Slender man incident

[heartsink]

Surprised I hadn't found a thread on this forum mentioning this case but surely its well known by now:

http://news.msn.com/crime-justice/judge-halts-proceedings-in-child-stabbing-case?

I've been following articles on this story and several have mentioned psychologists being involved in testimony and assessment, but never psychiatrists per se.

Is this likely due to general public ignorance of the distinction between the two, or might there really be no place for a psychiatrist to be involved in this case?

Particularly interested to hear what @whopper thinks about this

 

[whopper]

I've only read the headlines and haven't given this the type of intellectual investment (yet) that should be given for me to make a comment without adding a disclaimer that I don't know what I'm talking about! A lot of that is due to me settling into a new job. I'll try to give this a look soon.

 

[whopper]

Still don't know enough to really talk about it but read up on Slender Man.

Here's what I can say and I'm still attaching the caveat that I don't know what's going on in the specific case.

Slender-Man apparently has become a modern folklore, like a modern-day equivalent of Paul Bunyan though Bunyan is a good guy. Slender Man is a boogey man.

Kids hurting others due to some cultural reason is nothing new. It's happened throughout history. Just like Joseph Campbell wrote in Hero with a Thousand Faces, a new character might come into play such as Luke Skywalker but he really is the same entity from other previous cultures such as King David, Greek heroes and such. The hero (or villian) really is the same fundamental force at play just with a different face for the newest generation.

The cultural impact is important. We psychiatrists are supposed to understand the culture behind what is going on. Slender Man has apparently become a new phenomenon that is appealing to the public on level given that it's gone viral and has developed a following. Several psychiatrists are out-of-touch and never heard of Two Girls One Cup, the trend in the South of radical 2nd Amendment backers to show up armed with an assault rifle to a restaurant and subtly intimidate people while no one can do anything because it's not illegal, branding of candidates in African-American fraternities, sodomization in Hispanic fraternities, the self-sovereign movement, or even things that are common such as owning a gun because as a whole we tend to be in a culture with our own biases (hyper educated, financially well-off). If one doesn't know about Slender Man and had a case involving it, the doctor ought to look it up and research it before coming to any conclusions.

The legal problem apparently from the article is competency to stand trial. One cannot go to trial if found not competent to stand trial. The standard without using exact quotations from the landmark case Dusky v. United States is competence to proceed was defined by the court as the defendant's ability to consult rationally with an attorney to aid in his own defense and to have a rational and factual understanding of the charges.

So one could be mentally ill and still proceed to trial if he understands what is going on, can rationally consult with an attorney, aid in his defense and rationally and factually understand the charges. E.g. a sober alcohol abuse defendant, a mildly depressed defendant, etc. Someone capable of defending themselves but choosing not to do so (e.g. a malingering defendant that can speak but refuses hoping it'll make the court think he's schizophrenic) is still competent to proceed.

It's when one's mental illness is on a worse extreme to the degree where it robs the person of their ability to think rationally and understand the court process where one could be found not competent. A more likely dx that fits this bill would be disorganized schizophrena, or a manic defendant convinced that the judge, jury, and his lawyer wants to sleep with him so during the trial will make sexual advances on all of them.

Is this child competent? I have no idea and cannot answer that question without doing a thorough investigation. This could be done by a psychologist or psychiatrist. Psychologists as a whole tend to be better in cases where testing may be needed, psychiatrists tend to be better in cases involving complex pharmacological interventions. That statement is based on experience not from any studies I've seen but I think it's quite apparent why because of the different training we receive. It's always a good idea as a forensic psychiatrist (or even as a clinical one) to have a partner psychologist work with you if you ever need the other's services. I have and so has one of my mentors-a psychologist who occasionally would call me up and ask my opinion on a case or knock on my office door since it was just a few doors down (I miss the guy).

A child of her age could be suffering from early-onset psychosis, or be caught in some type of imaginative world that can also happen in children. Distinguishing between the two could be very difficult. It could be something completely different as well. Again I only know what the news reports and haven't investigated the case to truly be able to say anything substantive about it.

