The Eating Disorder Community is in Decline and I will not Pretend Otherwise

I am angry.

Not performatively angry. Not professionally offended. Not angry because I lost an argument on the internet or failed to receive applause from a community that mistakes approval for moral authority.

I am angry because my daughter is dead.

Morgan died from anorexia. On October 30, 2016, a brilliant light was extinguished. That date is not rhetoric. It is not branding. It is not “a platform,” as some room temperature IQ marketer once had the gall to call this advocacy.

It is the dividing line in my life. Before it, I was a father. After it, I became something else … a grieving father forced into a world that talks endlessly about compassion while tolerating cowardice, corruption, incompetence, ideological vanity and institutional decay.

The eating disorder community does not like anger like mine because it cannot domesticate it. It cannot convert it into a panel discussion, a diversity statement, a certification module or a social media campaign. It cannot make it polite enough to ignore.

That is why it wants people like me to be quiet.

And yet, I will not be quiet. I cannot be quiet.

After my daughter died, I tried to serve. That is what grieving parents often do when the alternative is collapse. You try to turn pain into usefulness. You tell yourself that if you can help one family, warn one clinician, reach one school, educate one employer or reach one terrified parent, then maybe the unbearable can be forced into some form of meaning.

I gave TEDx talks. I worked with physicians. I organized presentations for Apple and Raytheon. I spoke to school counselors, nurses, churches, treatment programs, television stations and radio audiences. I hosted mental health programming. I tried to bring serious voices into public spaces where eating disorders were still misunderstood, minimized or sentimentalized.

And still, it was not enough.

Eventually I learned far too late what many families have not yet learned. The eating disorder community is not merely underfunded or misunderstood. It is dysfunctional, fragmented and frightened of accountability. It too often rewards performance over substance, ideology over science, credentials over courage and consensus over truth. Worst of all, it has become increasingly comfortable using death as scenery while fighting over status.

The public is told this is a community of care. Families are told to trust the experts, the advocates, the organizations, the conferences, the language and the credentials. But behind the soft vocabulary sits a harder truth. This field remains divided on treatment, weak on accountability, vulnerable to private equity extraction, susceptible to ideological capture and far too willing to treat bereaved families as inconvenient when they ask direct questions.

The result is moral rot with professional polish.

The certification sector epitomizes this reality. Credentials now multiply like weeds. Every faction seems to have a course, a module, a preferred vocabulary and a moral test. Some programs lean clinical. Others appear more interested in political catechism than medical seriousness. One can now encounter training materials that seem more committed to ideological confession than saving lives.

Meanwhile, families still cannot get clear answers to basic questions. What treatment works best for which patient, at what stage, under what conditions and with what measurable outcome? What standards are truly evidence based? Who is tracking deaths? Who is tracking failed discharges? Who is tracking relapse after residential treatment? Who is accountable when a facility markets hope, collects enormous fees and sends a patient home no safer than when she arrived?

The field has conferences, hashtags, consultants, committees, coalitions and continuing education products. It also has frauds and charlatans.

What it does not have is a unified standard of excellence worthy of the dead.

That is the indictment.

When insurance companies dictate care, the community complains. When private equity turns residential treatment into a revenue model, the community whispers. When families are bankrupted, the community sympathizes. When clinicians disagree on basic treatment principles, the community schedules another panel. When misinformation spreads, the community looks the other way if the messenger belongs to the right social tribe. When organizations drift from mission into self-protection, the community ignores it.

But, when a grieving father says the system is failing, some of these same people suddenly pretend to discover standards of civility.

No.

Civility is not the highest virtue in a field where people are dying. Truth is. Accountability is. Competence is. Scientific seriousness is.

The eating disorder community has too often chosen theater. It has chosen language games. It has chosen familiar alliances over public correction. It has chosen to protect reputations more aggressively than families.

I have seen organizations that once claimed noble missions become captive to vanity, ideology or institutional self-interest. I have seen advocates confuse unresolved pain with public wisdom. I have seen professionals hide behind credentials while refusing to confront obvious dysfunction. I have seen activists reduce complex, lethal brain-based illnesses to social talking points. I have seen people who should know better treat mortality as an inconvenience to their preferred narrative.

This is not progress. It is decline.

And yes, I have made my fair share of mistakes. Grief does not make a man infallible. Pain does not make every judgment wise. I have spoken too sharply at times. I have misread people. I have trusted the wrong people. I have reacted when restraint would have served better.

But my mistakes are my own. They do not absolve the community of its failures.

That dodge has been used too often. Attack the messenger. Question his tone. Whisper about his anger. Pretend that if the grieving father is imperfect, then the institution is clean.

It is not.

NEDA did not need to become a stage for ideological conflict. IAEDP did not need outside pressure before obvious issues were confronted. Board certification did not need to become needlessly expensive or exclusionary. Treatment programs did not need to operate inside opaque business structures while families were told to trust the brand. The phrase “terminal anorexia” did not need to enter the field with the casual horror of professional abstraction while families wondered whether the system was preparing to give up on the very patients it had failed to save.

Again and again, the pattern is the same. The community avoids hard accountability until someone forces the issue. Then, after reform becomes unavoidable, the same community pretends the disruption was the problem.

