healthcare, mental health

High priced help for the hungry…

For some reason, my post about Adam and Darla Barrows’ love story has attracted a lot of attention. I am intrigued, because it’s somewhat uncommon for items in newspapers to generate interest for so long. Usually, you get a burst of interest in the hours or days after something hits, then people move on to the next thing. And I am especially surprised by the interest in my comments on Barrows’ piece, which was a Modern Love story, rather than a hard news item. I’m just an American blogger in Germany. Why do people care what I think? Why do they care so much that they want to respond or even set me straight? And do they know that sometimes their comments lead me on unexpected paths? That’s what today’s post is about– my unexpected trip into high priced help for the hungry in Switzerland. I never thought my post about a newspaper story would lead me there.

I recently got comments from two people who have never posted here before, both of whom have direct experience of loving someone with anorexia nervosa. One commenter seemed to agree with my take on Adam Barrows’ New York Times article about how he fell in love with a woman with anorexia. The other one clearly did not agree with me, and in fact, says my views are “outdated”. Both commenters have children who have suffered from anorexia. I appreciated that they took the time to read and comment. I won’t be surprised if others also comment, since that post is clearly very hot even a month after I wrote it. Adam Barrows’ story obviously really resonated with and rattled a lot of people.

I just want to mention a few things about that post. First off, all of my posts on this blog are mainly just my opinions. I share them with the world, but I don’t necessarily expect people to agree with me, nor do I assume I’m always right. I wouldn’t want everyone to agree, because it’s hard to learn anything new if everyone thinks the same way.

Secondly, I really think that Barrows’ story was less about anorexia and its treatment, than the development of Adam’s unique love relationship with his wife. I think a lot of people read Adam’s story, got very triggered by it, and felt the need to judge him. He probably knew people would have strong reactions to the story. Ultimately, I think a lot of people missed the point entirely, and focused on anorexia rather than the love story and his perspective as a man who loves someone with an eating disorder. Furthermore, Barrows’ story is not a long piece and was probably edited a lot, so it’s not a good representation of Adam Barrows’ character. It pained me to read so many nasty comments about Mr. Barrows, and that was why I wrote about his NYT piece in the first place.

Finally, I’m really glad he wrote that story and shared it, despite the polarized reactions. It has really made me think and, as you can see, continues to inspire new posts for my blog. 😉

Which brings me to today’s fresh topic. One of the people who commented on my post expressed disappointment that The New York Times shared Barrows’ piece and “glamorized” anorexia. Looking on my Statcounter results, it appeared that “Danielle” might have been writing to me from England. If she is from England, it would make sense that she would give me hell about my comments. She may or may not be aware of how different the US and UK healthcare systems are. In the United Kingdom, citizens have access to the National Health Service, which means healthcare doesn’t cost people as much as it does in the United States. A basic level of affordable care is available to everyone.

In the United States, healthcare is very expensive for most people, even for those with decent health insurance, which is also expensive on its own. Mental health care coverage is often woefully inadequate. It’s been years since I last had a “civilian” health insurance policy, but I seem to remember that my coverage only allowed for thirty days of inpatient psychiatric treatment per year. And that’s if there were no pre-existing conditions! Outpatient care was somewhat more generous, but it was not covered the same way or to the same extent a physical problem would be.

In the United Kingdom, there is also a process called “sectioning”, in which people can be involuntarily hospitalized for mental health conditions. The Mental Health Act of 1983 allows for family members and physicians to act in another person’s best interests when it’s clear that they need psychiatric help and won’t cooperate on their own. Anyone who is being sectioned must be assessed by health care providers first, but it appears that a person can be sectioned for a much broader array of reasons than they can be in the United States. Someone who is starving to the point of death because they have anorexia nervosa could possibly be sectioned, for instance, even if they are over 18 years old.

In the United States, we do have the means for hospitalizing people against their will for psychiatric reasons, but it’s a lot more difficult to force an adult into psychiatric hospitalization than it is a child. A lot depends on the laws of specific states. Moreover, in the United States, involuntary commitment seems to be done most often in cases in which a person is clearly a danger to other people as well as themselves, and is not in touch with basic reality. Someone with anorexia nervosa is probably not going to pose a genuine threat to anyone other than themselves. They also tend to be basically rational in things besides their body image. Anyone who is curious about how eating disorders in the United States are treated may want to watch the excellent 2006 documentary, Thin, by Lauren Greenfield. As you’ll find out if you watch this film, a person’s insurance coverage is also quite important in their ability to access care. I can’t say that adult people with eating disorders never get forced into treatment in the United States, but I think it’s more difficult to do it there than it is in England and Wales.

