Thursday, June 28, 2012

Photography & Bokeh: My Favourites!

©2012 Am Ang Zhang

What a run:

Jun 26, 2012
This one too has no reference to Anorexia Nervosa. ©2012 Am Ang Zhang. Chapter 42 What If …
Jun 26, 2012
I have often been asked the simple question: how is it that a lovely child could turn out to be so strong-willed about food and weight. We may have to go back to the beginning and I am ...
Jun 24, 2012
Thirty years ago, I saw mountains as mountains, and waters as waters. When I arrived at a more intimate knowledge, I came to the point. where I saw that mountains are not mountains, ...





















©2012 Am Ang Zhang
Jun 22, 2012
Il faut manger pour vivre et non pas vivre pour manger. (One should eat to live and not live to eat.) - Moliere (1622 – 1673): L ' Avare (The Miser). Some hae(have) meat and cannot eat, ...
Jun 21, 2012
Earlier in June in 2009 we spent some time with our friends in Dorchester . Somehow the after dinner conversation turned to the Pre-Raphaelites and our hostess promptly produced a ...
Jun 20, 2012
As we move into the gaming era of the NHS, one diagnosis that will be on AQP's list will be Anorexia Nervosa. Unlike hip replacement, the variation of the condition is such that it is ripe for Private Providers to make a case for a ...
Jun 19, 2012
Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private clinics springing up for the sole purpose of admitting anorectic ...
Jun 18, 2012
Can a seventeen year old Anorexia Nervosa patient be allowed to die? Not if we can possibly help it. But anorexia nervosa is truly pernicious illness, and sometimes it defeats us all - although usually a bit later in the patient's ...
Jun 21, 2012
When I took over the adolescent unit as its consultant in charge there were six Anorexia Nervosa patients in varying stages of emaciation or weight gain depending on from which side you want to look at it. It is not always wise ...
May 22, 2012
She had been hospitalised for Anorexia Nervosa. She was cured. She got married. Then she had Chris. If she did not tell me, I never would have guessed she had Anorexia Nervosa. At first I did not even know how I knew


Tuesday, June 26, 2012

Anorexia Nervosa: Hobson's Choice!



©2012 Am Ang Zhang

I
 am sure we all have been asked the great “what if…..” question. I was fortunate enough in my practice to have had some “lucky” breaks.
         Given my interest in the very young, now and again we had some strange cases that tested our ingenuity to the limit.  No amount of SSRI (Selective serotonin reuptake inhibitors) would be able to help.  Often it was a clear battle of wills, a battle between the consultant and someone barely one sixth his age.
         That this particular child had already beaten two adults with a combined age well over ten times hers should have been a clear warning to me on what I was to take on.
         The contestant was a little girl nearing five years of age who had developed an addiction to Huggies. Yes, Huggies.
         It could well be the success of advertising or it could be the future of the human race, I joked to the nursing staff as the desperate parents agreed that the girl should be admitted to the children’s ward for “nappy withdrawal”.
         The problem was simply this. She needed to put on a disposable nappy in order to pass urine, or do No. 1, as she put it.  At her age, she required the biggest size available.  The cost had been piling up.  As it seemed so trivial, the parents never sought help until now when school days were imminent. It would not be possible to contemplate her going to school with nappies.
         With our enlightened staff, admission to the paediatric ward was no longer the traumatic experience it used to be.  This little girl soon settled in and was promoted to be the No. 1 helper around the ward.
         However, whenever she needed to, she helped herself to a nappy, and after performing, took it off and put it in the appropriate bin. She worked that one out in no time at all.
         One nil.
         I needed to come up with a battle plan quickly.  The ward was fast running out of the giant nappies and I had no intention to make a special requisition.
         “That is it. I HAVE AN IDEA.”
         I found a large clean plastic bag and put all the nappies in it.  There were three.  I gave it to my opponent and said, “These are the last three and, when you have finished, there will be no more.
         Unperturbed she snatched the bag from me as if to say, “Not a problem, doc.”
         I went on with the rest of the morning round and went to the clinic.
         After the day’s main clinics, I decided to have a peep.
         “She used two of the nappies and is now down to the last. She carries it around with her. It is becoming quite a sight.”  Sister told me.
         Everybody knew I was not going to win this one, but were prepared to see it to the end.
         By now she was quite urgent and you could see she was struggling a bit. Her last performance was over three hours ago.
         She looked at her nappy, thought about it, and then something curious happened.
         She went to her favourite nurse and took her by the hand, “Will you take me?”
         She sat on the toilet and passed urine, still holding on to the nappy. There was a sudden cheer from all the mothers. My head was visibly doubling in size.
         “Well done!”
          Shortly after, Sister took me to the side and asked, “What if she did use the last nappy? What would you have done?”
         “Sometimes there just is no what if. You have to do certain thing as if it were the only way.”
         Her family went on their planned camping holiday in the South of France and from there they sent a post card.
         “Yes! It is still working. We have truly cracked it or you have. Thanks a million. We are all having a lovely time.”
        
