The Eating Disorders “Residential Treatment Industrial Complex”: Harm or Help? Part 1 of an Investigative Series

How An Industry Which Claims to be the Solution for Women Suffering from Severe, Long-Term Anorexia May Be Doing More Harm Than Good, and Destroying Lives in the Process

When I first entered the residential treatment system, for anorexia, in 2004, I thought it would clothe me: with nourishment – mental, spiritual, and physical – as well as flesh.

Instead, it stripped me. Bare. It tore from me my dignity, my sanity, my confidence – and, most of all, my hope. Before I admitted myself, at the age of 30, to Remuda Ranch – the first of the slew – I was an over-achieving journalist with a manageable eating disorder that had waxed and waned since high school. Most of my colleagues would have never guessed I was “anorexic.” Most thought I was merely rather thin; but I was also a runner, so it made sense. Prior to Remuda, when I worked several years as a staff reporter for daily newspapers, I was slightly underweight; thin, but not emaciated. I entered “The System” in a proactive attempt to prevent a longtime struggle from spiraling out of control, and derailing my life.

Little did I know that it was the treatment – not the disorder itself – that would end up derailing it.

By 2010 – several treatment centers later – I was emaciated enough to turn heads, struggled to walk up the stairs of my apartment, and had to admit myself to the hospital for the first time. Worse, however, was my daily functionality and quality-of-life: zero.

Now, thanks largely to the eleven years of inappropriate – and often dehumanizing, shaming, and non-evidence-based – treatment I’ve received at the hands of some of the nation’s most lauded residential, for-profit treatment centers, I’ve been reduced to an unemployable, psychiatrically disabled woman subsisting off of SSDI and food stamps. I’ve become a woman whose identity, to the outside world, is now completely defined by the mental health labels I’ve been branded with. And I’ve become someone who prays, almost daily, for death – because those labels (particularly, “ANOREXIC”), and the treatment that’s robotically administered when one’s saddled with it – have taken away my power to make my life mean something.

I drink at night – even though I feel guilty about the calories – so that I can distance myself enough from my thoughts to eat, and so I can have a couple hours’ relief from the daggers of self-recrimination which constantly fly through my head.

Whenever I’ve entered a new residential or day program, I’ve achieved the target weights the centers required of me. I’ve endured the humiliation of having to defecate, urinate and shower with 20-year-old “direct care” staff standing beside me – even though vomiting has never been one of my behaviors. I stayed the months and months the centers wanted. I participated in sometimes-pointless forms of group therapy which did not resonate with me, and imbibed the 5,000-plus calories daily they forced down my throat, producing an abundance of nausea and indescribable, painful bloating, among other things. Food consisting of staples such as tater tots combined with fried chicken strips, candy bars, and milkshakes, to name just a few. All in the name of “challenging me.” Overly-aggressive food regimens and weight targets, in other words, which have been shown to do little to improve the recovery rates of older women with severe, chronic anorexia and often force them to drop out of treatment even though they desperately want to shed their illness.

My last treatment center in Utah – which was, for me, the worst of the lot – put 40 pounds on me in three months and set a weight target that was not only far above what I needed, to be at a healthy BMI, but clearly not realistically maintainable upon discharge. One 36-year-old woman in that center with me had a meal plan which – while still not as high as mine – was so aggressive, for her, she developed a massive intestinal blockage. Writhing in pain, her complaints were dismissed for over a week. Finally one day, the center took her to the emergency room, where alarmed doctors discovered the blockage and had to pump stool out of her through a naso-gastric tube for two days.

At this same center I applied myself methodically to what therapy was provided and pled for homework my clinicians could never find the time to give me; it was my attempt to individualize my treatment because the center failed to live up to its promise it would do so, when I asked them pointedly about this, prior to admission.

Researchers and eating disorder advocacy groups have been increasingly attempting to spread awareness that anorexia and bulimia are not merely superficial disorders which mostly afflict teenagers struggling with dysfunctional families or the pressures that come with adolescence. There is no age limit to eating disorders, as Dr. Cynthia Bulik – director of the University of North Carolina at Chapel Hill’s eating disorders program, and a leading researcher in the field – puts it. Recent studies have shown that women ages 35 and over are being increasingly admitted to treatment programs for long-term battles with eating disorders. A landmark, 2012 study published in the International Journal of Eating Disorders also showed that 13 percent of women 50 and over displayed eating disorder symptoms, more than 70 percent reported they were trying to lose weight, and 62 percent felt their body dissatisfaction was negatively impacting their life[i].

