"And sometimes, because that was all he had to offer, his patients would simply stop coming to appointments. Yager would discover, later, that they had gone home and died alone on their sofas. Maybe by starvation, maybe by suicide. Maybe in pain. 'I felt like a failure,' Yager told me. 'They fired me, basically, at the end, knowing that I wasn’t able to help them anymore and wasn’t eager to just see them through the end.'... He came to think that he had been impelled by a kind of professional hubris — a hubris particular to psychiatrists, who never seemed to acknowledge that some patients just could not get better.... In academic journals, he came across a small body of literature, mostly theoretical, on the idea of palliative psychiatry.... 'I developed this phrase of "compassionate witnessing."... That’s what priests did. That’s what physicians did 150 years ago when they didn’t have any tools. They would just sit at the bedside and be with somebody.'"
From
"Should Patients Be Allowed to Die From Anorexia? Treatment wasn’t helping her anorexia, so doctors allowed her to stop — no matter the consequences. But is a 'palliative' approach to mental illness really ethical?" (NYT).
"Yager" = Joel Yager, a psychiatrist at UCHealth University of Colorado Hospital.
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46 comments:
Patients with anorexia deserve medical teams that will fight for them even as their own will to live might be zero. These patients are very sick and deserve support and not acquiescence.
Conceding mental illness may need special boundaries, it is a slippery slope treating patients against their will, especially when Claudine Gays are in charge of hospitals now. You think they’re going to err on the side of patient decisions?
So why bother with all the expensive education then? This is just a stark example of how useless most psychiatry really is. In this case it ends in death. Mode usually it just drifts on and on without any resolution. One drug or another may offer some relief, but the mechanisms by which they work seem to be rationalizations after the fact more than anything else. As with much of medicine, people get better, or they don't. Doctors can be very effective when the injury is specific and acute. They save many lives, but in many areas they try this and that and hope for the best. This is true in almost all cases where the problem is in the mind. Excepting neurologists,of course.
I’m surprised anorexia is still considered mental illness. It sounds like body shaming…
of COURSE they shouldn't "allow them to die"..
doctors should body dysphoria the way they treat body dysphoria; they should Cater to it.
Just like they prescribe drugs & surgery to patients with body dysphoria (Testosterone & mastectomy),
they should prescribe diet pills and liposuction to patients with this type of body dysphoria.
SURE, the patient will die.. NEWS FLASH! we are ALL going to die.
The important thing, is for the medical industry to Make as Much Money as POSSIBLE first.
I worked as a psychiatric social worker in acute emergencies for forty years. I can see both sides of this and am interested in the discussion. But I will say that that there are ways to do both, but it requires an emotional effort to switch modes. "I will try to find ways to help you even when you don't want to be helped. We will try treatments that are gentle and some that may even be harsh. But I won't give up. And through it all, I won't hate you or get angry at you or say that you are wrong. Because we are both somehow out of our depth, trying to find some way home."
Easy to say.
One of the other difficulties is that it is usually a treatment team with doctors from other specialties, psych nurses, dieticians, all of whom have opinions, and anger, and sometimes are very willing to get into fights with you or the patient about things. You try to neither punish nor rescue, yet find yourself surrounded by others who want to either punish or rescue.
Once you realize the point of medical care (MAKE as MUCH MONEY as POSSIBLE); it all makes sense
"never seemed to acknowledge that some patients just could not get better"
Problem is, you don't know in advance who they are, among all the patients you see.
"compassionate witnessing."
Ah, yes, letting people die is so "compassionate."
"They would just sit at the bedside and be with somebody.'"
Without charging fees or checking insurance coverage, right? I mean, that's part of "compassion," right?
Anyway, "palliative psychiatry" sounds like backdoor euthanasia.
Here we go. Here we effing go.
Lets just let people die, like we are letting people od on fentanyl and live on the streets. Mental health care is too hard. Let's just let them die. That's where we are headed, right? We are halfway there.
Agree with rrsafety.
After I suffered a stroke last January, I tried for a while to starve myself to death. Since I was in an intensive-care ward in a hospital, however, the doctors there prevented me from doing so. They threatened to force-feed me if I persisted.
In general, it's extremely difficult to commit suicide in a hospital.
Now I am very happy to be alive. And I've lost about 35 pounds.