         In early 2007, a female astronaut wore a nappy in order to drive non stop to threaten another woman, a rival in love.
         No, she was not my patient.



Anorexia Nervosa: Don’t You Dare!


I have often been asked the simple question: how is it that a lovely child could turn out to be so strong-willed about food and weight.

We may have to go back to the beginning and I am reprinting a Chapter from The Cockroach Catcher that may give you some clue. There is no reference at all to Anorexia Nervosa!

Chapter 20  Don’t You Dare

 © Am Ang Zhang 1998


D
ominic was a boy of nearly three from a rather well-off middle class family. He had an older brother of five and a much older sister of nine. His father worked in the City and earned good money to support their comfortable lifestyle. Mother was often the only one that  attended the clinic with Dominic. Sometimes the older ones attended as well if the appointment happened to be during school holidays.
         I used to see many similar ones in my sleep clinic and early handling problem clinic.  Wealth sometime detaches one from the extended family and with modern education and so on, mother’s advice becomes old wives’ tales.  These young mothers much prefer to see their friendly child psychiatrist who is believed to be armed with the latest medical knowledge.
         Dominic, like his siblings, was an angelic and smart child. There was one small problem. Since mother’s rather late failed attempt to train him, he had taken to tearing off his large nappy and poo’ing behind a sofa in one of their grandest rooms – the one with the grand piano. He had refused to perform in the Mickey Mouse pot and umpteen other Disney inspired ones. Nor would he use the special attachment on the toilet seat or seats as there were four toilets he could use.  No, he preferred the spot behind the sofa.
         Mother was soft spoken and like many of the mothers with sleep problem children too gentle – too gentle in my book. Often these mothers tried to explain things to their six-month olds.  They never shouted at their children. In fact they never shouted at anyone. Most were lucky to have a nice older daughter and in her case a nice older daughter and an older boy. 
         Knowing where the problem lies is often not the same as knowing what the solution is. It is virtually impossible to try and teach such parents to raise their voice.  That would be like teaching them to be violent to their own child. They have to work it out for themselves.
         You mean she became “violent”? My junior would ask me.
         Well, I told mother that it was really not a psychiatric problem which of course was vaguely unbelievable to her. I started telling her stories about other mothers with similar but not exactly the same problem and how they managed to resolve things simply by becoming very “firm”.
         Very firm indeed!
         “You mean you get them shouting?” My junior would ask.
         “I never had to.  But it worked.”
         “Invariably? So what happened?”
         One day she turned up still in her riding gear. She told me she was too excited to go home to change.
         “What happened?”
         “Well, as you know my cleaning lady had great difficulty cleaning the yellow off the carpet. The different cleaning fluids have not really done the carpet any good.  My husband is having his colleagues from his firm for a big Christmas do and so I have put in a new carpet. I have decided that all I needed to do is to keep an eye on the little devil and catch him before he could do any damage.” 
         “And?”
         “You know he was so crafty.  I had to pretend to be reading my magazine but at roughly the right time I noticed he was edging towards the back of the sofa. I waited a few seconds for him to get to his favourite spot. When he tried to pull down his nappy, I did not know what got to me, I just saw red and shouted: don’t you dare.  Go to the toilet and do the ‘poo’ like everybody else.”
         “As if by magic, he looked at me, pulled his nappy up, went upstairs to his own toilet, the one with Mickey, and did the job.” Mother was so proud. “He has been doing the same since.”
         We had one happy family again, with one happy grateful mother who had not got a psychiatric problem child.
         I often used her story to help other mums.


