European Eating Disorders Review
Eur. Eat. Disorders Rev. 10, 153 ꢀ2002)
DOI: 10.1002/erv.462
Winding Up
Leap of Faith
Growing up is a dif®cult business. ꢀIfound it so, anyway. Still do,
actually). The process of maturation is a journey from relative depend-
ence to relative independence, often with variable but increasing con®-
dence chasing a moving target of expectation. Eating disorders usually
start in the midst of this process. They arguably arise out of it in some
sense and certainly complicate it. Our services have to straddle this gap
between child and adult. They do so rather uncomfortably at times.
At the child end, our patients are seen as individuals but as operating
in a necessary context of parents or other caregivers. If push comes to
shove, the child is not the only person with rights and responsibilities.
With adults, the patient may still be viewed in the context of her
relationships with others but she is now responsible for herself. Others
cannot call the shots except perhaps in extremis. The two sides of the
divide are clear enough but that may not help the individual sufferer in
the midst of the transition.
Services usually have either a `child' or an `adult' emphasis. On each
side the crucial issues of responsibility are managed differently. This
re¯ects real life and the solution of having `young people's services' may
have merit but only if there is a notable ¯exibility of approach within the
service. More often such ¯exibility needs to be enacted between services.
Iwork with adultsÐor over 16s anyway. Sometimes Ihave to try
hard to resist having a jaundiced view of the practice of those who work
with children and adolescents. This is because any patients of theirs
whom Isee are likely to be `graduating' to the adult service because they
have not done well. Ido not see those who do well. To come into land in
a clearly adult service sometimes provides a useful fresh start. But
usually it is just dif®cult for the young patient, for the parentsÐand for
us. The irritating part for us clinicians is that it is we who have to be so
balanced and mature and see all sides and . . . all that grown-up stuff.
After all, we know that we have the easiest end of it. However, there is
nothing like a troublesome late adolescent for making one feelÐwell,
adolescent, really. Personally, Ihave a drink, slump in front of the
television and grunt if anyone comes near. Iam very grown up.
Bob Palmer
European Eating Disorders Review
Copyright # 2002 John Wiley & Sons, Ltd and Eating Disorders Association.
10ꢀ2), 153 ꢀ2002)
Riemschneider