It was not.

The problem was the misconduct. The problem was the silence. The problem was the cowardice before the lawsuits, complaints, public records and exposure.

When I acted, reform followed. Taxes, penalties and interest had to be addressed. Certification reforms moved. Chapters gained independence. Costs were reduced. Therapists were spared unnecessary expense. Research benefited. Conversations shifted. People who had been privately afraid, began to speak. I connected parents with doctors. And visited their loved ones in treatment centers.

Very few said thank you.

That is fine. I did not bury my daughter in exchange for applause.

But I will not accept lectures from people who confuse politeness with integrity. Nor will I accept moral instruction from those who watched dysfunction metastasize and called their silence professionalism.

The eating disorder community needs far less performance and far more courage. It needs fewer ideological purity tests and more scientific humility. Fewer certification pseudo empires and more measurable outcomes. Fewer self-appointed gatekeepers and more public accountability. Fewer slogans and more data. Fewer branded advocates and more grieving families at the center of the record.

It also needs to stop pretending that anger is the enemy.

Anger is not the enemy when children die, families are misled, treatment becomes a business model, public messaging drifts from science and organizations protect themselves before they protect patients.

I am angry because the stakes are life and death. I am angry because this field should be better than it is. I am angry because the public still does not understand eating disorders with the urgency they deserve. I am angry because families still enter this system terrified, uninformed, financially exposed and dependent on people who may or may not be worthy of that trust.

The enemy is complacency. The enemy is cowardice. The enemy is institutional vanity. The enemy is the professional instinct to survive scrutiny rather than deserve trust.

One more parent will soon stand where I stand. One more parent will replay the last conversation. One more parent will wonder what they missed. One more parent will be told it was not their fault and still wake each morning inside a private prison where no acquittal holds. One more parent will discover that grief is not a season. It is a climate.

So no, I will not soften this. I will not stand down. To the contrary. It is long past time for escalation. That is because the eating disorder community is in a continuing decline. And that decline is measured in more lives being taken.

A serious community welcomes scrutiny. A serious community puts mortality first. A serious community builds a public, adversarial, evidence driven forum where the brightest clinicians, researchers, families and survivors debate standards of care in full view. A serious community demands transparent outcomes from treatment providers. A serious community tracks deaths, relapses, readmissions, restraints, failed discharges, insurance denials, financial exploitation and conflicts of interest. A serious community would stop hiding behind compassion while avoiding accountability.

The eating disorder community is not serious.

That can and must change. But it will not change through another slogan, conference theme, awareness week, land use acknowledgment, moral lecture, branded certification or circular panel discussion where everyone already agrees before the microphones are turned on.

It will change when people with something to lose tell the truth. It will change when families stop mistaking credentials for character. It will change when organizations understand that their missions are not ornaments. It will change when clinicians accept that disagreement is not violence and scrutiny is not persecution. It will change when advocates stop using eating disorders as vehicles for every fashionable political obsession and return to the central fact that these illnesses kill.

My daughter died. That is where this begins. And that is where every excuse ends.

I do not write from theory. I write from the room no parent should enter. I write from the silence after the funeral. I write from the years in which grief becomes ordinary and yet still remains unbearable. I write from the knowledge that no award, no speech, no lawsuit, no reform, no public victory and no act of service can restore the life that was taken.

And so, I write. The eating disorder community can continue to resent my anger if it wants. But, I have earned my seat. I have earned it through the most horrific way imaginable. My seat in this dysfunctional community was paid with the dearest blood possible.

And until this community chooses truth over theater, science over slogans, accountability over self-protection and patients over politics, I will keep speaking and fighting.

Not because I enjoy the fight.

Because my daughter is dead.

And too many people who claim to care have become far too comfortable living with that kind of loss … so long as it belongs to someone else.

RIGHTEOUS INDIGNATION ?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Your life as you knew it … is over.

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

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

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

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

You give two TEDx talks on eating disorders.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I do. Every … single … day.

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

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

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

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

So … righteous indignation?

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

UPDATE iaedp

As many know, iaedp is facing an existential crisis brought about by its own lack of transparency, past irresponsible management decisions, litigation, and administrative complaints filed with the IRS, Department of Labor and the California Franchise Tax Board.

It has been almost a year since I last wrote on iaedp. This article is meant to give an update on various issues. As before, these updates will be coming from a person who is in an adversarial relationship with iaedp.

On behalf of aggrieved eating disorder certified professionals and a potential class, I filed the lawsuit in federal court in Dallas, Texas. Iaedp, Dena Cabrera, Dr. Joel Jahraus and Dr. Ralph Carson were named as defendants. They are represented by a law firm based in Chicago. Ms. Harken is represented by a different law firm. All attorneys are from reputable firms and have strong reputations.

The case was moved to the Central District of Illinois, a district in which Ms. Harken resides. Despite the passage of time, the case is in its infancy and none of the substantive merits have been decided. iaedp, its named board members and Ms. Harken have all filed motions to dismiss the case. In essence, the defendants are saying that the plaintiffs have not properly plead the case, do not have legal standing to bring the lawsuit and did not allege sufficient facts supporting their claims. These types of motions to dismiss are standard practice in most cases filed in federal court.

