When it comes to treatment for people with eating disorders there are many different options and interventions to be explored, various therapies, meal plans, pieces of group work and even hypnotism. However, alongside all the perhaps more psychological treatments, there are other more invasive practical treatments that can be used such as the NG tube (a tube that is inserted through the nose and into the stomach to feed a patient who is unable to consume food orally themselves), and this is something I never had much of an opinion on before it happened to me recently for several weeks of my admission to hospital. It may seem silly or odd to be bringing this up now as my tube came out over 8 weeks ago so surely I should be over it and not thinking about it anymore, but I have to say that even though it has been a while since its removal, the method of being NG fed still affects me to this day, is a fairly traumatic thing for people to go through, and it has made me wonder whether or not NG feeding should actually be used in eating disorder treatment full stop.
Obviously if I am going to open up a debate in this blog about whether or not NG tubes should ever be used I am going to have to say that aside from all the ethical, psychological, long term effect complicated sides to the issue, bluntly yes NG tubes should be available as a way to treat people with eating disorders. Despite their perhaps negative side effects down the line, it makes no sense to rule them out completely (unfortunately…I really hate admitting this…excuse me whilst I go away and grumble).
Sometimes, whether we like it or not, NG tubes are life saving necessary pieces of treatment and there are people out there who arguably would have died without them. If a person is unable to nourish themselves adequately and becomes seriously medically compromised, sometimes the only option is to NG feed them as a matter of saving a life and I know that, as much as I disagree with the methods used on me and wish more than anything it hadn’t happened, that that is the argument doctors and nurses have had with me in defending that method of treatment.
Aside from life saving serious stuff, NG tubes can also be positively used not just for getting nutrition into people but for providing a motivation to eat orally despite the screaming eating disorder wailing in their head like a banshee who just stubbed her toe on a particularly sharp piece of lego.
When someone is struggling to eat because of an eating disorder it is often made harder by the fact that eating always feels like a choice, an option you actively choose to partake in, and who would choose to torture themselves by forcing themselves to eat when they knew their brain would go off screaming at 90 miles per hour? With an NG tube in place however, the act of getting nutrition is no longer an option or a choice, it is going to happen one way or another and with this choice of whether or not the food will go in eventually being taken away, sometimes eating becomes easier.
Personally I can at least admit and testify to the fact that I found the NG tube helpful in the sense that it did motivate me to eat because the choice was taken away. No longer did I have the raging debate of “do I eat or don’t I”, it was just a matter of how it was going to go in/happen (“up the nose or down the throat” as I used to think). It also gave me encouragement to eat in a way because there were times when I knew that if I didn’t consume what was in front of me orally, I would get an increased number of calories down the tube and that certainly served as some motivation!
Indeed at my unit there was a rule that I was presented with a meal and if I were not to complete it, the entire meal would be started again via the feed. Therefore if halfway through a meal I was struggling and really wanted to give up, having the tube there motivated me to carry on as I knew that were I to stop, we would have to start all over again and I would essentially end up having to go through the same meal twice. NG tubes can also be helpful in the sense that they offer a way for medication to go into a patient when a patient is unable to take a medication themselves (another thing which I hated and disagreed with personally but can understand is necessary in some circumstances.)
As I said at the beginning of this debate however, alongside these positives there are a lot of negatives and it is the effect of these long lasting negatives that I am still feeling today. You see, when you have an NG tube, it takes responsibility for eating away, and whilst this is a good thing when a person is unable to eat by themselves, it is a bad thing because in learning to eat again or going through the re-feeding process they are not actually learning how to do it for themselves. Indeed, people go from needing the tube in an emergency situation to becoming dependant on it and that is what happened to me. For the first few months of re-feeding I was going through the motions but psychologically was making no progress and then when it came out I didn’t know how to eat. Without the tube, suddenly the guilt became much worse because eating went from being the lesser of two evils with the tube in to simply “evil”.
Another negative from using an NG tube and perhaps the one I am struggling the most with today is that of rapid weight gain. When you are on the tube it is possible to gain a lot of weight very quickly that mentally you are not ready or prepared for and although it can again be life saving and good treatment medically, it can be an incredibly traumatic experience. Similarly, now I have been left at a weight far higher than I am comfortable with because of the tube and because I reached this stage far quicker than I would have done without it, I am still struggling with the repercussions and am feeling overwhelmed.
In terms of trauma it can also be a traumatic experience to be restrained for feeds and when this happens it can damage the patient vs treatment team relationship. For example I used to trust my treatment team and even get along with a lot of them, but if I am honest, now I resent them all and want to be discharged from the entire service because the act of having something so traumatic being done to me has led me to dislike and mistrust them all. Having something like an NG feed physically done to you whilst you are held down means being treated as an object not a person, there is no therapeutic benefit, you are just a thing being pumped full of stuff you are terrified of with no chance to work through it or figure out a long term solution at home. It is a temporary fix and though you can force feed someone food, you cannot force feed them long term recovery, so in a sense the NG tube method is unhelpful long term. Then again that is just my experience and I know that for other people actually starting with an NG as a temporary measure can help long term as it gets enough nutrition for their brain to work and allow recovery long term afterwards so it really is all down to personal experience.
Overall then, should NG tubes be used to treat people with eating disorders? Well, I don’t know is the honest answer, it is a tricky one because I think the answer will be different for different people. For some people using the NG tube is not a matter of something to be debated but a necessary life saving act of treatment and sometimes it can even help long term recovery by motivating someone to eat orally by taking away the choice. Also the more nutrition someone gets the more likely it is that their brain will be receptive to treatment but then again there are the negatives of cases like mine where I have been fed up to an unbearable weight via physical methods without going through the proper therapeutic work, meaning that I am now stuck unable to deal with it and thus struggling with relapse. I don’t think when it comes to this question there will ever be an answer for everyone but it is certainly a controversial topic that I think we need to keep working on and talking about.
Take care everyone x