Today, we meet at the unit to discuss L’s progress. Or lack of progress. I am told they believe she is ambivalent about being there and that I am ambivalent too. The unit manager is there, as is a key worker from her last stay. I sense I am being managed. I meet L’s new case co-ordinator. We settle down and I am asked about my ambivalence about her stay here.
So, I describe her journey since her last stay. Her weight loss as soon as any choices and freedom of food was allowed. How I hoped that her new college life would pull her away from anorexia. And the reality that what made L happy was to lose weight. Which she did and all attempts to help her eat were rebuffed. I try to explain what worries me about their methods; essentially it depends on L wanting to be well and choosing to eat. If she does not eat a meal, there are no alternatives offered. She just sits it out for half an hour and then gets to go to bed. Surely, I ask, if her CAMHS team thought she lacked any capacity to make decisions, how can they believe she can make this choice, to want to be well? I ask them if they accept that there are other treatment models and indeed they do. In fact they used to run a programme based on insisting that patients eat. But they believe this works better. L’s case coordinator says she thinks that L can make the choice and I tell her politely that as she has only met L this morning. No changes will be made to the programme to assist L. So, we are asked to make a decision, should she stay or go? All eyes turn to L and I protest, that it is unfair to ask her to choose, right here and now. I tell them it may well be their approach works for most patients, but it doesn’t work for L. And as they can’t tell me that the approach of insisting on eating and then helping her mind to heal once she is weight restored, won’t work for L, then I refuse to let her stay unwell. She can’t want to be well, because she thinks she already is.
We agree she will stay until Monday, for thinking time and for her to keep trying. She worries that the Boyfriend will hate her if she doesn’t come home. But nor does she want to stay. She doesn’t want either of the options, she just wants everyone to leave her alone. Because she’s fine, just fine. She tells me this as she sobs.
If she completes all meals she will get leave. But tonight, a text from her hints she hasn’t eaten tea. My heart sinks. I can’t wait for her to want to be well.