Naturally, the Plaintiffs disagree with the Defendants’ position, are requesting that the motions be denied and the case be allowed to proceed. The Court has not yet ruled on those motions.

In the unlikely event the motions are granted and the case is dismissed, an appeal will be filed in the 7^th Circuit Court of Appeals in Chicago, Illinois. When the motions are denied, the case will proceed to the next stage. This involves engaging in extensive discovery, depositions and document production.

Regardless, the lawsuit will not be decided any time soon as settlement is unlikely. In the past almost two years, including before filing suit, the plaintiffs made at least three (3) settlement offers with the hope of expeditiously resolving this matter.

iaedp chose to not make any substantive response.

Before filing suit, we sent a letter with information and evidence showing improprieties and concerns about iaedp. We requested that we sit down and talk as professionals. We even suggested bringing in a neutral mediator to assist. No monetary demands. No demands that any iaedp officer be fired. iaedp and Ms. Harken decided to “lawyer up” and refused to talk. This necessitated filing the lawsuit. Had Ms. Harken and iaedp agreed to meet, perhaps the lawsuit would not have been necessary. And iaedp would not be on the edge of collapse.

In the past few months, we again made a settlement offer to Drs. Carson, Jarhaus and Ms. Cabrera. We requested that with their attorneys present, they sit down and have a professional, frank discussion about any knowledge or information they had of iaedp. In exchange, they would be dismissed from the lawsuit. No monetary demands. No public statements demanded. Just a request to talk. Again, our efforts were rejected.

As such, the parties are now set in their positions. No further settlement discussions are anticipated. No settlement is anticipated. When all efforts to salvage what is left of iaedp have been refused, what is there to discuss? Every attempt we made to resolve all issues so that past sins could be addressed leading to a more hopeful future were rejected.

There are times in a lawsuit, if one side is pushing settlement discussions, the other side looks upon that as a sign of weakness. The opposing attorney thinks, “They recognize the holes in their own case! We can exploit this.” At times, that is accurate.

However, there is another reality. At times one side may wish to pursue settlement for a much greater purpose. By addressing past sins, and then moving forward, the needs of a community are often best served. It is a sign of being willing to work for the common good. Far from a weakness, it demonstrates strength. It is not a sign of an unwillingness to go to war. Instead, it is a willingness to exhaust all possible avenues of resolution before going to war. Because that may be in the best interest of a community. The needs of the many outweigh the needs of the few.

An expeditious, confidential settlement was in iaedp and Ms. Harken’s best interest. Especially when you consider the following facts, all of which have been confirmed as being accurate:

For a significant period of time, iaedp was not in good standing in the State of California, the state in which it was organized;
When a California organization is listed as not being in good standing, it does not have the authority to conduct business (including perhaps, overseeing and issuing board certifications);
For most of its existence, iaedp was not registered as a foreign (California) organization in the State of Illinois, its principal place of business;
When a foreign (California) organization is not properly registered in the State of Illinois, it does not have the authority to conduct business (including perhaps, overseeing and issuing board certifications);
The Illinois Secretary of State lists a number of iaedp chapters as being dissolved or not in good standing;
As a result of the lawsuit being filed, iaedp removed the requirements of symposium attendance and association membership in order to acquire or maintain board certification. This happened only after the lawsuit was filed and was one of the key issues in the case;
Some person, presumably Mr. Harken, forged the signatures of Dr. Jahraus and Ms. Cabrera on corporate documents submitted to the Illinois Secretary of State;
Presumably in order to attempt to avoid paying taxes not just to the State of California but the IRS, Ms. Harken classified herself, or at times, her non-existent corporation as an independent contractor;
The California Franchise Tax Board assessed and is collecting significant back taxes, penalties and interest from iaedp;
Even though there is a legion of documents, including Ms. Harken’s prior sworn declaration that Ms. Harken was an independent contractor, last month Ms. Harken filed a motion with the Court stating that she was an employee of iaedp. The significance of misleading the Court on this issue was to attempt to avoid liability under the racketeering laws;
As a result of Ms. Harken’s false statement about being an “employee,” Plaintiffs filed a motion for sanctions asking the Court to assess sanctions against Ms. Harken.

There are many other facts supporting Plaintiffs’ right to recovery in the lawsuit. However, perhaps the most significant issue may be that since iaedp was not in good standing in either California or Illinois for significant periods of time, did iaedp have the legal authority to oversee and issue board certifications during those times? That is, if you were issued your board certification when iaedp was not in good standing, is your certification valid? Is your certification basically a worthless piece of paper? And if not, what are the ramifications? Those will be questions for the Court to decide.

In litigation as in war, you achieve victory by engaging in a relentless, well-orchestrated and carefully designed plan to obtain victory and deprive your opponent of the initiative. You make your opponent pay a price higher than it expected for choosing the path of war. In litigation, an attorney has the power of the legal system. Issuing subpoenas for relevant documents not just from the named parties but also from third parties and witnesses. Deposing people who may have information of relevant facts. Uncovering lies. Exposing arrogance, greed and collusion. Discovering facts which support long held suppositions. Hundreds of hours spent on the process. The uncertainty. The unexpected.

