Wanting to Help Is Not the Same As Actually Helping
I would’ve died in anorexia treatment if I was seen by today’s ‘compassionate’ therapists.
“I’m going to show you a trick. If you try to point to something outside and start a conversation with Ms. Nora and the guards, you can flip the packet of butter over before actually using any of it on your food. They won’t even notice as long as you leave it facing down on your tray.”
The advice given to me above was from a patient that, in retrospect, must have been quite a few years older than me; because she had signed herself in and out, she was at least of legal adult age. Known as the Eating Disorder (ED) Wing Bully, Emily was Beth Dutton reincarnate. I despise Beth Dutton from popular TV Series Yellowstone: not only is her pompous savagery a direct manifestation of insecurity, it’s perceived as an admirable personality by which young women should aspire to. Emily was the early 2000’s version of Beth, although perhaps less obvious in her mood swings. Most all victims of Emily’s were met with an eyeroll, a scorn, and an unnecessarily condescending comment, and group therapy sessions tended to focus solely on her myopic perception of how society functioned. In retrospect, I’m thankful that there were exactly zero conversations about the patriarchy, oppression, White men, or gender. We were a mentally ill group of women wrestling with one of the most lethal psychiatric diagnoses a person can develop, which put us in a unique, albeit unfortunate position, to understand true pain.
Emily was a customary bitch. She made the first 4 weeks of treatment miserable before she signed herself out, by use of abrupt interruptions to focus on herself, disrespectful slurs aimed at immigrant staff, and her general delusion of perceived importance. Emily’s entire aura appeared to be inspired by the DSM diagnosis for Narcissistic Personality Disorder. To be completely honest, she reminded me of many of today’s young therapists; a vicious proclivity for reprisal but at the same time quite weak. At 15 years old, I was terrified, not of Emily’s cattiness but of letting go of the disorder I’d conditioned myself to protect with a Gollum-like determination. Even as a teenager, I felt much more comfortable in the presence of men with impossibly high standards in athletic environments. Being forced into a whining knitting circle of competitive mental illness, then, was a personal brand of misery.
But it was far more than a petulant knitting circle. I would have given most anything to be surrounded by petulant tweenagers instead of the group of women I was with in treatment. Before my feminist readers grow worried: it had nothing to do with their character or their demeanor; it was the fact that young women infected with a cluster of psychiatric symptoms, all placed together for 8 hours a day, every single day, was bound to result in warfare. In my clinical opinion, one of the worst things you can do for a girl with anorexia is shove her into a group of 20 other women suffering from the same issue. Because I’ve written about rumination endlessly, I’ll only offer a quick recap as it relates to the dynamics of group therapy: rehashing negativity, only to be validated by other equally miserable people, is guaranteed to make an individual feel worse.
Meal times in the hospital where treatment took place were organized with militant precision. Every meal, which we were forced to eat (yes, forced--- I’ll get to this later), was under close surveillance by our team of psychologists as well as ED Wing ‘Guards’. Guards sat on either side of every patient to ensure they weren’t spitting out food into a napkin while pretending to cough or sneeze, “accidentally” dropping food on to the floor as a desperate attempt to not eat it, or dropping crumbs of food down our sleeves to later shake into the toilet we weren’t allowed to flush because of the bulimics. I hated every moment of it. Every moment of therapy, which started at 8:00 AM and ended at 5:00 PM, was hell. It’s difficult to explain how defeated you become when you’re forced to face your every neurotic judgment with such rigor.
Abigail Shrier, in her new book Bad Therapy, begins her first chapter with a concept called “iatrogenesis”. Iatrogenesis in Greek means “originating from the healer” and is, according to Google, “the unintentional causation of disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence.” We’ve heard of surgeons accidentally leaving a scalpel inside of a patient’s large intestine and proceeding to sew their skin shut. We sat aghast after watching ‘Dr. Death’, a show based on a real surgeon who maimed the intricate spinal cavities of his patients while under the influence of cocaine and sadistic thirst. And we’ve undoubtedly noted the clinicians who amputate the wrong limb or completely misdiagnose a fatal disease as a generic cold. But we rarely discuss iatrogenesis in therapeutic fields, as it’s a problem that goes largely unseen because of its gradual and relatively invisible effects.