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Email: cockroachcatcher (at) gmail (dot) com.

Sunday, June 24, 2012

Anorexia Nervosa & Sars: Parent Power!


 © Am Ang Zhang 2011  

Thirty years ago, I saw mountains as mountains, and waters as waters.

When I arrived at a more intimate knowledge, I came to the point
where I saw that mountains are not mountains,
and waters are not waters.
Thirty years on,
I see mountains once again as mountains, and waters once again as waters.
Adapted from Ching-yuan (1067-1120)

In 2003 the world was in the grip of a new plague that challenged our knowledge of medicine to its limit.

For the first time, doctors and nurses who were normally in the forefront of the fight against diseases were fighting for survival from SARS(Severe Acute Respiratory Syndrome), a new and dangerously contagious disease. The alarm was first raised by its first victim, Carlo Urbani. He was an Italian physician employed by the World Health Organisation (WHO) and based in Hanoi, Vietnam and he gave the disease its current name. It was as if this newly mutated virus knew what it was on about. Get the doctors as they would be the first who could deal with you. Urbani died. So did some of the medical staff that attended the first few patients.

Doctors often thought that they would be immune, a God given right I suppose. Not so this time! The virus obviously knew what it was doing.

Our knowledge base was in total chaos. What we knew was obviously not good enough. Nor were the most up to date antiviral drugs. Even then in some places they were sold out as rumours spread. There were rumours too of vinegar and certain dietary items giving protection to certain ethnic groups, notably Koreans. The lack of knowledge about this new infective agent led to the great proliferation of myths that were soon spreading like wild fire on the Internet. Anyone with cold symptoms was treated as if he was carrying the plague. It was the plague, the new plague.

Without any sound knowledge authorities took draconian measures – any measure anyone could dream up. Some worked well if only to raise public awareness. One actually caused more harm and unfortunately deaths. That was the restriction of movement in one of the tower blocks in Hong Kong – a true quarantine. In the absence of insight into how the infection was spread, more people were infected. Some broke the law and fled the buildings before the quarantine. Unfortunately 321 people were infected and 42 died. Eventually someone was sensible enough to move them to another quarantine site. Otherwise there would have been more deaths.

Canada's hasty decision to declare its virus free status when so little was known about the virus proved costly and further eroded the public's trust in governments and people in positions of influence. Clinicians’ view no longer seemed to hold any sway where commercial interest was more important.

Masks:


Mask wearing in Hong Kong AFP 
Except in Canada, one advice was almost universally adopted – the wearing of a mask. During this time, I was in correspondence with many of my medical colleagues and relatives in Hong Kong and Canada. One thing was clear: even the most difficult child complied and wore a mask. To this day one still needs to wear the appropriate mask to visit someone in hospital in Hong Kong, on top of having a dollop of alcohol gel to sterilize one’s hands. Many clinics require patients and staff to do the same.

Now this must be the clearest lesson to every parent in every land. Where life and death is concerned, there can be no compromise.

Anorexia Nervosa:
So it started me thinking about my practice, specifically Anorexia Nervosa and other difficult cases that I have encountered. Take Anorexia, it may have been unnecessarily classified as a mental illness, given that it is the result of the parents giving the individuals concerned too much right and freedom for self determination. If a child can be made to wear an uncomfortable mask, why can parents not make a child eat?

The answer may lie with our view of freedom. Many parents of Anorexia Nervosa sufferers are highly educated, and some hold high positions in big corporations and even in Health Authorities. Many are professionals. Many have a great respect for individual freedom and self-determination and unfortunately they get caught in a bind of not being able to be authoritarian as far as their own children are concerned. It is not difficult to see why many parents of Anorexia Nervosa sufferers are not prepared to give up being a modern parent, and until they do, we psychiatrists will have to soldier on with the difficult task of treating what need not necessarily be an illness, let alone a mental one.