About one-third of women who develop anorexia never achieve full recovery; and once they get past 15 years of struggling with the disorder, the most likely outcome is continuing, severe and chronic anorexia, or death[ii].

The media is starting to pay attention to this issue, at least a bit – such as in a 2012 Oprah Magazine story[iii]. But what nobody is paying attention to is how poorly women my age and older are being treated.

If you look at where the nation’s most prominent, residential programs and nonprofit advocacy groups – the National Eating Disorders Association (NEDA) being one of the biggest players – are directing their lobbying and advertising efforts, what do you find? They’re trying to get various state and federal legislatures to pass laws requiring insurance plans cover residential treatment for all age groups, and they’re waging expensive outreach campaigns proclaiming residential treatment as the gold-standard approach for women of all ages with anorexia. This, despite the fact that, current evidence is showing the treatment occurring at these programs – designed and geared, years ago, for mostly-adolescent populations – simply doesn’t work for older women.What current evidence does say is that outpatient care should be considered the first line of treatment for anorexia in both adolescents and adults, unless a person is acutely medically unstable, at a dangerously low weight, or unable to initiate change in an outpatient setting[iv].

We go to these centers, we relapse following discharge – and yet, we’re told to return again.

 

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35 comments

  1. Mary says:

    Thanks so much for your great article. Can’t wait to read the rest. While I’ve never been anorexic I’ve done my share of dieting and what not. I always assumed the treatment centers knew what they were doing. Why else would they call themselves ED treatment centers? Now I realize that they don’t always know what they’re doing. I’d love to see some more independent research of these centers, if it’s possible. It’d be good to know which treatments work and which do not. So sorry you went through this horrible experience. Thanks for sharing your knowledge, experience, ability to write to educate the public and help others.

  2. mari laskmi says:

    Great article, well written…I stumbled into this site via the Rachael Farrokh online controversy. I do not have an eating disorder, but suffer from biological depression, which also has inadequate/ineffective treatments, assuming one can even access any treatment. But this is true for most brain disorders aka mental illness….

    Is there any way you can post “Inside Those Doors” as the next installment? Trust me, most of us would like to read that asap!

    • Jeanene Harlick says:

      Thanks for your time and comment, Mari – I don’t know that I can post “Inside Those Doors” next because I still need to bring together the stories of those who’ve told me they’re willing to share them. But I will try to at least get that going faster this coming week, if possible. In general – I will probably be slower than I’d like in getting the rest of the series published; it’s hard for me to finish each article quickly because I still battle my own issues on a daily basis – so my work comes in spurts. I hope readers can bare with me. It’s also time-consuming to make sure I get all the facts right, try to obtain as many perspectives as possible, and to organize it all in a way that reads well! And I obviously tend to be very obsessive about pursuing all lines of research…. But thanks again for your interest!

  3. Mary says:

    I also stumbled here from the Rachael Farrokh story. That story is not just about ED. There are many other things going on such as enabling, using someone with ED to raise money off social media exposure via commercial gofundme. Gofundme makes at least 10% from private people raising money. They are happy to support people who take professional photos, videos of someone looking as horrible as possible with special angles, lighting and forced pathetic facial expressions. The funds they raised don’t seem to be going toward any treatment. She’s just sitting in a hospital room with no monitoring or refeeding. Her plea for money stated she would die if she didn’t get enough money to go to Denver for special monitored refeeding. Then she got enough money and then some to go to Denver but didn’t. I’m so done with the Farrokh “story.”

  4. Mike says:

    Powerful comments; thank you for sharing. I look forward to reading more.
    Does your last paragraph imply that recovery for you, at least, is a choice?

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  6. Nate K says:

    Thank you so much for this. Such an important aspect of the “treatment” issue that even those of us involved for years haven’t seen or didn’t realize. I can’t stress how important your work is. I will do everything I can to get this article out there. Maybe reddit can help spread the word. Thanks for your work!