Iatrogenesis in therapy may look like gender-affirming care or feverish passion for happy moods at all cost. While the initial moment may present as being useful, as it heeds to the ego of the patient and therefore makes them “happy”, it results in a wide array of emotional problems as they develop. The child that is coddled by a mother who refuses to place any form of a boundary becomes the teenager who punches a teacher in the face for not allowing him to play Xbox during a calculus test. A young adult whose university allows her to take part in firing a professor will mature into a clinician who humiliates her patients and attempts to poorly “educate” any practitioner who does not share her diluted worldview. When we coddle, we handicap. And if the outgrowth of this isn’t evident in the entirely unhinged and emotionally unstable clinicians who advocate for an 11-year-old removing healthy breast tissue, I’m unsure what is.
Any and all interventions, whether that be simple reinforcement or a complex course of psychoanalysis, carry risk. I’ve heard several practitioners make comments such as, “literally nothing can happen if we’re all more aware of trauma through trauma-informed care”, or “there are no side effects of compassion.” Both are clearly untrue. We’ve become a bit lazy in our thinking, appearing to believe that only the “bad” or “abusive” practices of clinicians are those which carry imminent risk or any possibility or harm. The positivity or negativity of the outcome should have nothing to do with the fact that the intervention itself always has side effects. Side effects are guaranteed collateral, regardless of whether those turn out to be beneficial or injurious. When researchers study placebo effects and give their research participants a sugar pill, for example, they are exposing these people to chance. Dr. Camilo Ortiz, a psychologist who recognizes this peril, developed a portion of his consent forms to address what’s largely undiscussed: “Because I likely will be asking you to undertake difficult tasks, such as thinking about uncomfortable memories, it is common to feel distressed during and after therapy sessions. Research also suggests that a small percentage of psychotherapy clients experience a worsening of symptoms. Therefore, there are real risks in undertaking psychotherapy. We will monitor your progress closely and discuss any lack of progress or worsening of symptoms.”
Today’s therapists, likely with minimal awareness and with good intentions, are without question imposing varying degrees of emotional harm on their clients, through obsessive and toxic compassion, externalization of personal responsibility, and adoption of politically correct “treatment”. As has been stated by so many female practitioners in slightly various ways, “I’m going to be so much better than her last therapist, because I care.” Caring is noble, but caring is not synonymous with helping.
You see, wanting to help is not the same as actually helping. Appearing to care or appearing to be compassionate are not the same as being of service. My therapists in treatment for anorexia, while they did occasionally exude warmth, were largely unconcerned with our irrational tantrums. Their job was not to indulge or validate our feelings as well as keep us “relaxed” or “engaged”, as affirming an anorexic’s delusional concept of justified starvation would inevitably kill her. Their honorable duty was to help us tolerate the agonizing discomfort of eating, to challenge our irrational beliefs around rigid food rules, and slowly transition us into using these skills in the real world in a therapist’s absence. The bluntness and stick-to-itiveness required to succeed as a clinician, in this regard, would never have survived much of today’s therapeutic mantras; I’m confident we all would have been dead had we been treated by today’s young, “compassionate” clinicians with their bullshit jargon and perverse fixation on “connection over compliance” or “avoidance of harm”.
When we were caught hiding food or engaging in some sort of sleight of hand to avoid eating it, we were accosted in front of the entire group. This, of course, violently triggered the patients who were actually making efforts to overcome their eating disorder. Dramatic bouts of wailing and yelling would then ensue, until eventually the food magician was taken into a separate room by guards and threatened with a forced choice: eat the food by chewing and swallowing, or submit to having it fed through a tube. Many girls who had completely submitted to their anorexia preferred the tube, as it still allowed them to profess allegiance to their eating disorder by not technically ingesting food by mouth. Eating disorders are funny like that; they ruin your life but make you dependent on them, empty without them, at the same time.
My first day of residential treatment was met with forced merriment by staff and a meek welcome from gaunt, starving patients. All but one patient was female, ranging in age from 9 years old to 54 years old; each patient was at different points in their recovery from anorexia or bulimia, with many of the patients being self-identified “frequent fliers”. Frequent fliers were those who had “worked the program” anywhere from 2 to 5+ times, liberating themselves from its locked double doors only to find themselves back behind them after realizing their compulsions couldn’t be tamed in the real world. This is unfortunate but unsurprising; with anorexia being unbelievably hard to treat, many women find themselves in chronically transient states of intensive treatment, one on one therapy, or competitive group circles aimed at “healing”. I’m thankful I was not one--- and I believe it was due in large part to the tenacity and protective factors my family helped to instill.
