The dark side of inpatient stays
‘But I ask myself if an eating disorder unit is the best place for an impressionable young girl to be,’ says Deanne Jade. ‘As any inpatient will tell you, a specialist unit is the best place to learn how to be really, really good at anorexia.’ They also breed their own subculture.
Oh, what a statement! This article is a couple of years old, but I still think it’s bold to suggest that the “highest level of care” for eating disorders actually makes people sicker. Everyone’s inpatient experience is different… but there is a lot of truth to this statement.
What about inpatient stays can make people sicker?
- Exposure to the sickest of the sick. You know who these people are… the frequent flyers who have the most severe symptoms and often are the most manipulative and/or resistant to change.
- Picking up other ED symptoms that you didn’t originally have. It’s not unheard of for a restricting anorexic to pick up purging after treatment.
- Competition among eating disorders. This ranges from being the thinnest, eating the least, and having the most inpatient stays to comparing “worst BP episode” and visits to the ER.
- Unhealthy modeling. Everyone around you is doing a great job of modeling ED-behaviors.. but other than the staff, there’s not a lot of “healthy eating” modeling going on.
- Negative attitude toward treatment. If you weren’t originally treatment-resistant, there’s nothing like being surrounded by a group of girls who don’t want to be there to kill your motivation.
- No life outside of the eating disorder. This is such a catch 22 of ED treatment… by making your recovery first and putting everything else on hold, your whole day revolves around the ED–which is kinda want the eating disorder wants. There’s no stress of school or work because all you’re doing is eating and sitting in eating disorder therapy.
As as for “breed[ing] their own subculture”… well, I’ve always said that there is an eating disorder world. You make friends in treatment. After discharge, you keep up and talk about how everyone is doing… is so-and-so back in treatment? I heard so-and-so is doing really poorly. Because you’ve given up school or work to go into treatment, the most interesting things going on in your life are your therapy and nutrition appointments. Everyone talks to each other about their appointments. You send each other cards. You continue doing the same arts and crafts that you were doing inpatient. Everyone’s lives are still consumed by the eating disorder so no one is doing great. It’s all very dysfunctional.
This is not true to everyone’s experience (not even necessarily to mine) and often residential treatment is the level of care that someone needs to get better and make progress in his/her recovery. My own inpatient stays were KEY to my recovery. However, negative stuff does go around in treatment. It’s kind of the dark side of inpatient treatment that people don’t talk about very often.
I can totally see where this is coming from and it was yet another reason I avoided treatment as a day patient, it did to some extent feel like playing into my ED’s hands. I was merrily slipping into the sick role as part of my identity and i really do think this would have fueled the fire. I needed to removed myself from the sick mentality in order to find more to myself than anorexia. Treatment can be compared to detention of youth offenders. Unless the facility is run as a “release orientated” program, then the “Them and Us” mentality overrides the useful nature of being looked after and focused on the behaviour
Lola x
Hear, hear. I couldn’t agree with you more. When my daughter was sick I was determined to avoid inpatient for her if possible for all the reasons you list. It’s part of why I”m a fan of family-based treatment (the Maudsley approach). Inpatient is good for keeping someone alive, but I’m not sure the way it’s practiced here that it’s a useful long-term option.
I also agree with a lot of what you said in this post. For me, I think my inpatient stays were absolutely necessary – my family would not have been able to do FBT, I wasn’t getting anywhere doing individual therapy, and I was having a lot of medical complications. That being said, I did pick up a lot of “tips” during my first stay – purging, ways to avoid eating etc, and seeing girls who weighed less then me or who had been inpatient multiple times only convinced me even more that I wasn’t really sick. However, I think a huge difference between my first and second inpatient stays was that the second time I was there, most of the girls were in for the first time and were really committed to recovery. That made a HUGE difference. In that instance, I was actually motivated to do well by seeing how positive they were. I was also motivated by one older woman – I did not want to be like her, having my kids come visit me in the hospital. I don’t really have a solution to the problems, but I think it is definitely something staff needs to be aware of and needs to actively work to correct. I also think that being in an inpatient eating disorders unit is far preferable to a general psych unit or simply a medical unit where all they do is treat the medical complications, and do nothing for the actual eating disorder.
