14 March 2010

Anorexia, assisted-suicide and injustice

The Netherlands, late 1990s: A 48-year-old woman with a history of anorexia nervosa and depression approaches her doctor and tells him she wishes to die. Her anorexia is in remission; however, she continues to struggle with depression after both her mother and husband die. She says she fears her anorexia will return and asks for help under that country's assisted suicide laws. She is evaluated and months later a psychiatrist helps her kill herself.

In spite of the fact that neither anorexia nor depression are considered incurable illnesses.

In spite of the fact that most likely her depression was situational; i.e. she was grieving the recent loss of two loved ones.

In spite of the fact that mental health professionals consistently state that depression is one of the most treatable of all mental illnesses, and that there is a wide variety of treatment options ranging from medication to cognitive behavioral therapy to ECT available.

In spite of the fact specialists treating eating disorders — including my own doctor — stress that full recovery is possible.

The Dutch woman was four years older than me.

This case chills me to the bone. It speaks of the stigma of mental illness and the lack of understanding of eating disorders. It tells me that it is easier to kill people than to make an effort to treat them.

It makes me believe that perhaps I am expendable.

This case is an extreme example of injustice toward someone with anorexia. But what about the many other cases of injustice and stigma directed toward those with eating disorders?

Recently, I found out that I did not get a position because of my illness. I was told through a third-party there was concern because of my recent relapse and hospitalization, and questions about my stability in relation to that. It was hinted that some people didn't like the fact that I am "too open" about my illness.

As the facts unfold, I am convinced that I was not denied the position due to a lack of qualifications. I was denied the position because I have anorexia nervosa.

I will continue to believe my doctor that I can achieve full recovery from anorexia and create a life that includes my wonderful, loving husband, supportive friends, complete involvement in life and the fulfillment of my long-time dream of obtaining my master's degree in English.

I will not deny being afraid. I often fear I will not achieve full recovery from anorexia, that I will die of this illness. I still struggle every day to eat and create a life of healing and health for myself. I wake up some mornings wishing it would all go away, and that the pre-anorexic Angela would come back from wherever she might be hiding.

But I will not live my life filled with fear, and I will not hide behind anonymity. I will not become a 48-year-old woman who asks for help in killing myself because of my anorexia and depression, perhaps thinking it would be easier for others.

I have anorexia, and I will continue to look for the best possible ways to achieve full recovery. But I also am much more than my illness.  I will not believe I am — or anyone — is expendable.

(Footnote: "Physician-Assisted Suicide in Psychiatry: Developments in the Netherlands" includes the case study about the 48-year-old woman with anorexia and depression. The case itself received little attention in the Dutch press and the psychiatrist was not prosecuted for his role in the woman's death.)


Tiger said...

You are not expendable.

You are NOT expendable.

You are not expendable.

YOU are not expendable.

You, my dear Angela, are nowhere near expendable. Neither was the woman who killed herself. You can get better, even if, even when it is difficult.

lisalisa said...

thats horrible that that physician helped that lady kill herself! It's just ridiculous that he did not go to jail! You are right, both those illnesses are totally treatable. I know when a person is in the middle of it, it does not seem that things will ever improve. But that thinking is irrational, and the mind is clouded by the illness. That is why the doctor should have been the voice of reason, steering the woman towards treatments that would have improved her life! Not agreeing with her irrational thoughts! Arrg, obviously I am irritated by this. I suffer with severe depression that i take 5 meds for and have had ECT and everything and I would hate to think that in a moment of despair a doctor would sign off on me killing myself!

YOU, of course, are more than your illness. As long as you are alive there is hope. Believe it. The fact that you were turned down for the position because you have a mental illness is inexcusable. the fact that you are open about your illness is a service to everyone who suffers in silence. I'm sorry you were punished for it.

Eating Alone said...

Got to say it sucks. I too was not considered for a promotion to managment due to my "appearing" sick. Not that I was or had been diagnosed - I'm a binge eater and it morphed into EDNOS physically you could see something was way wrong. Any way I found out from the manager that they replaced that I was put up for it but they didn't think I could handle it. Instead they made me ass. manager so I get 90% of the stress but none of the real bennies. Got love corprate leaders. Oh and since I've lost the weight and look normal, now they are all very supportaive and making move him noises. Gotta love it because to get to normal I screwed up my body and mind so much I'm much worse than before. At least then I had the ED to provide coping skills. (RANT sorry)

I'm with you though. I don't use insurance because I don't want them to know I'm seeing a therapist. How insane is that? But you just proved the point.

Good luck sorry for the ubber long comment.

Jennifer said...

It is so very sad, and you are right, scary, when someone with "curable" psychological-based illnesses, is helped to die rather than be assisted in a recovery process which could heal the mind, and thus the physical body - resulting in a well person who did NOT NEED TO DIE.
As opposed to having an actual incurable physical illness.
Angela, i just wanted to also say THANKYOU for commenting on my blog and letting me know there are other women in 30s and 40s out there!!
It meant a great deal to me - i look forward to reading back through your blog.
Much love,
Jennifer xx

Jennifer said...

jennifer xxoo

Cathy (UK) said...

Hi Angela

I found your blog through Carrie's post today on ED Bites. You are the same age as me - 44 - and I thought I'd offer you a bit of hope by saying that recovery IS possible, even after many years of anorexia nervosa (AN).

I developed AN at age 11-12 yrs old and only started to recover at age 40 yrs. I never thought that recovery would be possible. But, I have gained over 30 pounds and managed to lose many of my ED thoughts + behaviours.

I do still have some difficulties: anxiety, OCD and an ASD, but life is so much better that it was...

AN is NOT (in my opinion) justification for assisted suicide.

Best wishes


Anonymous said...

that is a creepy case. sweetie you will get better, just make the decision, make the plan, clear your head on paper or in typing, and do it.

doing it is your choice. you can sit around all day coping with recovery and coping with AN, but it is your decision to make changes. you need to think you WILL do it, more than "i think i can" you need " i will" no questioning or beating around the bush.

you WILL do it, i believe in you

Telstaar said...

You know, I see both sides of this argument... I agree that its sooo sad that this was the outcome and it also fits in with the discussion about palliative care for eating disorders, anorexia in particular.

*oooh being vulnerable here*

I guess, lately, various things have been happening and if certain outcomes had occurred, then I was fully prepared to ask my counsellor to just walk beside me and be a support to me while I very potentially died. Yes, that is different to assisted suicide, but not so much. I am unsure if she'd have done it... but so often right now, it is just sooo hard. The fight has been so long and lonely and overwhelming. I just want to go home.

But the person that is SEPARATE from me, the clinician, friend, advocate in me... that person wants to fight for people and their full recover...that person is extremely saddened that people would allow such extreme measures, especially given the circumstances surrounding it all...

It is hard and sad.

I wish there were simple answers... I wish there were stages of treatment like there is for cancer with relatively predictable outcomes for each stage... I wish there was some way to figure this (recovery) all out...

*hugs* xo

Anonymous said...

thank you