Duty Of Care

[RussH]

I tend to think of them like I do my doctor, who is the medical authority in my life. I go see them they give me recommendations of things to do to get better, and I do my best to follow their directions.

@moonbeam sorry if it seems we are changing the direction of your post, but my comments were simply to help you get a different perspective on your therapist instructing you to eat three meals a day.

 

[joeylittle]

She is worried that the Link Removed has been getting worse and I've stopped eating unless forced. Not because I forget but because I won't let myself eat though I rarely feel hungry.

She says inaction would make her an accomplice and she isn't comfortable with that. She has spoken to my GP about arranging me to see a nutritionist and wants me to eat 3 meals a day until our next meet up and says all therapy sessions going forward will start with food discussions.

I don't want to lie to her. The logical part of my brain says its a good thing and is her encouraging self care.

Actually, it's intervention. She is intervening, and being very clear about her reasons why. I've had something similar happen to me between me and my therapist, not about eating issues but about something else. I remember what you describe; part of me was relieved and part of me was completely freaked out.

I would say, let her help you. Self-loathing can manifest itself in lots of different ways, and I bet she's onto something about this being related to recently stopping self-injury.

Thinking of you.

 

[Justmehere]

Hey, btw, good work on stopping the self injury. That is huge. It shows you have it in you to find healthier ways to cope and to stop unhealthy ways of coping that are typically really hard to break.

I'm sorry things are so tough right now that you are feeling so crappy that you feel this urge and desire to not eat to punish you. Your whole self deserves nothing but kindness and compassion.

I don't have an eating disorder. At least I haven't. Its not about the food its about punishing myself.

Starving yourself to regulate emotions is actually an eating disorder, even if it is not about body image. Starvation actually biochemically induces numbness of emotions. It's putting the body into a numbed out survival state. Doing it to self punish, also an eating disorder. There are people who exercise too much to self punish, people who work too much to self punish. For you, you are using the disordered eating habit of anorexia to punish yourself and regulate emotion. Even though you are not doing it to become thin, it's still anorexia. People who are undergoing chemo and don't eat due to chemo side effects - that is called anorexia. This is a PTSD induced anorexia. You are right it is not an eating disroder like body dymorphic type of anorexia, but it is still a psychological state of anorexia. It's still a behavior done to regulate or express pain and self hate.

I've done the same thing. I was going through a really rough time with the PTSD and I just wouldn't eat. It was like another manifestation of the self injury. It almost felt good to punish myself by starvation. Self injury and all kinds of eating disorders are highly linked.

I never really thought of myself as having an eating disorder at the time, but it really was a PTSD induced eating disorder.

It is horrible road to go down, even just a little bit. Your body will become almost addicted to it. The longer you do it, the harder it will be to break.

But I so understand why you are doing it. It's like the self injury. Recovery is all about replacing it with better coping skills and working through the underlying trauma. As you do that, the urge to starve yourself will get better.

I don't know if you need full blown ED treatment or not, but I think it is a good idea to consult with a nutritionist. When I was struggling with not eating food, I did consult with a nutritionist, and it actually helped. She was very trauma informed, and didn't make a bigger deal of anything than needed, and helped me understand how to mange it. If you don't want to change this habit yet though, then that is your choice too. It is your choice to not talk about it in therapy too. Your therapist can ask all she wants, and you can decline to talk about it. She may not feel like she can move forward, and I understand her concern.

Aside from all of this, it would be really hard for me if a therapist demanded to talk about eating habits every time I came in or got help for me that I wasn't ready for. I can understand why she is doing it - to keep you alive - but still... A duty to care is not a duty to rescue. It isn't healthy when therapists get too much into rescuing and arrange help a client isn't ready for. Unless you need inpatient hospitalization, she shouldn't be jumping in to act - but rather encouraging YOU to act. She is forgetting that she can line up all the resources for you, but that you are not going to change until and unless you are ready to change.

In the end, the treatment you do is your choice - unless you keep going down this slope and end up to the point of needing inpatient care - but until you reach that point, it is your choice and maybe you and your therapist need to have a conversation about that. She has a duty to act if you need to be hospitalized. The rest of the time, her duty to care includes a duty to accept that she can't rescue you and that doing so is a disservice to you. You have to be ready to change. She can only help support you getting there and set clear boundaries along the way if you don't choose to work on this. One of the hardest things in the world to do is to watch someone we care about do something that hurts them. It's very hard to stand by and jump in and do EVERYTHING to help, but therapists have to respect the clients choice up until the point of them killing themselves. You are fully allowed to keep harming yourself through starvation and go down this dangerous path - and it's also fully your choice to get outside support or not.

