“It’s dangerous to feel empty inside. If you’re feeling empty for too long, you start to believe that you are empty and the world is empty too. And if everything is empty, then what’s the point of living?” Tara Richards age 18
“The meaning of life.”
This phrase is used a lot in the field of Positive Psychology. It is a phrase that scares many people, especially those who struggle with mental illness - people like me, who feel this nagging emptiness and long for something to fill us up, to make life purposeful again.
I believe that we are not asking ourselves the right questions to cure what we think are our hollow beings. So often, we think “what SHOULD I do with my life”? This question suggests that we are turning to others in the world to make meaning for us instead of us creating meaning for ourselves.
Evidence has shown that having meaning in life actually boosts mental health and encourages feelings of connectedness to others. So, let’s think about our practice at Ontario Shores. How can we help our patients find meaning in their lives - without creating this for them? The answer to the question of meaning is in all of us to find.
In recent months, the Canadian Institute for Health Information (CIHI) has released two very interesting reports. The first report is about the growth in bariatric surgery in Canada. I talked about this in my last blog. The second report on the use of hospital care for the treatment of eating disorders will be my focus today. Once again, this report is easy to misinterpret, without some context or understanding of the system. Taken at face value, it would be logical to assume that the need for obesity treatment is ten times greater than the need for eating disorder treatment and that in fact eating disorders are truly rare and rarely lead to the use of urgent care options in our system, such as the emergency department. This is absolutely wrong. To understand why, we need to take a closer look at the data.
According to CIHI, the total number of admissions to hospital (one person could have multiple admissions and each would count as a separate admission) was just over 1,500 admissions to hospital for the treatment of an eating disorder with an average stay of just over a month in 2012-2013. This represents a small increase from 2006-2007, when there were 1,300 admissions for the same reason across Canada. The total number of admissions across Canada and across all ages seems to confirm that it is a rare disorder. In a country of over 33 million people, this would suggest that less than 0.005% of the population had an eating disorder that required an inpatient treatment.
However, there is a flaw in this interpretation. In most of the country, patients, even those with severe and life-threatening eating disorders, are only admitted to “eating disorder beds” that are few and far between. They are not admitted anywhere else. It is not unusual for someone to die because of the delay in access to treatment, including medical treatment. This means that Canadians with eating disorders who have life threatening medical complications are not admitted anywhere, not even medical units for treatment. They are expected to wait as an outpatient until an “eating disorder bed” opens up. This can take months. So what the CIHI data reflects is not the numbers of Canadians requiring admission to hospitals across Canada, but rather the number of spaces the various provincial governments and/or health care systems have allowed Canadians with eating disorders to access for any reason.
In recent months, the Canadian Institute for Health Information (CIHI) has released two very interesting reports. The first report is on the growth rate of bariatric surgery in Canada and the second is on the use of hospital care for the treatment of eating disorders. The reports are interesting for what they tell us and what they do not.
Reading the reports together would lead one to think that the need for obesity treatment is ten times greater than the need for eating disorder treatment. It would seem a matter of fact that obesity is rife with medical problems and that the “cure”, bariatric surgery is safe and improves the health and quality of life for those who access the treatment. While on the other hand, eating disorders seem rare and rarely lead to the use of urgent care options in our system, such as the emergency department. We need to analyze the reports very carefully to understand what they are really saying.
First, let us look at the report on bariatric surgery. Between 2006 and 2013, the number of bariatric surgeries performed increased by 280% (from approximately 1500 to 6000 surgeries) annually. In the report, CIHI seems to act as both cheerleader and apologist for these surgical procedures. The assumption that these procedures are beneficial and necessary is never questioned, in spite of the data presented. It should be concerning that the majority (80%) of patients are middle aged women, but this is explained away by the statement that there are more women with class II and class III obesity (this statement is made despite the fact that BMI of patients undergoing these procedures was not available and so we cannot know if all the patients did in fact fall into those BMI categories).