If iaedp prevails in the lawsuit, it will attempt to continue its existence the best it can. Or if and when the plaintiffs prevail, and a judgment especially on a class wide basis is entered, many certified professionals will be eligible to receive some type of monetary compensation. However, iaedp may not have the financial resources or enough insurance in place to satisfy a large judgment. This will inevitably result in iaedp failing or declaring bankruptcy and the certification program either being adopted by another organization or falling altogether.

In any event, the eating disorder community is at a crossroads. We can only hope that the community finally comes together and proceeds in a direction that is designed to bring collaboration, wisdom and insight. We can only hope.

BMI … Barely Medically Important

In the past few years, the State of Colorado and the American Medical Association reviewed the use of BMI, (Body Mass Index, or perhaps it should be known as Barely Medically Important) as a tool to measure health.

The Colorado legislature implemented a new law.

The AMA adopted a new policy on how BMI should be used as a measure in medicine.

Both instances represent a more thorough understanding of health, eating disorders and medical and mental health issues. And they are both good starts. But as in all things, there are issues.

American Medical Association

In June 2023, the AMA adopted a new policy clarifying the role of BMI as a measure of medicine. Aspects of the policy can be found here:

https://www.ama-assn.org/delivering-care/public-health/ama-use-bmi-alone-imperfect-clinical-measure#

In short, the policy states, “Under the newly adopted policy, the AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations. Due to significant limitations associated with the widespread use of BMI in clinical settings, the AMA suggests that it be used in conjunction with other valid measures of risk such as, but not limited to, measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic/metabolic factors. The policy noted that BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level.”

The AMA also modified existing policy on eating disorders calling on the AMA to:

Encourage training of all school-based physicians, counselors, coaches, trainers, teachers and nurses to recognize abnormal eating behaviors, dieting and weight-restrictive behaviors in children and adolescents and to offer education and appropriate referral of adolescents and their families for evidence-based and culturally informed interventional counseling, and;

Consulting with appropriate, culturally informed educational and counseling materials pertaining to abnormal eating behaviors, dieting and weight-restrictive behaviors.

Interesting and somewhat forward-thinking policies which have been debated for quite some time in the eating disorder community.

The Colorado Law

According to data sourced from the Center for Disease Control, Colorado ranks as the second healthiest state in the United States. Its high ranking is attributed to its active lifestyle culture, abundant outdoor recreational opportunities, and a strong focus on healthy eating. It is also known for having a number of tree hugging, Birkenstock wearing, pot smoking, hippie libruls. [I kind of respect that last aspect.]

With its liberal politics and lifestyle and focus on health, it should come as no surprise that Colorado politicians wanted to do away with the much criticized BMI as an indicator of health. And so, the Colorado legislature passed a bill which greatly limited the use of BMI

This bill can be found here:

Click to access 2023a_176_signed.pdf

If you can work your way through this bill and then reach a place of partial understanding, there is much to embrace. And much which provides confusion.

On the one hand, the some of the substance of the bill states, “… SHALL NOT UTILIZE THE BODY MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING AN ACHIEVED WEIGHT WHEN DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH AN EATING DISORDER, INCLUDING BUT NOT LIMITED TO BULIMIA NERVOSA, ATYPICAL ANOREXIA NERVOSA, BINGE-EATING DISORDER, AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER, AND OTHER SPECIFIED FEEDING AND EATING DISORDERS AS DEFINED IN THE MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS.

But then, the next part of the bill states, “SUBSECTION (1)(a) OF THIS SECTION DOES NOT APPLY WHEN DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING SUBTYPE, OR BINGE-EATING/PURGING SUBTYPE; HOWEVER, BODY MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING AN ACHIEVED BODY WEIGHT MUST NOT BE THE DETERMINING FACTOR WHEN ASSESSING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING SUBTYPE, OR BINGE-EATING/PURGING SUBTYPE.”

Ok, so I am a reasonably intelligent human being. But, what in the blue hell does the language of the bill mean? On the one hand, BMI, ideal body weight or any other standard requiring an achieved weight can only be applied to anorexia nervosa – restricting subtype and binge-eating/purging subtype so long as they are not the determining factor? Well, that doesn’t seem too vague, confusing and subject to interpretation!

It would also appear as if the bill, albeit well intentioned is having adverse effects. Dr. Elizabeth Wassenaar, the Regional Medical Director for the Mountain and West regions at Eating Recovery Center and Pathlight Mood & Anxiety Center was interviewed by an NBC news local affiliate. This interview can be found here:

https://www.9news.com/article/news/health/doctor-warns-law-designed-to-expand-eating-disorder-treatments-creating-barrier-to-care/73-9ac527d4-9d38-4d67-b212-6067fe53d714

In the interview, Dr. Wassenaar stated:

“On face value, I 100% agree with this legislation,” Wassenaar said. “I absolutely want to see every person who needs eating disorder treatment be able to access it. And I never want to see someone be discriminated against because of the size of their body, especially when it comes to receiving care for their eating disorder.”

“Unfortunately, what we are seeing is that patients who are in small bodies who are malnourished are actually being excluded from care or being asked to step down before they are ready because we can’t consider their degree of malnutrition as a part of their degree of severity of illness.”

