Recently, my blogs were responded to by supporters of F.E.A.S.T. and the Maudsley approach to re-feeding anorexic children or teens.
It is interesting to me how much fire these advocates of family-based treatment inspire. Their responses almost always result in an an outcry of protest and inflamed feelings. That's a shame because F.E.A.S.T. and the supporters of family-based treatment have something critically important to say. As a result of their work, we now know to include families in treatment and we know that there is an important genetic component to anorexia. We also know that it is extremely harmful to blame parents for their child's eating disorder.
But blame and curiosity are two different things and I think it is important to question the role of the family with any symptom that arises, be it genetically based or not. Every family should take a look at itself and see what is working and what isn't, to allow for growth, independence, intimacy and exchange with all family members. We often take better care of our cars than we do our families. I would posit that even in a family with a schizophrenic child or an autistic child, there are many things that can be done to help the family operate more effectively. I would say that of any family, including my own. This isn't a mandate to blame. It's an opportunity to help families consider what might need to change to better meet the needs of all of its members.
So in that spirit, and in total agreement with F.E.A.S.T., parental involvement is critical when any child, adolescent -- or for that matter -- young adult has an eating disorder. But the goal is to look at what is going wrong and what can be fixed -- even if what is going wrong is difficulties handling a very severe illness. The goal is NOT to assess blame.
What inflames many people about the F.E.A.S.T. push for no family blame is that this leaves no room for any curiosity about the family. Since when is talking to one's kids about problems in the culture a completely ineffective means of prevention?
I still believe that parents should talk to their children about eating disorders. For some children or adolescents, this will have no effect on the development of an eating disorder. For others, it will allow for an open dialogue which may indeed influence their relationship with food. If that isn't the case, why are we talking to kids about drugs and alcohol? Alcoholism is now proven to have a genetic base. Does that mean that parents shouldn't talk to their kids about drinking because talking won't stop someone from being an alcoholic?
So, after all is said and done, I (thoughtless parent and author that i apparently am) still think that parents should talk to their kids about eating disorders, and about developing ways to listen to and attend to one's needs without turning to food or starving oneself. Will this help everyone? Absolutely not. But, I would like to think that parents can be actively and thoughtfully involved in the lives of their children, guiding, directing, encouraging. That has nothing to do with blame. That's just good parenting.
Talking to one's kids doesn't prevent a disorder from developing. Life is rough and many things way beyond our control occur. However, trying to have an open dialogue with our kids is one way we can try parent as best possible. In a world where just about anything can happen, that's the best we can do.
NOTHING enrages me more than having "experts" cast the blame from MY eating disorder on my parents.
After a HORRIBLE therapist, who dug at everything in my past, I was moved to a CBT approach: change a behavior, change a thought. CBT is based on "behavior modification" .... if you stop the behavior, the symptoms (and then, thoughts) will cease. I'm living proof that this approach WORKS.
And science backs it up.
Parents DO need to be made aware of the signs and symptoms of EDs. But they need to know about ALL treatment options available for their child! They need to know to get multiple opinions!
Most importantly, digging through the past brings up gunk that worsens an already awful condition. It further isolates the patient from their parents, while it amps up their reliance on the therapist; a horrible combination.
I found the right doctors and thank G-d I got the right treatment. I was shown that while getting sick was not my fault, getting well was and still is my responsibility. And ONLY mine.
Blaming someone else does not allow one to OWN her own recovery. I OWN it. It is mine to lose or keep.
when working with an individual with an ED, there are so many factors that need to be taken into account. many ED's are only a temporary period in someone's life, that with the right help and support, with a lot of hard work can be over come and the individual can go on to live a healthy life. some ED's though need more and have aspects that complicate things further. what rarely gets taken into account is the factors that lead ED's to be considerable more complicated eg: co-morbid conditions such as personality disorders, bipolar, schizophrenia, OCD etc. abuse of any sort can very much complicate an ED and can also be a contributing factor to deveoping a co-morbid disorder.
ED's are so complicated that a black and white view in treatment (how ironic that that is one the main personality trait that is deemed to be a factor in ED's) i don't believe are helpful.
Then we changed to family based care and DBT. The curiosity focused on what she was eating. We had a 4 month family DBT group. But there wasn't much curiosity with that either. Just skills on how to regulate emotions. It was great for all of us because by that point, we were all feeling a bit fried from the illness and all that prior curiosity.
Here's what happened with that switch: we all felt like a team working together, even though we are a divorced family. Hospitalizations immediately stopped, her weight is stable, she went right back to school and continues to make progress. I will take evidence based care over curiosity based care any day. Just wish I had found it sooner.
Her last weight gain, depression and bulimia episode was a period when she was eating mostly vegetarian. Recognizing that helped her change her eating to a low-carb lifestyle and most of her issues have vanished.
I still take responsibility to her and her brother (who suffered severe ADHD on a low-fat diet) and apologize to them regularly. Sadly, many parents still are mislead by the mainstream mantra of "low-fat, low-calorie," and their children will continue to suffer. I hope that the work of my heroes, Gary Taubes, the Eades's, Steve Phinney, Jeff Volek, Eric Westman, and others who are pioneers in metabolic research that promotes carbohydrate restriction will become the mainstream.
Now, as an adult, again, I don't "blame" her because I don't believe she meant harm. She just didn't see the value (or harm) in food. Where she faltered in one aspect of parenting, she excelled elsewhere.
It's situation temperamental. Parents should be take some responsibility if responsibility is due. But, like most issues, it's not that cut and dry.
