Catch and release

Do you fish? The current reality for most eating disorder patients is a lot like "catch and release." Feeding people to the point that they are no longer gasping, and then sending them back out into the world to cope with it... not a great strategy. We KNOW this doesn't work. But we keep doing it because we use a crisis-based medical model combined with a choice-based psychological model.

Everyone in the system hates it. Everyone externalizes the problem: "it's expensive" "there are legal issues" "insurance works that way" "our health system doesn't work that way" "it's coersive" "it's so challenging for the patient" "it can't be forced" "true recovery comes from within" "they have to do it on their own sometime..."

It's crap. Patients are not better able to manage themselves at a minimum weight/minimum stability. In fact, that is the exact time they are least likely to manage. It is the world that needs to change - the illness isn't going to. Here's the ONE change we need to make: continue the same high level of support/monitoring for months after medical stability. In other words, still catch, but don't release until swimming easily in deep waters. And take account of the hook damage and the handling.

Our catch and release system is creating chronic illness. If we don't change the system, then it is not the illness to blame - it's us.


  1. Well said! Can't tell you how many times I've thought this same analogy when watching friends fish up at my cabin...

    I was talking with a bullying/harassment expert here in the Twin Cities who has been around the block a few times..she just asked me yesterday how insurance executives can actually feel okay about the decisions being made about paying for eating disorders treatment. I could hardly believe I was having to tell her that typically people are kicked out of treatment way before they are recovered.

    You nailed it that parents don't know all the options and don't understand them. More information and more training for families is a good place to start. We need to keep spreading the word!
    Becky Henry

  2. Agreed - and this is one of the problems in ED care that is world wide. There may be differences in the excuses given for the poor practice, but the practice is the same in all sorts of systems whether publicly or privately funded.

  3. This is so true! I go in-patient, get to a stable weight, and then insurance kicks me out before I've even challanged my fears and felt safe. I'm in my forties, and feel hopeless and alone with this disease.

  4. You are so right. It is depressing, though, to think of all the barriers that would have to be overcome for this to happen for all sufferers. I am thinking especially of independent adults. My independent young adult daughter has been suffering from various EDs for years, and starting in January when her new insurance kicks in will finally be receiving excellent specialized care. She is working full-time, and, she is welcome to lean on her dad and I as much as she needs to, including going on a leave of absence, living with us and concentrating on her recovery.

    Angela, I grieve for you. This illness is all about fear, is treatable, and you need support to conquer it. I hope you will continue to seek for clinicians who can really help you. There is always hope with the right help.

  5. Oddly, my two most experienced therapists and I were talking about this very thing just last night, as we were contemplating changes (additions) to our program. We feel strongly that the terrible anxieties of an ED will need more than a brief return to weight restoration, and will almost certainly force a later return to weight loss, unless addressed.

    Though it will not be popular to say so, at least as often as we have had insurance terminate treatment and force us to "release" a patient too soon, when the weight has gone up enough to allay parental anxiety and everyday concerns resume their pressure, the parents decide that "she needs to get back to her life and we don't feel it's natural for us to monitor her eating anymore". Understandable, but very often a mistake.

    We need to all speak out for doing what it takes, as long as it takes.


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