It's not antithetical in a lot of instances, to temporarily hand over autonomy and agency. That's the basis for a lot of recovery from a lot of things. The goal is to get to where one does have those things, but that doesn't mean the first step to getting there isn't to give them up initially. Especially when people are in serious, serious danger of death. Stabilization first and then reassess.
The concept that there's "always time." People get really upset about losing any "gains" from compulsive behaviour (exercise endurance, weight), or like when you "interfere" with someone's suicide plan by hospitalization.
However, a lot of people, as described in the scenario around privileges, etc, will end up "playing ball" because they have to. They recognize that the only way to get their autonomy back (discharge) might be to eat the food, gain the weight, attend the therapy, take the antidepressants, whatever. Surely no one thinks that initially the ED patient that is finishing their plate to get the privilege of an Ipad is turning over a new leaf to choosing to do so at home.
I think it relates to insight, to some extent. The deeper you are in the thralls of illness, the harder it is to recognize it. I said earlier, that a lot of times nothing you do will make someone wake up and smell the crazy. That's not always exactly true.
In any case, *sometimes* the more that is done to get someone well, even if they're just going to group therapy on the inpatient wards thinking this is total BS but I want my phone call, or finishing their meals to more quickly get a DC so they can go home and lose all the weight and then some, is that some of these things start to work for patients despite themselves. Sometimes if they get the push towards what it is healthier, it will start to take.
I hate to say in some ways it's analogous to children. Like, you have to make them do things for their own good a lot of the time. Growth is partly where they start to recognize this and no longer have to be forced. It's more complicated in what we're discussing for a lot of reasons. Point still stands that often you have to get over a degree of resistance to see change, and the fact that it is external forces overcoming the resistance, doesn't mean that it won't be an internal choice to then maintain that change.
Personally, I love to be told to do what's good for me. I benefit enormously.
No, not to be tongue-in-cheek, but while it can be maladaptive, sometimes it is healing and not at all unhealthy or abnormal the need for this. That's not to say a disorder causing this need isn't a problem, just that the need/reaction in itself isn't necessarily the issue. Sometimes people can't manage themselves and need to not be responsible for themselves or make decisions, even if they aren't consciously aware of this or choosing to do so. And actually, even better if someone does recognize when they are in this situation and choose that kind of help when it is needed. Even if they don't, that doesn't make it any less therapeutic.
Someone very close to me who is themselves in healthcare, has struggled for decades with a severe ED and relapses, and hospitalizations. According to them, to what degree as a patient you are focused on weight, portions, etc etc changes depending on where you are at in recovery (as described here by the physicians with inpt ED tx). However outpt that can change substantially. Far from weight focus, after discharge, and in the setting of pregnancy, they never weighed themselves or looked at the scale. Their providers did this, and basically the idea was that they would only be informed if things needed a change. As far as diet, as I understand it, there was significant structure inpatient, but then education to help teach them how to eat in a way that was meant to avoid obsession and falling back into dysfunctional ways of relating to food. I know it varies depending on the individual patient and their patterns. For them, an absolute restriction on exercise was put in place (ie not more than is considered healthy for them). They were not to think in terms of "calories" but instead had meal goals designed to ensure they met their nutritional needs. This was more centered around food choices and portions. For one thing, I know that there was a goal for fruits and vegetables, and that they were allowed "unlimited" amounts of healthy vegetables, for example. Frankly, from what I know, there are a lot of things supporting this approach to food in people not only looking to maintain a healthy weight, but also to lose weight to be healthy. I think there's more evidence for a food choice/portion control/meal goal strategy than strict calorie counting.