Another point that could be useful to students is child forensic psychiatry is very very different vs adult forensic psychiatry. It's for this reason that forensic fellowships require a child psychiatrist to be on faculty. For example if a 5 year old child is molested, and the perpetrator caught and put on trial, in the US Constitution, the defendant has the right to face his accuser even if it's a child. The defendant and his lawyer could devise a strategy to intimidate the accuser by making dirty looks at the child who could be suffering from PTSD, causing the child to fall apart in court if placed on the witness stand. Another confusing aspect is child testimony is highly inconsistent and malleable by the interviewer, making evaluations of children even more difficult. One should not simply be a forensic psychiatrist without good child training to do this type of work. In the case of minors, it's not considered a trial but a "hearing." Reason why are children are put in a legal category where the state is supposed to help them despite that the consequences could seem like anything but that (a local juvenile detention center had a nickname of "gladiator school"). For that reason, child hearings don't have a "title of "State of Whatever vs. Little kid." Kids could be tried as adults if they committed a serious offense based on the laws of the specific locality.

 

[PistolPete]

Wow. Never heard of this "Slender Man" amongst my child and adolescent patients. Thanks for the article.

 

[whopper]

An interesting tidbit about Slender Man is that it's folklore. There's no canon. It started as a post in a forum with a pic, it went viral and people started making their own Slender Man fiction contributions without any person owning it saying it was canon or not.

In a case like that, that only makes it more difficult to tell what's going on. For example if someone told me they were a Star Trek fan and loved the original captain, Jean Luc Picard, then I tell the person Capt. Kirk was the original and they disagree, I know they aren't a real Trek fan or something's mentally going on with them. With a folklore topic, whatever the person says, you can't nail it down as correct or not.

 

[Ceke2002]

An interesting tidbit about Slender Man is that it's folklore. There's no canon. It started as a post in a forum with a pic, it went viral and people started making their own Slender Man fiction contributions without any person owning it saying it was canon or not.

In a case like that, that only makes it more difficult to tell what's going on. For example if someone told me they were a Star Trek fan and loved the original captain, Jean Luc Picard, then I tell the person Capt. Kirk was the original and they disagree, I know they aren't a real Trek fan or something's mentally going on with them. With a folklore topic, whatever the person says, you can't nail it down as correct or not.

Yep, far as I remember Slenderman started as a picture post on Something Awful forums as part of their 'creepypasta' section.. He's gone beyond just a simple image, he features in stories, videos, etc etc, the character went on to end up with an entire mythos surrounding it (which varies depending on who you read or talk to. Creepypasta itself is a sort of internet subculture devoted to all things creepy and terrifying - ghost stories, horror, monsters, creepy images, and so on.

Here's one example of the Slenderman Mythos (includes links to early appearances/creations of the character):

http://creepypasta.wikia.com/wiki/The_Slender_Man

Has anyone come across Anamadim in any of their Eating Disorder patients? Or is that a little too early to mid 2000's? I remember that was the big thing among the teenage (predominantly) 'Pro Anorexia' movement back around 2002-2005. Anamadim is a made up 'Goddess of anorexia', with an entire ritual for summoning or evoking her, which was at least partly based on occult rituals of groups such as the Hermetic Order of the Golden Dawn. Yes I'm sure they were just tickled pink to find out a bunch of teenage anorexics were utilising aspects of their belief system to try and call forth a 'Goddess of Anorexia'. Among some of the Xanaga groups especially it wasn't uncommon for people to have entire altars dedicated to 'Anamadim'. I think she fell out of favour when people started realising that ritually evoking a made up Anorexia Goddess wasn't really going to grant any sort of magical immunity from death or serious illness - "Holy sheet, what do you mean three of my friends have died in the last month? But we did all the rituals properly"...Ah, yeah, no.

Here's the entire summoning ritual in full, just out of interest.

http://ana-gracilis.tripod.com/id4.html

 

[Shikima]

Who knows what you can find out from the deep, dark webs of the innerwebz.

 

[whopper]

I never read up on the case but a few years ago a psychiatrist was asked as an expert witness in court whether or not inmates should be allowed to play Dungeons and Dragons. I'm not joking about the case. It made the NY Times among several other news outlets. The prison argued no because it promotes gang behavior. (Hmm a bunch of nerds in prison doing nerdy things? Oh no!)

OK, I never read the case and found it so I will read up on it but there is where culture becomes important. You as a doctor could be called as an expert witness to give opinions on such matters.
http://caselaw.findlaw.com/us-7th-circuit/1498113.html

Anamadim? Never heard of this until you mentioned it. Again, another example of a situation where a clinician should try to read up and understand the psychosocial implications of this cultural phenomenon.