    • Jeanene Harlick says:

      Thank you Nate! I am so glad you find this article helpful – I so hope it can spur change and lead to better, more transparent treatment. And I greatly appreciate any efforts to help spread the word about this piece!

  7. Fiona says:

    My story is so similar to yours, except I’m Australian and been at the mercy of repeated abusive, traumatic and pointless forced admissions to the same ED unit (the only one in a state of over 6.5 million, with just 4 beds). I too am an ‘older’ person and I do think they have made things much worse. I often wonder had things been different, had I avoided ever going to hospital, would I have recovered by myself? I believe I certainly wouldn’t have gotten as seriously sick as I did. And if I’d gotten actual support rather than punitive ‘care’ all those years ago I might have made something of my life instead of being a 37 year old NOTHING now.
    Thank you for shining a light on the industry.
    They need to be held accountable.

    • Jeanene Harlick says:

      I’m so sorry to hear of your experience, and I am certainly inclined to believe things would be better for you today had you not had to endure abusive treatment in that ED unit… I want to challenge your statement that you are a “37 year old NOTHING” — remember, I’m 41 – I, too, often think I am a “nothing” – but I’m still trying. Please try too! You’re even younger than me! And i’m sure you’ve heard the stories of many people recovering from a long-term, severe eating disorder at older ages (June Alexander, who is well known in the field, is a good example of this). If you live in Australia, then perhaps you might also be able to participate in one of Dr. Touyz’ studies? Maybe you could look into that?

  8. JS says:

    Thank you so much for this! Stumbled upon it via a friend’s fb. So well researched & articulate! Mirrors my own feelings– I was tremendously lucky to have a non-traditional team that was game w me staying in school through the worst of my disorder. I had life-saving inpatient treatment, the longest being only a month… And I kept up w school-work while there, and had a very busy life waiting for me when I left the hospital. That motivated me to eat, I knew I had so much to lose if I starved myself. I’m so grateful I didn’t take “time off” bc I’m not sure what would have kept me motivated in early recovery if not my work. I wish you had been afforded the same treatment. Recovery hasn’t been linear, but it’s been nearly five years since I’ve been in structured treatment, and I’ve made life-gains I couldn’t have anticipated. I’m older too, and went inpatient initially for “stabilization” w the plan of going to residential after, but felt that I could do better “on my own” w my outpatient team while being in school than I could do w continued 24/7 weird treatment. It was a gamble, and I was told I didn’t care about my recovery and wasn’t surrendering fully when I refused to skip final exams and skipped a day of day treatment instead. Taking time off of school would have made it v hard for me to become licensed (any gaps must be explained) and everyone just said whatever, this is your life on the line… And basically told me I was going to die if I didn’t go residential. Several places you mention were suggested. Shudder. Prattling on here– but really just a very sincere thank you for writing.

  9. Thanks for your blog – I think there is a lot ‘wrong’ with the eating disorder services world and we as affected people need to keep pointing this out . I’m a survivor and also a parent with two children who developed anorexia. We’ve had good success with my youngest by using evidence based ‘family based treatment’ . Two years into it and it’s still hard but she is weight restored and fairly analytical and working hard now to get back to normality. I had a lot of support from other parents in online support groups. As a result of her illness I and a few other mother started International Eating Disorders Action – a Facebook group and website http://www.iedaction.weebly.com of parents and those affected to start fighting the inconsistencies and misinformation in media, companies and increasingly the ED world itself. My first big wake up that we might be shaking things up was when we started activism to get the Something Fishy website to revise its outdated, parent blaming, scientifically incorrect content. A whole bunch of people suddenly got their backs up. The online mothers support group I was a member of. A federal eating disorder advocacy organization. A national advocacy and education group. For some reason defending this group that 100s of advocates – including well respected parent advocate Laura Collins – called for change… [Part of this comment was deleted by the Web site moderator due to length and negative comments toward a specific advocacy group, which is not appropriate here. Please visit IEDAction’s Web site if interested in learning more about the subject discussed here.]…

    Please joint IEDaction online and keep doing your own open conversations going! Thanks so much for this post.