In the 1960s, there was a big push in the United States to deinstitutionalize people with mental illnesses, which meant that a lot of facilities closed down, for better or worse. The emphasis is more on outpatient treatment. In fact, healthcare is more for outpatient treatment for regular medical conditions, too, mainly because of how bloody expensive it is.

An eye-opener about how eating disorders are treated in America.

As I was thinking about Danielle’s comment and chatting a bit with my friend, Alexis, who is herself employed in healthcare, I got to wondering how eating disorders are treated in Germany. I went Googling, and found a few items that didn’t tell me much. But then my eyes landed on an ad for a rehab in Switzerland– specifically, Paracelsus Recovery in Zurich.

I know Switzerland has really excellent medical care. I also know that it’s an eye-wateringly expensive place. I know healthcare is not cheap in Switzerland, either. I was interested to find out what this place in Zurich was like. I found out that it’s a family run business. Clients are treated one at a time, and have the option of staying in one of two huge penthouses.

The fees include five star treatment, to include a personal chef and a counselor who stays with the client 24/7 in beautifully appointed accommodations. There’s a medical staff, including nurse practitioners and physicians, a wellness staff, with personal trainers and yoga instructors, and therapists. If you access their Web site, you can take a tour of the posh penthouse, which includes a bedroom for the therapist. If you like, you can pay separately for accommodations at a hotel, although the accommodations are included in the price of the treatment and I’m not sure if you get a price break for staying off site.

A very comfortable place to recover in Zurich.

This center treats several different psychiatric conditions, including drug addictions, eating disorders, mood disorders, alcoholism, and behavioral addictions (porn addiction or gambling, for instance). It’s a very discreet place and, judging by the fees they charge, is intended for helping only the very wealthy. At this writing, it costs 80,000 Swiss Francs per person per week to be treated at this facility. To put this price into perspective, at this writing, 80,000 Swiss Francs is equal to about $86,000 or roughly 72,000 euros. The fees cover everything related to the treatment, although if you fall and break your arm or get sick with COVID-19 and need hospitalization, you will have to pay for that medical treatment separately. Also not included is accommodation for anyone who accompanies you or a two day pre-assessment, which is an additional 20,000 francs.

As I was reading about this place, it occurred to me that there must be a market for it. I’m sure their clients are mostly extremely wealthy people, such as royalty from the Middle East, Hollywood movie stars, rock stars, or business moguls from Wall Street. Paracelsus gets excellent reviews online, but I wonder how many people have had the opportunity to experience this kind of treatment. Still, it’s fascinating to read up on it. I wonder what it would be like to work at such a place. I’m sure they deal with some extremely high maintenance people. I also wonder what would prompt someone to start such a practice, which seems to cater only to extremely wealthy people. To be sure, that population is unique and may need special accommodations, but I’m sure the cases are uniquely challenging, too. People with a lot of money are often used to hearing the word “yes” a lot. Maybe such posh surroundings are less effective for people with addictions. But again, I could be wrong. At the very least, it looks like a very competently run place, and in a city well known for psychiatric care.

Wow… very beautiful and very expensive! And no need for a translator.

I found another rehab in Switzerland, Clinic Les Alpes, that has a relatively bargain basement cost of 45,000 Swiss Francs per week, although the typical stay is for 28 days, so you do the math!. It looks like there, you can be treated for exhaustion or burnout or addictions. They seem to focus on addictions the most and offer care that emphasizes comfort, as well as the classic 12 step program to sobriety. It’s in a beautiful area, just off the shores of Lake Geneva, in an area with many forests and no sound pollution (which sounds wonderful to me). But this program appears to be a lot less private. There are 27 rooms for clients to stay in rather than two exclusive penthouses.

I would imagine that healthcare in Switzerland there is delivered expertly, especially if one is paying many thousands of Francs. My experiences in Switzerland have mainly been in a few hotels, a couple of which were high end. The Swiss definitely do high end hotels right, although on the whole, I find it a rather boring, soulless place, even if it is also very beautiful and scenic.

Well… I’ll never darken the door at one of those very special rehabs in Switzerland. I do find them interesting to read about, though. They’re not for ordinary people with big problems. They are for extraordinary people with big wallets. Obviously, there’s a need and a market for them, since at least two of them exist… and to think I found out about them because of a comment on my post about a Modern Love story I read in The New York Times over a month ago! I am always amazed by what inspires me to think and to write… and that’s why I like to hear from people. I’m sure Danielle never knew her comment about how wrong my opinions are would lead me to research luxury rehabs in Switzerland. You learn something new every day!

