My own experience is that many times, those seeking rehabilitation from an eating disorder do not actually want contact. They do not want to give up their symptoms because they are a protective mechanism that the patient very much needs. Family dynamics, societal expectations, peer groups—the potential sources of stress that trigger a patient's protective instincts are numerous, and often multi-faceted. So many patients that show up for treatment don't actually want it. How do you treat someone who doesn't want treatment?
Mr. Shumake concurred that many patients do not actually want to be cured. He believes that eating disorders are among the most difficult psychiatric illnesses to treat, and establishing a therapeutic relationship with the patient has got to be the primary goal. Otherwise, it is extremely difficult to engage with the patient, because the disorder represents their ability to control a certain aspect of their life, and sending the message: “we will attack what protects you” is going to make any patient reluctant.
Over the past thirty years, a great deal of progress has been made in understanding the genesis of this disease. For example, anorexia nervosa and bulimia are now seen and treated as completely separate disorders. It is hard to believe that the first diagnosis occurred in 1684, and here we are in 2014, and still there is no one protocol, no one treatment, that has been proven most effective. Why? Well, Mr. Shumake said that the research points toward cognitive behavioral intervention and the Maudsley model—a family-centered model developed in the UK upon which The Renfrew Center protocol is based. Of course, it is very challenging, time-consuming, and expensive to conduct the type of robust, long-term research on which we could base treatment outcomes. Moreover, as the Renfew Center demonstrates, effective treatment must be greatly tailored to the individual.
The Renfew Center takes a comprehensive, family-based approach, because--like all psychiatric illnesses--eating disorders affect not just the individual, but also those close to them. Contrary to popular belief, when a patient recovers, a family's equilibrium is threatened: the patient is often a scapegoat, their disease a great source of shame. Once treatment is well underway, family members must re-define their roles. That is why the Renfew Center treats whole families. They provide education, therapy, and a support system that lasts the rest of their lives (the Renfew Center has a very active alumni network). In the meantime, a team of specialists work together to create a comprehensive therapeutic intervention for the individual, including (but not limited to) cognitive therapy to help uncover the problems underneath the food issues and a nutritionist to educate the patient away from destructive stereotypes surrounding nutrition.
As Mr. Shumake pointed out, mental health is emerging from the shadows. We now see public service announcements about depression and schizophrenia. Hopefully eating disorders will be next. As the #1 killer among psychiatric illness, and it deserves our attention!
If you or a loved one may have an eating disorder and would like to seek further information, Mr. Shumake urges you to call 1 800 RENFREW at any time, where you can talk it over with an expert.