Fitting the solution to the problem, or the problem to the solutions?

Once a problem shows up I want to know how to to fix it. THEN I figure out what is available.

But I see a lot of people doing the opposite. They start with what is available and then cram the problem into it.

If the local providers don't offer it, the national health service doesn't offer it, the insurance company won't pay for it, the law doesn't support it, the family doesn't have time to provide it, and the ex is going to actively oppose it... those are real problems but they don't change the basic fact that RECOVERY may require it.

I spend a lot of time talking about what is required or recommended or good for treatment and keep hearing reasons why those things are not available. I know that. What we should be concentrating on is why, and how to fix that: not trying to argue that treatment shouldn't need those things.

We can't change availability, law, opinion, and practice without actually identifying the tools we need. We can' progress at all if we keep saying "we don't have that." If eating disorder patients need, for example, a year of supported recuperation in order to have a chance to recovery then they just do. Giving them some fraction of that and then dropping it isn't "better than nothing" it's failure. If FULL weight normalization is necessary to restore brain function then getting halfway there is NOT better, it's cruel. If hospitalization is needed, then getting a once-over and release at the ER/A&E is not a step forward it is a step back.

I'm weary of fitting the problem into the solutions. It is time to focus on finding solutions that fit the problems.


  1. Yes and I am tired of hearing that insurance companies won't pay for things!

    I don't think that doctor-patient or therapist-patient relationships should be about the insurance. They should recommend what is best for the patient, not what the insurance will pay for. Then it is up to them to defend themselves to the insurance companies when they threaten to withdraw care. Most heart surgeons wouldn't take no for an answer if their patient wasn't ready to go home. A NICU wouldn't discharge a premie who couldn't eat yet without fighting for what they think is medically important.

    Laura, this is the same thing you are saying, only it's about the money. I think that hospitals, doctors, therapists and insurance companies should be held accountable if they shut off the care too soon because of monetary reasons. That's just unethical and we should stop tolerating it and saying it is just the way it is.

  2. I absolutely, totally agree too. When I started my recovery from decades of anorexia as an older (deemed 'chronic') patient I knew it was going to be 'long haul'. Being given enough financial and professional support to 'get halfway' in recovery would have been FAR worse than having no treatment at all.

    I am extremely grateful to my psych for continuously pushing the funders to support my treatment. I had the choice to drop out any time, but living with longstanding AN is total sh*t. I desperately wanted to get better. However, not knowing whether I would necessarily get continued funding was terribly stressful. My case was reviewed every few weeks or months by the funders in conjunction with my psych's report. But whenever my psych had discussed continued treatment with me (and my willingness to continue) I would worry for days on end that I would be left 'half-baked' to fend for myself (i.e. without support due to lack of funding) in the incredibly anxious state that is a normal part of the weight gain + recovery process.

    For adult patients in particular, all parties (patient, professionals, funders) NEED to know that recovery is a slow process. In theory, weight can be gained quite rapidly, but usually there is a need for adequate follow-up support with co-morbid psychological difficulties that arose as a consequence of living with AN, or were present before the onset of AN (as was the case with me).

    Adult patients often have little support network at the outset of treatment because of years of isolation. They therefore depend upon support from professionals and anyone else who is there to help them. To just re-feed the person rapidly in hospital/EDU, then release them into the community with few 'tools' to cope with life is cruel. The person may look much better, yet mentally they may be struggling with terrible anxiety.

  3. I couldn't agree more with this post. I'm hopeful that complete and appropriate treatment will be more readily available in the future for those who need it. I've had to resort to the "how do I fit the problem into the solutions" as insurance has time and again limited the number of day that I warranted treatment. Any treatment beyond that I've had to fight for and even then it's limited to what can be afforded by a college student. The result has been living with a "functional" eating disorder. I truly hope that something is done so that others do not fall into a similar cycle.


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