Even if she trying to rescuing you too much, remember, the choice is still all yours to get more help or not. Or to keep on this path and risk getting to the point of help being forced on you in the terms of inpatient hospitalization.

 

[anonymous]

@Justmehere what makes you think she is not at the point of dying and/or needing help? You might see it as rescuing but it could also be appropriate professional help.

@Justmehere what you are talking about are your issues of control and not moonbeam's issues of control. Can you see how you have almost hijacked this thread?

@Justmehere I think you have let your own issues get in the way of what you have said to @moonbeam. You might want to look at that. I don't think that is helpful. You are offering manipulative ways of thinking about and managing the situation. That doesn't seem a useful strategy to me.

I have been where you are moonbeam, and I came close to organ failure. I also thought I did not have an eating disorder.

 

[Justmehere]

Annoymous poster - I value your feedback and opinion. I disagree with your interpretation of my feedback to moonbeam.

what makes you think she is not at the point of dying

At no point did I state she is or is not at "at the point of dying."

If moonbeam is "at the point of dying," then the therapist would be committing serious negligence by ONLY setting an appointment with the nutritionist. The GP would be negligent as well. It is uncommon for multiple professionals to be that negligent. It does happen from time to time. Perhaps moonbeam is "at the point of dying" and multiple professionals are putting their licences on the line and allowing someone to die without taking steps to hospitalize her. That is when they would have a duty to act irregardless of moonbeams desires.

It seems more likely they are worried about her wellbeing, appropriately taking this problem seriously, and trying to make sure she doesn't end up "at the point of dying" and setting up appointments for her to get more help and support around this.

Self starvation is a very serious issue, to be sure. There are degrees of struggles with self starvation. There are degrees of appropriate intervention. It is not as black and white as either no problem or the person is about to die. It is possible to struggle with self starvation and need only some additional outpatient providers to work through it in order to avoid becoming "at the point of death." I am one such person who only needed a couple of visits with a good nutritionist to re-develop healthy eating patterns again. Other people need more help. It varies person to person. It sounds like you had a much more severe battle with disordered eating. I have a dear friend who had to do inpatient treatment for a PTSD related eating disorder. She never developed any body image issues, but she did get to the point of death and waited so long to get help that she eventually was at the point of death and had to be hospitalized. It's a tough road.

It's scary for most people to watch someone begin to go down that road and even have a small problem with self starvation, because it can quickly become a very hard to break habit and it can lead to death. I believe that is what is worrying this therapist and compelled her to act. She doesn't want moonbeam to slide further and be at the point of death.

I also think that her therapist is trying to make sure moonbeam has all the support she needs so that therapy about other issues can be as effective as possible. It sucks to even have a mild problem with self starvation, and it can severely impede treatment for other PTSD symptoms.

Therapy is hard work. It;s important to make sure people going through therapy are eating and sleeping well, because if they are not, it biochemically screws up the body and brains ability to heal and learn new behaviors and change.

what makes you think she is not at the point of dying and/or needing help?

I never stated she did not need help. Quite the opposite. I think moonbeam could benefit from more support and help and I hope she goes to see the nutritionist.

Even if her therapist claimed a duty to act when she really didn't need to jump in and rescue moonbeam, it is important to remember that moonbeam still has choice, control - and responsibility - for her own treatment and recovery. I hope she remembers she has a choice. This is her recovery. She can say no. It is her choice.

Trauma takes away all our control and choice. Part of healing from trauma is regaining our choices. Recovering from trauma also means taking responsibility for our own recovery and well being.

Ideally, Moonbeam should be the one taking the action to schedule her own appointments with her own nutritionist. Not letting it get to the point where her therapist feels like she needs to step in and rescue and schedule the appointments for her.

It's very clear that the support Moonbeam has now around starving herself isn't working well enough. It is clear that she needs more support. She has a choice to go out utilize that support or not, and I think recognizing that choice and responsibility is part of healing from trauma, where all choices were taken.

She can also choose to just keep doing what she is doing - and will likely keep getting the same results - but it is her choice.

Just because someone is in need of help doesn't mean they are ready for that help. No matter how much help is provided to someone, people don't get better until they are ready to engage and utilize it.

