The physical treatment of patients with eating disorders can at times be very demanding but nothing like so demanding as the psychological treatment. Helping people to put on weight or take it off is a relatively straightforward matter of controlling the food intake and exercise output. People who are undernourished can be helped to put on weight through having regularly supervised meals and highcalorie liquid supplements and they can even be fed through a naso-gastric tube or intravenous infusion if life is at risk.

People who are overweight can have "plated" meals, where the portion size is predetermined by someone else. People who are bulimic can be locked out of the lavatories and personally supervised for one hour after each meal. All these approaches are possible - even though some of them may require intervention by the Courts - but they are pointless unless the psychological problem is dealt with at the same time.

In the circumstance of extreme anorexia, the psychological problem is inaccessible: the brain is so shrivelled, along with the body, that it shuts out any outside influence. It is in these extreme circumstances that recourse to the Mental Health Act may be indicated. As mentioned previously, prescribing one tablet of Naltrexone a day as an anti-euphoriant may also be a sensible starting point for the first month of treatment in order to help counter the absolute madness of anorexic self-destruction. Patients who are at the compulsive overeating or bulimic end of the eating disorder spectrum require no medication. All they need, alongside those at the anorexic end of the spectrum, is the support and challenge of a group of patients suffering from similar conditions.

At PROMIS we see all addictive behaviour as being essentially the same process, irrespective of which particular addictive outlet may be used in the selfadministered "treatment" of the underlying neurotransmission disease. However, this view is often not shared by the families of patients with eating disorders. They may dislike the idea of their sons and daughters, husbands or wives, having anything whatever in common with alcoholics and drug addicts. They fear that they might learn new destructive habits from those patients. On this issue PROMIS has given up the unequal struggle and we have now built a separate treatment centre in London primarily for patients with eating disorders.

Doctors, counsellors and therapists often share those misgivings. Our own contrary experience is that patients learn much more about neurotransmission disease by seeing it in all its manifestations across the whole range of addictive behaviour. They see what they are really up against, rather than continuing to believe that the problem is more in the substance than in the person. There is in fact a risk that, in a specifically designated eating disorder unit, patients will learn "eating disorder tricks" from each other. This can be exactly what happens in units that focus only upon food and body weight - and throw in a bit of cognitive behavioural therapy - as opposed to Minnesota Method units that focus primarily upon the