I do not usually get on my high horse and my soap box is generally banished to a dark, spider web infested corner but I feel I have to make a Blog post about this topic;
Doctors and mental illness/self harm/eating disorders.
I belong to a few online communities that deal with self harm and eating disorders. Today i logged on and there were two messages from very good friends, one struggles with self harm and the other with bulimia.
My friend who self harms recently ended up in A&E, needed stitches for her wounds but was told, by a doctor, that ‘people like you don’t need stitches’.
The girl with bulimia is on medication for an allergy. Her mother went behind her back to her GP, concerned about her weight loss and her GP prescribed her a different allergy medication where the most common side effect is weight gain.
I am going to write about these two incidents seperatly but I think they are equally awful and show that, whatever progress that the medical community has made, both frontline medics like A&E doctors and family GP’s need to receive further training. Self harm and eating disorders are both ‘passed off’ as ‘phases’ or ‘fads’. They are both serious symptoms of underlying mental illness and both can and do have very serious medical complications – that is ignoring the suffering of the person dealing with these issues.
Firstly, self harm. It is not ‘trendy’. It is not a teenage ‘phase’. Self harm is a coping skill, a bad one, yes, but a method of coping used, unfortunately, by a very varied demographic. It is not just teenagers, I personally know people in their 40’s. 50’s even 60’s who struggle with self harm. It is not just a ‘cool thing’ that teenagers experiment with, it is a symptom of an underlying issue.
It is very rarely done for attention, most self harmers go to great lengths to hide their activites. Most are ashamed, scared and feel alone, which is why it is a problem of a much larger scale then actually seen in A&E. If a self harmer has the courage to actually go to seek treatment for their wounds then they should be supported and encouraged, not shot down. Even IF it is an attention seeking act (because I would be naive to say this never happens) surely the origins of the need for attention should be looked at? If somebody is hurting so much inside they come to A&E claiming, for example, they have taken an overdose and it turns out they have not, surely doctors should be more concered about the origins of this lie than the fact that their time has been taken up? Nobody craves negative attention over positive attention unless there is something wrong, so even acts that appear to be ‘attention seeking’ signal to some kind of problem on an emotional level.
I do not understand why a self harmer is seen as undeserving of help. If people were to apply this warped and discriminatory logic to all health conditions then there would be a much higher death rate amongst the general population.
Yes, a self harmer picks up a ‘tool’ and afflicts damage to themselves. ( I loathe to use the word ‘cut’ as although that is the most common cause of self harm it is not the only one, there are many, many different methods opf self harming which all points to the same level of emotional turbulence and an inability to cope with stressors and day to day events.) However, a type one diabetic may skip his/her insulin because they are tired of having to constantly monitor what they eat/their activity levels – when they are unconscious in A&E due to a hypoglycaemic episode or having keytones they are not viewed as time wasters. It is a fact (and I can dig out the published study) that most admissions to A&E and subsequent moves to medical wards for type one diabetics is caused by an ignorance or mishandling of their condition…so how are self harmers all that different?
Alcoholism is now, thankfully, widely accepted as a disease and a patient suffering from acute alcohol withdrawal is not as likely to come across judgemental nurses/doctors or to find themselves refused care as self harmers. (This observation has been made by talking to self harmers who also suffer with alcohol misuse issues/ online communities dealing with alcohol misuse and through my own first hand experiences of a working A&E department.)
Everybody has a right to medical treatment and care. A self harmer has as much right to self-present at A&E, or even call for an ambulance if needed, as a patient suffering from psychosis, breathing difficulties or any medical complaint.
If a self harmer who needs stitches/medical care does not go to A&E they pose a serious risk of infection and could then find themselves being in need of more serious and time consuming medical intervention than if they went in the first place. If the doctor in question, who decided my friend was ‘seeking attention’ in needing her wounds looked at did not know she was a self harmer would she have been treated differently? Yes. If she has come by the wound via a ‘real’ accident she would have been given more medical care and attention than she did receive. Even if doctors do not want to pay attention to the emotional needs of a patient than the wound should be viewed in isolation, with the same risk assessment and infection management rules applying as with any patient.
Also, A&E is a ‘first response’ unit for psychological crisis’s. If someone feel like harming themselves or ending their life and are not already in contact with the mental health services then their first port of call in A&E. Even if a patient does already receive input from a local mental health team they will often be referred to A&E because CPN’s/psychologists cannot often make emergency appointments or admit patients to a ward without going through the emergency psych team connected to A&E. Therefore this is a KNOWN part of the job. Doctors/nurses/HCA’s should be more adequately trained in mental illness, ranging from self harm to how to deal with a panic attack or psychosis because they are going to encounter it often, possibly multiple times in a day.
I can recognize how it is easy to become jaded. Self harm is selfish, it doesn’t really help and yes, it does take a long time to give stitches to somebody who may possibly go and make another, similar wound within days or hours or treatment – but that shouldn’t be a reason to deny treatment, ever.
If an idvidiual is repeatedly self harming and repeatedly presenting at A&E and needing time intensive treatment it probably does get irritating. There was a time in my life, and it wasn’t that long ago, where I was on first name terms with the receptionist at my local A&E. I was very ill at that point and I wasn’t trying to put doctors out or annoy them – I simply was trying to stay alive. (I realise that it may seem counterproductive but for most self harmers the act of harming oneself is not a suicide attempt, it is a method used to try and keep alive.)