I've always thought so, but clearly some do not. In my opinion the cause in no way could be attributed to a single person - much ore elaborate and complicated... but very much still important. Why? Because it answers the question "why?"
some people are able to recover and have very little trouble with it thereon (for example it may have been brought on situationally, such as for teens, i had several friends growing up who were anorexic as a result of pressures and turmoil at home and in school, but were able to move on from it once they left for college and were away from the negativity)
other people struggle with it periodically for the rest of their lives. for myself, (yeah, another anecdote to balance out the first) and i know for many others, ive been more or less free of the worst of it, but it hasnt gone away completely. i have to be aware of slipping back into it due to stress or whatever.
so it does vary. some people, even in remission, must stay continually vigilant to keep it that way.
i think it depends on what the triggers for the initial disorder was.
like how some people are chemically depressed and can get 'better' but must battle it and manage it even then, while others become depressed in resoinse to external events and are able to eventually put it behind them, permanently.
sorry that was lengthy, i wanted to try and be as clear as possibe, im not always very good at getting my thoughts into words.
I'm currently in therapy and working toward recovery (and back on my mess, thank goodness) but I totally blame my parents, in part, for how I am today. Not only did I more than likely pick up the genes for the mental disorders I deal with from them (they both have mental disorders) they also created an environment where I couldn't react or get help for the issues they knew I was experiencing. I had to be the 'perfect child' or I was vilified. How do you not blame that?
And yet ... my father doesn't have to bear any responsibility for my ED?
It wasn't until I learned to start to quiet those voices from my past, my father's voice, that I started to recover a bit.
This combined with their need for me to be perfect-nothing less than straight A's was acceptable, couldn't be late to curfew even by 2 minutes (I am not exaggerating on this in the least), dinner had to be finished at the exact right time...I could go on and on...instead of rebelling, I did everything as 'perfect' as I could and took everything out on myself, including restricting my food, exercising like a fiend, and becoming obsessive about only eating certain foods. And the funny thing is they didn't seem to notice or care.
So I'm having a hard time understanding how parents are never to blame for ED's. It's always been my understanding that ED's are part genetic and part environmentally influenced. Parents are part of your environment, so how can't they be an influence?
"EDs are a result of both biological and environmenÂtal factors. Parents are part of the environmenÂt and, therefore, *could* influence the risk of an ED developing if other factors are also present."
Where are you getting this information from?
Most of the experts in the field do not KNOW the causation of eating disorders.
The latest research suggests that - at least with anorexia - eating disorders are biological brain malfunctions brought on by malnutrition.
There is so much bad information out there and it is doing more harm than good to sufferers and families.
And as to Judith, I am not sure why you think that it is the role of treatment providers to be 'curious' about familities.
Take care of the sufferers. Let the families not become subject of curiosity.
The population of parents out there is not a single voice or single-minded. People who support F.E.A.S.T., even, are pretty diverse. Some feel strongly about certain issues and others focus on entirely different things - and vigorous debate exists between them. F.E.A.S.T.'s positions are simply stated in our principles. Each parent deserves their opinion to be considered individually.
Speaking only for myself here, I don't think that saying that parents don't cause eating disorders means the end of curiosity about the family or some sort of absolution for all parent actions - each family brings unique skills and issues to the table. I only suggest separating that from cause of the illness itself, and being very cautious about the idea of "prevention." I would expect the same for a family facing autism, for example, or a car accident.
Disordered eating and body image is not an eating disorder. An eating disorder is a severe mental illness where disordered eating is but a symptom. Although we do influence whether our children practice disordered eating, we do not know whether we prevent the mental illness through messages or parenting. We should all work to prevent disordered eating, however - on that we can all agree!
EDs are a result of both biological and environmental factors. Parents are part of the environment and, therefore, *could* influence the risk of an ED developing if other factors are also present. And just as parents could influence the development of an eating disorder, they could also play a role in preventing an eating disorder. Saying so is not blaming parents any more or less so than saying genetics could play a role is blaming genetics.
In my mind, there cannot/should not be blame simply because there is no single cause.
If blaming parents worked, even a little, then the history of eating disorder treatment would probably be better. We need to stop blaming patients and their families and start focusing on care that works to strengthen all concerned, and on the problem itself, I believe.
Without getting into that debate, I also wonder what proponents of FEAST view as valid treatment options for parents who choose to not get involved - who are in denial and choose to ignore it even once their child has been diagnosed (making the topic taboo to speak about)
To those who have had the incredibly unfortunate and painful experience of having both the wiring and parental abuses, I am truly sorry that this has been your experience. And, it is my sincere hope that you will find the resources who can help you to forgive, let go of the blame and victim state that is keeping you trapped. That may sound harsh, but before you start slamming me with emails, please consider the experiences, peace, joy and freedom that some of these folks have found with forgiveness: Nelson Mandela, Elie Weisel, Oprah Winfrey, Maya Angelou. Forgiveness releases the poison within us. It is a gift we give ourselves and does not condone the actions of those who hurt us.
Until we have more answers we can love and include parents & families and model healthy behaviors, for that benefits all involved.
The only way I could even begin to heal was to separate ties with them. How can anyone be expected to heal with that kind of pressure and treatment? They are poison. I remember telling my mom once when I was in college that I went to see one of the therapists at the college for help. My mother raged at me over the phone because she was sure that we talked about her, and how I needed to just 'get over it' and how I always made things worse for everyone by being so negative, and I just needed to shut up and be happy...does that sound like a parent who wants to help her child? She convinced me to stop therapy...