Tag Archives: #eatingdisorders

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


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

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

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

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

So is the normalization.

Inside treatment systems, the language feels technical and reassuring:

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

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

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

The illusion is not cruelty.

The illusion is normal.

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

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

Which raises an uncomfortable question:

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

The Silence Around Mortality

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

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

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

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

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

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

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

Why?

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

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

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

Those are not comfortable conference topics.

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

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

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

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

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

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

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

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

Meanwhile, mortality remains stubborn.

And rarely centered.

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

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

If truncated treatment is normal, no one is responsible.

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

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

The silence itself becomes data.

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

If mortality is not the headline metric, what is?

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

Those may matter. But survival matters more.

Progress should be visible in survival curves.

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

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

Instead, the field risks mistaking activity for advancement.

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

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

How Is That Progress?

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

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

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

And when scrutiny diminishes, reform stalls.

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

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

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

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

That is not progress.

It is normalization of unacceptable outcomes.

Dialogue Without Accountability is Performative.

“We have to abandon the conceit that isolated personal actions are going to solve this crisis. Our policies have to shift.”

Al Gore — Inventor of the Internet

“Effectively, change is almost impossible without industry-wide collaboration, cooperation and consensus.”

 Simon Mainwaring — Author, Consultant, Branding Expert

In the past month, eating disorder organizations collectively released two podcasts. These podcasts featured several purported leaders in the eating disorder community. The theme was “collaboration and coalition.”

This first podcast was entitled, “Unity in Action: How NEDA, AED, and iaedp are Reimagining Collaboration in Eating Disorder Care.” Its moderator was Dawn Gannon, the Executive Director of iaedp. The participants were Dra. Eva Trujillo, Chairperson of the Executive Committee of iaedp, Doreen Marshall, the Chief Executive Officer of NEDA and Gry Kjaersdam Telleus, PhD, FAED, President of AED.

https://iaedpfoundation.com/s1-e3

The second podcast was entitled, “Hope in Action: Advocacy, Education and Family Support in Eating Disorder Care.” Its moderator again was Dawn Gannon, the Executive Director of iaedp as moderator. The participants were Dra. Eva Trujillo, Chairperson of the Executive Committee of iaedp, Judy Krasna, Executive Director of F.E.A.S.T. and Johanna Kandel, Founder and CEO of the National Alliance for Eating Disorders.

https://iaedpfoundation.com/hope-in-action

[As an aside, Judy Krasna is working tirelessly at F.E.A.S.T. The hand she was dealt is incredibly daunting. Judy’s ability to bring hope to others despite her own personal tragedy is inspirational. This article is in no way, directed at Judy nor F.E.A.S.T., a parent focused organization.]

As for the others though …

Having turned their backs on cooperation for years, these organizations through their annointed leaders now peddle podcasts on “unity” — as if the worsening eating disorder statistics their arrogance helped create have nothing to do with them. This is not collaboration; it is historical revisionism dressed up as thought leadership, an attempt to recast failure as vision while the damage to patients, families, and the field itself continues to deepen.

For decades, these organizations have operated less like partners in a shared mission and more like rivals protecting their turf. Their leaders’ unchecked egos, refusal to share platforms, and insistence on gatekeeping professional legitimacy fractured a field that desperately needed cohesion. While the need for collaboration was obvious to clinicians, patients, and families, the so-called “leaders” chose pride over progress.

The results are plain in the data. Nearly 9% of Americans — about 28.8 million people — will face an eating disorder in their lifetime. Yet fewer than half of those suffering ever receive treatment specifically for their condition.

When my beloved daughter, Morgan died from anorexia in October 2016, the mortality rate was believed to be one death every 62 minutes. Under the “leadership” of these organizations, the mortality rate worsened. Now … the death toll is one soul every 52 minutes. One beloved daughter, son, wife, husband, brother or sister … every 52 minutes. At least one family fractured and condemned to exist in a living hell every 52 minutes. 10,200 Americans every year. To call this a systemic, reprehensible organizational failure would be charitable.

These outcomes did not happen in a vacuum — they were shaped, in part, by these organizations that prioritized self-promotion and control over collective action.

Now, with public scrutiny mounting, their very existence in doubt because of their incompetence, corruption, and statistics impossible to ignore, these same voices have turned to podcasting as if to reinvent themselves as conveners of dialogue. But dialogue without accountability is just performative. To applaud their sudden embrace of “collaboration” is to reward the very behaviors that deepened the crisis and worsened the mortality rate.

The Podcasts: A Sudden Conversion to Collaboration?

In their recent podcasts, the organizations present themselves as apostles of unity. “We don’t need to say the same thing. We need to say the right things together,” one leader insists, followed by declarations that “true partnership is not a press release” and that the field must “move from collaboration to coalition.” The language is lofty, almost aspirational — but it also reads like a confession.

