Facebook profile photos and email addresses and Skype images became people you can sit next to and just smile with. A lot of that, actually, so delighted to be in one another’s presence. One dimensional relationships develop tangents and then shared jokes and new tenderness even on short "real" acquaintance.
My trip had me alongside F.E.A.S.T. families and friends formally -- in the EDIC conference sessions -- but also marvelously convened klatches of friends who couldn’t afford the fee or the time to attend sessions but met at nearby museums and coffee shops in a rolling three-day get-together I didn’t want to end.
I took city busses and cabs and the Tube, crossed bridges, ate Italian and Turkish and one night just “nibbles” that were so delightful I didn’t realize until I tucked into bed that I hadn’t really tucked in to a meal. My stay at the Russell Hotel was London charming: tiny room, palatial breakfast hall. I didn’t forget any chargers and used exactly as many pairs of shoes as I brought. For some reason I still, at my age, feel terribly adult when I negotiate all the transitions and packing and make it to the last leg without major snafu. Let’s not speak of the time I wandered away from my luggage… no one stole or blew it up.
|The blue-haired ladies of EDIC|
I see differences now. Far more active, informed and opinionated families. Sorry about that, England. More alliances with former and present adult patients – a really delightful aspect of the UK F.E.A.S.T. crowd. Less parent-blaming from the podium. More collaborative talk across disciplines and between families and clinicians. And, F.E.A.S.T. was often recognized as a resource to families in the UK and elsewhere, even thanked, as a collaborating partner in the parent, clinical, and advocacy worlds.
|The shoes, the shoes!|
The biggest difference is this: “anorexia” is often used here as a proxy for all eating disorders. I have always been jarred by it but more so lately and it jumps out at me here more than anywhere. But context is important and for those outside the UK’s NHS we need to remember the cruel reality that specialist eating disorders services are almost impossible to access if you are not at a dire low weight. You can have all the horrific psychological and behavioral symptoms of an eating disorder, you can binge and purge nearly unlimited amounts, and you can be quite underweight but you are only hospitalized or referred for specialist care for one late-stage symptom: extremely low weight.
This means the specialists in eating disorders really only see anorexia nervosa and only see those patients in extremis. The statistics, clinical experience, and resources are seeing one sliver of patients. The majority, the vast majority, of eating disorder sufferers are being seen on a non specialist, outpatient, local basis if at all.
It’s a self-perpetuating false view of eating disorders. It’s like defining infection only at the level of amputation-level gangrene. No one in the UK ED world likes this, accepts it, or doesn’t want to see it changed, but, when even dire ED cases have to struggle for resources it’s clear why the language has developed this way.
I live in a “system," the US, where we diagnose ourselves, seek out the kind of professional we believe best treats our condition, and get as much treatment as we can afford or our insurance will subsidize. It is often very bad care. It is often marketed to vulnerable families and then withdrawn when bank accounts are drained. We can get care for bulimia or BED as easily as we can anorexia, so our language and advocacy reflect that. Those who treat one ED also treat the others and has seen the range.
|The British Museum, and we |
didn't see the Vikings!
True, nearly everything we can say about anorexia is also true for the rest of the ED spectrum. The parental demands, the professionals to consult, the issue of malnutrition, and the danger are all the same. But “Anorexia” is a specific sliver of the spectrum, not a term that can be fixed with an asterix or subtitle. Solution: let’s just say “eating disorders” for the spectrum and be specific on sub-diagnosis when talking about specific patients or treatments?
|Helix team on duty!|
Question: how’s that working for you? As a parent who talks to a lot of UK parents, it’s not. They want a health system that considers it a critical situation for a developing adolescent to be malnourished. Not just “starving.” Any malnourished child is in peril. And that includes bulimia, BED, OS-FED (EDNOS), and FED-NEC. Oops. Soap Box moment. (or Hyde Park moment, really)
I’m curious about how different cultures and healthcare systems interpret the existing science. For example, while the APA’s diagnostic category book, the DSM, is widely used in the US, and the categories are the standard in most research publication, but it is not widely used elsewhere clinically (um. the DSM manual costs $100+). That means we don’t all use the same terms and even the definition of the disorders may differ. The international standard, the ICD, has different dimensions and although it tracks mostly with DSM is emphatically not used in the US and not often in research – and some countries (learned this at EDIC) don’t use any. (France, call me?) So we are a tower of Babel when we really need some stone tablets.
|My first croughnuts,|
care of Miranda
My answer is simpler: anorexia is not a weight condition, it is a mental illness at all weights. “Obesity” is a weight condition, not a mental illness.)
|Selfie at the park|
My plenary presentation at EDIC went off okay, I think. People always say nice things, but I like to think I’ve gotten better at public speaking over the years and really did do F.E.A.S.T. proud, and the parent community proud, and that the four years since my last EDIC stage (with Fiona!) were good training.
As always, it’s in the hallways and dinners and lobbies where relationships are formed and nurtured, not to mention seatmates during presentations. I met many new people over the sandwich table and during coffee and after Q&A. My walk through London with Miranda was unforgettable (and involved croughnuts)! I had one meet up at a museum that turned out to be two separate museums – mine being the wrong one – giving me a free hour to sit in Russell Park and watch the London world go by. Another gathering was graced with gorgeous weather, a gaggle of dear friends, but far too short a time. I loved the opportunity to address Charlotte Bevan’s friends about the Helix, with backup by video from Cindy Bulik and a star turn by Susan Ringwood of Beat. Dinner out with S & G ended on the most hysterical interaction with the server not soon forgotten. And an al fresco shared bottle of wine at that most relaxed moment: after the speeches, back in flat shoes, but before going home to do laundry and catch up on email.
I really, REALLY did not like the good-byes. Sue and Helen and Erica and Rachel and Fiona and Becci, thank you for your support and kindness on the Saturday, and beyond. Thank you to the Monsons for hosting a wonderful conversation with nibbles and the sweetest and most attentive dog. Big shout out to the KCL team for the professional and energetic Helix recruitment stall. Thank you to Beat for the invitation and F.E.A.S.T. for the support. Thank you to hubby for sparing me and carrying on (British sense, not US).
Charlotte, you were missed. You are such a part of the community. Your voice is in our ear, and your attitude is there to keep us from anything maudlin or vapid. I thank you, too, for the bonds you made between us and how leaving us something to work on together has created new relationships. Still mad you’re gone, though, so don’t let it go to your head.