Tough questions

Should psychiatrists be able to impose involuntary treatment on anorexia patients?

(photo cropped from original by daniellehelm/Flickr)

Canadian psychiatrist David Goldbloom has been treating Kristen, a woman suffering from a severe case of anorexia nervosa, for twenty-three years. During one of their sessions, Goldbloom writes in his new book How Can I Help?: A Week in My Life as a Psychiatrist, Kristen confronted him with a difficult question. “I wish you had been more aggressive. Pushed me into treatment,” she said. “I know this illness now, and I know that if you can get it early, you have a chance of escaping its clutches. Why didn’t you or my parents — anybody — step in more forcefully?”

Anorexia has one of the highest mortality rates among psychiatric illness, and the disease can pose extreme threats to a person’s health: decreases in reproductive hormones, bone loss, muscle weakness, severe dehydration leading to kidney failure, heart failure. Studies have demonstrated that children and adolescents with anorexia tend to recover better than adults, suggesting that anorexia should be diagnosed and treated early.

But more than any other psychiatric disease, anorexia raises questions about the intersection of involuntary treatment and free will. “Most of us agree that if the patient with schizophrenia becomes convinced that she needs to cut open her skull to remove [an imagined CIA] implant, the health-care system would be justified in restricting her ability to harm herself irrevocably,” Goldbloom writes. “For complex reasons, the notion that a patient with anorexia nervosa whose disease has inflicted irrevocable physiological damage should be forced to accept treatment is far more controversial.”

Part of the hesitation, Goldbloom continues, is that unlike “those whose perception of reality and normative behavior has been eroded by psychosis, many patients with anorexia can seem more ‘like you and me.’” In his book, Goldbloom wonders if these discomforts and perceptions influenced his decision to hold off on placing Kristen in involuntary treatment. “I know that Kirsten’s words to me today — ‘I wish you had done more’ — will haunt me.”

Read the full excerpt at The Walrus.

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