The Not-So-Easily-Measured (What Are The Dangers of Prioritizing Objectivity in Mental Health Care?)
Western medicine today, like much of science, prioritizes objectivity and quantitative research (what can be empirically investigated and either verified or falsified using mathematical, statistical or computational techniques.) The goal of such research is to yield unbiased results that can then be repeated and eventually generalized to larger populations. This is an important process in scientific fields and reflects Western society's high esteem for reason, which is not problematic in and of itself, in fact it has many benefits. However, what I would like to explore in this particular blog post are the ways in which the prioritization of objectivity and the focus on what is measurable, plays out in healthcare and the treatment of people with eating disorders (as well as other mental health conditions). At the end of the day, all I really want to do is encourage is awareness around prioritizing objectivity, clinical types of language, and potential bias/stigma.
Measuring the Hard-to-Measure:
How do you determine progress in healthcare? In physical disease you can look to resolution of signs and symptoms, you can assess blood work and the normalization of laboratory values, you can assess medical imaging or electro-physiologic studies. Essentially you can look and you can measure.
But how do you measure progress in mental illness? In some cases you can do similar things: you look to the resolution of signs and symptoms and sometimes blood work and other studies can also inform you of progress. In the case of eating disorders, weight is often looked to as a benchmark for progress. This is understandable as eating disorders can affect a person's weight, but in other ways, focusing on weight is limited and reinforces disordered beliefs in patients.
Personally, it feels ironic to be told to get on a scale with a sign pinned on the wall behind that scale, that says "your weight is not your worth." But you still have to get on the scale so your weight can be measured and your BMI calculated and in an eating-disordered frame of mind, what feels like the validity of your illness assessed. How much concern have you warranted? That is likely not the way the clinician is looking at that situation, but it is common for that to be the way the patient views the situation.
Weight is certainly a tool and I am not implying it does not have a place in the assessment and treatment of eating disorders. However, the focus on weight can reinforce the belief of patients that their weight is in fact their worth and they are not "sick enough" to deserve help unless they can provide clinicians with visible and disturbing illness. This focus on weight is one of the reasons why patient's often speak about a kind of "hierarchy of eating disorders." This idea of a hierarchy is problematic as it leads patients to actively attempt to "get worse" in order to feel "valid."
The thing is, eating disorders are both about weight and not about weight. Some eating disorders will be reflected in a person's weight (whether they are under or overweight or cycling up and down), but many patient's appear to be of entirely normal weight regardless of the damage they may be doing to their bodies and certainly the pain they are experiencing psychologically, disturbing their day to day lives and basic functionality. Take a second to consider two examples of theoretical patients. Patient #1 is of a normal weight and loses weight due to their eating disorder. People become concerned quite quickly. Patient #2 is of a higher weight and loses weight due to their eating disorder. People praise them. Both people are suffering, but receive entirely different responses. When you only look at weight, something fairly easily measured, you miss a lot.