“And the reality is when you have a statute that makes this sort of determination, then it takes the decision out of the hands of the medical providers who are taking care of people with these patients.”

Indeed.

Which brings up the seminal question …

The Question

With BMI being an incredibly troubling issue regarding its use (or non-use) with eating disorders, why hasn’t a definitive policy or statement been released from experts in the eating disorder community? A unified, collaborative statement so strong, so authoritative, that legislatures, organizations and health insurance providers alike adopt it as THE definitive word on BMI.

After all, the research, study and treatment of eating disorders are the raison d’être for our experts’ existence.

Shouldn’t the continued existence of BMI, or the genesis of its demise lie with the recognized experts in the eating disorder community? Those who study it and either use it or decry it as a diagnostic tool.

Envision if you will, some of the most renowned experts worldwide in the field of eating disorders coming together to brainstorm, to share research and ideas. And then issuing a comprehensive study supported by all of the eating disorder organizations and treatment entities. Including representatives from the health insurance industry.

If ever a time existed for this wisdom, this type of collaboration, this coming together as one, that time is now.

And so, the last question is … who is going to step to the plate and turn this into a reality?

Consequences and Ramifications?

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

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

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

So, with that in mind …

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

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

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

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

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

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

Within

ACUTE Center for Eating Disorders and Severe Malnutrition

Alsana

Blue Ridge Eating Disorder Care Center

Center for Change

Eating Recovery Center and Pathlight Mood & Anxiety Center

Equip

Focus Treatment Centers

Healing at Hidden River

Koru Spring

Laureate Eating Disorders Program

Monte Nido

Odyssey Eating Disorder Network

Rogers Behavioral Health

SunCloud

The Emily Program

The Renfrew Center

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

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

And all we hear is silence.

Where is the integrity?

Where is the dignity of human life?

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

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

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

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

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

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

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

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:

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.

Palliative Care’s Ultimate Loss

Whether it is because media outlets are finding more click bait worthy stories or whether it is because we have finally passed a tipping point, we are finding more stories seemingly on a weekly basis on the attempted intersection between anorexia nervosa and palliative care.

The Shadows of our Demise. The Harbingers of Hopelessness.

In the Netherlands, a 29 year old is allowed to take her own life after suffering from mental health issues. Her doctors believe they are out of options and have given up hope.

A 34 year old young woman in the Netherlands is diagnosed with an eating disorder, recurrent depression, autism and mild learning difficulties. She said she tried countless therapies but struggled her entire life. And then in 2022, a counselor told her that euthanasia for psychiatric reasons was legal. She made it her goal ever since, admitting that she always thought about death.

In the UK, recently a 19 year old young lady suffering from anorexia died from eating disorders after waiting for treatment. The UK’s overburdened mental health system could not admit her for treatment.

In the United States, a very small sect of treatment providers is embracing medical aid in dying for persons suffering from anorexia. Palliative care for persons with eating disorders has entered our lexicon. This despite the fact that we have no generally accepted standard of care for treating eating disorders and limited knowledge of evolving medical interventions to treat this brain-based illness. The ignorance in the medical and mental health industries has grown so much that some treatment professionals have written, “Terminal Anorexia” (don’t get me started) is the same as Severe and Enduring Anorexia Nervosa.

I can’t help but wonder … for those medical and mental health professionals who support, if not actively engage in physician assisted suicide for those who suffer from anorexia, how many have had a beloved child die because of this insidious illness? Or is it merely an academic exercise impacting persons not of their blood line? How many have felt that anguish that cannot be adequately described and yet, still tears apart your heart and soul to a depth that cannot be fathomed unless experienced? How many of those medical or mental health professionals who have looked into the eyes of a patient suffering from eating disorders and who said, “I can do no more. There is no hope.” have had a child cruelly ripped from life?

Any? Probably not. That type of pain forever changes you.

So, for those medical and mental health practitioners who support physician assisted suicide for anorexia nervosa, let me attempt to describe for you, [as much as my limited abilities permit] the pain, the anguish so deep, so permanent, that it is almost beyond comprehension.

Think of your beloved daughter. The memories. The memories of going on Indian Princess campouts in Southern Oklahoma. And as you walk back to your tents late at night, you are holding her in your arms, she so young and precious, and then you look up and see the blackest of night skies, bright stars so numerous as to be uncountable … you see so clearly, the Hale-Bopp comet. You breathe in your daughter. You feel her so close to you. Her head on your chest, hearing your heartbeat. You see her innocent eyes closing, a blissful smile on her face.

You remember the joy on her face as that very afternoon, she caught her first fish! And she is jumping with elation.

You remember so distinctly the day she was born. And you being filled with an incredible love that captures you.

You think of those many nights helping with homework.

You think of those nights when, because you are a dad and she is a blossoming young lady, she wants nothing to do with you!

Then, you think of those many days and nights when she called you “twins.”

You think of that day when you took her to the circus. How she clapped with joy when the elephants marched in. And her howls of glee when a circus clown dragged you to the center ring and threw plates with you while thousands looked on.