 

[slappy]

...if someone told me they were a Star Trek fan and loved the original captain, Jean Luc Picard, then I tell the person Capt. Kirk was the original and they disagree, I know they aren't a real Trek fan or something's mentally going on with them.

You're such a nerd.

 

[whopper]

I'm a nerd with a hot wife. I think the LASIK, going to the gym, and having been in a fraternity makes me not seem like one on the surface. A buddy of mine when I worked at U of Cincinnati-he was a geek at heart too, handsome, good build, guitarist in a real band that did concerts, had groupies, but we'd hang out and talk about comics and superhero movies all the time.

 

[Ceke2002]

Anamadim? Never heard of this until you mentioned it. Again, another example of a situation where a clinician should try to read up and understand the psychosocial implications of this cultural phenomenon.

I missed this before. The history of the so called 'Pro Ana' (or 'Pro Anorexia') movement is a fairly interesting one. Starting from probably around 1998/99 and extending through to approximately 2004/05 you had what I would call the 'first wave' of the Pro Anorexia movement. The first wave basically believed that what they were doing was a 'lifestyle', or what they sometimes termed an 'anorectic praxis', and strongly disassociated themselves from what some termed 'medical anorexics' (somewhat ironically in the first wave incarnation of the movement if you actually developed or had anorexia nervosa that meant you had actually failed big time at being 'Pro Anorexic'). From around 2003 to 2006 I was involved in a loose affiliation of eating disorder bloggers, in various stages of recovery, who tried to act as peer support and online outreach persons to people we saw as being 'at risk' - not to replace professional help, but to encourage early intervention and entry to treatment programs. Sometimes we were successful, and it was always cool to see young teens especially go from being all 'bonez for lyfe yo!' (imagine that typed in alternating caps) to being fully engaged in the treatment process and getting better (we kept in touch with anyone in treatment or recovery and acted as mentors/cheer leaders/all round recovery pep squad patrol etc to them where appropriate.) Other times though, well let's just say our attempts to establish any sort of dialogue wasn't exactly well received (and usually resulted in profanity laden responses with the added caveat that just because we had lost control and failed at our 'anorexia praxis', don't be coming after them....(followed by about a hundred or so emails now informing you of your apparent status as a female dog with obvious developmental deficits, complete with instructions on how to rectally insert your own words and the computer screen they rode in on).

Running sort of opposite but parallel to the 'Pro Anorexia' movement in the first wave years was what many termed (and still do) the 'Pro Support' groups. These were groups that rejected the idea of any eating disorder being a 'lifestyle' choice or 'praxis', and fully accepted they were life threatening psychiatric conditions - but who also gave the term 'support' a bit too wide a scope in its meaning. So they ran the full gamut from people in active recovery, to those considering it, right through to those who were adamant at remaining enmeshed in their condition regardless of consequences and could someone please teach them some tricks of the trade to fool their parents/friends/therapist/hospital treatment program/other concerned parties (Hiding food 101? Sure, scroll down, first forum on your right, second thread to the left, have a nice day). The 'Pro Support' groups were partly in response to the 'Pro Anorexic' groups but also a bit of a backlash against the 'Pro Recovery' groups around at the time that were extremely regulated to the point that a lot of sufferers felt they lost any potential support they were actually meant to have.

Fast forward to around 2005 and the Pro Anorexia movement was seriously in decline, and we're entering what I call the 'second wave' of online eating disorder support groups. Unfortunately as many 'Pro Ana' communities eventually discovered for themselves, people actually die of this condition, and seeing your friends dropping dead left, right and centre makes it ever so increasingly difficult to continue waving the 'Eff off, we're not sick' banner. The Pro Support forums also began a gradual modification of their approach for much the same reason (and these are groups that are extremely close knit, with many establishing friendships and support networks stretching back more than a decade from current time, so when a member passes away it tends to hit pretty hard). In the current age the vast majority of 'Pro Anorexic' groups, at least the way they were defined in the first wave moment, are no longer in existence, and the 'Pro Support' groups have pushed further and further into treatment and recovery advocacy with a major overhaul of how they operate.

 

[whopper]

Adding to what you mentioned about the pro-anorexia movement, there's also an emerging self-asphyxiation culture with some studies showing as many as about 10% of children at least trying it.
http://www.uptodate.com/contents/th...lation-activities-in-children-and-adolescents
This is something that several attendings have no idea is going on.

