Compulsory Treatment for Anorexia Nervosa: Compassion or Coercion?

Abstract

Compulsory treatment for anorexia nervosa was recently once again a topic for discussion following the case of J, a 16-year-old girl who unsuccessfully applied to the Court of Appeal to refuse treatment for her anorexia nervosa. In this instance legal opinion was sought in order to clarify the Children Act 1989. However, much of the media coverage focused on the controversy surrounding the compulsory treatment of anorexia nervosa, under the provisions of the Mental Health Act 1983. There is a lack of research into the compulsory treatment of anorexia nervosa, so debate has to be informed by clinical experience.

Pros and cons of using the mental health act for severe eating Disorders in Adolescents

“…As with other Western countries, in England and Wales the compulsory treatment of severe eating disorders is considered controversial (Draper, 2000(Draper, , 2003Dyer, 1997;Edwards, 1993;Giordano, 2003;Melamed, Mester, Margolin, & Kalian, 2003;Mitrany & Melamed, 2005;Newton, Patel, Shah, & Sturmey, 2005;Russell, 2001;Tiller, Schmidt, & Treasure, 1993;Webster, Schmidt, & Treasure, 2003). Motivation to change is seen as an essential requirement for successful treatment and for this reason, there are only a few centres that are prepared to treat patients against their will.…”

Ethical dilemmas in treating clients with eating disorders: A review and application of an integrative ethical decision‐making model

“…Even without the expressed intention to die, actions such as continued food and water refusal or extreme laxative, emetic, and diuretic abuse can result in death in more chronic and severe cases. Yet Tiller et al (1993) maintain that arriving at the conclusion that severe, self-imposed weight loss and/or severe electrolyte imbalance placing the client at risk for death consequently means that the client wants to die is flawed logic; rather these are psychiatric symptoms of the eating disorders.…”

“…Conversely, mental health professionals arguing against involuntary treatment recognize that while involuntary treatment prolongs life, in the long term it may actually be more destructive and counterproductive for the client's autonomy to be usurped, leaving her feeling out of control and desperate to resort to more drastic measures to return to her former weight upon discharge from the hospital (Dresser, 1984a;Dresser & Boisaubin, 1986;Tiller, Schmidt, & Treasure, 1993). Furthermore, those opposed to involuntary treatment argue that such treatment is not curative and indicative of longer chronicity and an increased risk of suicide (Birmingham et al, 2005).…”

'@ the doctor's office': Pro-anorexia and the medical gaze

“…While many examples illustrate that medical practice is beginning to acknowledge the needs and concerns of the individual in its treatment of disordered eating (e.g. Andersen, Bowers and Evans 1997;Draper 1998;Fairburn, Marcus and Wilson 1993;Goldner 1989;Tiller, Schmidt and Treasure 1993;Vandereycken and Beumont 1998), the long historical trajectory of the medical pathologization and abjection of women continues with the psychiatrized construction of anorexia as a distinctly 'feminized' disease. The clinical exchange, in which diagnosis occurs, both harnesses and expands the power-laden knowledges infiltrating feminized identities -in particular, the hegemonic constitution of the thin feminized aesthetic through hierarchies of ethnoracialization, western affluence, heteronormativity and youth.…”