Watching the Super Bowl last Sunday afternoon, one commercial really got to me. The "Dove Self-Esteem Fund" spot, featured girls and women revealing their insecurities of their bodies. I was happy to see this Public Service Announcement. I liked the attempt to spur the nation into thinking about these sorts of issues, issues related to the problems I see in my office everyday. Then, in the next few days, I saw that Dr. Frist made the headlines with his questionably ethical relationship with pharmaceutical companies. So, I wanted to share with you all some thoughts I have about Dr. Frist and his oath to "do no harm" as a physician. I thought that with the passage of time, my strong feelings about the tragic case of Terri Schavio would begin to fade... That my concern about the actions of people like Senator Bill Frist, MD would lessen, as well. I know this particular issue is not on our radar right now but... it saddens me that Senator Frist has been at the forefront of public health issues and has failed. For example, he failed to highlight one of the most important messages that Terri Schiavo's life could have given us: Capitol Hill needs to hear and heed the desperate cries of eating disordered young women and their families.
I am a physician, a psychiatrist/psychoanalyst, and treat young women and teenage girls with eating disorders on a daily basis both in my office and at a residential treatment facility. And I hear their cries and whispers loud and clear. I couldn't agree with our President more, as he is quoted in a BBC report, stating that we should "continue to work to build a culture of life where all Americans are welcomed and valued and protected, especially those who live at the mercy of others. The essence of civilization is that the strong have a duty to protect the weak." But the danger is, that we allow ourselves to discriminate and selectively chose when to show our mercy. Was Terri Schiavo's life more worthy of attention because she was in a vegetative state for years? What about all the years she spent in the throes of Bulimia?
It is heart-breaking to me that throughout the Terri Schiavo media blitz, I never heard discussed once; not by a politician, not by a news commentator, not by a treating or consulting physician, that Terri Schiavo's tragic medical dilemma could very possibly have been avoided if she had been properly diagnosed and treated for Bulimia Nervosa. It seems we, collectively as a nation, have been in denial about a very serious and key issue in this case. Unfortunately, Terri and her family may also have been in denial, thus putting her at great risk for the tragedy that took her life.
Bulimia is a psychiatric disorder that, according the American Academy of Child and Adolescent Psychiatry (www.aacap.org "facts for families"), occurs in as many as 10 out of 100 young women in the United States. A recent study in the British Medical Journal (Br J Psychiatry. 2005 Feb;186:132-5 ) reports that Bulimia tripled in incidence from 1988-1996. Bulimia is a highly complex disorder that usually indicates not only severe suffering on the part of the individual, but complicated and problematic family dynamics. From what I can garner from the coverage of Terri's young adult life, she was an undiagnosed woman, actively binging and purging at the time of her cardiac arrest. Cardiac arrest is a well-known risk for someone with an eating disorder. The risk is especially serious in Bulimia, where the problem is that the young woman either vomits too much or abuses laxatives, which then causes a precipitous loss of potassium in her blood. The low potassium is what ultimately causes the cardiac arrest, which can lead to sudden death. It seems in Terri's case, she avoided death but suffered a stroke as a consequence of the loss of blood circulation and oxygen to her brain.
I watched Terri's passing become a rallying call for those focused on a narrow and selective idea of "the right-to-life". Terri Schiavo did have a right-to-life, a right to a life with relief from mental illness. Because of this "over-sight", we continue to miss the opportunity to shed light on the enormous problem of eating disorders in this country. We miss out on the chance to highlight the overwhelming obstacles professionals face in treating this affliction.
And Dr. Frist should have been the first in line to sound this rallying call, not use Terry's life as a means to politicize an issue that further divides the country.
I challenge Senator/Doctor Bill Frist to implement congressional pressure and laws that accomplish the following:
•Regulate the restrictions insurance companies put on treatment of mental illness. There are many ethical problems facing us, as we continue to rely on insurance companies to regulate health care. A particularly onerous problem, is that insurance companies will regularly only "authorize" treatment for eating disordered young people when the disease has reached an acute state. As any psychiatrist knows, and data backs up, long term and highly consistent treatment is the only path to sustained improvement of bulimia. The only hope for cure.
•Encourage more funding for treatment and research of eating disorders. More research is needed and more access to high standard treatment is essential.
•Encourage education in our society to decrease the stigma of individuals and families seeking psychiatric treatment.
With heartfelt respect for Terri Schiavo's family, the facts are, most Bulimic individuals come from families in trouble. Often, in these families, the most powerful dynamic is one in which the young woman feels her body and mind are being intruded upon, sometimes with violence. These feelings can become so overwhelming that the young woman is compelled to "vomit out" her anger, hurt and her pain. I know this is going to rankle many people, but it's my opinion, that unfortunately for Terri Schiavo, her family seemed to be playing the part of intruders on her body until the very end. Perhaps if Terri and her family had received the proper psychiatric care in the first place, she would be here with us today. I appeal to Senator/Doctor Frist to bring to bear his understanding of the art and science of medicine on this issue. We need government policy that can truly help its eating disordered citizens realize their right-to-life.