I got suicidally depressed for months over the Atlanta Child Murders, until a much bigger (white) friend decided he'd had enough, and physically assaulted me - I mean seriously beat me up - before depositing me in the shower with a bar of soap to clean myself up. Then he took me out to dinner and we talked about the future and how I had to be in it.
And here I am.
I once took anti-depressants until everything glowed blue. But, as a child of multiple early traumas, I've otherwise cured myself of excessive hair-pulling, nail biting, anorexia, over-eating, cigarette smoking, drug addiction, abandonment issues, a mad gag reflex, and more. Once cultism got introduced into my life, I stopped talking to Head Doctors all together, simply telling them, like most people into yoga and meditation, they're not qualified to help me - at all.
I don't need anyone to talk to. Other's "beliefs" are too disturbing. Just listen to/buy my music when I make it and I'm cool. That's all I need to be fine.
I’m sure professional “ethicists” will find a way to justify one more way for health care providers to kill their patients “ethically.” The fact that it will save money will be ignored as just a coincidence. Coming to a health care system near you - if it hasn’t covertly already arrived.
Medical Marijuana Munchies might be a solution.
A lot of comments here along the lines of "Just do something!" Which isn't a great help in real life.
I have no strong opinion, just empathy for all involved.
We've gotten away from acknowledging any benefits from forced institutionalization, but we are also living the reality of having these types of cases out and about in society, and that's not good for anybody. We need to change our views on how society intervenes with those who are clearly not in control.
I'm not saying that this is the proper route for anorectics, but with this illness, I would have to believe that passivity as a treatment is a poor choice, and taking the approach of interested compassion in the individual is probably a lot more constructive. There has to be a desire to see someone heal. I've known a couple of women with eating disorders, and for them, it was a phase they were able to pass through and go on to find happiness.
"I’m surprised anorexia is still considered mental illness. It sounds like body shaming…"
It is a mental illness, not just "considered" so.
Canada decided to skip that step and just assist with the suicide for a faster death, which honestly seems more ethical if you believe it is ethical to just let them die anyway. I’m on the fence when it comes to some mental illnesses, but I wouldn’t put anorexia in that category. Mostly, there are so many other issues yet this is one I lack much knowledge. However, I find it interesting that is unethical to have mental health wards as we did in the past (and yeah they were problematic), but fair enough to just kill the mentally ill.
If only one could predict which patients can be helped and those for which help will fail.
We have gone from “life is sacred” to “life is all there is” to “since life has no meaning, what difference does it make?”
I don't know. A lot of crazy people, I can understand where they are coming from. I could see myself becoming a paranoid (I know what you're thinking!). Or profoundly depressed. I don't get anorexia. How does that work? Are you, like, hungry, but you are repelled by the thought of eating? Or, you're not hungry, so you don't eat? You are starving, but by a supreme exercise of will, you resist the overpowering temptation to eat the food they bring you, so as to remain true to your principles? I don't get it. Do you?
Is it the case that people with anorexia want to die? Is that their desired endgame? I thought it was some hypothetical and unrealizable perfect body, but that it may end in death because of their process for trying to achieve it.
Is the quoted doctor saying that some of his patients wanted to die because of his attempts to treat them? Isn't that a different matter from the terminal patient who will definitely die no matter what the treatment team does, who wants her life to end on her own terms?
I hate the idea of assisted suicide (and even more the Canadian idea of "assisted death"), but I do find it understandable on the patient's side in certain cases. This - like the Canadian mental illness => "let's just kill you and be done with it" approach - does rather smack of gilbar's assertion. And rehajm, I think you're wrong that a truly "soulless administrator" would disallow a "treatment plan" that would lead to relatively quick death, as long as the patient signed the appropriate waivers.
On either side of this fence you gotta want to.
You have to believe you deserve "better".
NYT writes, "But is a palliative approach to mental illness really ethical?"
Yes, especially in the case of so-called eating disorders. Across the face of the globe and the span of history, there have been eating disorders, mainly the one called famine. But nowhere except North America and a few benighted spots in Europe, e.g. Amsterdam and Milan, do humans, overwhelmingly female and financially comfortable, deliberately starve themselves. They hate being helped, so let them be. Other insanities often endanger third parties, but the crazy living skeleton next door threatens only herself.
