D#12 H#2

Revised Essay:

Anorexia is an eating disorder that affects women of all ages, and sometimes even men. Between 5 to 10 percent of girls and women, and about 1 million men in the United States have eating disorders. This awful truth is very unsettling, but the treatment of this disorder can be just as disquieting. Adolescent girls seem to be most susceptible to acquire eating disorders. This is due to the fact that they are more in tune to the societal pull to be a certain way. Some may take this disorder lightly, but it is an unquestionably serious and life threatening disease. In fact it has the highest mortality rate of any other mental disorder. Characteristics of this disorder include: an all-consuming fear to gain weight, and an obsession with restricting food intake (even though they are severely underweight) (Anorexia Nervosa Site) Anorexia is more than just a problem with food, most of the time, anorexics use the technique of starvation to help them cope with struggles, stresses and anxieties they may be going through in life. It is a way for them to control something when they feel that their life’s surroundings are out of their control. Since the effects of this disorder are life threatening, it is sometimes necessary to enforce controversial treatments.
2 There are a variety of treatments offered for anorexics. Some of these treatments are not as widely accepted as others. In fact some treatments are considered to be quite controversial. One such treatment is Compulsory treatment. Part of this treatment includes making the patient do things that they do not want to do. This often brings about the question: If the patient is given treatment contrary to their wishes, but survives the disorder does that still make the treatment ethically wrong? While a life may have been saved in the process, are doctors crossing the boundaries of a patient’s own decision making process? There is great belief that doctors should try and save people’s lives not matter what. Other people disagree, and believe that the patient should be in control of everything. It is without a doubt that people who are severely underweight and starve themselves should be considered unfit to make decisions when it comes to taking care of their bodies. Anorexia is a psychological disorder, and the mind can be greatly affected when it is malnourished and paranoid. While some of these treatments may be more invasive, they are an essential part of saving someone’s life. Is it ok to watch someone slowly starve themselves to death, or do doctors, family, and friends have an obligation to intervene whether or not the anorexic wants help? When someone is not able to physically take care of themselves and stay healthy, that is when doctors should have the right to perform compulsory and other types of controversial treatments.
3 It has been said that, “Every treatment will be confronted with the dilemma of enhancing personal well-being and respecting the person as a self-determining individual.”( Vandereycken) One such treatment is compulsory treatment. Under normal circumstances, when a patient is being admitted, they usually sign a conformed consent, stating that the regimen in which they will be receiving is what they want. It is a different case when compulsory treatment is given. Compulsory treatment is defined as any type of treatment given contrary to the patient’s wishes. When treating anorexia, there are numerous times when the doctor has to make a decision of whether or not to perform compulsory treatment. In general it is thought that “treatment contrary to the patient’s wishes is almost always unethical, because it has the effect of offending against the principle of respect for autonomy.”(Vandereycken) This brings about the question of whether or not compulsory treatment is legal. By rule doctors are supposed to comply with a patient’s wishes, even if it puts the patient’s life at a greater risk. However every rule has its exceptions. Two main reasons that overrule a person’s consent are incompetence in adults and those who are minors. One may wonder if the outcomes are different with anorexics that have been treated solely by their own will and ones that have been treated compulsorily. Research that has been done on this subject shows that there really isn’t any difference in the outcome of the patient. The only difference is the treatment that the patient received.
