Art therapy for everyone

I am officially the LAST person to blog about this study, but my thoughts seem to be pointed in a different from the other posts that I’ve read.

The Psych Central article, “Half of Young Adults Have Mental Disorder,” states the following:

“A total of 45.8 percent of college students and 47.7 percent of young adults not in college met the criteria for at least one psychiatric disorder.

The most common disorders in college students were alcohol use disorders (20.4 percent) and personality disorders (17.7 percent), whereas those not in college most frequently met criteria for personality disorders (21.6 percent) and nicotine dependence (20.7 percent).”

Now personally, I don’t lump alcohol use disorders and nicotine dependence under the umbrella of psychiatric disorders. Definite health problems — yes. Addictions — sure.

I think that Health News explained these results much more accurately:

“The effects of today’s lifestyles are taking some telltale tolls on many, and most especially on young adults. A recent analysis of more than 5,000 young people between the ages 19 to 25 has revealed that almost 20 percent of young adults in America have psychiatrics disorders that interfere with their everyday lives. Furthermore, the percentages of young adults who are abusing alcohol or drugs are even higher.”

20% is still a pretty alarming statistic, especially since the study found that “less than 25 percent of these college-aged youngsters who suffer from mental problems actually seek treatment.”

Laura Collins blogs that “it is obviously NORMAL if half of young adults have mental disorders.” Personally, I feel that when a majority of individuals of a disorder, that it is time to redefine “disorder.” Think, what if we considered yo-yo-dieting a diagnosable eating disorder? It’s definitely unhealthy and probably stems from personal issues, cultural expectations, other mental health issues, etc. but is it a disorder?

My point is that maybe the baseline of “normal” needs to be adjusted. I guess that there are two ways that you could approach this… either say that the quality of “normal life” should be lower (aka: moderate depression, anxiety, and substance abuse being the norm) or that society as a whole should be healthier.

Making society healthier is clearly the harder option. However, the first option of just accepting a degree of mental illness as a fact of life, is pretty depressing.

I would never say that all of these mentally-ill college students shouldn’t receive help… but I think when percentages start to reach this magnitude you need to look at global changes rather than specific, individual treatment. It is impractical (and nonsensical) to try and setup each of these kids with a therapist, psychiatrist, group therapist, etc. Counseling centers are already overloaded — no way could they handle that.

There is a lot of talk about the stigma that surrounds mental illness and its corresponding treatment. I don’t think that you can wait for this to subside to make mental health treatment more available, though. It needs to work in the opposite direction — first make treatment more common and easily accessible.

I think that college kids are much more open to getting help than others realize. My school had “stress reduction” as a PE class — and it was ALWAYS full. It was probably one of the hardest classes at the University to get into. Why aren’t there five of them? Why isn’t there a stress reduction group at the counseling center? I guarantee you that if there were a pre-med support group, that it would be packed. The pre-med track is stressful and probably causes a lot of the anxiety, depression, insecurity, and whatever else that causes more significant mental illness.

Why aren’t there art therapy groups at Universities? I was in IOP during my freshman year and my two best friends would kid that they wanted to make up eating disorders so that they could go to art therapy, too. Why do you have to have a significant mental illness to go to art therapy? Everyone could come up with something to process.

The system is setup so that you have to be sick to get help. The mental illness stigma is encouraged by the barriers to treatment. Seriously, create a program of “supportive groups” — regular misc. process groups, art therapy, stress relief groups, career-centric groups, psychodrama, grief & loss therapy, relationship issues group — whatever! I swear that students will come. If you offer a little more support to everyone, then treatment will seem less weird and fewer people will reach the point of needing intensive help.

The Rule of Thirds

Around one third of patients [with anorexia] recovery fully; another third improve significantly and the last third do not recover.

—Eating Disorders Factfile

I had a therapist explain this statistic to me once…

Group 1: Full recovery – The individual either recovers on her own or with treatment. The duration of the illness doesn’t really matter… what’s important is that the she goes on to live a relatively symptom-free life.

Group 2: Significant improvement – This could mean two things: Either the individual improves to a point where she can have a life with manageable symptoms or she “rides the ED roller-coaster,” so-to-say, with up and down periods of recovery and relapse. While the eating disorder still may affect her life, she’s a functional, productive member of society.

Group 3: Chronic illness — The individual is severely ill for most of her life (since diagnosis). Periods of recovery are brief (if existent at all) and all of her time is spent either consumed by the eating disorder or in treatment for it.