Virginity pledges appear to increase anal sex
http://www.webmd.com/sexual-conditions/news/20050322/virginity-pledges-dont-cut-std-rates

Internet self-cutting forums exist and are teaching young people to experiment with it.

Getting to the point there's a heck of a lot of stuff out there that a psychiatrist could flippantly or even well-intentionally dismiss without a good understanding of it. The self-sovereign movement is causing major headaches in courts and many psychiatrists flippantly attribute it to psychosis when in fact it's a subculture of extreme right-wingers.

 

[Ceke2002]

Adding to what you mentioned about the pro-anorexia movement, there's also an emerging self-asphyxiation culture with some studies showing as many as about 10% of children at least trying it.
http://www.uptodate.com/contents/th...lation-activities-in-children-and-adolescents
This is something that several attendings have no idea is going on.

Virginity pledges appear to increase anal sex
http://www.webmd.com/sexual-conditions/news/20050322/virginity-pledges-dont-cut-std-rates

Internet self-cutting forums exist and are teaching young people to experiment with it.

Getting to the point there's a heck of a lot of stuff out there that a psychiatrist could flippantly or even well-intentionally dismiss without a good understanding of it. The self-sovereign movement is causing major headaches in courts and many psychiatrists flippantly attribute it to psychosis when in fact it's a subculture of extreme right-wingers.

I'm really surprised at the attendings that don't know about the asphyxiation game. That's been around for decades. I can remember stupidly playing a variant of it back in the 80s (hyperventilating instead of choking, but the desired result was pretty much the same - to pass out/experience an altered state of consciousness).

I haven't personally delved too far into the online subculture of cutting, except in a support environment. From the little I have seen, there does seem to be two distinct groups - the pro self injurers for whom self injury seems to be more a fetish and/or a way to get an endorphin rush they find pleasurable (these seem to be the ones most likely to encourage others to try it out) and the pro self injurers who accept that it's a negative coping mechanism, but if it's the only coping mechanism a person has, then it shouldn't be forcibly taken away from them if they're not ready to give it up.

Patient involvement in certain forums and/or groups shouldn't be automatically dismissed as entirely negative either, even groups that have content that some might find questionable. There does seem to be a bit of a knee jerk reaction wherein if a group is not 110% committed to the pursuit of recovery at all times, then that immediately relegates them to the realm of bad, or evil, or somehow 'preying' on the impressionable. I know one so called 'Pro Eating Disorder Recovery' group that was so strict in keeping everyone what they deemed to be 'on track', that you couldn't even mention having a negative emotion, let alone ask for help in dealing with it, because you'd be berated for bringing the 'positivity' of the group down. Obviously on the other side of that the type of 'Pro Anorexia/Pro Eating Disorder' groups that have been around in the past (there are a few left here and there, but nowhere near to what they used to be) aren't exactly ticking too many boxes in the 'yes' column either, but at the same time I don't think that should necessarily mean we throw the baby out with the bathwater and tag *all* support forums as being negative if they don't fit within a very limited ideal. The support group I've been involved with since 2002 was originally very open with what it allowed in terms of discussion, but I still credit it with my being in recovery today, and that's even with all of the triggering content that was available on there at the time (over the years, especially with more and more members entering treatment programs, and also sadly seeing the long term effects of Eating Disorders, including deaths of members, the focus has shifted a lot more towards health and recovery). I won't go into detail regarding my exact situation, as it isn't appropriate, but let's just say the combination of knowing I'd receive support regardless, and being exposed, without expectations or judgement, to other members who were in recovery ended up tipping me from 'no way in hell' to 'well okay, how about we just try this out for a few months and see what happens'. When I say 'support regardless' as well, I don't mean support in a sense of literally supporting someone to their death. Interventions have been, and do get staged, including letters and phone calls to parents being placed, and print outs of a member's posts being sent to their treatment team to let them know 'hey, person so and so is telling you one thing, here's what they've been telling us'. Naturally when interventions happen the person on the receiving end is never happy about it, but so far not one of them hasn't returned to eventually say thank you. And then you also have the aspect that those who are recovered, or further along in the recovery process, will tend to act as a support network/mentoring program for those who are just entering treatment. We've already been there, most of what they're going through we're familiar with, so we're able to talk them through a lot of stuff, give them different ideas on healthy coping mechanisms, encourage them to be open with their treatment team, and so on.

