Mood and Treatment

Mood is a hard thing to measure, a chimera at times, hard to grasp, hard to define. Good mood, while often eluding exact definition, is obvious to the observer: the step is light, the smile is on, the shoulders are straight, the energy level is high. Low mood is just that: the shoulders are held low, the facial features droop, the light goes out of the eyes and energy is… low.

Depression seems to be expressed as consistently low mood. It is hard to experience and it is hard to be around. Like chronic pain it can be absolutely personality-unraveling.

“She was so happy and energetic before,” I was told of one patient. “Since she started treatment her mood is worse everyday. She cries, she hates herself, she is angry at us. This is just not my girl.”

Must be bad treatment, right? I’m afraid not. The hard truth about treating eating disorders is that mood is no indicator of efficacy of treatment. The more successful weight restoration is, for example, the darker the mood. Most (but not all) children and teens with anorexia nervosa do not actually want to get well. Or they may want to, as long as it doesn’t involve gaining weight.

With anorexia nervosa the simple fact is that, as we say at Kartini Clinic, “lose weight, get happy.” And the converse of that is “gain weight, get sad.” So, when a patient is restricting and exercising they may feel on top of the world. And yet it is bad for them. When they are in the process of weight restoration they may be sad/mad/depressed. And yet it is good for them.

The literature written by parents and advocates of family-based treatment is replete with accounts of how wild the ride can be when a young person with anorexia is re-fed. I have even seen a young mother covered with bruises from encounters where she tried to feed her panicked, desperate and angry child, a child who had always been sweet, conscientious and kind.

And yet that is not the hard part. The hard part is that when our children are in pain, we are in pain. When our child seems to suffer worse moods with treatment we blame the treatment or the providers or ourselves.

Who should we blame? The illness.

It just isn’t true that if it makes you feel good it is good for you. Examples? Heroin and all the drugs of abuse; they make you feel good. And medicine, as everybody’s grandmother knows, is often bitter. Immunizations hurt. Repositioning a dislocated shoulder is painful.

Though it doesn’t make me popular to say so, sometimes we walk through a long dark tunnel to find the light. But the light is there and the person who cares about you is the one holding your hand.