The view from France

A report from France. Interesting to compare and contrast. The red highlighting is mine:

"I thought you might be interested in our story, from the other side of the Atlantic. We live in France and our 12-year-old daughter began her anorexia freefall in November. As her condition was complicated by increasing thoughts of self-destruction and by a pre-existing explosive-anger issue, we came to the conclusion that our attempts at home-based refeeding could not work for us at this time; despite occasional "victories" at the table, we were fast losing the overall war; we had to get her into a hospital, and quickly, to save her life.

Last week we were very lucky to find an opening at the Hôpital Robert Debré, a progressive public children's hospital in Paris. They have an anorexia unit with 13 beds. Unlike other hospitals in France, they do not believe in "parentectomy". They argue that it's both cruel and unhelpful, a vestige of dark-ages psychiatry. As our psychiatrist put it, "the family is rarely the cause of anorexia, but is very often the solution."

However, visitation and contact with family are counted highly among the privileges that are accorded when the child manages to fulfill her "contract" by finishing her plate (100%) each meal (the week's meals--items and quantity--are agreed to in advance with the child, so there is never a surprise). If the patient can't finish, she is offered an equivalent amount of calories in a drink form; if that is refused, the feeding tube is imposed. If she manages to live up to her side of the bargain she will be able to maintain contact with us 5 days a week (phone calls Tuesday and Thursday; visitation Wednesday, Saturday and Sunday afternoons.) Meanwhile, we are invited to call in for daily updates and we can talk to her doctors directly at any time. The hospital treats anorexia both medically and psychologically. In the first few days she has received full blood analysis, EKG, a brain scan and an EEG. Her heart is monitored every night. The unit provides a tandem team of psychiatrists--one specifically for anorexia, the other for more general issues (depression, anger, etc). They also have a family therapist on the team who will meet with our family regularly to help get us back on our feet and to prepare for the period after hospitalization.

During the hospitalization period, which may last 3 months or more--the children are able to continue their education. The unit has a fully equipped classroom; a team of middle-school teachers arrives every day to run classes for the kids (after consulting with their respective schools to insure continuity in their respective educational programs). Maintaining school is an integral part of the therapy. As anorexics are usually, by definition, high-performing kids, it was explained that the last thing they need is the added stress of worrying that they will fall behind because of their illness.

The cost of all this? The hospital fees come to about 1000€/day (about $1,450), but it is covered 100% by our universal national health insurance, which is offered to everyone (paid for by mandatory employee-employer contributions, or, if the person is unemployed, by welfare). So will this program prove effective? We don't know but the initial signs are positive.

Our daughter has been succeeding at her 1000-cal/day targets since being admitted--triple what she managed to take in at home--and apparently without a fight (at least visibly). She has a very long way to go to build back from her current 64 pounds, but we have reason to be optimistic. Of course, we recognize that we will need to ultimately move into some version of a home-based therapy down the line. You may wish to pass our story on to your readers."


  1. The sounds much like to program we have been using through the Mayo Clinic, with great success. One of the keys for us has been having the child choose her own food, complete with calorie counts. Hiding this from her was very counterproductive since the nutritionist-defined food groups were arbitrary and counterintuitive.

    Programs like this help rebuild trust between child and parent and help the child to grow up and out of the disease with self esteem intact.

    We wish there were more of these programs!


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