Once again an incredible entry, I’m so happy to have come across your blog. Its odd thinking about 8 years ago how innocent my eating disorder was and how through intensive treatnemts its evolved. Its hard for those who want you to recover to grasp the unhealthy setting that is inpatient or IOP. A lot of the time I think today I would be relavitvely “fine” if I hadn’t gone into treatment. Just a few months in treatment and my ED has spiraled completely out of control making each day more and more difficult to make progress in healing. I used to use the analogy that when you look in a boarding school, or even prison that people join and teach each other their “tricks” same goes of an ED program. Many times I think it happens by mistake – something someone said in group therapy that you havent thought of.. and it just sticks.
those are precisely the reason i don’t want to go into hospital. For me i have already experienced most of those reasons when i was hospitalised for depression and self harm, which i guess is why i am even more against going IP.
http://ramblingsofasanityseeker.blogspot.com/2009/01/life-without-anorexia.html (mentioned you at the end of this post)
I found you via the ED digest box that was in the side bar of ED Bites.
Susie
As someone who spent many years as an inpatient, i can totaly understand your point. However, this is not always the case. Had i NOT been admitted to a specialist unit, i would most definatley have died and had it not been for my fellow in-patients, wouldn’t have got through my darkest moments whilst in treatment. I do agree with you about competative behaviour as during my first admission, i was one of the worst at playing the game of who could get away with eating the least, playing up the most etc,and it drove me mad when i was beaten at my own game, so much so i discharged myself on my forst admission. My second, third and fourth admissions were, however, compleletly different, i was inspired by other people’s gritted detemination not to give in to the ED and join in with these games (out of 35 patients, there were only a couple who played them anyway) and learned to focus on my own recovery and do my best to try and help other people stop any behaviour that wouldn’t help them in the long run. We also had the most amazing clinical director and nursing assistnats who stopped such behaviour before it had barely begun. The most amazing thing was to see the change in the patients, from admission to middle of treatment to discharge and the more we learned to change, the closer we became as we were all going through the same thing, something that nobody on the “outside” could ever understand. I used to refer to my ED unit as “Nania” because it was a whole different worldand nobody else’s buisness. A
As someone who spent many years as an inpatient, i can totaly understand your point. However, this is not always the case. Had i NOT been admitted to a specialist unit, i would most definatley have died and had it not been for my fellow in-patients, wouldn’t have got through my darkest moments whilst in treatment. I do agree with you about competative behaviour as during my first admission, i was one of the worst at playing the game of who could get away with eating the least, playing up the most etc,and it drove me mad when i was beaten at my own game, so much so i discharged myself on my first admission. My second, third and fourth admissions were, however, compleletly different, i was inspired by other people’s gritted detemination not to give in to the ED and join in with these games (out of 35 patients, there were only a couple who played them anyway) i learned to focus on my own recovery and do my best to try and help other people stop any behaviour that wouldn’t help them in the long run. We also had the most amazing clinical director and nursing assistants who stopped such behaviour before it had barely begun. The most amazing thing was to see the change in the patients, from admission to middle of treatment to discharge and the more we learned to change, the closer we became as we were all going through the same thing, something that nobody on the “outside” could ever understand. I used to refer to my ED unit as “Nania” because it was a whole different world and nobody else’s buisness. I also found it the one place where you were allowed to think the way you did and have the worries that you did and there were people there to support you who completly understood. I made the best friends in there and yes, we still check on each other’s progress and offer support because we formed a bond that will never be broken. Your life has to revolve around your ED whilst in treatment because tackling it and focusing on recovery has to be your main priority,something i learned through “revolving door syndrome” I am back at uni now, and have a life that revolves around “normal stuff” but had i not been admitted, i would have no insight, would still be lying to my GP, blagging my out-patient appointments, acting like nothing was wrong and not doing much else with my life. I am in recovery, but the only way i can stay that way is to keep on board everything i learned in treatment.
Wow,
Makes me glad I never went to treatment.
I started a blog about NOT throwing up no matter what.
I invite any and all to read my blog and talk to me about their experiences. I cannot stay ‘clean’ alone, and desperately want to create a community of HOPE.
WE DO RECOVER
fabu