders were directed at me.  And quite frankly, I am ok with that. Attorneys live with that type of derision every day.

But there is one line that no civilized person ever crosses. One sacred line. And that is when a child dies as a result of eating disorders, you never, never state nor even imply that a parent subjected that child to substandard medical treatment and as a result, was even partially at fault for her tragic death. Only a subhuman monster would tread that dark path.

If that messaging appears on your social media page, you have the absolute duty to immediately remove that message, apologize to the parent and perhaps, look at your own ethics and morals.

However, that line was crossed in an intentional and malicious manner. When given the opportunity to walk back those words, or to delete the offensive messaging, not one of these activists stood up or even spoke out against that messaging.

When the Militant Fat Activists came together to blame me for “allowing my daughter to endure” alleged negligent medical care and ipso facto, blamed me for causing her death … and not one person called out that reprehensible statement, that conduct is unforgivable. This time, they attempted to bully someone who cannot be bullied. This time …

This time… for all parents whose children died from eating disorders; for all therapists and mental health care professionals who have been harassed by the Militant Fat Activists; for persons who have been bullied because they do not embrace ASDAH’s extremist political views … it is our turn now. 

And it is their time to be afraid.

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?