  10. Meant to also mention that LOW cost family based treatment has the best and most lasting outcomes. However very few residential centers are adapting to the findings in science to support families EARLY in treatment. Given that each 6 month stay costs a family about 180k USD I have to wonder if their refusal to adapt to the science is driven by money? Most of those in treatment advocacy groups come out of the residential world and thus don’t know or understand FBT models. Many are estranged from their families because of the toll of ED. The new generation of families who are able to access evidence based treatment are a window into what outcomes should look like. Thanks!

    • Jeanene Harlick says:

      Amy – thanks for your feedback and the interesting info you provide. I don’t agree with all of IEDA’s agenda (ex., Dr. Strober has talked about how evidence for FBT is not as strong as is often claimed – and, at any rate, it is only an EBT for adolescents, not adults, the latter being the demographic my current series is focused on. In addition, the “brain-based disease” model is too reductionist, and not science-based. Biology plays a role -but is only one part of the equation in the etiology of EDs. The “brain disease” model of mental illness has also been shown to significantly increase stigma toward those with all types of mental disorders, over the past 40 years [read, for example, Ethan Watters “Crazy Like Us,” where he discusses this. I also have an article on this site which discusses the issue). But I am very appreciative of your advocacy work and think you bring up valid points. I want to review your comments more carefully and will respond more thoughtfully once I do – thanks again.

  11. CK says:

    THANK YOU!!! I spent 94 days in hell in a swanky residential center that only treated adults (official diagnosis was bulimia, but was severely restrictive, so although not AN, I think the issues are similar.) But I was almost 30, had lived on my own and been financially independent for 12+ years, had a career to go back to, and when I got back home, would be responsible for myself to make sure I ate all my meals. My treatment was not different than for the 18 year olds that were going back to their parents who would cook for them or the college cafeteria.
    I would love to share my experience with you for the inside those doors chapter. I believe I may have a unique perspective as someone who actually ended up in a solid recovery (no thanks to that treatment center).

  12. April says:

    What a great article. It’s amazing that ED treatment centers can charge so much money, make so many promises of recovery if you do what they say, and do not have to deliver on what they are “selling” which is emotional and physical health or “recovery”. Often the treatment activities are not individualized and do not appropriately address the needs of the older patient as they desperately try to recover. Under-trained staff or staff that often have no empathy for ED patients, especially older patients, who oversee most of the patients’ day often cause more emotional harm to those they are supposed to be helping. I have not heard of many successful recovery stories from the treatment centers I have experience with. Many patients leave worse off than when they entered with additional “labels” and some have given up and after multiple attempts at recovery have died. Most gain the weight knowing they will loose it once they leave. The individualized reason for their ED is not adequately explored or treated. But perhaps they got to draw pictures, play drums or pet a horse…not helpful for many older sufferers who are desperate to recover. There needs to be accountability for ED centers. Families buy into the clever marketing and promises of recovery. What they get is often their loved one returns from treatment with shattered self esteem, shame, and often additional problem behaviors, like OCD or addictions added to try to cope with their “failing” at recovery and stigma they now have for their mental health label. Families are lied to by many facilities. ED sufferers need to be listened to and the centers need to have objective proof that the service they are providing will help and not cause more harm. Thank you for your very informative and accurate article.

  13. Melissa says:

    Amazing article! I have been to many inpatient and residential programs that were basically a force feed, weight gain and lots of CBT. They never helped me transition back to life and in some cases brought up terrible trauma issues that still affect me today. I can say that I recently went to a treatment center that was different! It don’t think it was CARF certified but it was way different than anywhere I had been before. They actually helped prepare me to transition. The treatment was very individualized, they challenged me with things that I needed…not just standard programming that was mandatory. My meal plan was individual to me and I had a say in it. Of course I don’t think it was “perfect” but it helped me more than anyone by providing me with life skills and helping me get back into school and working and not just riding horses or doing ropes courses all day! Actually helpful therapy that gave me skills and motivation to get well and stay well, they actually told me recovery wouldn’t be easy and that treatment isn’t a cure which I found refreshing compared to the usual you will get better if you do what we tell you model that I usually heard. I really think this program is one of the most helpful in the country (I’ve been to many). I also am wondering what you are defining for the adult population. In some places in the article you mention “older women” and others you say >18. Just curious as I am 28 and I often felt in other treatment centers that I was being treated like an adolescent and told what to do and if I didn’t do it I was noncompliant etc etc. Great article, can’t wait to read the rest! Would be happy to converse with you by email about my experiences.