Just because someone is in need of help, and someone schedules appointment for them, doesn't mean they loose their option to choose - unless they are on the verge of death, at which point they only loose some of their choice.

Moonbeam can be dying and her therapist can schedule appointments all she wants with a nutritionist, and heck, let's go to the extreme for a moment here - they can even hospitalize her against her will and tube feed her - but in the end, moonbeam still has a choice. It's still up to her to engage that help or not. Moonbeam can find other options or other treatment providers to get more support around her eating problem.

A therapists duty to act is one thing. I think we shouldn't lose sight of our own duty to act. Even if a therapist is overreacting and taking too much action outside of what we want - we still have a duty to act to find what options will help us mange and heal from an unhealthy coping behavior.

 

[intothelight]

She is worried that the Link Removed has been getting worse and I've stopped eating unless forced.

Loss of appetite is a symptom of depression, and the worse the depression the greater the symptoms. At the same time, not having energy and feeling fatigued fuel the symptoms. My personal belief is that you need to treat the whole person and not just one area, as there is no real separation from the physical and the mental. Just my personal opinion.

Whenever I have sought assistance whether it be from a doctor or a therapist, it isn't that I have made them my authority. I have made a decision that I want to get better and that is wholly my decision. I have also made a decision that I need help in doing that. By seeking the assistance of someone else, I have viewed them as a guide, resources, mentor, etc. as they have a set of skills or knowledge that I need to tap in to in order to achieve the results that I want. Where the lines get gray is then I slip from self improvement to self destruction and it is their professional and honestly a moral responsibility to intervene. The when, the how and the how much is the gray area and only you and your therapist know where that point lies.

Being malnourished affects a persons brain and the way that they think. To be optimum and to deal with the issues that brought a person to therapy in the first place can't really be addressed and worked on until some type of balance is restored. You made a decision to get better and maybe at this point the getting better is eating. Members here had made some really good points and you are going to know what rings true with you. For myself, to get started eating again, I was too tired to cook and couldn't tolerate a large meal. So I used meal supplements, fresh fruit, soups, yogurt and anything that was simple but gave me the nutrition that I needed. I found small frequent meals/snacks worked best and eventually I did feel better and was able to move forward in other directions.

I hope you find what works for you.

 

[moonbeam]

I am going to take a completely different track and agree with your therapist. If I read your post correctly you will not allow yourself to eat. If that is the case, then your therapist is taking the decision from you. This is a tool they are using to circumvent your denying yourself the right to eat.

Thank you Russ. That is a helpful thing to consider. I can rationalise that she is trying to help and only has my best interests at heart. It feels more like a me vs me, or as her trying to support me against the hurtful part of my brain. It's just freaking me out. I think the words duty of care and saying that there are parts of my brain that can't be trusted has made me even more unsure of myself.

Annoymous poster - I value your feedback and opinion. I disagree with your interpretation of my feedback to moonbeam.

At no point did I state she is or is not at "at the point of dying."

If moonbeam is "at the point of dying," then the therapist would be committing serious negligence by ONLY setting an appointment with the nutritionist. The GP would be negligent as well. It is uncommon for multiple professionals to be that negligent. It does happen from time to time. Perhaps moonbeam is "at the point of dying" and multiple professionals are putting their licences on the line and allowing someone to die without taking steps to hospitalize her. That is when they would have a duty to act irregardless of moonbeams desires.

It seems more likely they are worried about her wellbeing, appropriately taking this problem seriously, and trying to make sure she doesn't end up "at the point of dying" and setting up appointments for her to get more help and support around this.

I am not at the point of dying and I assure you if I was my T would not be scheduling appointments but would have me as an inpatient. I know they are trying to prevent that and get me back on track. I think I may have accidentally left out a detail here that my GP is really bad so I have given my T permission to speak with him because he frequently doesn't listen to me. That being said I also wouldn't have asked to see a nutritionist.

I think all of this is a good point and something for me to think about. The logical part of my brain knows I am making it worse. And that its cyclical so I feel crappy. Don't eat. Feel more crappy, etc. But it loses to the stronger part of my brain that isn't very nice to me.

 

[The Albatross]

After my military sexual trauma I was "ordered" to the chow hall... and my attendance (or not) was marked. I was anemic and had malnutrition.

But I couldn't have said any better than what Into the Light says. Treat and/or seek out treatment options for the depression. I wasn't hungry cuz my stomach shrank, I was traumatized and depressed. It was a difficult period... I was under weight 3 times in a decade (20's through 30's).