My second thought is that when something as familiar as chest infection can turn out to be a deadly new plague called SARS, we need to examine again the relationship between our existing knowledge and medical practice.

We have to keep an open mind. What we know from the past should be an aid, not a hindrance.

Otherwise we shall never see the mountains and waters for what they really are.

From The Cockroach Catcher


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Friday, June 22, 2012

Anorexia Nervosa: The History

Il faut manger pour vivre et non pas vivre pour manger.
(One should
eat to live and not live to eat.)
-
Moliere (1622 – 1673): L'Avare (The Miser)
Some hae(have) meat and cannot eat,
Some cannot eat that want it:
But we hae meat
and we can eat,
Sae let the Lord be thankit.
-
Robert Burns (1759 – 1796): The Kirkcudbright Grace
This is a collection of material that relates to Anorexia Nervosa in a chronological order.

First introduction of the term Anorexia
Sir William Withey Gull (1816 – 1890) first used the term:
“In… 1868, I referred to a peculiar form of disease occurring mostly in young women, and characterized by extreme emaciation…. At present our diagnosis of this affection is negative, so far as determining any positive cause from which it springs…. The subjects…are…chiefly between the ages of sixteen and twenty-three…. My experience supplies at least one instance of a fatal termination…. Death apparently followed from the starvation alone…. The want of appetite is, I believe, due to a morbid mental state…. We might call the state hysterical.”
Source: Anorexia Nervosa (apepsia hysterica, anorexia hysterica).
Transactions of the Clinical Society of London, 1874, 7: 22-28.
Classic description of Anorexia Nervosa.
Earliest published accounts
Richard Morton (1637-98), a London physician: The Treaty in his book Phthisiologia, or a Treatise of Consumptions, first published in Latin in 1694.
Ernest-Charles Las├Ęgue (1816 - 1883), a professor of clinical medicine in Paris: “De l’Anorexie Hysterique” containing descriptions of eight patients.
More recent views

Girl in a Chemise circa 1905 Pablo Picasso (1881-1973)
Tate Collection
Anna Freud’s psychoanalytic view (1958):
  • Adolescent emotional upheavals are inevitable
  • Anorexia Nervosa is the outward manifestation of the battle between the ego and eating, with the former struggling for it’s very survival

Bruch (1966): relentless pursuit of thinness
Crisp (1967 - 1980):
  • Anorexia nervosa serves to protect the individual from adolescent turmoil.
  • Anorexia nervosa reflects a phobic avoidance of sexual maturation.
  • Unsettling effects of sexual maturation at puberty may drive the female adolescent to a pursuit of thinness leading to greater acceptance, self-control and self-esteem.
  • Anorexia nervosa tends to appear in families with buried, but unresolved, parental conflicts.
Palazzoli (1978) on women’s role (not just Anorexia Nervosa)
  • Women are expected to be beautiful, smart and well-groomed.
  • They are expected to have a career and yet be romantic, tender and sweet.
  • They are expected to devote a great deal of time to their personal appearance even while competing in business and professions.
  • In marriage, they are expected to play the part of the ideal wife cum mistress cum mother.
  • They are expected to put away her hard-earned diplomas to wash nappies and perform other menial chores.
  • The modern woman is therefore exposed to a terrible social ordeal, and the conflicting demands and dual image of the female body as sex symbol and as commodity.
  • An adolescent girl may develop feelings of insecurity and alienation toward her changing body.
Finally, it is appropriate to close with two quotes:
L'appetit vient en mangeant.
(The appetite grows by eating.)
-
Rabelais (1494 - 1553): Gargantua
One hath no better thing under the sun than to eat, and to drink, and to be merry ...
- Ecclesiastes 8.15

Thursday, June 21, 2012

Anorexia Nervosa: Law & Reversal!



Chapter 34  Failure?



I
t is not easy to admit to failures and harder still for doctors to do so especially if they did everything right and according to protocol. 


