Here is a final note for now on the issue of parental involvement with eating disorders. Previous blogs have brought up thoughts, questions, disagreements and clarifications. I am grateful for that and would encourage all of you to read through online responses to the earlier blogs. In them, alot of important information abounds.
First, as for the research cited in my last blogs, there was alot of confusion regarding what I meant. When I cited Minuchin, for example, as "proving" that parents caused eating disorders, that was because he said that he observed anorexic families as being overly enmeshed, with no boundaries and poor communication. He was quite famous for those observations, and that's a big part of where parent "blame" began. But his research was terribly flawed, and I was trying to say that we cannot look to his findings to prove anything.
Of critical importance, I want to underline the fact that I don't think families always cause eating disorders. When I say not "always," what I mean is that there indeed are families in which there is emotional turmoil or neglect. Here, kids will cling to whatever they can to get by -- and yes, in these cases, cutting, drinking, binging and sometimes starving are all symptoms used to cope. Thus, in some families, there is such stress that many symptoms develop in the kids -- eating disorders among them -- as means of dealing with intolerable feelings. Yet even in these cases, with anorexia, re-feeding is the first line of intervention, whether it is by the family, professionals or an intensive care inpatient facility.
For many, many other kids, however, there is a genetic predisposition that our fertile cultural terrain allows to explode into the mess of a severe eating disorder. For anorexia in particular, this means there is a gene that tilts the person toward obsessive, perfectionistic behavior -- a gene that would likely not be activated if the culture didn't demand bodily perfection, change and a sense that "winner takes all." In our demanding and bodily obsessed culture, however, this gene lights up like wildfire, and serious eating disorders can be set into play. This has nothing to do with family dynamics and can erupt in any family environment.
With anorexia, re-feeding has to be the treatment of choice. Where I differ from some readers is that I believe just how that re-feeding occurs can be different depending upon the needs of each family. Right now I have two older teenagers, restricting anorexics, with whom the nutritionist and doctor set up food plans and minimal weight gain needed per week. I work directly with the parents to help them set limits regarding what activities will be lost (treatment at home instead of a hospital, camp, sports, etc.) if the teens don't meet their weight gain each week.The parents don't directly feed the kid, but they are intimately involved in the treatment process. I do ongoing work with the parents (and, in other cases, with the kids) to see what is getting in the way of keeping to the treatment and food plans.
Alternately, I have two other cases with younger anorexics in which the parents and I are working together in a direct re-feeding kind of manner in which the eating is non-negotiable: the parents either feed the daughter directly or monitor every bite.
In all cases right now, the work tumbles back and forth, and there are many chaotic, difficult moments, but for now, all the kids (despite different approaches to the actual re-feeding) are moving forward and gaining weight. Some parents can't afford to stay home and sit with their child 24/7, but others can't afford not to.
So I try to work with the resources and wishes of the parents and give them different options, and I firmly believe (and have seen, many times over) that different options can work well with different families.
I hope we all continue to think hard about these issues and allow for ongoing questions to evolve. I am grateful for the people at FEAST, who have allowed me to more clearly put into words the thoughts I have on this issue, and to the Maudsley researchers, without whom I wouldn't have even known to try to get parents to re-feed their kids. (Go here for information on the FEAST November conference, where these ideas can be discussed openly -- and off-cyberspace!)
I'll be writing more soon in other arenas, but for now, let's all keep thinking and questioning what works -- and why.
Anorexia cannot be "caused" by culture of media either. I fear that pointing towards unfounded "causes" will distract scientists from doing the appropriate, necessary research it will take to find better treatment modalities for these serious, deadly illnesses. The focus needs to change- from what caused this to what can fix this. We need to stay on track!
My boyfriend (non-Chinese) loves me for who I am regardless how much I weigh or what size I happen to be at any particular day. I once weighed 230 lbs and he loved, respected and admired me at 230 as much as today at 150. I once dropped to 143 and I asked him what he thought and his response was "I want you to be happy and healthy" - I was so touched by his answer.
The focus should be on health and not so much on what other people are or may think - the superficial stuff is perishable. Thinness and beauty only last so long...feed your mind & soul and the rest will come!
I am sorry, I think I let my negative experiences with even well meaning clinicians who really don't seem to grasp the nature of anorexia and how many aspects of this illness do not allow patients trapped at sometimes dangerous and often below the their needed weights, coupled by the strong distorted thinking. These patients dont seem to benefit from much theraputic interventions before they are more long term weight restored and the most ( and of course this is individual and dependant on familiy support systems) effective way to accomplish this is to educate and use the family as a vital part of the treatment team. Too many therapist see this crisis situation often met at their initial meeting of therapy as the cause and obstacle to recovery. There seem to be many committed, loving healthy parents who are begging for direction and pushed away from the treatment process, especially with teens and young adults.
My anorexia began in senior year/high school and got full-blown by 2nd year college.
My now 24 year old dauhter is recovering from anorexia. Her onset was senior/hs and ful blown by 2nd year college. We both had social anxiety, anxiety and depression pre-AN. My daughter also had OCD as a child and still does. It's a 'brain issue' in my opinion.
Instead of spending time being curious about families, clinicians should spend more time reading up on the latest research and treating sufferers appropriately.
I am profoundly grateful for you clearing all that up for me. AND I will look forward to seeing you in November.
Charlotte Bevan
Feast UK
William Anderson, LMHC
Author of 'The Anderson Method - Secrets of Permanent Weight Loss'
Website: www.TheAndersonMethod.com
Blog: http://theandersonmethodblog.wordpress.com/