I'm baffled by the resistance to new science in eating disorders. This month a major study came out that offers hope and immediate practical use for millions of families but is the response joy and relief? Not enough. Evidence-based treatment like the Family-Based Maudsley Approach to eating disorder care scares people.
We're talking about a disabling, life-sucking, family-destroying illness for which there has been so little good news many psychologists and psychiatrists simply refuse to treat it. Wouldn't good news be ... good news? Not a miracle, or a cure, or a one-size fits all, but just good news. We really need it.
I understand resistance to change. Ironically, that can be a symptom of the illness. Since a good proportion, perhaps the majority, of therapists who specialize in eating disorder treatment are themselves former sufferers, maybe this is a field less likely to embrace new information. Conservatism is good, too, as it discourages wild ideas and less credible approaches.
I understand skepticism, too. After all it is that very history of specious theories and self-promoting experts that threatens credibility. The field has no professional standards or codes of conduct or licensing; it is divided between specialties with no one profession holding central responsibility. When it comes to eating disorder treatment there is not one single principle or scientific fact or protocol that is agreed upon between fields or within fields.
Pessimism, well, who can be blamed for that? The illness has been wreaking havoc on helpless patients, their families and deeply caring clinicians throughout history. Recoveries are generally partial if at all, and despite a surfeit of good intentions there's no clear path to recovery. The data that exists -- data gathered by scientists, not casual observers -- is a few push-pins on a large empty map. So it frustrates me when someone does put a data point on that map and the response is largely a defense of the parts we don't know. Somehow the empty parts of the map are more important, more valuable, more threatened by any change at all.
I would not want to live in or participate in a system that only allowed for the little we clearly know about eating disorders. That would be a thin gruel indeed. But when we do get information we need to give it more attention and let it be a starting point. The nihilism of "it won't work for everyone" or "it wouldn't have worked for me" is disheartening and seems to hold the field to a different standard than would be expected in cancer or infection.
Part of this fear of evidence-based practice is, I really believe, a lack of grounding in science. Many people are uncomfortable and uninformed about genetics, for example. The science of metabolism and nutrition are complex and rapidly changing. Psychiatry as a whole is undergoing a shift to more empirical and rigorous practice but faces resistance from within. Physicians cede case management to therapists, and therapists end up managing cases that require far more expertise than their training provides.
Another scary aspect is letting go of ideas that work for many people. If food is medicine, for example, how about individual will? If the illness is brain-based then what role does environment play? If the illness is not based on external events then will patients get help for their real problems? These are good questions, but they need to be faced, not avoided.
Defending what currently exists in treatment as better than what has actually been studied isn't science. It isn't intellectual rigor or "fairness." There is no reason to balance sense with nonsense just because so much of the latter is available. It is painful to reexamine cherished ideas and it is difficult to accept when good intentions have led to harm. New is not always better, surely, and with luck these new advances will soon give way to more. With the new information coming from psychology, neurology, brain imaging, metabolism and even immunology we could be on the wave of a truly optimistic era of better treatment and better outcomes. That is everyone's goal, and it will take a balance of innovation and caution -- not just caution.
Lives are at stake here. If there are improvements to be found and those offer a challenge to the status quo, that is a fair price to pay. Let's set aside opinion-based practice and embrace evidence-based treatment where it exists.