The progressives used to blame Barbie, which was simplemindedly plausible as the toy's first appearance roughly corresponds to the childhoods of the first starvation hobbyists. (I almost wrote anorexia victims. But they're not victims, are they?) They don't hold Mattel responsible any longer. Barbie is an important weapon against the white patriarchy. There's Brain Surgeon Barbie ("Subdural hematoma!") Barrister Barbie ("I object!" Vegan briefcase not included) Mathematician Midge ("Math is hard only for Ken!") and Synecologist Stacie ("Volvox is algae!"). A Barbie for every vocation coming soon! Every Barbie is a strong, confident, empowered woman or something woman-like with a Y chromosome. How Barbie has total autonomy and yet remains oppressed by Ken's thoughtless misogyny is undefined. If Barbie devours an entire 14" Meat Lovers Supreme pizza and then pukes it into the toilet is her choice entirely, so STFU and pass the potatoes. Barbie is not an example of an unrealistic body. The fact that her feet are hardly bigger than her ears is her informed decision, and furthermore, Trump must be destroyed.
American "eating disorders" have only gotten worse. Previously, these lifestyle choices focused on thinness, now gross obesity is progressive-approved. I see them every time I visit the supermarket. Sometimes I take pity. You're destroying your pancreas, lady, say I, then I duck when the rollie-pollie swings her Twinkie-laden purse at my noggin.
"These patients are very sick and deserve support and not acquiescence."
If rrsafety, believes these women deserve support, then he/she/it can bloody well pay for their unwanted psychiatric care and leave others' wallets unassailed.
"I don't get anorexia. How does that work?"
You are terrified, or stressed, or any other psychological complaint, but you blame it on the food. If you only stop eating this troublesome food, you'll feel better. Of course, the less you eat, the worse you feel, but you can't see the connection. It's the food's fault.
"I thought it was some hypothetical and unrealizable perfect body, but that it may end in death because of their process for trying to achieve it."
The body perfection is only a tangent. Mostly it's about restricting food to stop mental pain. If you can get to the point where you see your actual body and how skinny it is, you'll begin to heal.
"Then he took me out to dinner and we talked about the future and how I had to be in it."
Welcome to Now, Crack. Hang around for Tomorrow, please.
That said, I don't see the relevance of your short-term depression to the long-term phenomenon of otherwise prosperous women who choose to eat far too little or far too much.
"If you only stop eating this troublesome food, you'll feel better."
That's crazy!
Robert Cook:
"I’m surprised anorexia is still considered mental illness. It sounds like body shaming…"
It is a mental illness, not just "considered" so.
Did you pretend to not understand the comment was sarc? True, it wasn't self-flagged as such, but...
Robert Cook writes, "It is a mental illness, not just 'considered' so."
Trust Robert Cook to never pay due attention. The Diagnostic and Statistical Manual of Mental Disorders has been revised many times. What IS today may well be IS NOT tomorrow.
How is this any different than treating those who identify as Trans? Anorexics seek treatment to affirm their identity. Who is this or any other doctor to question their identity or try to "repair" them? But perhaps the Ally ratchet turns in only one direction. Anorexics may need their own flag to get the respect they deserve.
Kate writes, "Of course, the less you eat, the worse you feel, but you can't see the connection. It's the food's fault."
So it's no more complicated than simple, garden-variety stupidity, is that what you're implying? Plausible. Anorexia is notoriously resistant to treatment, a characteristic it obviously shares with fatuity.
If only absurdity could be treated with a soapy scrubbing and a relaxed meal with a friend.
“ If rrsafety, believes these women deserve support, then he/she/it can bloody well pay for their unwanted psychiatric care and leave others' wallets unassailed.”
If I told you how much I’ve paid out of pocket for my daughter’s care (much of it unwanted by her) you’d pass out. I will keep getting her treatment whether she wants it or not. It has been six year and she is a Sophmore at college and doing “ok” but each day is a struggle.
I had a friend (now dead) who had a daughter who died at age 33 from anorexia. The anger and anguish he and his wife felt over their daughter's death was palpable. The daughter left two young children (and a husband who was unsuitable as a parent). The friend and his wife raised the two grandchildren to maturity.
The question "Why?" haunted my friend until his death. Just as the question why? haunts this psychiatrist.
Pro-Choice ethical religion, her choice... eugenics?
"Palliative psychiatry?" Sounds a lot like, "My discipline isn't developed enough to treat this, so we'll bill people to sit in their presence." I'm sure a CNA is qualified to "compassionately witness" people die, and they probably bill at a tenth the rate.