Obviously an online support group isn't a replacement for professional treatment, but I think there is some scope for these groups to be used as another treatment 'tool', instead of being dismissed offhand. I've lost far too many friends over the years so I'm all for finding anything that works, especially if it helps reduce further harm.

 

[Promethean]

Has anyone come across Anamadim in any of their Eating Disorder patients?

I followed Pro-Ana very closely, having a loved one who was deeply involved in many of those sites...

"Anamadim" is a relatively uncommon name for the entity that pro-ana folks use to personify their disorders. Not saying that isn't used, but more common is "Ana" for anorexia and "Mia" for bulimia. ED patients describe using these names as alibis when talking with family. "I'm not hungry. I had lunch with Ana today."

Anyone who treats eating disorders needs to take at least a few hours to check out these sites. There are hundreds of forums and tip sites. Google pro-ana or thinspiration to find them. You will find many of your patients there, trading tips and tricks to outwit your best efforts to help them.

 

[Ceke2002]

I followed Pro-Ana very closely, having a loved one who was deeply involved in many of those sites...

"Anamadim" is a relatively uncommon name for the entity that pro-ana folks use to personify their disorders. Not saying that isn't used, but more common is "Ana" for anorexia and "Mia" for bulimia. ED patients describe using these names as alibis when talking with family. "I'm not hungry. I had lunch with Ana today."

Anyone who treats eating disorders needs to take at least a few hours to check out these sites. There are hundreds of forums and tip sites. Google pro-ana or thinspiration to find them. You will find many of your patients there, trading tips and tricks to outwit your best efforts to help them.

Yes, Ana for Anorexia, Mia for Bulimia and then there was Betty and Chloe for Binge Eating Disorder and Compulsive Over Eating, but those didn't really catch on. In 12 years of being involved with both ED support sites, and trying to get people away from destructive 'Pro Ana' sites, not once have I seen the term 'Ana' being used as an alibi for not eating - unless you actually have a friend named Ana, saying to someone 'It's okay, I already ate with Ana' I would expect would lead to the obvious question 'Who's Ana??' I have seen similar statements used in a semi sarcastic manner to express frustration about their illness, for example, 'Well I was planning to have lunch today, until Ana showed up'. The use of names to personify an Eating Disorder isn't exactly a new thing either, I named my Anorexia 'Anna' back in the 80s, and I know a lot of people from support groups back then who did the same. As a teenager 'Anna' was the 'friend who kept me safe' and part of the therapy work I now do for the remaining aspects of my Eating Disorder involves a degree of acceptance and even gratitude for the fact that although it was ultimately destructive, 'Anna' was still a coping mechanism for me, and it was one of the only ones I had at that time - accept that it's there, accept that it was/is a coping mechanism, look at it with compassion, and then let go with the reminder that what once was a necessary emotional survival skill is no longer needed. The first time my Psychiatrist went through that process with me I think I looked at him like he'd just grown another head.

I did re-personify my illness many, many years after being a teenager (in the first few years of my involvement in ED support groups, and in the subsequent early stages of recovery). There is a saying by Sally Kempton, which often appears on mental health support forums, 'How do you fight an enemy who has outposts in your head'. Well for some people personifying their Eating Disorder with a name such as 'Ana' or 'Mia' (Eddie's another one that is used sometimes) gives them something concrete to fight against. One should never assume that if a person or patient is using terms like 'Ana' that they are automatically using it in the context of being 'Pro Ana' and are looking at ways to fight treatment at every turn. I'm far enough into recovery now that I no longer need to personify my Eating Disorder with a separate name and identity, but in those early stages it helped.