         Doing the “right” thing is not an indication of success.  

         Hardly.
         Yes. I am coming back to Anorexia Nervosa again and I do not apologise for it. I am apologising for our failures though.

         The British Daily Mail reported in March 2007[1]:
         “It is thought there are between 60,000 and 90,000 adults being treated for eating disorders at any one time in the UK. The average age of diagnosis is between 16 and 18between 60,000 and 90,000 adults are estimated to be treated for eating disorders at any one time in the UK.
         Over a 13-month period from March 2005, 206 preteenage children across Britain and Ireland were newly diagnosed with serious disorders ranging from bulimia and anorexia to binge eating.
         Half were admitted to hospitals for in-patient treatment. Some were showing symptoms of starvation such as a low temperature and a slow heart rate, while 10 per cent had to be fed by tube.”
        
         In the same month, the British Independent[2] reported:
         “Anorexia Nervosa has the highest death rate of any psychiatric condition. In ten years 3% of these patients died, and although half were by suicide, the rest were related to the starvation process.
         Just this week in Rome a 27-year-old model identified only as Ilaria died of Anorexia after an illness lasting ten years. She weighed 35kg at her death. Luisel Ramos, 22-year-old Uruguayan model died at a fashion show in August, 2006 after suffering a fatal heart attack that was thought to be the result of Anorexia. Ana Carolina Reston Marcan, the Brazilian catwalk queen died only three months later in a Sao Paulo hospital.”
        
         When I took over the adolescent unit as its consultant in charge there were six Anorexia Nervosa patients in varying stages of emaciation or weight gain depending on from which side you want to look at it.  It is not always wise to have so many anorectic patients together as they do share tricks with each other and it is often more difficult to customise treatment.

         What needed my urgent attention was of course Sammy. Sammy had a very feminine name but preferred the nickname Sammy. Sammy’s Section was due to expire in less than 14 days and I had to compile a report for the Tribunal which would be sitting to decide on her fate.

         It was perhaps a sign of our failure as psychiatrists to effectively treat Anorexia Nervosa that eventually case law was established to regard food in Anorexia Nervosa as medicine.  Therefore food may be used forcibly to treat Anorexia Nervosa when the condition becomes life threatening. 

         The usual test of mental capacity no longer applies. Instead the law is used forcibly to feed a generally bright and intelligent person “over-doing” what most consider to be “good”.  They try to eat less and eat healthily by avoiding fat and the like and wham we have the law on them.

         I have to admit that I have not liked this aspect of Sectioning. Unfortunately it is used often, judging by the high numbers of tube fed patients.

         On the other hand not everybody is able to treat Anorexia Nervosa patients or, in reality, do battle with them. It requires experience, energy, time, wit, charisma and often impeccable timing. However, sometimes I do wonder if we are indeed doing a disservice when we take things out of parents’ hands by agreeing to take over.

         With hindsight and upon reflecting on a number of cases I have dealt with, I often wonder: if hospitalisation had not been an option at all, would improvement rate and, more importantly, mortality rate have been any different.

         We do not section people for smoking, drinking, or doing drugs, which all endanger life. Nor do we stop people running the Marathon or eating raw oysters when these activities regularly lead to mortalities.

         Society is coming round to do something about over-eating in children but it will take some time before they apply the Mental Health Acts. 

         To me, the moment a psychiatrist turns to the law he is admitting that he has failed. 

         At least that is my view and if I perpetuated the Compulsory Order with Sammy, I too would be part of that failure.

         There had been no weight gain in Sammy despite the tube feeding and the debate was: shall we increase the feed or shall we wait? Everybody just assumed that she would stay on as a compulsory patient.

         Despite bed rests and even more embarrassingly the use of bedpans, many Anorexia Nervosa patients managed not to gain weight whatever we pumped into them. The balanced feeds were in fact quite expensive. There was no secret that they were aware of the exercises they could perform even on bed rest and the determination not to put on weight had to be seen to be believed. If such determination was applied elsewhere I was sure these young girls could be very successful.

         I had to find an answer, an answer for Sammy and an answer for myself.

