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Monday 14 November 2011

Appeasement 1 - following the Guidelines.

My daughter is doing Appeasement, Sudetenland and the invasion of Poland in history at the moment, so there have been many discussions about appeasement.  It has become a slightly dirty word in modern parlance BUT it did give both France and Great Britain (and USSR) a chance to speed up their armament plans and prepare for war.  Without the few extra months that were granted by Chamberlain's "Peace in Our Time" piece of paper, the outcome of the war, its length and the European Union would probably have been completely different.

Against this, we must counter with the fate of the people in Germany's newly annexed states, who were given no time to leave - the Jewish population, the Romanys, the enemies of the state who opposed annexation and Hitler, who probably all lost their lives.

So was this Appeasement of Hitler justifiable?  What was the cost of lives lost in concentration camps or shot and buried in mass graves in forests?  How do we compare it to the lives saved by the few extra months of war preparation of Britain, France and other European countries?  Did the fact that Appeasement did not work for Hitler sway Franco into remain neutral?  Not questions I could begin to answer but one that should be considered, especially at this time of year around Rememberance Day.

As I am the C behind C&M, I help write films for parents and clinicians to help them understand Eating Disorders and Evidence Based Treatment.  Appeasement is a subject that comes up a lot.

Many parents (and clinicians) find it helpful to separate the patient from their eating disorder and recognise that various "out of character" actions and reactions  are not the patient's choice, but a  manifestation of their brain disorder.  A common theme is the extreme anxiety about weight.  Many patients are "obsessed" with the number on the scales.  To appease their eating disorder and relieve their anxiety (albeit temporarily), they are compelled to make the number go downwards.  For a carer, the way to save a patient's life and to help the patient's body AND brain repair, we need to make the numbers go up.  This is a sort of reverse appeasement and is almost unbearably stressful for the patient.  However, if we do not and we continue to appease the eating disorder's unreasonable demand, we risk the patient's life.

The NICE Guidelines suggest that weight gain should be between 0.5kg and 1kg per week.  The NICE Guidelines took a long time and a lot of input from some pretty clever experts.  They were not conjured out of thin air round a table in the smokey pub on Saturday evening.  They were the result of months and months of hard work from hundreds of people and as Susan Ringwood of B-eat will tell you, they were not agreed without contention and controversy.

It bewilders me to learn time and time again on the Around the Dinner Table forum, that clinicians are afraid to push this kind of weight gain, once a patient is medically stablilised and the risk of Refeeding Syndrome has passed. (7-10 days)  Surely all they are doing is appeasing the eating disorder?

1 comment:

  1. It is sad, Charlotte, that they don't know any better. In time, I hope they will learn. Whose job is it to educate them properly?