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Monday 12 August 2013

Sheppard Pratt - or the leopard not changing its spots

I blogged over a year ago about the inhumane punishment regime at Sheppard Pratt, with regard to a 13 year old girl.  There was some serious back-channel chatter and I was assured that things were going to change, via a friend of a friend.

Well, they do have a shiny new website, with all sorts of film-flammery on it and they do pretend to pay lip service to FBT, but it seems that what they advertise and the actuality of treatment for a 12 year old girl are miles apart.  Their treatment protocols seem to emphasise Family Therapy and their thinly veiled "blame the parents" approach sickens me.  I was actually scared to read their "Three main goals of Inpatient Treatment"

"The three main goals of inpatient treatment include:

  1. Medical Stabilization
  2. Normalization of nutrition and symptom blockade
  3. Developing an understanding of the role of the eating disorder"

WTF is a symptom blockade?  Why do you need to understand the role of an eating disorder?  Where is weight gain?

Symptom Blockade

We are talking about a treatment modality for a somatoform disorder.  In plain English, these are seemingly neurological disorders that have their roots in trauma. People who develop sudden neuroplesias [paralysis of a limb or limbs, loss of sight, that kind of thing] due to some overwhelming emotional event.  An Eating Disorder is NOT a somatoform disorder.  

Understanding the Role of an Eating Disorder

I have googled pretty hard and read a lot of stuff but am unable to find another psychiatric disorder where an understanding of the role of, say, schizophrenia is an important (Top 3) priority for treating psychiatric patients who are sick enough to need to be hospitalised.  Why would SP think that "understanding the role" - whatever that particular psychobabble actually means - would help a patient?  I am all ears for any sort of justification of this.

Weight Gain

There are all sorts of "punishments" metered out for not putting on weight every single day.  Please note, SP, if a patient is not putting on weight, it is NOT their fault.  It is yours.  You have got your treatment wrong.  Also, putting on weight every day is pretty much a physical impossibility, especially in early re-feeding when the body metabolism changes and a patient usually loses weight.  Weight gain should be a "Top 3" goal.  Putting on weight - something on which you place great emphasis in your little rule book - seems to have no role AT ALL in your main goals of inpatient treatment.  Why not?   

Shame on you, Sheppard Pratt.  How dare you curtail a 12 year old girl's visit from her parents as a punishment for not finishing her meal?  Parents are not a "treat" to be earned when desperately sick in hospital.  They are not considered visitors.

There is a lot of "sop" to parents and new ideas about treatment on the website but, in practice, it seems that SP is still punishing innocent children by withdrawing visits by parents.  I only hope they are not doing the disgusting "If you do not gain weight for three consecutive days, you may take a shower on the third day." thing - that is against Human Rights Act.

Just to be clear where F.E.A.S.T.  stands on all this, along with B-eat, Joy Jacobs, Dr O'Toole, Kitty Westin:

F.E.A.S.T. Protests Continued Use of “Parentectomy” In Eating Disorder Treatment

WARRENTON, Virginia( January 21, 2009) - Families Empowered and Supporting Treatment of Eating Disorders 

F.E.A.S.T. calls on all clinicians treating eating disorder patients to end the routine practice of restricting families from contact with loved ones during hospitalization. Parents were once routinely blamed for causing or failing to prevent eating disorders in their children, and treatment consistently involved removing the patient from the family’s influence, sometimes called “parentectomy.” Although modern science indicates anorexia and bulimia are treatable brain-based disorders, “The legacy of blaming parents and patients for eating disorders lives on in the continued practice of limiting parent access to their children during hospitalization,” says Laura Collins, FEAST’s Director.

Parents of eating disorder patients need and deserve clinical support in understanding and responding to this grave illness. Supporting the family as a whole is one part of supporting the patient’s long-term health.

FEAST calls on all professionals treating eating disorder patients to:
 Allow the same family and caregiver access to patients as appropriate with any other medical illness
 Learn about recent advances in treatment that emphasize family involvement
 Set aside outdated prejudices about “over-involved” and “enmeshed” parents
 Include parents and other caregivers as an integral part of the treatment team
 Communicate with the family in the same way as with any other medical illness

From the experts:
o “There are very few circumstances in pediatrics under which a parent should be restricted from contact with their own child regardless of the diagnosis… Parents are an essential part of the team, without which there really can be no healing.” (Dr. Julie O’Toole, Kartini Clinic, US)
o “Parents should be part of the treatment team. They should be valued and respected and given the knowledge they need to help make important decisions regarding the care and health of their child.”
(Kitty Westin, Anna Westin Foundation, US)
o “Parents are part of the solution, not the problem. If progress made in the hospital is to be maintained post-discharge, parents must be involved from day one.” (Joy Jacobs, JD, PhD, Healthy Bites, US)
o Parents feel overwhelmed and disempowered by the way the condition takes over their lives, and this gets compounded and entangled by the way they are sometimes excluded by professionals and clinicians.
Professionals and clinicians are challenged by treating this condition, and some still hold outdated and mistaken views about how parents cause the problem. (Susan Ringwood, beat, UK)
o “I think parents' guilt is significantly amplified when professionals push them to the side. There's an implicit message that they have, in fact, contributed to their child's illness.” (member of FEAST’s Parent Council)

Laura Collins, Director

Last, but not least, digging a little deeper into SP has provided some interesting tidbits, for those of you who are thinking of sending an adult there.  They are advertising for workers - not licensed mental health workers or  physicians assistants, please note, just anyone - to work under an RN to "participate in the planning and evaluation of patient needs based on patient behaviors".  Really?  Really?  You are employing unqualified staff, at the most basic level of pay, to care for "the short term crisis stabilization of adults experiencing acute symptoms from major psychiatric disorders".  Is this even legal?