  14. Trish says:

    Excellent and very important article! Every ED treatment professional should read this. I will pass it on.

  15. Tina Klaus says:

    Wow, you are on to something. This article is going to roll heads and conviently the ED community especially treatment centers are going to keep on blaming you because you are spot on. We need to connect and talk.

  16. JD Ouellette says:

    I am glad to have connected with you on Twitter and we share a lot of common ground. My experience has been that questioning the RTC agenda might have conflict with the affected person/carer agenda in any form is verboten in the current climate in the advocacy world. I was one of over a dozen people kicked out without warning from [a parent advocacy group] and I think a large part of that was me expressing we need to look at what treatment is with fresh eyes–versus legislating more coverage for a treatment model that has not been a resounding success so far. This is not to say I don’t believe there should be no RTCs-I believe there will always be a need for them. I do think we need to look at more community-based options and having different treatment goals for different populations.

    Your piece sparked some great conversations about those with SEED and how SEED might both be prevented and how the treatment for it needs to differ from that of adolescents. These are important conversations and when I am discouraged from asking them I find that telling.

  17. Evelyn Cohen says:

    I was one of many who were suddenly, without any warning, removed from MAED, for which I have never received an explanation. I broke no rules, nor was I ever told that I did. I did notice that removal of so many members seemed to occur right after some had shared negative experiences their children had had at certain residential treatment centers, expressed concerns about outdated information about eating disorders on certain websites and questioned why comments by those members seemed to be repeatedly deleted. I remain quite baffled as to why I was removed along with so many other people.

  18. Alexis Elliott says:

    HI Jeanene,
    Thank you so, so much for the elucidating, well-researched, and well-written article. I resonated so deeply with your writing. I have had some eerily similar experiences at a number of treatment centers that proclaim they have “hallmark” centers “grounded in expertise,” with “specialized” and “individualized” care. Instead, my time in these centers were some of the most dehumanizing I have experienced heretofore. Not to mention the countless treatment providers that convinced my parents that family-based treatment was the most appropriate approach for me, when it clearly did more harm than good. Because of these centers, I was forced out of school, work & social opportunities, and was alienated from my friends and family, which ultimately exacerbated my symptoms. I too have a difficult time reconciling the causes of my “failure” to respond to so much treatment, and have deeply internalized that I am the problem, not these centers or so-called “professionals.” I am still relatively young at 22-years-old, but the past 7+ years in the treatment merry-go-round has aged me and stripped me of any sense of identity. I look forward to reading the rest of your installments in this series, and would be more than happy to share with you some of my experiences. Sending you positive vibes & warmth. Thank you again for speaking up about this issue. You are an inspiration.

  19. Soraya says:

    Thank you! I was just kicked out of EDIOP for not making enough progress on their timeline. I’m actually doing better not in IOP. I’ve been in Res, PHP, and IOP multiple times. I think it’s dehumanizing. I’m terrified of relapsing to the point where my psych demands I go back.

  20. Salvatore Candrilli says:

    I feel like I’m reading my own story through the eyes of a woman. Im a 24 year old bulimic who has been in several treatment centers which only led me to falling down and becoming worse throughout my life. I currently am in the same boat: on ssdi and food stamps and I have no quality of life. I wish to die every day and wish someone could just possibly help me. I see no solution, but Im glad to finally see that I’m not alone in this fight.

  21. Leslie Thompson says:

    I am so happy I stumbled upon this! This piece is absolutely fantastic. I am currently 30 years old, and for a much of my late teens and early twenties I spent more time within walls of residential treatment facilities than outside of them. You cannot replicate normal life within the confines of a treatment facility you just can’t. When I got off this merry-go-round and returned to school, obtained my bachelor’s degree, and finally launched a career I began to heal. Spending so much time analyzing your problems and cut-off from society can make you extremely self-absorbed, over analytical, and leads to pathologizing normal behavior. The sole purpose of life becomes analyzing and dwelling on how crappy your life is rather than moving forward. What good is nourishment of the body if the spirit becomes destroyed in the process?

