Thoughts on Maudsley

La Comtesse Marzie sent me this link to a Miami Herald article on Maudsley treatment with the following commentary:  "Kinda scary.  It has the potential to be so abusive and coercive, no?"

The above article calls Maudsley little-known, but I'm at least a little familiar with it, by way of Harriet Brown.  I just don't know if it would work long-term in any but young cases, and while this piece states that later on, along with paying lip service to the idea that some parents really do contribute to EDs, this Miami Herald article kind of gets my ears steaming.  The problem isn't so much Maudsley as it is the article reading more like a press release than a piece of journalism. 

For instance:  the focus on refeeding and weight restoration is a cornerstone of all anorexia treatment, so this article does traditional therapies a disservice by suggesting this initial focus is unique to Maudsley - and outright stating that refeeding is ignored in "traditional therapy," in place of blaming parents for the disorder.  It is accepted medical fact that emotional and psychological repair can't occur in a state of starvation, and anyone who knows anything about ED treatment know that "traditional" therapy is a more intelligent construct than to ever suggest something as simple as, "the parents did it, the end."

Another fallacy the Miami Herald article blithely tosses in: "traditional anorexia therapy often excludes parents from treatment."  No!  No, no, no!  Not unless you redefine the word "often."  Not often!  NOT often!  Family therapy is an integral part of the best-known and more traditional U.S. treatment centers.  Renfrew, Remuda Ranch, Cornell - they all employ family therapy for many patients, as do dozens of smaller centers whose approach is based on those big three.   

Finally, later in the piece, the Miami Herald writer notes that Maudsley has its highest success rate with younger patients whose anorexia has been of relatively short duration.  There's about a two-paragraph concession to journalistic footwork toward the end of the article, with one quotation from a patient whose relationship with her parents was damaged by Maudsley and who didn't feel treated "as a whole person."  Then the piece moves back to Maudsley worship.

Again, I'm not convinced that the problem is Maudsley itself.  (However, it's hard to imagine - from an older patient's perspective - a treatment course in which refeeding is literally not explained or discussed while it's going on, at the hands of professionals, much less parents.) 

In a perfect world, the basic steps make sense.  But most families that produce eating disordered children are not perfect little worlds.  (Is any family, even one with perfectly adjusted children??)  In more dogmatic and controlling families, especially, the warped sense of self that is at the root of so many eating disorders is NOT going to be repaired while the child is immersed in only the environment that produced the warped sense.  Similarly, if a child has learned eating disordered behaviors from a parent (as children so often do, whether or not the parents will acknowledge it), then the parents had damn well better have training about and insight into their own behaviors and how to modify them.

The success rate of Maudsley for younger patients is impressive, especially at five-year follow-ups.  If that statistic reflects reality, it's great.   But you'd have to be one seriously open-minded parent with a penchant for being brutally honest with yourself about yourself to execute Maudsley in an emotionally responsible manner.