4 Another controversial treatment that is used frequently among anorexics is forced feeding. The thought alone seems cruel, invasive, and an infringement upon everyone’s civil liberties and rights to choose what is done to their body. However upon taking a closer look, one may be surprised by the need for this treatment. Statistics show that twenty percent of all anorexic sufferers will die. That is a significant number! However if forced feeding is one way of making that number decrease, should that still be considered a bad thing? Here is a good analogy: Do people consider it forced feeding when a mother nurses her baby? The baby does not know better, (and cannot control it) but the mother gives the baby food and he/she learns from there. This scenario has a lot in common with anorexics. Once a person has lost an immense amount of weight and is consciously starving themselves they have lost their ability to make proper decisions about their health. Just like the baby is fed my it’s mother because she knows what is best for the child, the same goes for anorexics. Except the feeding is now taking place by nurses and doctors. When an anorexic has lost the ability to make competent decisions as far as eating is involved that is when intervention is needed; even if it is not wanted by the patient. Most procedures done without the consent of a patient is considered assault. However that has not been the case with forced feeding. In England, Denmark, and Wales patients with anorexia can be admitted and artificially fed regardless of the absence of a signed consent form. This is only allowed under the provisions of section 63 of the Mental Health Act. (Vandereycken) Most doctors seek consent forms for every case, but that is not always possible. As long as a doctor follows the principles of the existing declarations and acts with good faith and reasonable care, he will be protected from civil proceedings. (Vandereycken) This statement should make people who do not believe in controversial treatments to think. As long as a doctor is doing the procedure ultimately for the benefit and health of the patient, it should be allowed.
5 Cognitive-behavior therapy is another controversial treatment for anorexia. This type of therapy for anorexics began in the 1970’s. Cognitive behavior-therapy has been widely investigated and is now empirically supported for bulimia nervosa. However it is a different story with anorexia nervosa. Cognitive-behavior therapy can be long and methodical. Treatment begins with each anorexic patient being assigned to a primary therapist. There are four types of assessments and evaluations that take place in the first session with the primary therapist. Theses assessments are “psychological, psychiatric, dietary, and body composition.” (Miller) The psychological assessment is performed through using the “Interview for Diagnosis of Eating Disorders.”(Miller) The next assessment that the anorexic has to go through is psychiatric. This assessment is another method that comes closer towards a diagnosis. Psychiatric treatment looks at the anorexics family history of psychiatric problems. Next on the agenda for cognitive-behavior therapy is the dietary assessment. This assessment must be taken with a registered dietician. The dietician has to have extensive experience with eating disorders. The last assessment is all about the anorexics body composition. In the assessment the dietician measures the patient’s skins folds. Measuring someone’s skin folds is known today as a BMI. (Body Mass Index) After the first session and all the assessments have been completed by the patient, evaluations and laboratory studies are ordered. If there is any uncertainty about acceptance of the recommendation of the assessment team, a patient and her family will often be asked back for one or more follow up sessions. (Miller) With these evaluations, the therapist can better establish the severity of the symptoms of the eating disorder. From the results of these tests, therapists can usually detect if the patient has a personality disorder. If the therapist thinks that a personality disorder is a possibility, he can suggest further tests for the patient. Once the patient has reached this point they are usually interviewed by the therapist for post-traumatic stress disorder and obsessive compulsive personality disorder. If a patient has one of more of these disorders it can be considered a major cause for their struggle with anorexia. Cognitive-behavior therapy can be arduous, but it is well worth the effort. While some of these evaluations can seem invasive to one’s own personal space and privacy, they are entirely necessary towards overcoming the disorder.
6 The treatment of anorexia has come a long way since the beginning in the early 1900’s. In the 1930’s one doctor gave guidelines for the treatment of anorexia. He suggested that: “(1) every patient could be persuaded to eat normally, (2) the condition to be hysterical and that no patient should remain uncured, (3) the doctor should sit down with the patient and fight for every mouthful of food which could take an hour or two per meal, (4) the doctor should never lose his temper, and (5) one must cure the anorexia before one starts on the psychological problems.”(Miller) This doctor also believed that everyone would be cured and would return to eating normally. What is most outrageous about his method is that he thought the psychological treatment should not start until after a patient has overcome anorexia. That seems almost impossible, since psychological related issues are the main cause of the disorder!
Conclusion
Thankfully understanding of the disorder has come so much further than what it used to be. However there is still a lot left unknown about the disorder. Many treatments are controversial, and a lot of the times unsuccessful. Even though the success rate is lower than what would be ideal, if an anorexic isn’t treated it could lead to their death. There are hundreds of anorexics dying of self starvation and malnutrition each year. Until the severity of this disorder ends, or scientists find better and less controversial ways to treat it, there will always be a need for these types of treatments.