Life After Recovery

Take Action JULY 9 to GAIN Insurance Coverage for EDs

Dear Friends,

If you want to help make a real difference in the fight against eating disorders, please read the action alert below, and Call your representatives in support of Mental Health Parity tomorrow, Wednesday, July 9!

Use your power!

Aimee

Message from: Kitty Westin, President
Eating Disorders Coalition for Research, Policy & Action

National Call-in Day for Mental Health Parity Wednesday July 9th! Your
help is urgently needed to help pass Mental Health Parity this session!

Here is a link to National Call-in Day Online Advocacy Action Center:

http://m1e.net/c?37976226-nbbjYUNEr29Iw%403446049-9qUWgB0ScpbPU

On the website you will see background information, a script for the call
and a tool you can use to punch in your zip code and get your Member of
Congress and Senator' names and phone numbers.

The US House of Representatives and the Senate negotiators have reached a
final agreement on all the remaining mental health and addiction parity
issues. However, approximately $4 billion over 10 years in offsets is
needed to pay for the bill and must be found before parity can be brought
to the floor in both chambers for final passage. Once an offset has been
found, there is commitment from leadership in the House and the Senate to
bring the bill up for a vote as quickly as possible.

Although House and Senate leaders have not decided yet where they will
find almost $4 billion over 10 years to pay for the cost offsets required
by Congressional rules, negotiations have successfully concluded on the
key policy provisions.  This compromise is the result of long negotiations
and advocacy of organizations all across the country. The compromise
includes many key provisions that were included in the House-passed bill,
the Paul Wellstone Mental Health and Addiction Equity Act and would be an
important step in ending insurance discrimination facing people with
addiction and mental illness. Here are some key points in the compromise:
- The compromise requires parity in insurance coverage for addiction and
mental health treatment for both in-network and out-of-network coverage.
This does not mean that the bill requires that insurers cover addiction
and mental services, only that if they do cover these services, there must
be parity with medical/surgical benefits.  This of course would be a very
positive development both in requiring fairness in insurance coverage and
taking a strong stand against discrimination toward people in recovery or
still suffering from addiction and mental illness. - The compromise
requires plans to disclose their medical necessity criteria and reasons
for any denials of coverage.  This would be a major breakthrough, as many
plans refuse to disclose medical necessity criteria or reasons for denial,
especially when addiction treatment is sought. - On the issue of
protection of state laws, the compromise bill language is silent.  The
House bill explicitly protected state laws, and in earlier versions the
Senate bill explicitly preempted state laws.  Silence is a victory for
those of us who agree with the House approach that state laws should be
protected, since in most situations Congress must take explicit action to
overrule a state law in order for state laws to be preempted. However, to
make protection of state laws even more ironclad, we will be working to
ensure that the legislative history of the bill makes clear that the
sponsors' intention is to protect all state laws.  That way, as important
as the passage of a federal parity law would be, stronger state laws would
remain in effect and states would be free to enact additional stronger
protections in the years to come.

Wednesday July 9th is National Call-in Day so please call your Member of
Congress and Senators on July 9th and tell them that now that an agreement
has been reached between the House and the Senate, Congress must find the
money to fund this historic mental health and addiction parity legislation
and pass parity now.
Thank you for supporting Mental Health Parity and for taking a few minutes
to make these important calls. With your help we can get this done!

WHAT’S DEATH GOT TO DO WITH IT?

Why don’t we talk about suicide when we talk about eating disorders?

That’s what I wanted to know when I learned of supermodel Ruslana Korshunova’s leap from her 9^th floor balcony in Manhattan last week. Authorities quickly deemed the 20-year-old’s death a suicide.  According to New York Magazine, “Korshunova felt confused about the direction of her life, lost several pounds, and seemed to suffer from an undefined stomach problem.” But she was also 5-foot-eight and wore a Size 4. What no one would say outright is that she was likely one of the 40% of high fashion models who, according to a 2007 investigation by the British Fashion Council, suffer from eating disorders.

Instead, coverage of Korshunov’s death pointed to prescription drugs, a demanding work schedule, an ex-boyfriend, and even conspiracy theories about the Russian mafia. "There's no way she would have killed herself," a friend from her home town in Kazakhstan told the New York Daily News. "She loved life so much."

Yet the London Telegraph quoted from Korshunova’s blog three months ago: "I'm so lost. Will I ever find myself?" This is not the voice of a cover girl at the top of her game; it is the voice of virtually every person who suffers from a serious eating disorder.

According to David Herzog, professor of psychiatry at Harvard Medical School and director of the Harris Center for Advocacy in Eating Disorders at Massachusetts General Hospital, anorexia nervosa not only has the highest mortality rate in general but also the highest successful suicide rate of any mental illness.

The overlap of eating disorders with depression, panic disorder, post-traumatic stress disorder, substance abuse or dependence, dramatic or erratic behavior, and self-harming behaviors, makes it difficult to tease out the exact role an eating disorder plays in suicidal behavior. What’s less debatable is the fact that a starved brain does not function like a normal brain.

When I was struggling with anorexia as a fashion model at the same age as Korshunova, a loud voice in my head played a continuous loop: “You’re never good enough. You don’t deserve to eat. You fat pig, push yourself harder. Harder! Why don’t you just die!”

That voice belonged to “ED,” as people in the eating disorders community today call their illness. It’s the same voice that prompted one young woman now in recovery to write me recently, “If I still have an eating disorder next year, I will be dead---because if it doesn't kill me I will kill myself--I'm NOT willing to go on living in this hell any longer.”

What people who trivialize eating disorders as “choices” or “diets” do not understand is that these diseases warp the mind. There is nothing rational about the thoughts of someone with anorexia or bulimia. These are existential illnesses that gradually conflate life with death, control with surrender.

Dr. Cynthia Bulik and colleagues at the eating disorders program at the University of North Carolina at Chapel Hill recently looked at patterns of attempted suicide among 413 mostly female subjects in the Genetics of Anorexia Nervosa Collaborative Study. Almost 17 percent of these women had made at least one suicide attempt between age 7 and 40. More than half of these attempts required medical attention.

Particularly revealing is the difference in rates depending on the type of eating disorder behavior. Women with “restricting anorexia nervosa” severely reduce their food intake but do not binge or purge. Just over 7 percent of this group had attempted suicide. Among those who restricted and also binged, purged, or involved laxative or diuretic abuse, the attempt rate leapt to between 20 and 30%.

As I discovered when writing my book Gaining, behavior in eating disorders relates directly to core temperamental traits, such as impulse control. People who binge and purge tend to have lower impulse control than people with restricting anorexia, who tend to be more compulsive and anxious. Suicide attempts among these groups are also likely to reflect these traits. One may methodically horde enough pills for the day when she can no longer “go on living in this hell.” Another may impulsively jump nine stories from her apartment balcony.

Either way, it’s death -- not beauty or glamour, and certainly not choice -- that lies at the unmentionable end of  “successful” eating disorders.