For decades, collaboration has not only been neglected, it was actively resisted. The leaders now calling for “shared goals” and “mutual accountability” echo the same tired voices who presided over years of exclusion, ego-driven silos, and public refusal to partner. Their own admission — “we really don’t collaborate, and I think that’s holding us back” — is less revelation than confirmation of what patients, families, and professionals have long known.

The sudden insistence that “the field is watching, families are listening, we must speak with one voice” rings hollow when measured against history. It was precisely the lack of one voice — the splintering of the field into competing fiefdoms — that weakened public understanding, delayed medical recognition, and contributed to the worsening statistics. To now stage podcasts about “harmony” is to behave as though the crisis simply materialized, rather than acknowledging their own role in deepening it.

Even their calls for memorandums of understanding, shared campaigns, and joint advocacy are telling. These are not bold new ideas — they are the most basic commitments of any field facing a public health emergency. That such fundamentals are being floated as if groundbreaking only underscores how long the organizations refused to take even the first steps toward genuine partnership and how lost and vapid these organizations are.

The Gap Between Words and Actions

The dissonance lies not only in what is being said, but in what is conspicuously absent. These podcasts are heavy with declarations of urgency, integrity, and mutual respect, but strikingly light on accountability for past failures. Nowhere is there acknowledgment of how long collaboration was resisted, how many opportunities were squandered, or how deeply the credibility of the field was damaged by turf wars and egos.

The most obvious, blaring example of organizational hubris and failure is their betrayal of the Legacy of Hope Summit conducted in 2021.

https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-021-00501-w

Over 20 of the foremost experts in eating disorders met in Dallas, Texas to reach a collaborative consensus on eating disorders. All of the organizations were invited to attend and participate. All attended. However, as the Legacy of Hope process developed, those same organizations which attended the summit with grand words of cooperation, one by one withdrew from the process. Only AED, because of its then Executive Director, Elissa Myer, saw the project through to publication. The others? Actively slunk away from collaboration and sought to protect their own fiefdom.

In fact, one radical activist, who is embraced by one treatment center and as usual, is being trotted out during Weight Stigma Awareness Week had this to say about the Legacy of Hope: “The entire ED community is getting upskirted by certain men and we cannot put our own FOMO aside long enough to see it. Instead, we attend these men’s meetings and give them power to continue their gaslighting and lack of any willingness to see the intersections affecting our field. I’d love for other women to join me (and a few others) in being difficult when it comes to these people.“

Further, it is particularly galling that Johanna Kandel, one of the persons on the second podcast appeared at the Legacy of Hope in person and via telephone and then… Nothing. She did not sign off on the Legacy. She and the organization she leads did not endorse it. She and her organization turned their backs on the community’s greatest hope for collaboration. Without explanation. Just silence. And now she is one of the voices calling for collaboration?

What could have started as the foundational cornerstone for collaboration instead turned into one of the darkest moments for the eating disorder community. Perpetrated by these organizations, their egos and self-interest.

There is no concrete evidence that their current rhetoric will translate into change. Promises of “more clinicians trained,” “a new website,” or “sharing resources” are thin commitments when weighed against the scale of the crisis. Families listening to these conversations do not need another press release in audio form — they need assurance that the field is finally willing to dismantle the silos that have left so many patients without timely, effective care.

Meanwhile, the systemic problems remain glaring. Most medical schools still provide only a few hours of eating disorder training — if any at all. Physicians themselves admit they lack confidence diagnosing or treating EDs, leaving patients vulnerable to misdiagnosis and harmful delays. Early detection remains the exception rather than the norm.

When leaders now speak of “raising the bar for what trained really means,” the statement lands as an indictment of their own failure to make such training a priority long ago.

The access gap is equally damning. Even when patients are identified, treatment is often out of reach due to cost, lack of specialized providers, or long waiting lists. The promise of “connecting people to care” is meaningless without structural solutions to these barriers. Instead of confronting these realities, the podcasts retreat to abstractions about “shared truths” and “moving mountains” — lofty words detached from the urgency families are facing right now.

What Real Collaboration Would Look Like

Real collaboration does not begin with polished talking points or podcasts lacking in substance.

It begins with humility. It begins with listening — not only to one another as institutions but to the families, survivors, and frontline providers who have long recognized the cost of division. It means relinquishing the obsession with brand dominance and professional gatekeeping in favor of shared goals that truly prioritize patients over power and profit.

True collaboration would look like joint initiatives with transparent governance, shared funding streams that prevent duplication, and open access to resources across organizational boundaries. It would mean building structures that ensure accountability — not merely mouthing the word. And it would require leaders to acknowledge their role in perpetuating division before claiming the mantle of unity.