Protective factors are “characteristics at the biological, psychological, family, or community level that are associated with a lower likelihood of problem outcomes, or that reduce the negative impact of risk factor on problem outcomes.” In plain language, they’re buffers against the development of mental illness or psychiatric symptoms. One of the prime factors, specifically for young girls, is authoritative, respectful parenting. Parents who demonstrate resilience through their ability to cope with the stresses of everyday life are imperative should young, mentally unstable tweenagers stand a chance to do the same. My parents, who I’ve written about endlessly, were “late bloomers” in parenting: they had me when they were 41. While I don’t believe their age is the only factor in their perseverance which I so admire, I do believe I had an edge on the others born to parents in their late 20’s. We didn’t eat together at the dining room table, nor did we attend church as a loving clan only to later discuss the integration of religion into our psyche. But my parents were disciplinary, no-bullshit, reliable people; there was no question about the wrath my brother and I were in for after we’d been caught being idiots. I don’t respect and adore my parents because they were “compassionate” and gave us “tons of choice”. I respect and adore them because they loved us fiercely enough to stick to their guns when it felt impossible to do so. They didn’t lower the standard or even their emotional threshold when I was in treatment for anorexia or when my brother was in rehab for heroin. In the parallel universe where I’d ever become a parent, my Mom and Dad are people I would aspire to be.
This is what’s so sorely misguided with so much of today’s therapy. We find it more important to appear nice, gentle, and loving than to actually instill any valuable lesson about how to treat other people. We eagerly place stupid bumper stickers reading “Connection over Compliance” or “Happy, Relaxed, Engaged” on our MacBooks and iPads, as doing so is the laziest and fastest means by which to earn respect in a largely liberal, white, female field hellbent on playing God to a child’s nonexistent psychiatric fever. Quite frankly, I think it’s repugnant. My disgust may be different if these women continuously plugged these ideals yet went on to provide legitimate therapy; in that regard, live and let live. But this isn’t what’s occurring. Not only are mostly-female therapists more concerned with their digital reputation as Stand-In Permissive Mommy, they’re treating clients as fragile beings incapable of tolerating even a moment of discomfort or adversity. We seem to forget that our childhoods were rife with name-calling, wrestling, roughhousing on the ABC mat for morning circle, and sometimes diabolical bullying. We’ve also drawn a blank as it relates to life’s most important and sometimes life-saving interventions being those that, in the moment, are inescapably painful. Therapy isn’t in place to ensure the burden falls on everybody else to accept us and our unique problems. The purpose of therapy is to teach us how to accept ourselves so we’re not so reliant on validation from other people.
Agencies that have, whether intentionally or passively, adopted such policies as “gentle therapy” or “DEI-focused outreach” should be ashamed of themselves. Truly. An educated individual who is expected to understand child and adult development, and develop treatment that assists their clients in learning more adaptive skills and bettering their lives, cannot truly believe that teaching victimhood is useful. Any sane person, therapist or not, recognizes that coddling ends horribly, and that babying or spoiling children transforms them into adults who become activists and are hellbent on blaming the world around them for their misery. I haven’t spoken to any of my treatment team from the hospital since I was discharged, and I occasionally wonder if they’re still offering services or if they’re retired. More often, though, I wonder how they’d respond to today’s budding clinicians. They’d probably be fired by cowardly administrators too afraid to admit that therapy is inherently hard.
“We can do hard things” has to be an adage that we put into practice versus print in a curly font for a classroom poster or Instagram post. It’s sad that it’s a platitude more than it is a golden rule. Put the goddamn spoons away and recognize that you are the only person who can change your life for the better. Behavior analysts, specifically, like to believe they can change behavior in other people. This is a hopeful delusion.
My teen is in weekly arfid therapy and he HAS to eat the food he's working on. A lot of parents that have bought into the social media therapy and these so called "arfid dieticians" that aren't using evidence based treatments, think it's awful to be in this kind of therapy. I did so, once upon a time, when my son was very little. But he's a growing teen now. He has to have variety to grow and he has to understand that not everyone is going to cater to his sensitivities. He is recommended for day treatment summer program where they do 5 scheduled meals, but we don't have respite care to do it. ❣️