By Fiona
In the Beginning
For several years, I have closely followed the development
of unique and revolutionary treatments for anorexia nervosa
and none of these stories is quite as intriguing, mysterious
and puzzling to me as that of the Montreux Clinic in Victoria
, British Columbia (BC). This is a tale that has been haunted
by secrets and laden by rumours and it is quite likely that
only a few individuals have detailed knowledge of the sequence
of events that transpired behind the closed doors of that
old mansion on Rockland Avenue in Victoria , BC, eventually
bringing it to a close.
The Story of Montreux
In 1982, Peggy Claude- Pierre was an undergraduate psychology
student in BC, who was struggling to raise two daughters
as a single mother. Her studies were sadly interrupted when
both of her daughters developed anorexia nervosa. Claude-
Pierre became their primary caregiver during the acute phase
of the disorder, and, as she nursed and cared for Kirsten
and Nicole, she observed that an extremely negative force
appeared to have consumed their thoughts and behaviours entirely.
This "negative mind" was the driving force behind the anorexia
and commanded that they did not deserve to eat. Confirmed
Negativity Condition (CNC) was the term that Claude-
Pierre devised to describe the relentless battle between
the "negative and logical minds" in anorexia nervosa. She
believed that round- the- clock, unconditional love was essential
in overcoming the voice of self- hatred, shame, and constant
criticism. In this way, recovery was only possible when the "logical" mind
dictated the greatest proportion of thought, and, when Claude-Pierre
founded her outpatient and residential care facility, this
framework of thinking provided the rationale for intensive
treatment. Indeed, it was often confirmed that all anorexics
did suffer from CNC, one patient at Montreux claimed that
she was God's biggest error, and that "anorexia was the punishment
for this dreadful mistake."
As if overnight, Claude- Pierre won the reputation of a
miracle worker, the "angel on earth" who could speak the "secret
language of eating disorders". In her alternative, non- institutional,
and compassionate approach, she promised a cure for this
devastating illness where all others had hopelessly failed.
She strategically capitalized upon the emotions of the public,
deeply touching desperate parents and health care professionals
alike. Indeed, whose heart would not be wrung by the image
of a devoted care worker carrying an emaciated patient down
the long, winding staircase at Montreux? Assisted by popular
television stars such as Oprah Winfrey, Maury Povich, and
Barbara Walters, the Montreux Clinic was publicized in countries
as far from the British Columbian coast as Ireland , England
, and Japan. Sadly, those who most often found their way
to the clinic had already been told that there was no further
hope of recovery, and, in this way, Montreux was portrayed
as the "last chance" for people who were deep within the
clutches of anorexia. It rekindled hope for frightened sufferers
and their and loved ones by giving them something to believe
in.
The Clouds Come Rolling In
Montreux thrived both locally and internationally for almost
ten years. Claude- Pierre continued to dazzle the public
with her charisma, charm, and compassion, while the not-
for profit organization flourished, and the clinic continued
to admit new patients locally and abroad. Those who closely
followed the story however, noticed that thunder clouds were
beginning to form over what had always been blue skies at
Montreux; troubling suspicions that beneath its glowing exterior,
perhaps all was not as rosy as it appeared. After much deliberation,
a staff member at the clinic "blew the whistle" on what she
believed to be harmful patient practices, initiating a three-
year heated and controversial inquest into the operational
procedures at Montreux
Those seeking an objective and humane account of the various
factors that eventually led to the closure of the coveted
Montreux Clinic in August 2000 should refer to Barbara McLintock's Anorexia's
Fallen Angel. I will discuss a few of the fundamental
issues that contributed towards the demise of this "ill-fated" clinic.
The original inquest began with a search for evidence to
support claims that a few of the "difficult" patients had
been repeatedly held and forced fed in a manner which was
unsupervised, not approved, and physically and psychologically
damaging. This merely served to open the door to a host of
other complaints.
It was of great concern that the majority of caregivers
at Montreux lacked the specialized training and academic
credentials required to administer treatment to people with
anorexia. There was no doubt that staff members, who were
selected by Claude — Pierre herself, demonstrated the
utmost compassion and care towards their clients. However,
no clinical experience or formal studies in the area of eating
disorders theory, nutrition management, and treatment methodology
had been undertaken, and methods were unique to Montreux
alone.
A treatment protocol that was largely developed and implemented
at Montreux with little outside professional opinion may
have contributed towards the dangerous blurring of boundaries
that occurred between staff, patients, and family members.
One case for example, involved appointing a current patient
at Montreux to the position of caregiver for another more
critically ill peer, thus depleting the former of the emotional
energy required to engage in recovery. Similarly, allegations
raised against a male staff member who was involved in a
romantic relationship with a resident at the clinic, also
illustrated the diffusion of boundaries and appropriate professional
roles.
Inadequate training may have provided the back- drop for
ill- defined definitions of recovery, as well as the lack
of essential outcome measurement tools required to prospectively
track progress. Claude- Pierre often stated that Montreux
resulted in a close to a 100% recovery rate, with no clearly
established ideas of what this constituted. More importantly,
anorexia is a disorder that has historically been plagued
by relapse, and long-term assessments were not included in
claims about recovery.