Until that happens, these podcasts serve less as roadmaps for progress than as monuments to irony: the fox guarding the henhouse, the arsonist auditioning as a firefighter, the vampire running the blood bank.

The eating disorder field — and the people it is meant to serve — deserve better than revisionist performances of collaboration.

We deserve the real thing.

AND THEN … THERE WAS ONE

“One of the saddest lessons of history is this: if we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. That bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.”

            -Carl Sagan

“Integrity, transparency and the fight against corruption have to be part of the culture. They have to be taught as fundamental values.” 

-Angel Gurría, OECD secretary general.

In the past, I have been asked why I focused quite a bit of attention on iaedp and Acadia.

Regarding Acadia, that is about to end. Not because of great strides made by Acadia in terms of patient care. Certainly not because of transparency nor implementation of a state-of-the-art eating disorder treatment program which addressed all past sins.  Oh no.

It is because … there is but one remaining.

On September 10, 2025, media outlets reported that Acadia was shuttering four facilities.  Options Hospital in Indianapolis and Azure Springs in California.

Oh… and Carolina House and Montecatini. Their last day of operations will be October 9, 2025. Although if you look at their websites, you will never know they were shuttering.

Montecatini still advertises on its website that it is, “Southern California’s Premier Residential Eating Disorder Treatment for Female-Identifying and Nonbinary Individuals Providing Life-Changing Care for Adults and Adolescents for Over 30 Years.” It fails to mention … at least until October 9, 2025. After all, we have to squeeze every last penny from our victims!

Carolina House on its website still advertises, “Personalized Programming in a Safe, Healing Environment. Carolina House offers a range of programming options for individuals struggling with primary eating disorders (age 17+) or primary mental health concerns (age 18+).” It fails to mention … at least until October 9, 2025. After all, that incentive bonus of $1.7 million payable next March to Acadia’s feckless CEO is not going to pay itself!

So, we are left to wonder… are they closing because of gross incompetence of the treatment staff? Or are they closing because they simply were not profitable? And really, aren’t the two inextricably intertwined?

Even though they are closing, are they still accepting new patients? And if so, are they telling those who are suffering that they are being accepted only because Acadia needs a few last dollars and their recovery could possibly be compromised or set back because of Acadia’s greed? Aren’t we justified in assuming new patients, if any, are not being told because Acadia cannot even be transparent on the websites of those two entities?

So, Acadia is left with one eating disorder specific treatment center. McCallum Place. How long will it be before Kim McCallum’s legacy is shuttered?

Kim McCallum and her husband Mark, opened McCallum’s Place in 2002. In 2014, they sold to Acadia reportedly in a cash and stock deal valued at $40 million. Who can blame them? Although that stock portion isn’t looking too rosy right now with Acadia’s stock price in the last year, plummeting from $82 a share to $21.87 today. [Hope you already cashed out Kim.]

McCallum Place is now owned by McCallum Group, LLC. McCallum Group’s organizer, vice president and secretary was Christopher Howard.  Mr. Howard was also general counsel to … Acadia Healthcare until he retired in 2023. In short, Acadia Healthcare, which is NOT a provider of any mental health nor eating disorder treatment services, owns and runs all operations of McCallum Place.

The same Acadia Healthcare which owned Timberline Knolls. Until gross incompetence and systemic abuse resulted in that facility closing.

The same Acadia Healthcare which owned Carolina House. We are justified in questioning whether it was gross incompetence or simply a lack of profiteering which caused that facility to close.

The same Acadia Healthcare which owned Montecatini. We are justified in questioning whether it was gross incompetence or simply a lack of profiteering which caused that facility to close.

Acadia has already clearly demonstrated its “treatment model” for operating eating disorder facilities is an epic failure. How many people suffering from eating disorders have had their recovery set back because of Acadia’s incompetence? How many more will there be?

At this point, we do not know that answers to those questions. But the one thing we do know … for an absolute fact is … McCallum Place … step to the plate.

You are next.

Changes at the Morgan Foundation … The Future Beckons

Progress. Movement. Advancement. Matriculation. Enlightenment. Action which needs to be pursued if a person, organization, business or foundation wish to accomplish their goals and embrace their vision.

So too with The Morgan Foundation.

When the Foundation was started, it began as many foundations do. Born out of a tragedy. Clouded vision. Great passion. Wanting to make a positive difference while at the same time, finding and then preserving a legacy for their loved one who was taken. Believing, perhaps naively so, that the memory of your loved one can be used as a catalyst to inspire others to increase their efforts and service with the noble goal of “saving lives.”

However, unless that foundation or business consistently finds new avenues and means of overcoming obstacles placed before it, it is in peril of languishing and then perhaps perishing. Time marches on. We must stay one step ahead of the tidal wave of mortality pursing us all lest we be overtaken by obsolescence.

And so, the Morgan Foundation boldly marches forward.