If I were an insurance company, I would be looking pretty hard at this facility and wondering about its care standards. its staffing and its treatment modalities.  It is time to stand up to this sort of inhumane and cruel regime of care for ALL eating disorder patients but especially to stand up for the young children who are, in my opinion, being abused and punished for having a brain disorder that they don't understand on any level.  Bullying parents and patients is NOT acceptable.  Ever.

Last, but not least, aside from the shiny new website, perhaps their complete lack of knowledge about eating disorders, especially in children, is highlighted by this particular gem - sigh!


Anorexia Nervosa

        A refusal to eat a balanced diet resulting in a loss of at least 25 percent of body weight is indicative of a mental illness, especially if there is no known physical illness accounting for the inability to maintain a normal weight for height and age. The disorder most often strikes teenage girls who have low self-esteem and an irrational belief that they are fat, regardless of how thin they become. Without treatment, the self-induced starvation can lead to death.

Where to begin?  Well, boys and men with eating disorders face quite enough stigma as it is.  "The irrational belief that they are fat" is a SYMPTOM of the disorder, not the cause of it.  The starvation is not "self-induced" - that would make it a CHOICE by the patient.  Anorexia Nervosa is not a choice.  It is a psychiatric disorder. 

I am amazed, in this day and age, at such ignorance, banality and sweeping generalisation by a facility that claims on its shiny new bs website

"It is important to understand that eating disorders are mental illnesses, and they are not simply a lifestyle choice. "

They are NEVER a lifestyle choice, SP.


  1. Whew, an important post, for sure! Thanks for laying it all out there, Charlotte. Makes my blood boil to read.

  2. This sounds absolutely horrible and the antithesis of what treatment should be for this illness.

  3. I especially dislike this:

    1. Lol. Thought you might really enjoy this Cathy. Not!

  4. Unfortunately SP aren't the only people by far with such an unprofessional and indeed dangerous level of ignorance about eating disorders and how to treat them, while purporting to be 'experts' at it - it's sadly too common. As someone who has experienced this sort of treatment (In a different facility and country) I can tell you it causes far more harm than it helps - I strongly believe I have been sicker for longer as a direct result of this kind of treatment.
    And just WTF at the inpatient treatment goals. Firstly, medical stabilisation without weight restoration and normalisation of eating isn't going to happen. Neither is it likely that a high level of insight will occur - I've never met a starvation victim who was stable in body or mind and I doubt we ever will. I have to add, I'm not saying that when someone is at a normal weight they are healthy either, that's why I said 'normalised eating' too. Starving at a normal weight or high weight is also still starvation.
    Also I take it that by trying to 'understand' why someone got an eating disorder, they are laying the blame for it firmly at the door of the sufferer and probably other people in their lives, as a choice in response to something external to themselves rather than being an actual mental illness ie. internal - biologically based, not a choice.
    It's disgusting that treatment programs still exist in 2013 that are so outdated and ignorant and downright cruel.

    1. I just wish I could call the, all out. I got documented proof of this one. Attitudes must change. Naming and shaming seems one way forward

  5. One of the biggest dangers of a 'privatised' system. What is the regulatory structure for psychiatry?
    It turns my blood cold to hear that this goes on in the here and now.

  6. My young D had the unfortunate experience of being "treated" at SP over a decade ago. I still shudder at their parentectomy approach - looking at parent dysfunction as causes and the sufferer's choice.

    They incorrectly set her target weight range far too low and discharged her when she was still very ill and no real transition or aftercare plans.

    We were so traumatized by this place, that we never would seek another IP program again. I did everything in my power to help my D recover and sought out many outpatient clinicians.

    It was only when we found FBT for my D at age 22 that we were included as part of the solution (to help get my D accurately weight restored), that my D had any chance at recovery.

    Before that she wasted years of time and money with therapies that she could not benefit from because her brain was still malnourished and cognition was affected. Her ED thoughts/behaviors became more entrenched because we were not provided the support to give her what she needed - full nourishment and accurate weight restoration.

    I think if anyone can write a letter to Dr Insel and National Institutes of Health - this would be helpful. He was very wise and clear to all parents that this is a complex illness and family based treatment is the treatment of choice - especially for a 13 year old.

  7. the website claims that they have staff trained in FBT. I wonder how they square that training with this kind of practice

  8. very powerful piece Charlotte, I agree 100% and thank you for writing this...

  9. I am unable to comprehend how they are able to continue to purport the use of, for example, FBT/Maudsley and blatantly, in reality, ignore this treatment approach? Sounds like a 'bait and switch' tactic which, if I am not mistaken, is an illegal form of promotion/selling in the US?

    I agree, issues of this nature, treatment for adolescents which exclude family involvement must be reportable to someone!

    Thank you Charlotte for raising this again and how shameful that a year on it is still an issue with this treatment provider! Shame on them.

  10. It's appalling that for-profit residential treatment centers can exhibit such a profound misunderstanding of eating disorders!

    Here's to a new age of science and enlightenment...