Leading Article: The rights and wrongs of treating anorexia

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THE CASE of Samantha Kendall, the anorexia nervosa sufferer who discharged herself from hospital despite doctors' fears for her life, has highlighted the confusion in public thinking about this disturbing and perplexing disease. Ten years ago anorexia was still dismissed as nothing more than slimming gone too far. Today it is recognised as a treatable medical condition; but the degree to which treatment should be carried out without the patient's consent has become a topic of debate.

Researchers have suggested two psychiatric explanations behind the onset of anorexia. One is that the patient, faced with an unacceptably stressful or difficult adult life, is trying to retreat into childhood or avoid leaving it. Another is that choosing what to eat - and specifically choosing not to eat - is often an attempt to exert control by people who feel that their lives are too constrained in other ways. But the truth is that for all the resources that have been devoted to its study, the syndrome remains imperfectly understood.

It is beyond doubt, however, that anorexia is a severe psychiatric disorder. There is no other way to describe an illness that allows a patient to look in the mirror at her own emaciated, starved body, and see someone obese staring back. Severe sufferers often deny that they are trying to kill themselves, but the diet they are pursuing is all too likely to make death inevitable.

The 1983 Mental Health Act provides for sufferers from severe psychiatric disorders to be held in hospital for treatment against their will if there is a danger that they will do harm to themselves or others. Yet even though one in 10 anorexia sufferers dies, doctors are sometimes reluctant to use their powers under the law. This is often because of a fear that treatment by compulsion is self-defeating, since force-fed victims of anorexia often return to starvation diets when they get home.

There is clearly work to be done in making the treatment of extreme anorexia - which often involves leaving patients in isolation and without their clothes, and watching them as they eat and go to the lavatory - more humane. But the shortcomings of the available treatments should not obscure the fact that the alternative to treatment can sometimes be death. If doctors made more use of the powers available to them, lives could be saved.

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