The housing of critically ill and unstable individuals
in a residential facility, which lacked the appropriate medical
staff and equipment, was a matter raised by the physicians
during the inquest process. Outsiders observed that traditional
inpatient eating disorders programs are often as equipped
as intensive care units in a hospital. The absence of health
care professionals and follow- up care at Montreux may have
placed patients at great medical risk.
Another contentious issue concerned whether or not the
Montreux clinic falsified information regarding the admission
of a three-year-old patient to the residential program. The
public was made aware of this inconsistency; although staff
insisted that the little boy, who may not have even had anorexia
in the first place, had never been admitted to Montreux or
separated from his mother, written staff reports directly
contradicted their statements, thus jeopardizing the clinic's
integrity and credibility.
Perhaps the final overt and observable blunder was the
holding and screening of patient mail, as well as the forced
separation from family and friends when this was not always
warranted or the preferred choice. Loved ones were cautioned
that letters, telephone calls, and visits could potentially
trigger the "negative mind", thus jeopardizing recovery,
and Claude-Pierre acted as arbiter as to who could visit,
as well as why and when. In this way, Montreux was very much
a world unto itself, and patients had to be concealed from
experiences in the wider context that could potentially upset
the already fragile "negative mind".
Aside from questionable institutional practices, the implicit
attitudes and actions which characterized Montreux's interior
may have had an equally damaging impact. Some patients complained
that their problems were not isolated to the anorexia alone,
and that there were different, more pressing issues to address
than solely the "negative mind". In fact, a few patients
repeatedly told staff members that the "negative mind" did
not describe their experience at all, but their claims fell
upon deaf ears. Furthermore, several of the clients remained
away from their families at Montreux for several months,
even though little or no progress in the way of recovery
was made. When questioned at a later date, a few clients
believed that the anorexia had deteriorated further during
their stay at the clinic. Lastly, a few of the adult patients
expressed their desire for greater independence, stating
that 24- hour a day care was stifling. Similarly, outside
observers asserted that rather than enabling independent
functioning upon discharge, Montreux bred dependency by permitting
residents to remain at the clinic for several years, allowing
them to "graduate" and become staff members.
Despite Montreux's continued effort to fight allegations
made by the local licensing authorities, many could sense
a losing battle. The clinic had failed to institute the necessary
changes after numerous warnings, and the accumulation of
new evidence against the clinic continued to mount. Then,
in a strange twist of events prior to an application to the
Supreme Court of BC to force a review of the decision that
the clinic be allowed to stay open, Montreux voluntarily
withdrew their license to operate as a clinic. They claimed
that they were completely exhausted from fighting a political
battle that did little to care for human lives. This shut
the doors on the Montreux residential program entirely.
Closing the Doors of the Mansion
This story touched me deeply, and it is ever so challenging
to summarize the "falling of anorexia's angel". Although
I supported the closing of the Montreux Clinic, this is only
because serious legal infractions occurred. Aside from these
legal errors, such as preventing competent patients from
the right to discharge themselves, I am not entirely certain
if the impact of Montreux's operational procedures on quality
of life of clients differed greatly from traditional eating
disorders programs in a hospital. For example, it is likely
that even though it is supervised and approved, force feeding
and monitoring of patient visitors in hospital settings,
has an equally negative, long- term impact on the quality
of life of the client. I believe that the larger issue is
that anorexia continues to be a very problematic disorder
to treat regardless of the type of settings. Support for
the closure of Montreux should be isolated to those actions
which broke the laws in BC, rather than the problems that
characterize the treatment of anorexia in general.
In addition, Montreux illustrated the longstanding philosophical
debate regarding the effectiveness of traditional versus
alternative treatment programs. Residents and their families
arrived at the clinic believing that the reductionist, medical
model had failed them repeatedly, and that perhaps their
daughters were more likely to respond to the gentle and compassionate
atmosphere at Montreux. But when Montreux closed, many of
the patients who had to return home were ironically advised
to continue with care at the very institutions that they
had previously fled, that is, local eating disorders centres.
Overall, I was astounded that the divide between traditional
and alternative "treatment camps" remained impenetrable,
and that the collaboration of methods proved to be so difficult.
This tale also highlights the intersection between health
and politics. From decisions regarding who could afford to
be admitted to this expensive centre, to the indirect use
of ill patients on national television to raise funds, to
the Montreux Society's questionable documentation of finances,
to the involvement of local public servants in Victoria during
the inquest, I am saddened that money lurks behind even the
treatment of persons with anorexia.
Lastly, this case served to perpetuate the silence that
already characterizes anorexia. The voices of those most
affected by the events, that is, the patients, remained silent
in the face of the noise made by the clinic and licensing
officials.
What We Learned
When I was just fourteen years old, I was captivated by
the magic of Montreux. Although I briefly questioned whether
it was suitable for the mother of two daughters with anorexia
to operate her own clinic, I was in awe of the Montreux Clinic,
so eloquently named after a boardwalk of flowers along Lake
Geneva in Switzerland . As well, I travel to Vancouver and
the BC interior each summer, and it is easy to see the way
in which the natural environment may facilitate recovery;
perhaps there is no greater place for reflection and renewal
than a small, mountainous community off the Pacific Coast
.
In the end, I am disappointed for those who like me, dared
to throw caution and skepticism to the wind, and place blind
faith in a very beautiful idea. Although there is much to
be learned from the story of Montreux, it appears that the
search for the cure for anorexia is still on.
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