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healthcare, mental health, modern problems, psychology

What’s eating young women these days? Eating disorders and COVID-19…

This morning, I read a news story about how eating disorders are on the rise in the United Kingdom, especially among young women. Pediatricians in the United Kingdom are seeing a tremendous rise in the number of patients who are coping with the stresses of the novel coronavirus by engaging in harmful behaviors such as binging and purging, starving themselves, or exercising excessively.

Karen Street, a consultant pediatrician at Royal Devon and Exeter Hospital and an officer for child mental health, says, “Eating disorders are often related to a need for control — something many young people feel they have lost during the pandemic.” Eating disorders often occur in young women who are extremely accomplished and driven, engaged in extracurricular activities and earning high grades in school. Thanks to the pandemic and being forced to isolate, many of the activities that young people could be engaged in are now unavailable. Teenagers don’t always have the coping skills that older people have, which would allow them to find a more COVID-19 friendly passion. It’s also harder to see a health care provider face to face right now, as many of them are either focused on treating patients with COVID-19 or are not doing so many in person consultations because of the risk of spreading the disease.

I was interested in reading about this phenomenon. When I was much younger, I used to struggle with eating disorders myself. I think my issues were actually connected with depression, anxiety, and terrible lack of self-esteem and secret wish to exit this life. I never really saw anyone about treating them and eventually managed to outgrow my obsession with food, diet, and exercise. It took years, though, and most people had no idea of the extent of it and would not have taken me seriously even if I had tried to tell anyone. I certainly didn’t look like I had a problem with food or dieting. I think, in my case, I exchanged my problems with eating disorders with something else. My issues with food mostly seemed to stop once I started taking the right antidepressant.

I’ve often marveled at how a few years taking Wellbutrin permanently seems to have changed the way I used to feel all the time. Before I got treated for clinical depression, I often felt overwhelmed and out of control of my emotions. I would vacillate between being funny and gregarious and being very depressed. When I was much younger, people would often ask me, in all seriousness, if I was bipolar. I am not bipolar, but I did have a chemical imbalance for years. Wellbutrin seems to have permanently corrected it, though– that, and having Bill in my life has made a huge difference. He treats me with love and respect. I literally don’t feel the way I used to feel all the time. I feel much more balanced and in control, and with that balance and control, I stopped caring about dieting. I don’t need a lot of people in my life. I just need one person who cares. I have that in Bill. If I didn’t have him, maybe I would go back to the way I once was.

I’ve often thought about what life must be like for young people right now. I think if I were a teenager in the lockdown COVID-19 era, I’d be going crazy. I can remember being 13 years old and stuck at home with my parents because I was sick or there was a big snowstorm. The first day or two was great, but then I got bored and frustrated, and being with my parents was hard, because we didn’t really get along that well. My parents were always at home, because they ran their business from our house. So snow days were particularly difficult, because I had no escape, other than going to the barn where I kept my horse. It wasn’t always easy to get to the barn when there was snow. I usually rode my bike there. It’s hard to bike on snow packed pavement. I remember getting very cagey and depressed when I was out of school for several days due to snow. I would have absolutely hated the way things are now, even though I’m a fairly self-directed person and would have probably done fine with online school.

Being isolated from their peers, teachers, and health care providers, has increased the risks to mental health issues in teens. Young people in Britain are developing eating disorders and can’t get treatment because there are not enough beds in treatment facilities. Washington Post reporter, Miriam Berger, quoted a couple of pediatricians who have seen eating disorder cases rising. From her article:

Luci Etheridge, a pediatrician specializing in eating disorders at St. George’s Hospital in London, reported… a 250 percent increase in cases compared with 2019, with a particular spike in September. Previously, the center had been able to access referrals within a nationally mandated four-week window; now they have 30 children on the waiting list to be assessed.

And:

Jon Rabbs, a consultant pediatrician in Sussex, [claims] his eating disorder service usually saw 11 referrals a month. Since September, it has risen to around 100 monthly.

The increased time people are spending online is probably contributing to the problem. With fewer offline activities available, youngsters are focusing on apps that have to do with calorie counting and recording exercise. Some people will become hyper-obsessed with their diets and exercise because it may take their minds off of the horrors of COVID-19. Or they worry about getting fat because they’re supposed to quarantine or stay at home as much as possible. Or, for some, it could be that the dieting apps are even like video games, as in, “let’s see if I can beat my record for jumping jacks”. On and on it goes, as the sufferer focuses their obsessions on the disorder and being alone with it, instead of getting back to living normally someday.

