Occupational Therapy and Eating Disorder Treatment: An Interview With Bekah Mack, Part 1
Written by Renee Outland, Published on October 8, 2018
[Trigger warning: if you have an active eating disorder or are in recovery from one, please pause to reflect and determine if you feel able to tolerate a discussion about treatment from a clinician’s point of view, as well as one reference to a specific number of calories.]
This article was written as a follow-up to the article Eating Disorders and Occupational Therapy; Bridging the Gap, which addressed the ways in which OT is uniquely suited to meet some significant needs in the field of eating disorder treatment. To give an inside view of one OT’s role with this population, I interviewed Bekah Mack, an OT on staff at the Johns Hopkins Eating Disorders Program — one of the few eating disorder treatment programs in the US that employs OTs. Bekah generously gave her time to share her path from grad school to Johns Hopkins, her approach to treatment, and her thoughts about our role as OTs with this population.
This interview has been edited for length and clarity.
RO: How did you start working in the eating disorder field?
BM: I knew that I wanted to work in mental health forever—well, for a long time, but it was kind of affirmed in school. There’s such a need for it and there are so few jobs available in [mental health], which is especially astounding given the fact that that’s where we started.
That said, I started my journey looking for any sort of mental health type things that I could get involved in, and I found out that [Johns] Hopkins has a residency program, and then ended up being offered a full-time job there instead of the residency, and the two services that I would be covering would be eating disorders and young adults with affective disorders.
Both are pretty difficult niches, so I was initially a little bit overwhelmed to say the least, but I liked the fact that it’s definitely an area where we have the opportunity to make a difference and make an impact in those people’s lives, and really give to them and they have a lot to give back to us.
So, while I’ve always found eating disorders interesting from the little I knew about them, I can’t say that I necessarily started by looking for a job treating them, and I didn’t really have a very firm grasp as to the depth and complexity of them until I started working here.
RO: Had eating disorders been covered at all in your grad program, or when you say, “the little I knew,” was that from life experience?
BM: A little of both. I have several friends who have struggled with eating disorders, and I was also aware of the stereotype versions of it just based on TV shows and movies and those sorts of portrayals; the “oh, they’re just afraid of food or have a bad relationship with food” idea that’s still unfortunately the stereotype.
My perspective and understanding is so different now, and when I hear people talk about this desire to find that one causal item that led them to end up with an eating disorder I just think, “It’s not about that; it’s so much more complex and akin to an addiction than it is to a fear that came from one event.”
It’s not about [causal items]; it’s so much more complex and akin to an addiction than it is to a fear that came from one event.
As far as grad school, we didn’t cover a whole lot. We had a biopsychosocial class that was really like the core foundation of my psych background, and then everything else mental health was [woven] into the program. My professors always said, “we really do have a really heavily based mental health program,” [but] we didn’t really talk a lot specifically about eating disorders other than kind of glazing over it as a DSM diagnosis and watching a couple videos from The Doctor or Doctor Phil or something.
RO: With that limited exposure, what was it like to start working at Hopkins?
BM: I was really blessed to have a mentor, who actually still works at Hopkins, who helped train me for it, and I spent probably a month and a half at least, if not two months, of getting to follow her around and get a better understanding of the culture, and then taking over bits and pieces with her there to support me if needed.
I’m very comfortable with the job now, but initially it was very overwhelming because — I don’t know if you’re familiar with Hopkins’ program at all — it’s very, very intense and a different culture — exemplified in the fact that we have a rule book that’s like 10 pages long. [The eating disorder program is] very structured in order to be able to address everybody’s needs.
RO: Would you mind telling me more about the program and how it’s structured?
BM: I work specifically in the inpatient [IP] unit, and then we have a PHP [partial hospitalization program], and then I occasionally take outpatients. But the inpatient unit is a locked psychiatric ward that’s shared with the adult affective disorder patients and the young adult affective disorder patients, which has pros and cons.
People who are significantly depressed may binge or restrict unintentionally without it actually being eating disorder behavior, which can have a complicated effect on the milieu, but it can also be good because patients are engaging and having the opportunity to socialize with people who are struggling with an illness that isn’t theirs. On top of that many people with eating disorders often have comorbidities of depression, bipolar, anxiety, so there’s a lot of good things that I see coming from those groups being together.
The biggest goal of having people inpatient is to do two things — the first is to break the cycle of the eating disorder behaviors, whatever they might be. Typically we see individuals struggling with various forms of bulimia, all forms of anorexia, and occasionally binge eating disorder. But because the people coming to the IP unit are going to be those who are more chronically ill and more acutely ill; most of them come with an anorexic diagnosis because they need to be medically stabilized before they can go through the refeeding process.
Check back on Wednesday for Part II of this interview, which covers more about the role of OT and the lived experiences of Bekah’s clients during their treatment at Johns Hopkins.
A note from the author: Since publishing my first article, Occupational Therapy and Eating Disorders: Bridging the Gap, I have been overwhelmed by the many responses from both students and clinicians, each full of interest and encouragement. That support helped me to make the decision to take my work from theory to reality, and open my own private practice offering the type of services that could reduce the “gap” in care. Thank you so much to everyone who read, shared, and responded to my writing, I am incredibly grateful!