Sunday, August 1, 2010

smart people, un-smart posts

Something that gets to me a lot is the way in which Maudsley advocates boast about the approach.
I understand the Maudsley treatment method. I understand how it is implemented and why it seems to work. I also understand is that, to date, it is really the only treatment method that has been well-researched in the ED science field and actually has been proven to be effective. What i do not understand is why people who advocate for the Maudsley approach seem to become so attached to the idea that Maudsley is like a freaking miracle, god-sent treatment and speak (or write) about it as though there is nothing else that could possibly be effective.


This pisses me off.


I really do respect a lot of the people (bloggers, mostly) who advocate day-in, day-out for the Maudsley method and I think they are smart individuals with valid points and good intentions. What I would like to pose to them, however, is a reminder, that "The aim of an argument ... should not be victory, but progress."(Joseph Joubert
Recently, whenever i read a post by someone who is advocating for Maudsley, they always seem to be trying to win some argument against the world. They always seem to somehow frustrate other readers by implying that Maudsley is the ONLY approach that works, just because it is, so far, the only approach that has actually been well-researched. Effective and researched are not synonymous. 
I also, personally, get frustrated because there really are so many pitfalls in the Maudsley approach that just seem to be ignored. First of all, I would like to see any individual with a diagnosis of BN rather than AN actually successfully be treated by Maudsley. I honestly think that this would be a freaking miracle because all of the studies on Maudsley have been done on AN, and the two are very different disorders (especially in terms of how the individual relates to their family, which is a key component of Maudsley) and, knowing the way in which those with BN tend to act with their families, I would be astounded to see anyone with that diagnosis have a successful Maudsley treatment.
Let's be clear here. I know professionals who like to say that for adolescents with bulimia, purging is like puking up the family. Purging is like a f***-you to the rest of your family who you are angry, resentful at. Often, with AN, this is not the case. Most adolescents with AN tend to not have the same experience of rage and resentment to their families. Most girls i know with anorexia suffer the sweet, well-behaved, "good-girl syndrome". They often seen as the "golden child", and while this is not to say that they are not angry with their families, or tyring to convey something with their ed behaviors, it is often quite a different experience than that of someone with BN. 
And secondly, aside from diagnosis, lets just take a look at the multitude of families who CAN'T for either personal, emotional, physical or financial reasons, in any way,shape or for, ever conceive of using Maudsley. Some parents  are clueless, and couldn't give a shit about their child's eating disorder/ recovery for that matter. Some don't have the financial resources or the time to invest so much energy in feeding their child. Some are just emotionally unavailable or unable to be a support to their children in this way (if a parent rarely sets any kind of boundaries for their child (homework, curfew, friends, etc) there is no way that they are going to either A. Be interested in bothering to set boundaries around food + eating or B. be able to have any kind of authority over their sick adolescent). 
I guess one of the reasons I am so touchy on this entire subject (and hence am writing this massive, bitchy post) is because it really just frustrates me that my family couldn't (+ most definitely wouldn't) ever do Maudsley. The idea of my family trying to implement the maudsley method is a joke. Sometimes I laugh when people suggest that it's a good treatment for the majority because, um, I think i know about four people in the entire world who have families that would be suitable/able/available/willing to do Maudsley(if it was ever needed). I imagine my mother and father cooking me some "nutritious" meal, telling me to sit down and eat, and then offering to have some sort of "family activity" afterwards to keep me from purging (as is suggested by Locke + LeGrange) and i have to roll my eyes at the absurdity of that image. 
Basically, I often find that people can be a little freaking self-righeteous when it comes to Maudsley and it bugs the hell out of me (for both personal and general reasons).
I really do think that for the most part, yeah, it's great and i love when people advocate for well-researched, fast, safe, effective care for eating disorders as others would for any other possibly-fatal illness, but i really do wish that people could be a little more understanding and far- sighted, and just freaking get it through their brains that it can't work for all of us, and that maybe, just maybe, it's okay to try something else!


Sorry if this post is ranty. Just needed to get that off my chest. 
Phew.

3 comments:

  1. Actually, "all of the studies on Maudsley have been done on AN" is not accurate. Family-based treatment (FBT or Maudsley) for BN was compared to supportive individual psychotherapy in a randomized controlled trial. http://www.ncbi.nlm.nih.gov/pubmed/17768270 Outcomes weren't bad, but at 40% remission, it's no magic bullet. I don't know anyone (least of all researchers) who would suggest that it was.

    There have been more treatment studies on bulimia than anorexia overall. CBT is often recommended as the first choice for adult BN. A study comparing CBT to FBT for adolescents with BN is now recruiting at Chicago and Stanford. There have been a number of studies of medication for BN. There continues to be a great need for studies in many areas of eating disorders. Thankfully, the research world is not standing still.

    You say that people say a number of things and they always seem to be trying to win some argument against the world. That seems so vague to me (exactly who are "people" and "they" in this context?) If a website calls a treatment "promising" that's not the same thing (or even close) to saying "it's a freaking miracle.") FBT seems like a good first bet for adolescents at this time, even if it's not the be all and end all. Maybe the issue is more with the style of argument of some specific people, rather than with the treatment approach itself.

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  2. It is annoying when people go on and on about the same topic. But if the blog is about that topic then surely it is understandable?

    I plan to stop talking about it as soon as it does indeed become standard and uncontroversial to do so. I already have done so, a little. I think it may be sign of success that someone would see it as overkill!

    ReplyDelete
  3. It is annoying when people go on and on about the same topic. But if the blog is about that topic then surely it is understandable?

    I plan to stop talking about it as soon as it does indeed become standard and uncontroversial to do so. I already have done so, a little. I think it may be sign of success that someone would see it as overkill!

    ReplyDelete