    I used to think insurance pulling the plug on clients who lived at centers for months on end was a horrible tragedy, but I now agree it is a necessary evil in a futile attempt to regulate the industry. Mental Health Parity laws are forcing insurance companies to shovel out endless amounts of cash for often worthless treatments. I am not against parity laws, but I am against parity laws being abused. Practices like this are why American healthcare costs are the highest in the entire world (17% of GDP according to the World Bank, although with the ACA this has been decreasing). Markets need regulation to protect the consumer- and this market has very little oversight (as you touch on more in your other article). It is unconscionable that mental health facilities are not held up to the same standards as physical health facilities. A hospital would not perform an experimental surgery on someone based on positive testimonials. Testimonials about the effectiveness of a treatment are not the same as peer-reviewed, replicated scientific research that proves a theory is safe and effective. Many of the experimental therapies these centers are employing have no science yet out on their effectiveness. You could argue that they have not been proven ineffective either, but that is a fallacy known as reversing the burden of proof. Consumers are lured into a facility from a cushy website, rather than sound science.

    I remember being promised the moon at so many of these places, “we’re different”, “we’re individualized”, “we treat the whole person here”. The standard was set so high that I expected to achieve self-actualization on Maslow’s Hierarchy of Needs, only to leave many of these places completely broken, incompetent, and feeling purposeless in life. Flushing my own toilet, administering my own meds, driving a car… I lacked confidence in performing life’s basic tasks. Living in society with eating disorder behaviors would have been better than being so stripped of my identity, autonomy, and dignity that I no longer knew how to function. The community-based treatment models you reference other countries doing sound fascinating. We need to take the magnifying glass to this industry, because the road to hell is paved with good intentions. I can’t wait to read more of your articles, keep up the great work.

  22. Dolly Reynolds says:

    Thank you so much for your intelligent and insistent voice. I was hospitalized for two very abusive years in 1982-84 and have never recovered. Remuda Ranch is truly nothing compared to the old days of eating disorders “treatment”. I am trying to recover now but what does a 30 year bulimic have to offer the world? I saw the pictures of you and your mother in the Chronicle. You are so intelligent and I pray you find the help to beat back the anorexia and achieve all you are capable of.

  23. Tamara Pryor says:

    Jeanene,

    Very insightful and very important topic to address. I have spent over 30 years struggling to determine who can we help, how can we best help, and….who do we harm. Particularly when we try to implement a “one size fits all” model. Joel Yager and Michael Strober have written brilliantly and eloquently about “chronic” or the individual with a severe and enduring eating disorder. Sadly, trying to figure out how to implement the most effective type of support within the confines of programs focused upon full recovery does NOT work and increases a sense of failure and shame. For those of us who also do research, the funding is so lean and competitive that figuring out how to include (let alone find) a chronic subset is next to impossible. We have several fMRI studies taking place now but the criteria are so stringent with regards to age, sex, and co-morbid diagnoses that we end up looking at the same young, pure restrictors over and over again. Even if you are weak and devastated in so many ways by the years of your struggle….your voice is still strong and needs to be heard.

  24. Jerry H. says:

    Jeanene: thanks for your courage in writing this. Our 13 y.o. daughter was just diagnosed with anorexia, social anxiety disorder and mild OCD and we are struggling with a decision on how to treat her. I have been spending hours on the internet researching this, and your article confirms what we had started to suspect, that the residential programs are not the answer. We are leaning toward a week of Intense Family Therapy supplemented with counseling for the underlying disorders and giving it the best we can. Our hearts go out to you…you have found your purpose…you can save others from what happened to you!