You remember taking her to Del Frisco’s Steakhouse for her 10^th birthday and after the waiter announced all the specials that night, she looks him in the eyes and says… “I believe I will have the lobster.” You laugh seeing the waiter’s incredulous face. And then smile watching her take each piece of lobster and delicately dip it in butter and eat it with a smile on her face.

You remember taking her to her first opera when she was 7 years old. As intermission happens, she looks at you and sweetly asks, “Daddy, will there by more music after halftime?”

But you also remember years of struggle, pain and heartache.

And then, one dark night. One dark, unholy night, eating disorders claims its next victim. As you are holding her hand, the attending doctor looks up at you and softly says, “She’s gone.”

In your numbness, shock and an anguish that cannot be measured, you realize that you will never be the same. The man, the parent, the daddy you were, is forever changed. Whoever you thought you were … is gone.

After awhile, you come to realize that you will never see the joy on her face when she tells you, “Daddy! I am engaged!” You will never walk her down the aisle. You will never have that first Daddy-Daughter dance at her wedding reception. You will never hold for the first time your grandchild from your beloved daughter.

You will never hold nor hug your daughter ever again. And you will never, ever, ever, ever hear again, your daughter’s voice saying, “Daddy, I love you.”

It is exactly that. That is what physician assisted suicide for anorexia rips away. That is the dagger to the heart. That precious life. Those precious words. Gone forever.

“Daddy … I love you.”

Harmful Mental Health Ignorance

Words matter.

Especially when those words have been universally disavowed and do not accurately reflect a medical nor mental health condition. Nevertheless, they are thrown out by uneducated medical professionals in a cavalier, irresponsible and harmful manner.

In May 2024, an abstract was published in the Journal of Pain and Symptom Management, entitled, “Consider Concurrent Hospice Care for Patients with Terminal Anorexia.” Its authors were Ingrid Berg, DO, Kevin W. Craig, MD and other initials, and Lea C. Brandt PhD and other initials.

Websites list Dr. Berg’s areas of expertise as chronic diabetes, sepsis, tobacco use, chronic heart failure, insomnia, pneumonia and respiratory infections, stroke, gastrointestinal bleeding, irregular heartbeat, inpatient urinary tract infection, kidney failure and chronic cutaneous skin ulcer. They missed the “kitchen sink.” In addition, there are no references to any expertise in treating eating disorders.

Dr. Craig is at the University of Missouri School of Medicine and lists his expertise as Alzheimer’s disease, geriatrics and hospice care. On the University of Missouri website, Dr. Craig only lists 5 publications. None involve eating disorders and Dr. Craig does not list eating disorders as any type of specialty.

Lea Brandt, PhD is also at the University of Missouri School of Medicine and lists her expertise as clinical ethics. I found 22 publications authored by Lea Brandt, PhD. NONE involved eating disorders. The only reference to eating disorders and Lea Brandt, PhD is related to the above abstract. Clinical ethics? Thy name is not Lea Brandt on this topic.

With this information, we can safely discern that these “Three Harbingers of Death” have no substantial experience with eating disorders, do not write about eating disorders, do not treat people with eating disorders, have no lived experience with eating disorders, do not understand how eating disorders impact the brain and biological system and have no expertise with eating disorders.

When one looks at the topic which apparently was presented at the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice & Palliative Nurses Association (HPNA) Annual Assembly, combined with media reports of the paper, we can readily see the false statements, the naïve and outright misunderstandings of eating disorders, the dangerous course of conduct supported by these doctors and the dark mindset which infests their souls, assuming they even have one. Their lack of understanding and knowledge on this topic is so egregious and harmful that certainly the State Boards of Medicine in Missouri and Nebraska will be contacted to determine if disciplinary consequences are appropriate for such egregious misconduct.

With this background, let’s address just some of the more open and obvious deficiencies in their thinking and presentations.

First, they believe and represent that, “Severe and Enduring Anorexia Nervosa” (”SE-AN”) is the same as and is also referred to as “Terminal Anorexia.” The ignorance and falsity in that statement alone cannot be understated. Good Lord!

While there is no formal consensus on a definition of SE-AN, Hay and Touyz (2018) proposed the following criteria:

(a) clinically significant functional impact;

(b) at least a 3-year duration of illness; and

While SE-AN is clearly a debilitating illness and some do not recover or may die due to complications of AN, studies indicate that most individuals with a protracted illness course do recover (Eddy et al., 2017).

Ergo … there is no “terminal” aspect to it at all.

Contrarily, “Terminal Anorexia” was an ill-advised term proposed by Dr. Jennifer Gaudiani in February 2022. Since that time, an avalanche of papers have been published criticizing Dr. Gaudiani’s paper while also showing that the term, “Terminal Anorexia” is a non-sequiter. Its criteria was fundamentally flawed. In fact, Dr. Gaudiani has repeatedly and publicly called for the term to stop being utilized, that additional study needed to be done and she apologized for any harm which may have been caused.

In short, the unrecognized, debunked theory of “Terminal Anorexia” cannot in any way be compared to Severe and Enduring Anorexia Nervosa except for perhaps in one way … One is a direct path to immediate and certain death. The other is an enlightened, hope and faith based journey which leads to life.

