Let's say the parent believes it, commits to it, and has the courage to make it happen.
But the patient says, "no."
Who will support the parent? Almost no one.
- Legally, most patients have the right to refuse treatment
- Traditionally, patients are considered to be in charge of their eating and thoughts and the eating disorder is seen as having deep meaning and environmental causes - and food is considered merely a symptom
- Most professionals (doctors, psychologists, social workers, dietitians, teachers, coaches) will not support the family in doing this and most will DIScourage it
- Healthcare insurance and national health systems will rarely support it
- Emergency medical services will not apply until the family has failed
- Public opinion, which includes one's best friend and neighbors and sister-in-laws and co-workers, will not support the parent
- Very few of those who have chosen to specialize in eating disorder treatment will support it and many will have negative views of the idea
And yet, this action by parents is considered not only helpful but the "gold standard" when part of the Family-Based Maudsley approach and failure to do so is known to lessen chance of recovery from a potentially lethal and usually disabling mental illness.
What I am seeing around the world are parents who ARE ready, able, and willing but face insuperable obstacles not least of all the lack of credibility. Only a tiny number of parents are told about the option at all and those who seek it out rarely find skilled clinicians. Most clinicians who are prepared to support families through this are themselves undermined by conflicting messages by other professionals and public opinion. Insurance and health systems do not depend on effectiveness and in fact tend to privilege ineffective and emergency-only care.
Thanks to the focus and professionalism of a handful of researchers, we have solid evidence that FBT is a life-saving intervention for many -- probably for most patients. We have not gotten that knowledge off paper, however, and into practice except in small isolated islands besieged by other messages and undermining factors. That is the work that needs to be done NOW.