One of the times I visited Jess (please see Be that someone! for an introduction on Jess), she was an inpatient at the Child and Family Unit (CFU) at Starship Hospital in Auckland. I remember being apprehensive to see her as I know that sending her there was (another) final resort from her parents, clinging to any hope for recovery. I knew it meant that she was again very sick which meant she isn’t reaching her target weight set by one of numerous dieticians. The last time I stepped into a rehabilitation centre was for my own admission while battling bulimia. I didn’t know what to expect and felt very nervous.
When I walked in the unit felt welcoming. The living and dining quarters were all open plan with a lot of natural light coming in from the wall of windows. There were several private rooms in which Jess accommodated one. The unit had several teenagers staying there, receiving treatment for a variety of mental illnesses. The majority were for drug abuse, self-harm and depression. There was an entire unit separated from the main centre for high risk individuals. You can’t imagine that the patients in here are no older than 18. I felt great sadness as Jess showed me around. The light coming into the unit is in stark contrast to the darkness which bears down on these youngsters.
Jess and I spend some time in her room, talking and looking through her diary entries and art work. We must have been in her room for nearly an hour when there was a knock on the door and a nurse announced that it was lunch time. As I wanted to excuse myself and leave Jess to it, the nurse asked if I would like to stay and sit with Jess at the communal dining area? Jess sounded desperate when she said “Yes please, will you?” I felt my heart sink to my stomach but I couldn’t say no to Jess.
There were about 15 teenagers and staff seated to have their lunch. They offered me a plate too, the exact amount that Jess was being served. Everything in me wanted to reject the offer. Why? Not because I wasn’t hungry, but because of the amount of food that was presented. The meal was served in a plastic sealable container. In it was a small tub of yogurt, a fruit, a juice and a lettuce, carrot, chicken and cheese filled sandwich. I looked at this meal with dread and could only imagine the internal battle Jess was having with her demons. Jess picked at her food, but was forced to eat it all within a given time. When her time was up, I had just finished the sandwich and juice. I was so full! The only excuse I could think of for not eating all my food was that I was planning on having a meal on my way back home on my 2 hour drive. I couldn’t admit to Jess that the meal was too much even for me to eat even though I am recovered.
I honestly don’t know if this extreme approach to recovery is doing any good. Perhaps when you are further along in your journey and you have overcome the fear of weight gain. But for someone still in the midst of recovery, continuously relapsing? I completely understand that these measures are often taken because of frustration, taking a no nonsense approach to the patient. But at what point do we ignore a patients’ mental state and start enforcing far-reaching treatments?
During my stay at a rehabilitation centre (receiving treatment for bulimia) I too was forced to eat a considerable amount of food. I couldn’t believe how much they were expecting of me to eat. I was not treated any different to the other patients there. I was the youngest in my ward and the ONLY one with an eating disorder. My food was not prepared any different nor was the quantity adjusted. I remembered dreading meal times. I purged a few times during the first two days. It was as if they didn’t understand that I was there to learn how to control my binging and not be overwhelmed by large food intakes and feeding off the need to purge. When the second week came around and I have had intensive therapy sessions, I was able to eat the meals without feeling guilty for which I am now truly thankful. It still strikes me as odd that the meal plan was not adjusted and gradually increased.
I need to add that the above mentioned approach was so much different to my personal dieticians though. She was amazing! She was there during both battles with anorexia and bulimia. She was careful with all the meal plans, slowly increasing as was needed. Yes she was disappointed when I lost weight, but elated when I ate any additional food that was otherwise stated on my meal plan, or when I controlled any outbursts by going for a walk instead of binge eating.
I wonder if that is the difference with private and individual care compared to state care? And is there even such a thing as a standard meal plan when treating an eating disorder? Obviously it will be adjusted depending on the needs of each individual, whether they are diabetic or have food allergies/intolerances. Or should health professions look at quality vs quantity?