         Being forced to eat by the State remained the treatment of choice for everybody except for one stubborn consultant.

         “At least we did all we could,” my staff constantly reminded me.
         “And she is the most determined of all the Anorectics we have right now.”
         More reason to show the others that this new psychiatrist had some other means than brute force, I thought to myself. 

         Yes, I could be as determined as they were.

         The hours of family therapy only brought about accusations and counter accusations with hardly any resolution. Middle class families have certain ways of dealing with things where some branches of family therapy are not particularly good at all.

         The modern trend is certainly moving away from blaming families.  Or that is the rhetoric of most who write publicly about it.

         Whatever the official line, families cannot help feeling blamed.

         “If we are not to blame, why do we need family therapy?”

         “There are so many other families like ours.  Why do they not have the same problem?”

         We may reassure them that there are and that is the truth, but the truth is that there are also Anorexia-free families.

         Yes, it might help if they do find a gene like they did with obesity.  Yet that cannot explain why there are more extremely obese people in say the U.S. which collects gene pools from across the globe.

         So Sammy’s family had the full benefit of eight sessions of family therapy by two very experienced therapists. In the end, there was just a lot of recrimination between all parties including the therapists and all agreed it would not be the way forward. That was when tube-feeding started.

         Minuchin[3] dealt with over-involvement, over-protectiveness and conflict avoidance in these families with no special apology on whether he blamed the family or not. He used to start with a meal session with the family. His success, like many such methods, probably had more to do with his charisma than his method and is thus difficult to replicate.

         For Sammy and her family the message was simple and clear enough, no matter how hard we lied.

         The family had failed and the hospital had to take over.

         That was the blunt truth. 

         But the hospital had failed too and we had to resort to the Mental Health Act on one of society’s most sensible and decent and safest citizens. 

         I decided enough was enough. I could no longer perpetuate the no-blame approach. I could no longer continue to hide behind the power conferred onto me by the law. 

         In short, I had to reverse just about everything that had gone on before, and more.

         Just two weeks before the tribunal sat we had the big review meeting. To most at the unit, the review was fairly routine as there was hardly any choice – a full Section for Hospital Treatment primarily intended for difficult to treat Schizophrenics and difficult to control Bipolars in the acute manic phase. Sammy would be “detained at Her Majesty’s pleasure”, and classed with the likes of the few psychotics who had committed the most heinous murders. To save Sammy’s life, it would be natural to continue with the Mental Health Act.

         Yes there would be weeks of tube feeding and bed rest, but the State had to take over the complete care of this bright young thing for her own sake.

         I could not see any other way either.

         Unless …….I could reverse everything that had gone on before.  

         If our work is to be therapeutic then a sort of therapeutic alliance is important, even if tentative.  Some people do not realise that you can fight with your patient and still have a sort of therapeutic alliance.

         I had a plan.

         These meetings were attended by just about everybody who had anything to do with the patient.  They were held at school times so that most of the teaching staff could be present as well. These meetings also had a tendency to drag on as everybody seemed to have a lot to say about very little, a trait not just limited to psychiatrists but also seen in social workers, therapists, nurses, junior grade doctors, teachers and visiting professionals. People always seemed to have a lot to say on cases where there was the least progress. 

         My personal view is that this was a sure sign of anarchy which had unfortunately drifted into our Health Service, encouraged in part by the numerous re-organisations that had gradually eroded the authority of the doctor. 

         Saul Wurman[4], an architect by training but also an author of business and tour books, famously wrote that meetings really do not always need to be an hour long. Why can it not be ten or twenty minutes?

         Could I achieve that?

         After briefly explaining to all the purpose of the meeting, I turned to Sammy, who still had the nasal feeding tube “Micropore’d[5]” securely and said, “What do you think?”

         “It is so unfair.  Now I shall not be able to go to Harvard.”

         It is generally perceived as a given that a U.K. citizen who has been Sectioned will not be able to use the Visa Waiver to visit the U.S. If that person then has to apply for a Visa, having been detained under the Mental Health Act must be a major hindrance, although I have never seen this applied in practice. One of my patients did have to cancel a horse trial trip to Kentucky because she was sectioned at the height of a manic episode.