I was very ashamed of my actions and embarrassed but I could not curtail my behaviour. It was not something I was in control of. When I am ill I do not expect tea, sympathy and fluffy bunnies and neither, i think, do any self harmers. I do not go to A&E looking for a pat on the head or a cuddle or for someone to feel sorry for me, I go because I have a medical issue that needs addressing urgently. A doctor who refuses to treat a patient does not help. It simply puts suffers off seeking aid when they require it which increases the chance of infection, or any progress being made, of sufferers receiving help from the psych team, and can, in cases, heighten the change of fatality from wounds or injuries.
My friend is writing a complaint to the A&E department that was involved in her ‘care’. I strongly advise anyone who experiences anything like this to do the same. The medical population as well as the general population need educating about these issues.
I could write about this for ages – I know professionals often raise other points such as ‘why reduce scarring on someone who already has many scar’ and if anyone is interested I am happy to give my opinions on this matter – but from here on it gets very opinion based and (although I am not good at it) I wanted to keep this post as concise as possible in the hope people will take my points on board.
Now, my friend whose GP gave her medication that would cause weight gain.
To me this demonstrates a massive lack of understanding about the fact that eating disorders are a mental illness. It is a pathological fear of weight gain and of food that means that individuals engage in behaviours such as self induced vomiting or excessive exercise and calorie restriction.
A GP prescribing medication in this way is not only going against patient confidentiality but also spreading the mindset that if somebody with an eating disorder ‘puts on weight’ or ‘eats normally’ they will be magically cured. I am sorry, but this is bollocks, and it makes me so angry to see evidence of a GP still viewing ED’s (eating disorders) in this manner.
Yes, most people do, at some point, struggle with their weight and diet. Most people have dieted at some point, a lot of people have taken this to an unhealthly level..but, luckily, few people get to rthe point where there life is ruled by food and they are diagnosed with Anorexia, Bulimia or EDNOS. An eating disorder will never be fixed by weight gain alone.
If a patient is underweight then their medical risks increase, I agree with this in theory, but it a ‘normal’ weight will not ever reverse the eating disordered mindset.
In this particular case the mother was concerned about her daughter’s weight loss and spoke about her concerns with her daughters GP. The GP, on hearing this, should have called in the daughter for an appointment and spoken to her about her eating habits as well as running a physical which included a weight check and blood test as well as blood pressure and an ECG. None of this was done, which not only demonstrates an utter lack of medical knowledge about the dangers of eating disorders but also reinforces stereotypes.
Again, eating disorders are going to be something that a GP see’s a lot of. It has also long been viewed as a ‘teenage illness’ and a ‘diet gone wrong’. Recently a study (again, I can provide this if wanted) has shown that anorexia is more commonly diagnosed in women in their early twenties and thirties than teenagers..and the population of male eating disorder sufferers is increasing rapidly.
In 2007 when I was in treatment for anorexia I was unusual as I was only 17, most of the inpatients were a lot older than me. I also saw several boys come through treatment with me. Of the ‘older’ population in the inpatient unit most suffers had developed the illness later in life and only one woman, who was in her sixties, had been a lifelong sufferer from a pre-teen age. (This woman went on to make a full recovery after over twenty years of being in and out treatment centres from life –threatening anorexia.)
I feel I am going a little off point here, but ED’s should not have the stigma that continues to be attached to them. It is not a ‘diet gone wrong’ and gaining weight is not a miracle cure..similarly in ALL eating disorders, including binge eating disorder, weight does not dictate health – a patient may appear to be a normal, healthy weight but be medically very unwell, a heart attack can be fatal at any weight, as can many other complications of an ED. For me, I was much more of a medical risk at a higher BMI than a emaciated one. At my highest weight I was abusing laxative, diet pills, water tablets and purging in order to try and get my weight back down, it was at this stage that my heart, blood pressure and electrolytes were the most of a whack. At a very very low weight I was very poorly, yes, but my blood pressure was a lot more closely monitored and a lot more stable than it was when I was at my ‘worst’. There is a preconception that a person with an ED is super-skinny, skeletal, quiet, shy, fragile and a victim – this is not true at all. Any individual that has any signs of an ED or shows ‘faulty thinking’ when it comes to food and weight should be taken seriously, especially by the medical community.
As with A&E Gp’s are on the front line for giving access to mental health professional, dieticians and professional that can aid an individual with any type of eating disorder. Professional help is often crucial to a sufferer. Eating disorders are not born from a desire to be a size 0 but are rooted in psychological issues and fears, also, if depression/ insomnia/ anxiety is not already present in a individual with an ED they are bound to become co-morbid problems. It is never ever just about food. GP’s especially should be better trained in recognising the signs of all ED’s and know where to make referrals.
It makes me so angry that a GP can prescribe weight gaining medication to a patient without even explaining the side effects, this would be true even if my friend did not have an eating disorder – this GP would still be in the wrong, the fact that he was told that this individual was losing vast amount of weight and inducing vomiting should have begun a very different chain of response than prescribing a pill that will make her feel more alone, more scared, angry, misunderstood and overall less likely to seek help.
I would like to end this by saying that I have had many, many run in’s with the medical community in direct regards to my ED and my self harm over the years. I have had some amazing doctors and nurses who have helped me considerably – I have also had doctors and nurses who have obviously had their own opinions about such matters and got on with the job regardless. I think that both responses are fine and appropaite. I am not asking for every Doctor/healthcare professional to put aside their own opinions but just to treat people as equals and following the correct protocol and procedures. There are understanding and wonderful Doctors/professionals out there…similarly there are so called ‘specialists’ who deal with ED’s/self harm on a regular basis who treat individuals badly..I really am glad of all the GOOD care I have received and I urge ANYONE WHO THINKS THEY NEED MEDICAL ATTENTION TO SEEK IT AS SOON AS POSSIBLE. However, these two events are described above need addressing.