Saving lives one bite at a time
Psychiatrist Janet Treasure has devoted her life to the clinical treatment of eating disorders and research into these challenging conditions
Janet Treasure is a psychiatrist who has specialised in eating disorders and is the director of the Eating Disorder Unit at the South London and Maudsley Hospital and professor of psychiatry. Since 1989 she has been working at the Maudsley Hospital, the largest mental health training institution in the UK. Treasure has been active in both clinical practice and research, with over 200 peer reviewed papers and various prizes for her work, such as the 2004 leadership award in research from the Academy for Eating Disorders and the OBE (Order of the British Empire) in this year’s honours. She has written clinical textbooks on eating disorders and coauthored self help manuals for patients and carers. She is currently chief medical officer for BEAT, the UK’s main charity for eating disorders.
Did you plan a career in psychiatry and eating disorders?
No, not at all. I didn’t really think of doing psychiatry till quite late in my career, although in hindsight, it looks like [the path had already been laid]. At school and at medical school there were girls with anorexia in my class. I won a psychiatry prize writing about anorexia too, and I did a PhD on the hypothalamus-pituitary axis, which is related. I decided to do psychiatry because my husband was a surgeon and we lived near the Institute of Psychiatry, so psychiatry seemed a sensible option. When I applied to the Maudsley Hospital I was pregnant and didn’t want to start work until the baby was 9 months. But they rang me up and said there was a locum position available. My husband and I had gone to America for a year and I had just come back to Britain. I rang my mother-in-law, who offered to help me to look after the baby, and the first work I did was in eating disorders.
What fascinates you about eating disorders?
It’s a nice mixture of the physical and the psychiatric, a wonderful paradigm of a psychosomatic disorder. We learn in psychology that things that give us only intermittent reinforcement are engaging and captivate us. Getting people to recover from anorexia is not easy, it takes a lot of patience and skill, but it grabs you once you get into it.
You have an impressive academic track record, as well as working at the hospital providing eating disorder services for South East London. What do you find more rewarding, doing research or working with patients?
It’s nice that you can do both in an integrated way in the UK. My colleagues in America tend to be much more confined to a lab separated from patients, whereas we do both—that is wonderful. There is an iterative circle. Patients make you raise questions, try new ideas; they give you feedback. My career has been about those iterative circles of patients and carers. I’ve written books with patients and carers about management, and that’s been extremely rewarding.
What is the secret of writing books about eating disorders for a lay audience?
I think the secret is making sure you have coauthors because you do slip into jargon so easily. So if you have patients or family members as coauthors, they keep you grounded. One thing about our patients is that they’re usually extremely bright, hard working, and perfectionists. There are people with joint skills in psychology, psychiatry, or neuroscience as well as having an eating disorder. They can really give a fascinating insight.
What are your current research interests?
We are trying to develop management tools using iPhones, particularly with little vignettes and videos of recovered patients. People with eating disorders are often sceptical; they don’t believe it when parents and doctors tell them they should eat. We have discovered that they find people who have recovered from an eating disorder much more convincing and helpful. You need to tackle symptoms of eating disorders many times a day and under so many circumstances because you have to eat so many times, so having a little bit of therapy “on tap” is helpful. We’re also looking at different ways of training away from the automatic negative bias and high anxiety associated with meals. We are hoping to do a study using substances such as oxytocin to increase trust and hopefully overcome these treatment barriers.
How much do we know about eating disorders compared with how much more remains to be discovered?
I don’t think we’re far along the track yet. There was a phase when sociocultural factors were considered the most important—for example, “fat talk and the internalisation of thinness.” To a degree, this is important in bulimia, and we’ve got treatments for that. But it’s much more difficult to get good evidence of risk and causal factors for anorexia. A problem with both of these disorders is that you have secondary problems in the brain because of starvation, which means that social processing is impaired, and, similarly, fasting-feasting can lead to an addiction pattern in the brain. These secondary consequences make people totally resistant to talking therapies, which require top-down cognitive mechanisms to be effective. So now people are looking at more brain directed treatment. You may have heard of the use of deep brain stimulation for anorexia.
You’ve held positions with various charities. What difference can the work of charities make to people affected by an eating disorder and their families?
I think they make a lot of difference. What we’ve realised when talking to carers is that they often don’t really know how to feed their child. So what we’ve done is to give them the skills that we teach our nurses—how to manage this behaviour. We teach them basic psychological skills in motivational interviewing, understanding how one can get overprotective or full of conflict; and they learn not to do that and not to get sucked into reinforcing the illness. Our team at the Maudsley Hospital and at King’s have written a book and created a website to give carers skills. Now BEAT, the national charity, has set up training for parents to run workshops, and another charity, Succeed, has helped to make a set of DVDs illustrating the not so good ways to deal with people affected by an eating disorder as well as a how to do it video to illustrate the skills that are helpful in overcoming the condition.
Would you recommend a career in psychiatry?
I think psychiatry is a fascinating specialty, and I’ve really enjoyed my niche and what I’ve done. Sometimes it feels like reading novels all day, hearing people’s stories and trying to be a detective, finding what needs to be repaired, and how you are going to do that—so it’s an interesting interpersonal challenge. There are some bits of psychiatry that are less easy, but overall I think it does offer a lot of interest and satisfaction.Eva Dumann, Clegg scholar, BMJ
1BMA, Tavistock Square, London
Correspondence to: email@example.com
Competing interests: None declared
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2013;21:f4589