         I did not know she had aspirations to get to Harvard but I was not surprised given what I already knew about mother.

         “Before I say anything else, can I ask you a few things?”
         “What? Sure!”
         “Do you smoke, drink, take Ecstasy or go out clubbing?”
         “No.  Why?”
         “Do you have piercings and tattoos on you?”
         “Tattoos—yuk!  Yes, I having my ears pierced. That is all.”
         “Do you like Pop music?”
         “No way. I play the violin and I like Bach and Bartok!”
         Everybody was attentive now.
         “Do you shoot heroin or smoke Cannabis?”
         “No way!”
         She was getting annoyed.
         “What about boys and sex?” I felt bad even to ask especially in front of her mother, who I thought would faint if we knew something she did not.
         “How can you even ask and in front of my parents? You know I don’t do things like that!”

         I can remember my own adolescence. I did not do any of those things either and I did not even have pierced ears.

         I then turned to the parents.  Mother was a history teacher at a famous private school in one of England’s most middle class town. She also spent a year at Harvard, hence Sammy’s ambition to follow her. Father was a prominent city lawyer.

         “You have always provided well for her, a good education, European and U.S. holidays, a comfortable home and expensive music lessons.”

         “We are fortunate enough to be able to do that. She is our only child.” Mother replied in a tone implying, “what’s wrong with that?”

         “And she has always been a bright child, strong willed and single minded. She passed her Grade 8 violin with distinction at 14 and could have become a musician. But she wanted to do International Studies.” Mother added.

         “So she always had her way.”
         “She has always got on with everything, studying and practising the violin. And she keeps a tidy bedroom!”
         A tidy bedroom! My goodness, everything was falling into place.
         “Sammy……”
         “Yes……”

         “You know what? You are the first adolescent I know that keeps a tidy bedroom, do not do drugs, do not drink, do not smoke and you do not do a load of other things I asked you about. You are by modern standards a FAILED adolescent!”
         Then I turned to the parents.
         “And you, FAILED parents!”
         “And we FAILED you. We failed you because we had to hide behind the law and force fed you.”
         Sammy said, “I can’t do all those things even if you make me.”
         Ah, the turning point.
         “No, don’t get me wrong. I don’t want you to either.”
         I then told her that I would like to take the tube off her despite lack of progress, or because of it.
         It simply had not worked.
         I wanted her to take over, do what she needed to do and I would decide in about ten days if I had to extend the Treatment Order.
         Forty five minutes. The meeting took forty five minutes as people had to present summaries of different reports, the details of which were irrelevant here.
         The battle was over. Sammy looked relaxed. Nobody was fighting her now. She was back in control.
         I took her off the Section as she started to put on weight and before long she was discharged. 

         We forget how easy it is to entrench. To entrench is a sure way to perpetuate a problem.






NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.


[1] Daily Mail report on 26th March 2007 – Children as young as six suffering from aneroxia.
http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=444646&in_page_id=1774
[2] Independent report on 29th March 2007:  The Versace family: Allegra and the curse of anorexia
http://www.independent.co.uk/news/europe/the-versace-family-allegra-and-the-curse-of-anorexia-442347.html
[3] Salvador Minuchin:  (born 1921 in Argentina), in 1965 became the director of the Philadelphia Child Guidance Clinic, which eventually became the world's leading center for family therapy and training. He is author of a number of books including Families and Family Therapy and Family Kaleidoscope and coauthor of Psychosomatic Families: Anorexia Nervosa in Context and Mastering Family Therapy.
[4] Richard Saul Wurman: (born 1936) an architect by training, published over 81 books including his best-selling book Information Anxiety and his award winning ACCESS Travel Guides. His latest books are UNDERSTANDING Children and UNDERSTANDING Healthcare (January 2004). http://www.wurman.com/rsw/

[5] Micropore™:  Micropore consists of a conformable, non-extensible non-woven fabric manufactured by 3M from 100% viscose, coated with a layer of an acrylic adhesive.