The sad thing is, when the pandemic ends and lockdowns are lifted, the people who have developed eating disorders will likely still have those problems. The obsessive behaviors won’t go away simply because people will, once again, be allowed to live somewhat normally. Thanks to the lack of treatment facilities and far fewer in person health provider visits and/or attention from teachers, friends, and guidance counselors, the disorders will go unnoticed and untreated for much longer. Delaying the treatment may lead to physical devastation, particularly if the person also gets sick with COVID-19. And one of the main features of eating disorders is the desire to be left alone and isolated. The pandemic provides a perfect environment for that, making the situation especially difficult for those who are already in recovery. I would imagine it’s the same for recovering alcoholics or other addicts, who need regular support to help conquer their addictions.

We are also now in the holiday season, which is stressful and often centers around preparing food and eating it. Usually, we celebrate with each other during the holidays. This year, many people are alone, and a lot of them are facing uncertainty about their finances or career prospects… life itself, really, since we don’t yet know when it will be safe to live in a more normal way. I imagine a lot of teens are hearing their parents worrying about surviving the pandemic, which adds to stress levels. Couple that with adolescents’ inability to do “normal” teenage things. Even dating someone would be difficult right now, which is another rite of passage that mostly affects adolescents. It really is no wonder that a certain type of young person– mostly females, but also males– is engaging in eating disordered behaviors. After all, the one thing most people can control is what they put into their bodies– even if they can’t control a novel virus that is ravaging populations around the world.

Sadly, a lot of people won’t take this issue seriously. As is my habit, I took a look at the comments about this article. At this writing, no one has left any comments on the Washington Post’s article itself. However, many dimwits have descended upon the Washington Post’s Facebook page to leave their ignorant and ill considered thoughts. Quite a few people hadn’t read the article and were spewing the usual crap about “covidiots”, which has absolutely NOTHING to do with the rise in eating disorders. Another insensitive male commenter kept making tasteless jokes about cannibalism– again, this has NOTHING to do with the topic. More than a couple brought up U.S. politics, which again, have nothing to do with the rise of eating disorders among British teens. And then there are the people who blame the media, claiming the media is making the pandemic out to be much worse than it is and is causing the depression and anxiety that can lead to the development of eating disorders.

Having suffered with eating disordered behaviors myself when I was young, this is not something I would ever wish on anyone. It might be funny to make jokes about eating disorders, something that a lot of people don’t understand at all, and don’t even TRY to understand– but to the people who have them, they are hell on earth. While in my case, my issues were mostly in my head and undetected by the people who cared about me, I would not want to be a parent having to deal with a child truly suffering from an eating disorder during the pandemic. It’s hard enough to help them when things are normal. Imagine trying to get help for your child when you can’t even get them in to see a doctor in person and, even when you can, there are no treatment facilities with available beds. Given the damage that eating disorders can do to one’s health, I would imagine that the risk of becoming severely debilitated or dying from COVID-19 would be much graver.

When it comes down to it, eating disorders are a very damaging coping mechanism, not unlike other addictive behaviors like alcoholism or drug abuse. People are stressed right now, and some young people are turning to destructive habits in order to cope with the anxiety and depression associated with the global pandemic. A lot of people who would not have otherwise gone down the dark road of an eating disorder are finding themselves on that path today. If I were a parent, I think I would be concerned… and it would be just one more thing to worry about. I don’t envy today’s parents at all.

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book reviews

A review of Hurry Up Nurse: Memoirs of nurse training in the 1970s

Sometimes, I like to read self published books. I find that they don’t have the same slick editing that comes from a lot of books released by major publishers. Self-published books are sometimes a little bit rougher around the edges, yet more candid. That makes them more interesting. Dawn Brookes, author of Hurry Up Nurse: Memoirs of nurse training in the 1970s. I can tell by the way the book is written, but also by the publisher– Dawn Brookes Publishing. We know what that means, right?

