Buyer Beware – Behind the Smoke-And-Mirrors: How Residential Treatment Is Being Sold as “First-Line” Treatment For Severe Eating Disorders Despite Research Backing; The Problematic Variation In State Licensing Standards and Oversight Across States; and Whether Accreditation is Really a Remedy to the Lack of Quality Control

by Jeanene Harlick | July 25, 2015 7:38 am

Part 2 of an Investigative Series

The first thing anyone sees when they walk through the doors of a residential treatment center for eating disorders is a sub-circle of women who – like me – have already been through several other programs. And who, like me, have been told by the admissions coordinator that this program is different, this program will help them – permanently.

I remember the first time I admitted myself to such a program, in 2004, to try to prevent a longtime battle with mild anorexia from spiraling into something more serious that would derail my life.

I was shocked when, following the preliminary bag search, vitals check, weight-taking and paperwork, nearly every client who introduced themselves to me did so by giving me a warm smile, stating their name, and then asking me my name as well as this question:

“So, is this your first treatment?”

I quickly and vehemently nodded my head, yes, it was my first. And then thought to myself – as a wraith-like 20-year-old, who looked like she should be dead, walked by me – “What?! You mean people do this more than once? I will never, ever become one of those people.” I shuddered in horror, turned quickly away from the woman (who I later learned had been cycling in and out of treatment for the past ten years), and whipped out my reporter’s notebook. If I was going to spend two months inside this place I was at least going to get a story out of it.

Unfortunately, I never did write that story. Because that first treatment marked the beginning of the end of my career, my confidence as a writer, and my life and identity as a “normal,” moderately-successful woman with boundless potential. I left the program with nearly all my underlying conditions unaddressed, but the obligatory weight gained. I had been supervised, the majority of the time, by blue-collar workers lacking any psychological training; women who worked there because it paid slightly better than the cafeterias or cleaning jobs they had held prior (I asked). I had been forced to attend pointless, hour-long chapel services every day despite being an agnostic verging on atheist.

At discharge, I tried to shrug off lingering feelings that for years I had been too “easy” on myself – since my anorexia had never approached the extremes of most women I was in treatment with in 2004. I tried not to think of myself as inadequate because I could never deprive myself as “well” as these women had. It wasn’t the failing to achieve their ghoulish degrees “thinness” that bothered me – it was the rigorous self-discipline it took to get there, and which I worried I lacked, in other areas of my life. Working very, very hard – giving everything 110 percent – had always been of utmost importance to me.

I tried to plunge myself back into my newspaper job. But two months later I had quit, and moved home. A year later I was in the throes of a full-blown relapse, and was trying to manage a menial but full-time, administrative job while having a resting pulse rate in the 20’s, and severe bouts of dizziness and exhaustion.

Finally, my parents intervened, pulled me out of work and, on the advice of my physician assistant – an alleged “eating disorder expert” (hah!) – demanded I go back into treatment. I had been trying, in the months leading up to the crisis, to avoid this outcome – I feared becoming “institutionalized.” I had tried to attend an intensive outpatient program, but lack of work and family accommodations made attending it feasible. So when the crisis came to its head, I begged to, at the least, enter a day or intensive outpatient program closer to home, instead of being shipped off to a residential program again. I had serious doubts as to whether repeating this expensive, level of care – which my parents would have to take a loan out to pay for – was worth it.

But my parents researched and sought referrals for two weeks, and they promised me, this center they’d found in the Midwest, it would truly help me. And the program did look awfully great, on its Web site, and its admissions coordinator told us all the things we wanted to hear. We didn’t know, back then, that you couldn’t necessarily trust what a for-profit treatment program was selling you. And we didn’t know about the accumulating body of evidence demonstrating that residential or inpatient* treatment is, for the most part, an ineffective level of care for adults with long-term anorexia – unless they lack all motivation to recover, are experiencing life-threatening medical complications, or are simply unable to initiate change on an outpatient basis.

Most centers present themselves as the only hope and first-line-of-treatment for individuals of all ages with severe eating disorders, and brainwash our families into believing the same. And once us clients are inside the centers’ doors, we often lack the resources or ability to discharge and fly home without our families’ support. We call home, crying, but the clinicians tell us, as well as our parents, that our protests are “the eating disorder talking”; that they are the rants of inherently broken and malnourished brains.

These people have letters after their names like Ph.D., Psy.D., LCSW, R.D., and more, so what are we (or our families) to think? Of course these clinicians are right, our vulnerable minds believe, even though everything inside us is screaming something isn’t. And it’s not the eating disorder screaming. Because we want to get better, and we know it will be hard. But we don’t understand how being locked up – in effect – and treated with less dignity than dogs, is going to translate to lasting recovery.

When we discharge, and inevitably begin our slow relapse, and finally – following years of repeating the same cycle – start asking whether maybe it’s the treatment center that failed us, instead of the other way around, our views are muted by the industry. Our voices are dismissed as the misguided notions of bitter and angry, “treatment-resistant” anorexics who have failed to “surrender” to recovery.

*“Inpatient” generally refers to treatment which occurs in a hospital-based program.

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