So, given these definitions, I decided that I was probably in group 2 (okay, go ahead and tell me that that’s the wrong mindset and that I could be in group 1 if I wanted to, etc. I am being realistic here). Kind of kiddingly I asked, “So, if you’re not in group 1, are you in therapy for life?” And her response: “Maybe–sometimes.”

WHAT! I only asked this question because I thought it was a pretty absurd question. She went on to explain that for the 2/3rds that don’t recovery completely, the goal is minimizing symptoms. Maybe you can go 6 months without treatment… and then after a year of going back to therapy and getting back on track, you can make it a full year without needing to see someone. The goal is always to get better… but if that means intermittent–or even consistent–treatment throughout your life, then that’s okay.

… thoughts?

For those stuck on the ED rollercoaster…

This is, by far, the most interesting article that I’ve read in a long time: Caring for the Chronically Remitting Anorexia Nervosa Patient

According to Dr. Michael Strober, most people who develop anorexia nervosa will not remain in an acute malnourished state throughout their entire lives, although a significant minority of people have varying levels of illness over decades.

I think this highlights an important point — that you can’t be severely malnourished for years. There have to be points of better physical health in there… why? Because something is bound to happen that requires medical attention. I’m not even referring to all the scary medical risks that come with a chronic malnourished condition (passing out, heart attack, etc.)… but at some point you’re going to have to see someone for a birth control prescription, or you’re going to have strep throat and need antibiotics, or have to go to the dentist or something. It’s easy to identify someone who is visibly ill, and any decent professional is going to say something to you.

Maybe being at this low point is the most dangerous time… but it’s also the time you’re most likely to get help. It’s the rest of your life when you’re not dangerously (or as visibly) sick that contributes to chronic anorexia.

Treatment-resistance in anorexia nervosa is best defined by patients with anorexia nervosa who have been unremittingly ill for decades—including those who have made attempts at treatment, yet relapsed—despite exposure to high-quality care. “It is reasonable to say that people who have never had treatment have actively avoided treatment,” Dr. Strober explains. “That does not mean that people with long-term illness deny it or fail to recognize their condition. The overwhelming majority of patients who rationalize their illness will, when pushed, admit that there is something abnormal about their thinking and their behavior.”

These “people with long-term illness” are in limbo — not really sick, but not really well, either. It’s a state of doing “okay enough.” You’re thinking, “Okay, well I’m eating and my weight isn’t dangerous. My vitals and labs are fine. I have friends and more of a life than I used to. Maybe I still obsess over food and worry about my weight, but lots of people in the world do that.” There’s this comparison between where you are right now and where you were at the height of your disorder. Maybe you know you’re not really okay right now… but you’re not sick… so treatment seems unnecessary.

Dr. Strober emphasizes that treatment must be administered through a completely separate framework when working with anorexia nervosa patients who have been ill for long periods of time.

“The discussion of weight gain and approaches to weight have to be very cautious and very deliberate,” says Dr. Strober. “The goal has to be weight maintenance as opposed to weight increase; the patient must be kept socially active to prevent malaise and isolation; clinicians must stress that the goal of care is to stabilize the patient’s condition and to reassure him or her that the issue of weight gain will not be forced.”

This is where I start to disagree with Dr. Strober… I don’t think that treatment needs to be completely different for someone with chronic AN. What, are you going to wait for the patient to feel like she’s okay eating different food or gaining weight? I’ve said it again and again in my posts, but you get stuck in ED limbo — and I think that it takes a significant force to move you out of that state. I had a nutritionist refer to some people as “functional anorexics” — capable of maintaining their disorder, career, and relationships. I almost feel like you need the opposite treatment. You need to be told, “Hello, this is important. I don’t care if you’re functioning and doing ‘well enough’ — you need to take care of this and make it a priority.”

I think that spending 10 years in ED limbo is a clear sign that you are not capable of managing your recovery. Someone else needs to be in charge — there is no way that you can objectively judge your condition. I don’t think that chronic anorexia needs any less aggressive of a treatment plan, but I do think you have to be prepared for more of a fall-out. More panic attacks, resistance, depression, etc. These patients have been holding on to the ED for a long time… but you’re not going to get to a point where you can work through all of that until you push them. More passive treatment is probably the worst that you could do — you’re just going to contribute to the apathy, and eventually the patient is going to include that this treatment (like the previous treatments) is not helpful.