I love controversy.

So naturally, I was thrilled to read the recent news article in the Sun Sentinel with a headline describing Maudsley as “a controversial treatment.”

This article gives an overview of the Maudsley Method and describes the experiences of two families – one with a 12-year-old girl and one with an 18-year-old boy – who used this approach to help their children recover from Anorexia Nervosa (AN). In a fair and balanced way, the article also lists some of the criticisms of the Maudsley Method that make it so controversial.

I believe that controversy is healthy part of living in a free society. Without controversy, there cannot be progress in the areas of ethics, morals, politics, or social norms. We must challenge old ideas and new ideas alike. We must approach life with an open mind as well as a healthy degree of skepticism. Some of the best ideas in the history of humanity, such as racial integration, freedom of religion, and equal rights for both genders, were born amidst extreme controversy. Thousands of people devoted their lives to the pursuit of these ideas. People died fighting for these causes. And to my generation, they seem so obvious and self-evident that we take them for granted.

Controversy accelerates progress in the aforementioned areas by shedding new light on old ideas. On the contrary, controversy tends to hinder progress in science. This happens because controversy over scientific ideas generally arises when people criticize or oppose scientific discoveries on the grounds of theology, politics, morality, or philosophy. Many scientific truths were initially met with extreme controversy. Galileo was tried – and convicted – by the Vatican for his scientific explanation of a heliocentric universe. And although Darwin’s theory of evolution has been almost universally supported by the modern scientific community, it was (and still is, in some communities) highly controversial for cultural, theological, and political reasons.

All viewpoints have equal merit in debating different perspectives on morality, philosophy, or politics. The winning idea is the one which is shared by the majority of people, which is then often supported by legislation and reinforced by social norms. This is what happened with racial integration, religious freedom, and gender equality. In debates over science, however, some answers are clearly superior to others. Ideas supported by scientific research are superior to ideas not supported by scientific research. Scientists conduct reliable studies, interpret the data, and present the results to their peers. Eventually, these results are disseminated into the public domain. Personal beliefs and political viewpoints and religious doctrines have no place in scientific inquiry. They obscure the truth.

In this vein, we have the controversy over the Maudsley Approach. Some clinicians say that they “don’t believe in Maudsley” just as some people say they don’t believe in God or Santa Clause or evolution. Maudsley, like evolution, is not a “belief” to be accepted or rejected. Maudsley, like evolution, is supported by a wealth of scientific literature which should be evaluated empirically and used effectively to understand and advance the human condition. To treat Maudsley as a socio-political issue like gay marriage that one sides “for” or “against” muddies the waters, misses the point, and makes one look scientifically illiterate.

Those who criticize Maudsley are doing so on philosophical, rather than scientific, grounds. They have not devised reliable, valid studies yielding data to the contrary. Rather, they cite antiquated and unproven ideas about eating disorders, they make criticisms that show a clear ignorance of the scientific process, or they ask irrelevant questions.

Some day soon, the Maudsley Approach will join the ranks of Darwin’s evolution and Galileo’s heliocentric solar system as a scientifically accepted truth. Some day soon, all therapists will approach psychology as a science – like biology and astronomy – which is guided by empirical data and impervious to personal beliefs.

8 Replies to “Controversy”

  1. Lydia,

    Your response to Julie is excellent. I hope it is published. I’m so glad your daughter has been able to recover through FBT. I wonder if the author may consider writing a similar article on FBT for young adults?

  2. Dr. Ravin,

    The second I saw the title to this post–without even reading–was the evolution vs. creationism debate. And you brought it up for me! That so-called debate is the one thing that gets my blood boiling faster than non-evidence-based views on EDs. (This is also the second most popular subject area for me to read about, behind EDs. I have a huge collection of evolution lit and Darwiniana on my bookshelf!). It’s also a debate I tend to charge into head-first, for better or worse.

    LOVE this post!

  3. Dr. Ravin,
    I find this post interesting and do agree with some points you make, especially about how in science, some ideas are “clearly superior to others”.
    I do have a question about one part though, which i thought maybe you could clear up?
    you say
    “Maudsley, like evolution, is supported by a wealth of scientific literature which should be evaluated empirically and used effectively to understand and advance the human condition.”

    I’d like to offer the point here that Maudsley has hardly been supported or evaluated as strongly and long as evolution. I think this is a bad comparison. What frustrates me often is when Maudsley advocates pretend that Maudsley is some god-sent treatment. It is not. And it has hardly been supported by “a wealth of scientific literature”. On the contrary, Maudsley has been supported by some literature, and this is definitely a plus, considering it is the only treatment that has been shown effective in the ED literature, but it hardly stands to be compared to evolution. Evolution is known scientific phenomenon that has been proven over and over again. Maudsley is a treatment approach in a field that is (sadly enough) still very under researched and is relied upon as the only evidence based treatment simply because there is basically nothing else.

  4. Rose,

    Thank you for your very insightful comments!

    The reason that I chose the Maudsley / evolution comparison is that, for both issues, some people continue to cling to other antiquated ideas despite all evidence to the contrary.

    After some reflection, however, I have come to agree with you that the Maudsley / evolution comparison is not a great one. You’re right, there is a wealth of evidence supporting evolution, and certainly the amount evidence supporting Maudsley pales in comparison. The reason for this disparity is most likely because human beings have been asking the question “Where did we come from?” for thousands of years, whereas we have been asking “What is the most effective way to treat eating disorders?” for only a few decades.

    You write: “What frustrates me often is when Maudsley advocates pretend that Maudsley is some god-sent treatment. It is not.” I think whether Maudsley is a “god-sent treatment” is a matter of opinion (what does god-sent mean, anyway?) and depends entirely on whom you ask. For the 75-90% of kids who go through Maudsley and recover within a year, often times after numerous failed hospitalizations and attempts at traditional treatment, it is a god-sent treament! And I’m sure their parents would agree! Remember, most Maudsley parents have already been through hell watching their child starve herself into oblivion, fearing for her life yet being told by traditional therapists to “stay out of it,” because the illness is somehow their fault. To a parent with a sick child, it is a god-send to be able to take an active role in the child’s treatment and help her recover in a relatively short period of time (compared with other treatments). And to me, as a research psychologist and clinician, it is a god-send to be able to use Maudsley to help kids recover from anorexia and become happy and healthy!

    For the 10-25% of kids who don’t recover with Maudsley, and to their parents, Maudsley is certainly not a god-sent treatment.
    Maudsley is NOT a panacea. It is not perfect. It is very difficult to implement. The majority of American families do not have access to Maudsley resources locally. It does not work for everyone. But, as you point out, it is absolutely the best treatment we’ve got right now. What little scientific literature we have right now supports fully. So I’ll continue to advocate for it until we find something more effective.

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