Nonetheless, these three “Specters of Death” insisted on inaccurately utilizing this term with no frame of reference and even though the term has been denounced by every ethical eating disorder research professional and clinician. And yet, there are other great concerns in their presentation.

Brandt (the so-called ethics expert) is quoted as saying, “Going into ethical considerations and debate, the diagnosis of terminal anorexia is relevant,” Brandt said. “And in that there is this intersection between law and ethics that really influences medical decision making. We do have to take into account this legal framework [for] how we make decisions within the health care system. The standard of care [is] a variable, but relevant construct when determining what is ethically indicated.

The first question is how does one diagnose a medical condition that does not exist? A medical condition which has not been studied, accepted nor proposed by ANY medical or mental health organization, group, or persons (except by the initial authors who have since backed away from this term)? The non-existent condition and phrase “Terminal Anorexia” cannot be diagnosed because it is not real. It has not been proposed let alone adopted by the American Medical Association, the American Psychiatric association nor any international medical or mental health association. It is a figment of the imagination, a flight of fantasy. It is Harvey the Rabbit. Not one reputable, eating disorder expert will vouch for its authenticity.

And yet, Brandt also wishes to talk about (1). the legal framework; (2). what constitutes a standard of care and, (3). terminal anorexia? Fine.

Going in reverse order, of those three issues, two do not even exist. First, Terminal Anorexia is in the grave. It was at best, a woeful term of art with no generally accepted criteria supporting it. It is now only being perpetuated by ill-advised, ignorant mental health or medical professionals (like these three) who don’t care how many people are hurt by its application. Second, there are no generally accepted standards of care for the treatment of eating disorders. There is no dispute about that. And so, that only leaves the legal framework, the sandbox in which I play. An area in which these three are about to become personally familiar … and not in a good way.

Brandt then digs her terminal grave deeper by stating, “Determining whether terminal anorexia is an acute condition versus a chronic, life-limiting illness resulting in death “becomes extremely difficult,” she said.

First, once again, terminal anorexia is a made up term with no independent medical or mental health studies supporting it and which has been lambasted by every reputable eating disorder expert. Secondly, every reputable eating disorder research professional, medical doctor and clinician classifies SE-AN as chronic.

Brandt continues with her own grave digging by stating, “Additionally, the variances around terminal anorexia nervosa criteria can make it difficult to determine what is medically appropriate, as well as ways to provide goal concordant care.” Brandt, … there you go again. THERE IS NO TERMINAL ANOREXIA NERVOSA CRITERIA. And even if there were criteria, your very words decry this criteria when you state there are variances around the criteria.

Perhaps the greatest concern arising from the abstract, media release and presentation is, “A case report from a Midwestern academic medical center about a 20-year-old woman with SE-AN provides an example of end-of-life care for this vulnerable population that is not guideline-focused, but patient-centered. When she enrolled in hospice, the hospice organization offered to cover ongoing treatment while simultaneously providing supportive care services to her and her family.”

TWENTY (20) YEARS OLD? TWENTY (20) YEARS OLD!!! We know that the frontal lobe hasn’t even finished developing until a person reaches 25 years old. Then there is the obvious arrested development so common with addictions and eating disorders. So, who recommended hospice for a 20 year old with anorexia? What reputable medical center would accept that? And, were these three involved in any way with that decision?

These Three Riders of the Apocalypse with no appreciable eating disorder experience take a term that has been completely debunked and try to fit it into their “Escorting You to Death’s Door No Matter What” practice and obvious mindset. They are the very definition of an inexperienced population which has completely misconstrued eating disorders and they latch on to their own ignorant belief that SE-AN is terminal. They obviously do not know that terminality usually means some biological process is irreversible and with relative certainty not going to respond to any available treatments.

Some people have postulated that once the phrase, “Terminal Anorexia” was placed in the public, Pandora’s Box has been opened, the genie is out, and it is never going away. Perhaps.

But I don’t think so. Instead, I believe there must be harsh ramifications and consequences for its perpetuation by ignorant medical professionals. We can rightly deduce that this 20-year-old person with SE-AN whom was escorted to death’s door took place in the medical center where two of them practice.

And so, once more unto the breach dear friends, once more. More research will be undertaken. And then, ethics complaints to the Missouri and Nebraska Boards of Medicine. Ethics complaints to the university medical centers where these people practice. Ethics complaints to every organization in which they belong. Social media blitzes. The irony of filing an ethics complaint against a person who specializes in clinical ethics is delicious.

And yet, these three were given the opportunity to discuss this matter with some of the foremost experts in the eating disorder community. An opportunity for enlightenment and wisdom. An opportunity to study further these complex issues. To date, they have not taken advantage of that offer and opportunity.

For those medical and mental health professionals who insist on using that term and in doing so, hurt a very vulnerable population, their patients, you will be called to account for your ignorance and your negligence. Research and ethics complaints await and are being processed.

These three are the first.

The Winds of Change

In the past few weeks, iaedp’s “Board” released an announcement advising its members that changes were coming and that the Board was launching a new initiative and strategic plan for the organization.

When I first read this, I equated this “major announcement” with the “major award” won by Old Man Parker in one of the best Christmas movies ever released, “A Christmas Story.” Visions of a fishnet stockinged leg lamp danced in my head.

