Takeaway
Helping patients change unhealthy behaviors can feel challenging, but what feels like today’s failure can be tomorrow’s story of recovery.
Lifelong Learning in Clinical Excellence | July 25, 2018 | 2 min read
By Angela Guarda, MD, Johns Hopkins Medicine
As a psychiatrist, I contend with uncertainty on a daily basis. Uncertainty about prognosis and uncertainty about whether I helped my patients. The outcome of therapy is not always evident —sometimes not for years.
It is my patients, however, who have taught me never to assume failure—that full recovery is possible for all, and it is the latent success of patients whose illness seemed overwhelmingly intransigent that have brought me the greatest joy and sense of purpose. I treat anorexia nervosa, a puzzling, poorly understood behavioral condition with high mortality. Neither a fashion statement nor a lifestyle choice, anorexia nervosa, like addiction, hijacks the lives of vulnerable people making starvation an all-consuming passion. Recovery requires a conversion—from valuing dieting as a solution, to recognizing it as the problem. Although aware they have lost control of their behavior, patients are strongly ambivalent and anxious about gaining weight or changing their eating habits.
Early in my career, I encountered Ashlee, a teenager with extreme anorexia nervosa whom I felt unable to help. Admitted at a life-threatening weight, she was weight-restored but stopped eating and relapsed after each of three sequential hospital admissions. Demoralized, I told her parents I was sorry—we had nothing else to offer, and suggested they seek treatment elsewhere. I was pregnant at the time with my oldest daughter and Ashlee gave me a parting gift—a yellow fleece baby blanket she made.
Months later, a coworker mentioned seeing a frail and thin Ashlee jogging in a park. I felt sad, assuming she would become another casualty to anorexia. Seven years later, however, Ashlee called asking if she could visit. She said, “I have a surprise I want to show you”.
At my door stood a radiantly healthy 24-year-old woman in her third trimester of pregnancy. I hugged her and asked her what she had done to recover.
She replied, “I want you to know that although I was not ready to change when you treated me, years later I decided to apply everything I had learned in the hospital. I truly believe I could not have overcome my illness without the skills I learned in treatment. I will never forget anything that you have done for me.”
That day I learned there is no hopeless case or treatment failure—all patients with anorexia nervosa are capable of recovery—our job is to assist this process as best we can. Even when I worry I have failed to help or that I did not connect with a patient, the treatment may simply need more time to mature since, as Ashlee put it, “the tools were there in my head once I decided to apply them.”