Pride and paté... with a limited, but nutritious diet.
We have a palliative approach to mental illness now.
Mentally ill people are being celebrated and operated on, destroying their own bodies right in front of us while we cheer.
Make looney bins great again...
in the United States (where there is MONEY to be made from medical "care"), we treat and treat.
In Canada there's "free health care"; so mental illness is JUSTIFIED Grounds for Medical Assistance In Dying
THAT'S RIGHT!
In Canada, there's NO MONEY TO BE MADE off your illness.. So, they WANT you DEAD
Here's the one i think is Most Hilarious: Suicidal Thoughts are GROUNDS for Medical Assistance In Dying.
EVERY ONE in the USA, that thinks it's "bad", should go to Canada..
[note: i DIDN'T Say, move to Canada, they WON'T let You immigrate]
When you get to Canada.. TELL an authority that you're SAD AND DEPRESSED (because of, whatever)..
They will FIX YOU.. FIX YOU GOOD. It's the ONLY medical "care" you can get in Canada without a waiting list
Of course..
If you count All people in the USA dying of anorexia; and ALL people in the USA dying of morbid obesity;
you'll see that anorexia is NOT the problem america is facing.
Not saying that there Isn't anorexia.. Just saying that america has larger problems
The real unethical aspect is the literature that suggests the person providing aid exert their will over the patient’s. This was the problem that took down Tavistock. Those who went to there to be care givers were told to push patients towards transition surgery (or else they’ll die) rather than help the patient explore and understand why they think they feel as they do and how they might mistaken by the feelings. Some of those patients are now suing, but dead patients can’t sue.
Robert Cook said...
"I’m surprised anorexia is still considered mental illness. It sounds like body shaming…"
It is a mental illness, not just "considered" so.
Ok, now do having a d!ck when you think you shouldn't, or vice versa.
As AVI (whose opinion I deeply respected) pointed out, in this case "it's complicated" is a viable answer. I lean towards the idea that so long as the medical professionals are providing palliative care rather than actively participating the patient's delusions (i.e. prescribing weight loss plans) then that option should be respected.
Eating suicide like all suicides is one more way to assault friends and family. The issue is the anger demanding control of the one thing they cannot control…your death. That will teach them!!
I would say that anorexia has about 3 causes; I want to be skinny, I want to be the center of attention, and I want to die. For the first, give them ozympic and get them down 40 lbs, if they still have a problem then go to cause 2. For 2, if psychiatry has any use at all they should be able to solve that. For 3, figure out which loved one they hate and want to punish by suicide, and have that person tell them they don’t care if they live or die.
If you want to save them you might have to sedate and give them a feeding tube forever.
Anorexia is a brain disorder, a variety of obsessive-compulsive disorder. The brain is misfiring, lying to its owner ("you're actually fat") plus instilling a compulsion -- in this case, a compulsion to abstain, lest something terrible happen.
The anorexic's brain is screaming "Don't eat! Food is the enemy! Terrible things happen if you don't exert absolute control over food!"
Fighting your own malfunctioning brain is a helluva job. You don't have the ability to override what your brain tells you is right and true. Maybe if you trust an outside observer, but then again, maybe not. For some people, the brain's lies are too strong to overcome, for biological reasons. Not reasons of character or willpower.
Eating suicide like all suicides is one more way to assault friends and family. The issue is the anger demanding control of the one thing they cannot control…your death. That will teach them!!
That's not how it is. The aversion to death is our strongest instinct, wired deep into our lizard brains. Suicidal ideations happen when the brain malfunctions, sometimes through prolonged trauma, such that the aversion to death is disabled. After enduring the misery of a malfunctioning brain -- often for years -- people get to the point where they just can't take it anymore, and so they decide to end the torment.
Getting back at the living is absolutely not part of the calculation.
Old and Slow gets it:
Doctors can be very effective when the injury is specific and acute. They save many lives, but in many areas they try this and that and hope for the best. This is true in almost all cases where the problem is in the mind. Excepting neurologists,of course.
-----------------------
It is very difficult for moderns to admit how little they know, how little prediction/control we actually have. "There are treatments for that" - but they usually are not fully understood, and may not have a great level of statistical success.
Despite the fact that psychiatry is even less scientifically based than other medicine, it is even more difficult its limitations- because it has replaced both community and religion for many moderns.
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