Dawn Brookes is a very British lady who spent 39 years working as a nurse in England. She started in 1977, when she turned up at an interview for nurse’s training in Leicester. The funny thing is, I was actually living in England in 1977. My father was, at that time, the base engineer at Mildenhall Air Force Base, in Suffolk. Dawn Brookes was 18 years old, same age as my eldest sister, Betsy. That little factoid immediately helped me relate to her very colorful stories about what it was like to be trained as a nurse in England during the 70s. She also mentions visiting a couple of places I went to in 2016– Thetford and Watton– both in Norfolk and on the way to Norwich. I went there in 2016 after a Scottish cruise to see Mildenhall and the area where I spent three years of my early childhood. Anyway, enough about me and my British connections.

Dawn Brookes was a typical young lady in England, not knowing much about what she was going to do with her life. As it often happens with young people without a specific direction, Brookes found herself in a set of circumstances that led her to enter the nursing field. Her book, which has since been followed by two sequels I haven’t yet read– and hope are better than the Karate Kid sequels I sat through the other night— is about her training as a nurse in England over forty (!) year ago.

One thing that struck me about Hurry Up Nurse is that the years have really flown by. It doesn’t seem like 1977 was that long ago, but as Brookes writes about her days as a young nurse, I’m reminded of how things have changed. For instance, back in those days, nurses in England wore caps and white uniforms with belts. They even had capes and gloves! Nowadays, nurses dress for comfort and practicality. In the early days of Ms. Brookes’ career, patients were put in huge wards with about forty beds. Now, I’m guessing the wards still exist, but they’re smaller. Ditto for equipment that made nursing less taxing on the nurses’ backs and drugs that are better than what was available in the 70s. Brookes mentions drugs, equipment, and treatments that were used 40 years ago, but really doesn’t give them a thorough discussion. They more or less get mentioned in passing. The same goes for the title, “Hurry Up Nurse”, which gets mentioned several times, but not really explained in a memorable way.

Another thing that struck me about Hurry Up Nurse is how very different some British slang is compared to American slang. For example, a couple of days ago, I posted an excerpt from Ms. Brookes’ book about how she used to enjoy eating “faggots” when she was a girl. “Faggot”, of course, means something entirely different to Americans. In British English, it can refer to a pile of sticks or, as I’ve learned because of this book, a type of sausage made of offal. In America, “faggot” is a derogatory insult to male homosexuals. Dawn Brookes uses a lot of British slang and, sometimes, takes for granted that everyone reading her book is from the United Kingdom. It’s not unreasonable that she would assume that most readers are English, since this is a self-published book. And I’m not sad that I had to look up some of her less familiar terms, since I learned new things. I just want to warn American readers that they may have to do a little extra work to understand everything, even if the book is in English.

Dawn Brookes comes off as friendly and funny, and she did surprisingly well as a nurse and earned several qualifications, even though she seemed to end up in the field by happenstance. However, this book, though entertaining and kind of educational in its own way, isn’t very well organized. The book doesn’t really flow like a story and seems more like a group of anecdotes cobbled together. I mostly enjoyed the anecdotes, but I didn’t really get a sense of the people Ms. Brookes writes about. It’s not like Echo Heron’s marvelous book, Intensive Care, from 1987, which told the story of her training, as well as stories about people she’d worked with, and special patients she knew in a linear fashion. Brookes’ book is not linear and therefore comes off as somewhat less personal. On the other hand, at times I was reminded a little bit of Call the Midwife, and it’s a good thing I’ve seen that show, because Ms. Brookes also includes terminology and job titles that we Americans would mostly never get, like “ward sister”. What the hell is that? I could kind of figure it out because I’ve seen British TV, but other readers might need to do some Googling.

The book ends very abruptly, too. I was in the middle of a good story last night, turned the page, and all of a sudden, it was over. I was actually a little surprised by the sudden stop and went looking for more. Alas, that was it, and I was left a little wanting, as if Dawn Brookes had left me with a cliffhanger.

I liked the book enough that I decided to order the next two parts of her trilogy. I expect they will be more of the same… although if they’re as bad as The Karate Kid part III, I’ll be pissed. I got on a Karate Kid kick because I just watched the second season of Cobra Kai, which also wasn’t as good as the first, and needed to refresh my memory about the Karate Kid films. The second part wasn’t as good as the first, but the third part stunk to high heaven. I doubt the next two Hurry Up Nurse books will be that bad, though. I just hope that Brookes finds an editor… not a slick one, mind you, but one who can make her books flow logically and lyrically, so they’re easier and more fun to read and do less wandering. She has some good stuff here– and I did learn some things by reading– but I’m afraid I’m having trouble remembering anything specific to comment on, other than the fact that I learned a new meaning of the word “faggots”.

I’ll give it 3.5 stars out of 5, and we’ll see what I think of her other two books…

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