antibiotics and residential care for eating disorders
There are many reasons for my lack of enthusiasm (and it is that, not a total rejection or wish to make it unavailable). Let me just focus on one, through an analogy that may work for many: residential care is like a super high dose antibiotic that is withheld until the infection is quite severe and then withdrawn before the infection is fully resolved.
Of course we want to make sure people have access to emergency antibiotic care if they have been poorly managed up to that time or have a particularly dangerous strain of infection. But to base a treatment system on that sort of emergency intervention leads to patients not getting the care they need early on when the prognosis is better. If we withdraw the sometimes excellent intervention before it is completed - and it is simply NOT POSSIBLE to stay in residential long enough to do that - and switch to a lower-dose treatment administered by less-trained and often completely cowed people - is there any question why the resistance is greater and patients repeatedly have to start over?
We have created a system - accidentally - where the appropriate dose and length of treatment are rarely available. We are creating treatment resistance, weakening long-term resources, and operating in crisis management as a field. No one meant for this to happen, of course, but it is being held in place by many factors - not least that people who understand the danger of eating disorders fear the withdrawal of those late-stage interventions and feel angry and betrayed by those who question the system.
I do not like being an irritant and hurting people with these questions. I would not do so if I didn't truly believe the system is causing preventable harm - and if I did not have example after example of people who have made the transition in their thinking on this topic. People are starting to speak up about misleading statistics, lack of accountability, and false advertising on the part of some residential care providers. Those people who are speaking up are brave, not traitors, and they care as much about the patients as anyone.