However, the announcement, when it comes, will end up being quite significant, if not different than what the Board initially intended. Although iaedp has not yet issued its official announcement, the subject has become known in certain circles of the eating disorder community. And that is …

Bonnie Harken, iaedp’s Managing Director is … “retiring.”

It is unknown whether she will also be stepping down as Chairperson of the Boards of Directors of all the “independent” corporate chapters. It is logical to presume that these positions will be included in her retirement.

Most people in the community know that I have significant issues with Ms. Harken and that we are in an adversarial capacity. But that should not diminish the accomplishments Ms. Harken achieved in the past.

According to her LinkedIn profile, Ms. Harken has been in the eating disorders treatment field since 1987. She states she was a founding officer of Remuda Ranch Centers serving as its Vice President until February 2002. Since February 2002 until two days ago, she served as the Managing Director of The International Association of Eating Disorders Professionals Foundation (iaedp). Certainly, twenty-one (21) years far exceeds the reign of any other leader of all other eating disorder organizations. Ms. Harken stated that she served many major eating disorders treatment facilities as a consultant.

In the past, she had a vision for eating disorder board certification. Under her leadership, this certification program was built. For that she should certainly be commended. She was instrumental in helping to bring information about eating disorders to the mental health community.

However.

After issues were brought to the attention of Ms. Harken and before the lawsuit was filed, Ms. Harken and iaedp’s attorneys attempted to deflect attention away from iaedp’s issues and stated their belief that the Morgan Foundation was operating illegally. This is generally known as a “straw man fallacy or argument.”

A straw man fallacy is the fallacious practice of attempting to refute an argument different from the one under discussion, while not recognizing or acknowledging the distinction. Ms. Harken failed to consider that in early 2020, I intentionally let the Foundation lapse.

Through my investigation and research, I found that there were people in the eating disorder community who instead of helping families, were hurting families suffering from this disease. I knew that to expose their conduct and get them out, I had to be aggressive and utilize social media and the court system. I had to become almost hated. I did not want my daughter’s name sullied with that which had to be done.

So, the Morgan Foundation does not, and has not solicited donations, accepted donations or co-sponsored any events since it closed. I regarded Ms. Harken’s attempt to use this to deflect attention away from her own alleged questionable conduct as a sin that cannot be forgiven.

To me, there are very few things/people beneath contempt. But, in attempting to take issue with, and besmirch the memory of my daughter is beyond all decency.

My daughter died after fighting eating disorders for seven (7) years. She possessed more courage, resolve and heart than people like Ms. Harken could possibly envision. However, Ms. Harken crossed the Rubicon of decency. For that, there can be no forgiveness. And that knowledge, that reality, hurts my heart.

Before the current situation, I was on a cordial basis with Ms. Harken. In fact, in one email she wrote:

“I have read Morgan’s journal entries several times. I feel very honored that you shared those pages with me because I imagine the contents of her journal are so very precious to you.

My mother left me a diary that journaled her health issues for over a year before her sudden death. She did not share the issues she was having with me or my brothers. She did not seek medical help which I believe was due to the fact that my father had died four years prior and she didn’t want to go on. Her diary was both a comfort and –sometimes– an agony for me. So many feelings… I am not comparing my experience for any other reason than to share that I know how precious those words on paper are and am so deeply touched that you shared them with me as someone you do not know.

I can’t even begin to fathom what feelings Morgan’s words stir in your father’s heart.

I have no context for her thoughts in terms of when she wrote them or how close it was to her death or the pages that precede or follow those you shared. I do not need to know because the pages I read spoke to me of her journey from a “higher power” to the revelation that our Savior is real and a comforter who loved and cared about her even if she didn’t understand her own circumstances or feelings.

I read the pages repeatedly and thought about my own journey to Jesus and all I have learned since I began my imperfect journey nearly 40 years ago with a Savior who is real and present daily in my life. I asked Him to guide my words to you.

My prayer is that my words comfort you.

I do know this with certainty: When Morgan closed her eyes here on earth, she opened them in the presence and love of Jesus. Heaven is beautiful with colors beyond our imagination. She is with God in perfect peace.

God loves you and I believe He has a call on your life and your journey.”

One statement in that message is particularly poignant. “I can’t even begin to fathom what feelings Morgan’s words stir in your father’s heart.” No, Ms. Harken, you can’t. Consider yourself lucky that you can’t.

I wonder what happened to that person. The person who crafted those words. The person who crafted that message. It is that person I want to remember. That person who at one time strove to help others. That person who made a difference. And yet, I fear that person no longer exists.

That person who could have remained an icon in the community … instead of an outcast.

A DAD'S JOURNEY WITH EATING DISORDERS

Musings on Mental Health and the Eating Disorder Industry

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Tag Archives: eating-disorders

The Eating Disorder Community is in Decline and I will not Pretend Otherwise

RIGHTEOUS INDIGNATION ?

UPDATE iaedp

BMI … Barely Medically Important

Consequences and Ramifications?

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

Et tu AED?

Palliative Care’s Ultimate Loss

Harmful Mental Health Ignorance

The Winds of Change

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