  25. Anna says:

    Hi! Thank you so much for speaking out against these residential facilities. They’re abhorrent. I would also like to bring up that the treatment geared towards adolescents is certainly no more affective. When I was 18, my parents sent me to the Eating Recovery Center in Denver, CO. At first, I was in the adult PHP program. I hated it, thought it was horrible, heard stories about adult residential, was disgusted. But it was nothing in comparison to how it was when they transferred me to child and adolescent residential (because I was “stubborn” and “inflexible”). Oh my god. It’s disgusting, what they’ll do to these kids. I had a friend who was 12 years old, and she had a habit of exercising too much. She was struggling to stay still when she was a new patient there, so what do they do? They locked her in solo isolation for fourteen hours, without so much as a toilet. She literally wound up defecating on herself because they would not allow her access to a bathroom. This isolation room was called the “quiet room”, and was always a looming threat if you got too out of line. The staff were bitingly nasty, passive aggressive, throwing things and being snarky and insulting. Many of the rules were similar to the adult center, but some parts were even worse.
    I am the only person I know from this place who has recovered. These type of centers are not in the business of helping people; they’re in the business of making money off of sickness. ERC and remuda ranch are both nightmares, and I wouldn’t be surprised if the other big centers (Timberline knolls, Renfrew, etc) are just as awful.
    I did go to a residential facility that was amazing, but it was amazing because it was tiny, individualized, and allowed a lot of freedom and personal autonomy. We got to prepare our own meals and never had anyone in the bathroom with us. There were only six patients max at a time. We had nearly the entire weekend free. It was in a house, in a really nice neighborhood. The focus was on individual, personal growth. They weren’t perfect by any means, but that place was the perfect jump start for me. I’m not going to name it here unless requested, but good residential centers do exist – they’re just so, so rare.
    The big centers, the ones with multiple locations and pretty pictures and clever marketing language splashed all over their websites, they’re horrible. They only make us all sicker.

    • Kelly says:

      I was at Renfrew Center back in 1998…. I hated it… Forced me to go onto Prozac so insurance would pay…. It was very dogmatic everyone was the same…. I remember I called my husband to get me out of here and I went home AMA after 2 weeks at that place…. About a year later my parents wanted to send me back…. I was worse my second time than my first… I was 29 and I threw the biggest temper tantrum because I flat out refused to go back there again… I went to Lamontgne in Festus Missouri in 1999 and was there for 6 1/2 months… It was very different far from perfect but I recovered…. Haven’t been back to a facility in 16 years…. I knew I wanted recovery and I was never doing this again.. The place I was at is no longer open… But, at the time I needed it… My only complaint is it took me away from my life…. I wound up getting my life back but I wouldn’t do it again… Still married and have a 13 year old daughter… I stay healthy not only for me but for them…

    • Ilana says:

      Which one was the small one? I went to Harmony Grove in San Diego and it was just like you are describing. I was even taught how to drive!
      It is no longer around but it saved my life. It’s a shame that there aren’t a lot of programs like that.

  26. Housecat Mother says:

    My 17 year old has spent most of the last year hospitalized, in two psych units, one inpatient ED and one residential treatment center. Her weight was restored a few times, but they didn’t get at the underlying reasons for her food restriction, so now she’s more emaciated than ever and her psychiatrist wants to send her back and no one on her care team thinks she can recover as an outpatient. I’ll admit it seems unlikely, but on the outside, she finished high school, got accepted to college, is working three days a week, gardening, and no one is controlling her bathroom trips. I don’t see how sending her somewhere to restore her weight is going to help if she has no motivation to maintain her weight on the outside. We just started OCD-specific treatment, which she has not had this whole time, and she is taking supplemental nutrition voluntarily until she can work her way up to a healthy amount of food. I just hope she can avoid involuntary commitment or starvation in the mean time. Thank you so much for this article. I have not wanted to put her back on the merry-go-round, and now I understand why.

  27. Barbara Lloyd says:

    I am 65,year old who has struggled my entire life. You are100 percent right , on everything you wrote, Luckily my doctor of 40!years, believed in the quality of life approach 40!years ago , even though we were both given so much grieve, it was a horrible approach . I’m married have two grandchildren , and still practice anorexic behaviors that are safe, but allow me a life, though a battle everyday, I can usually succeed, You have done a great service in this article , as I nelieve you are 100 percent correct in everything you wrote. In fact you are more intelligent about the illness then all those places you discussed! Thank you soo much , as no one will listen to me either. Barbara LloydWixom Michigan

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