New Chairman of the Board

Effective January 1, 2019, the Chairman of the Board of Directors will be Judge John Payton of Texas. Judge Payton’s history and life of service is as unique as the man himself.

Judge Payton was first elected to office in 1990 when he was eighteen (18) years old. In fact, he was listed in the Guinness Book of World Records as the youngest judge ever elected. Then a senior in high school, he defeated a popular incumbent who had been sitting on the bench. He held that judgeship for 28 years and overall was elected seven (7) consecutive times.

Judge Payton had tremendous success with those with whom he has worked in his court. He is a firm believer in servant leadership. Judge Payton created a community service program training students to lead the organization and teaching them how to connect with community needs.  Judge Payton had the students from his truancy court name the program that he led for 28 years….Students On Service…..S.O.S.  Over 30,000 students went through his program performing with him side by side over 750,000 hours of community service in Collin and surrounding counties.

Judge Payton started a juvenile truancy program that has been replicated throughout the State of Texas. Through this program, Judge Payton had the opportunity to help mold the lives of more than 98,000 children who came through his court. It is this exposure to and interaction with so many of our youth that gives him a unique view of eating disorders.

Judge Payton committed his judicial career to serving children and has been recognized by Mental Health of America, Sierra Tucson, and Tough Love Inc. for his exemplary service to his community.  Habitat for Humanity and running his own food bank are just a few ways he has used positive projects to help at risk students.  He and his students built 14 homes for families demonstrating the “learn by doing” mantra, and did it side by side with the kids exemplifying the “lead by example” attitude. 

He has worked with county, state and federal agencies and has extensive experience reading and interpreting legislation. Because he has spent a great deal of time in the Texas state capitol working with lawmakers on legislation, he has an insider’s understanding of the legislative process.

He has been a leader in the Collin County Republican Party for more than 25 years, serving as the victory chair in both 2014 and 2016 and heading up block-walks, phone banks and sign distribution. Because of his extensive work in the party, he has received numerous recognitions, including the Dixie Clem Award, three chairman awards, the Fred & Mazzie Moses Community Builder Award and the John McVeigh Lifetime Achievement Award.  It is this same drive and dedication that Judge Payton will bring to the Morgan Foundation as its Chairman of the Board of Directors.

Judge Payton has seen first hand the devastating impact eating disorders can have not just on those who are suffering from this disease but on entire families as well. He has seen the early signs of this disease and referring numerous teenagers to treatment. And just as he helped thousands of children stay in school and pursue their life dreams, he brings this tireless passion and experience not just to The Morgan Foundation, but the eating disorder industry as a whole.

In conjunction with its founder, Steven Dunn, its new Executive Director, Desiree Whitten, and the Morgan Foundation’s existing Board of Directors we are looking forward to reenergizing The Foundation and have appointed Judge John Payton as the new Chairman of our Board.

New Executive Director

New leadership to the Morgan Foundation is being spearheaded by its incoming Executive Director, Desiree Whitten. Ms. Whitten has decades of marketing and communications experience having leant her considerable talents to corporate entities such as McKesson Financial Center where she was a Senior Manager in Communications; Constant Care Management Company where she was Vice President of Marketing; Farmer Brothers Coffee Company where she was Marketing Communications & Digital Marketing Manager; Fischer & Company where she was Director of Corporate Communications and Quest Diagnostics, where she was a Manager of Corporate Identity/Corporate Communications.

Ms. Whitten is the Aunt of Morgan Dunn and will be utilizing her talents to refine the message of the Foundation and to be a liaison with corporations and entities who have not yet contributed their resources to the eating disorder industry.

Together, Judge Payton and Ms. Whitten will be handling the day-to-day operations of The Morgan Foundation, fund raising, marketing and growing the legacy of The Foundation.

As for …

Steven Dunn … I will still be listed as the Founder. I will give talks on behalf of my beloved daughter. I will continue to write messages which I hope will inspire, amuse, educate and sometimes, infuriate. And yet, the memory of my daughter’s life, her legacy and the incredible good the Morgan Foundation will accomplish for those who are still suffering cannot be tainted or negatively impacted by the battles which inevitably lie ahead.

Talking with Assistant Attorneys General, State Boards of Insurance, State Boards of Psychologists and Psychiatrists, pursuing legislative agendas and negotiating with legislators, instituting lawsuits, assisting as an expert witness in other matters are all matters which are being pursued and involve controversial matters which sometimes must be approached in aggressive manners. Exposing corruption in the industry, exposing those actors who take advantage of those entrusted to their care are all matters which require illumination. And yet, they cannot be allowed to negatively impact the hope and vision for a greater tomorrow.

The mission of the Morgan Foundation … “To Save Lives, One Precious Life at a Time,” must remain sacrosanct.

2019 and the future await.