Of course I'm not saying that destructive sites where the illness(es) are personified as something positive, don't still exist; however you will find that those resembling the first wave movement of 'Pro Anorexia' are nowhere near as prevalent, or well organised these days. Those that do still exist have migrated to other platforms, and if you read some of the responses to what they are putting out there, most of them aren't in favour or agreement at all. I left the recovery advocacy work I was doing a number of years ago to concentrate on my own recovery, but there are still people out there who do attempt to establish a positive dialogue with these (typically) girls and encourage them towards treatment. And for every 10 or 20 comments they get in return telling them to 'eff off' there's always that one voice that speaks up and says 'How do I get treatment?' That's one of the main reasons I'm actually against the banning of so called 'Pro Ana' sites. Banning these sites isn't going to magically make the problem disappear, and it just means advocacy groups can't access these girls as easily and (hopefully) move them towards accepting recovery. As for tips and tricks being given to outwit treatment programs, that did use to occur on the support site I'm a member of, although these days it happens far more rarely. There are other sites out there; however, that are more in line with what the original support groups were like going back a decade or so ago, where such questions are asked on a more regular basis, but again if you look at the progression of responses for every five negative replies a post of this ilk might receive invariably there'll be one member who speaks up and asks why they are trying to sabotage treatment, and then another will speak up, and another, and another, and so on. And then what started out as a 'please help me trick my therapist' post, eventually morphs into the person admitting their fears surrounding the treatment process and affords other members who are also in treatment the opportunity to talk the person through some of their fears with the hope of keeping them on track. Those sorts of conversations might never happen if it weren't for the fact that an individual was allowed to speak or express themselves openly in the first place. I'm definitely not saying these sites can't be an extremely toxic influence at times, and there are some people who do become further enmeshed in their disorder(s) because of their involvement in these types of groups, but again in the majority of these cases it tends to follow a very specific pattern that as soon as a persons behaviours are challenged, or concern is expressed for their welfare (believe me, no one in any of these groups ever wants to see a member die) their immediate response is to pack up shop and go somewhere else (with many of them just continuously moving from one group to the next).

Just personally I don't think there's any easy answer or one way only to approach or look at these sorts of groups. It's very easy to stamp them all with the label of 'destructive' but in my opinion, and experience, that's taking far too simplistic an approach. For some their involvement is both negative and ultimately destructive, for others the groups are a lifeline (quite literally in certain cases - at least one member of the support group I'm involved with had their life saved when an organised intervention was held, wherein contact with the person's parents was made and a full account of everything they'd kept hidden was handed over, resulting in an immediate emergency admission to hospital - at the time of that admission a full medical assessment indicated they were less than 48 hours away from dying, had they not been involved with the forum in the first place, and had their involvement not afforded people the opportunity to intervene when they did, they probably wouldn't be alive today). In both cases it does tend to be more what the individual is seeking, rather than the influence of the groups themselves (not always of course, but just as a general rule of thumb). For those who are looking to slip further down the rabbit hole, that's what they'll find and that's how they'll approach their own use of these types of groups (and like I said depending on the group's set up, they may find themselves moving from one group to the next in order to pursue their destructive goals), for those who are looking for support, and possibly a chance at treatment or recovery, that's what they will likely find and gravitate towards themselves.

I am very sorry to hear about your loved one being so deeply involved in what sounds like the destructive aspects of some of these sites. Depending on when they were utilising them I may have come into contact with them at some point during my days of recovery/treatment advocacy.

Just out of interest as well there's an article in the Journal of Eating Disorders regarding the success of mentorship programs. As I mentioned in my previous post there are support groups out there where a type of unofficial mentoring process occurs, with members who are recovered, or further along in the recovery process will take those newer to recovery and/or treatment under their wings and help them through the process.

http://www.jeatdisord.com/content/2/1/24

And while we're on the topic of support groups, I don't know if anyone on here, perhaps in the UK (??) is aware of the case of Jay Taylor, the B-eat (beat eating disorders UK) ambassador who died of heart failure last year.

http://www.dailymail.co.uk/femail/article-2405817/Facebook-tributes-Eating-Disorder-Association-ambassador-Jay-Walker-24-Newcastle-died-heart-failure-12-year-anorexia-battle.html

Jay was a member of our support group, and the word 'amazing' gets bandied around a lot in the media when people speak about her, but in Jay's case the term fits - she really was an amazing person. Unfortunately despite numerous hospital admissions, various attempts at treatment, being place on section, and all the support and encouragement towards wellness we tried our hardest to give her, she succumbed to her illness. She was loved by so many people and she is still incredibly missed, but shining a light in the dark if anyone happened to catch the 'Supersize vs Superskinny' episode where her story was featured, Jay's friend who also appeared in the episode, I'm very happy to report, is doing incredibly well and has just been accepted into a Mental Health Nursing degree, along with being involved in volunteer counselling and mentoring work with an Eating Disorders and Mental Health Advocacy group.

You can see the episode with Jay's story here (I think I have it set up so it should just play from that point to save people having to wade through the entire thing - I'm also assuming with the name of the YouTube Channel that this is from an official site and therefore doesn't contravene copyright as share options are in place).