When I saw an ED study with “All Better?” in the title, I of course had to read it. Often when a friend or my husband asks me how an appointment was, I say “I’m cured!” Maybe I’ll switch it up with “All better” in the future. Anyway, this was a great article — one that I could write many posts on (and maybe will?). It’s really interesting to hear how patients define recovery and make treatment decisions. It’s also kind of amazing how similar thoughts/behaviors can be between all of the patients. Many of the themes that emerged are things that I can relate to as well. However, I did have a couple of “WHAT!?” moments while reading:
First WHAT!? moment:
Participants were asked how the decision had been reached to avail of their various treatment options. Most participants had no involvement in any decisions pertaining to treatment.
WHAT? No way, I don’t believe that. I think there’s a BIG difference between treatment not being your idea and having “no involvement in any decisions pertaining to treatment.” I highly doubt that every person in this study was court ordered or dragged kicking and screaming into the treatment facility. 
Most of the people in the study were diagnosed in adolescence, so okay, maybe they HAD to go then… but the participants also all had “a lifetime history of AN.” As an adult, they CHOSE to get treatment. Even in Intervention (the TV series), you are given a choice — either get help or live a really difficult life where no one in your family will support you anymore. It probably doesn’t really feel like a choice, but it still IS one.
I know I’m fussing over semantics, but not taking ANY personal responsibility for your health / illness / treatment is a pet peeve of mine. I’ve had my fair share of anti-treatment periods, and can definitely separate the times I wanted help versus the times I didn’t, but the reality is that I DID show up for that doctor appointment. Maybe she “made” me go, but I could have immediately signed out. Staying in treatment is a decision.
Second WHAT!? moment:
(when talking about deciding factors for dropping out of treatment)
while for three participants (15%) the fear of weight gain was a major contributing factor to dropout.
Only 15% of patients would say that the fear of weight gain contributed to their decision to drop out / sign out of treatment? That’s just not honest. If everyone created a pros/cons list when considering quitting treatment, I bet that weight gain would be on 75% of their lists. Maybe it’s not in the top 3 reasons for leaving, but probably most patient’s top 10. Personally, I might not admit to my professionals that it’s a contributing factor, because I’d want to sound reasonable, rational, and believable (and definitely not want it to sound like a decision motivated by my eating disorder). Also, maybe I should clarify this is a list for dropping out of treatment — ending treatment because you’re ready or your team is ready to discharge you is different.
Anyway, I encourage everyone (who can get it) to read the article, and have a lot of other thoughts on it, but these few statements really stood out for me tonight.
6 comments
Sally says:
Jun 13, 2010
Could it not mean that the patients simply decide have any involvement in what their treatment involved, not whether they had it or not?
PTC says:
Jun 13, 2010
Bummer, I couldn’t get the article. Must be a sign that I’m “all better.”
Okay, that was a bit far fetched.
Laura says:
Jun 13, 2010
I couldn’t get the article either
Emily says:
Jun 18, 2010
Grey,
You hit on two really good points. I had a therapist that would challenge me when I stated that I “couldn’t” do something like confronting an annoying co-worker or parent. She reminded me that in fact it wasn’t that I couldn’t, but I “wouldn’t”. I think often times we forget that we do have choices, even when we are in treatment. Therapists, RD’s, Psychiatrists all give us their recommendations and we often trust them, but as you point out, most people in treatment aren’t there because they are court ordered to do so. We make choices about our treatment continually.
I am also intrigued about the fact that only 15% shared a fear of gaining weight. As you state, they probably weren’t being completely honest. I wonder if the survey was anonymous if the number would be closer to something that seems more reasonable. I also wonder if those who were leaving treatment were even being completely honest with themselves. I think we can get to a point when we really want things to be “all better” that we even lie to ourselves in an attempt to at least seem “normal”.
Finally, I think I would be remiss if I didn’t also point out that the sample size was really small. Only 20 participants (they stated that 3 respondents comprised 15% of the sample)! It is hard to generalize such a small sample to the larger population of people with AN.
woefare says:
Jun 26, 2010
great site, thanks! am following you on twitter and was going to direct message but somehow couldnt go thru.
JB says:
Jul 11, 2010
Ah, you’re speaking my language! It often irks me when people say, “My therapist is making me do X.” “I HAVE to do y, because so-and-so said.” It baffles my mind that people so much control over to other people without even a second thought.