Tuesday, October 21, 2008

Of parents, health, and eating

This semester I teach mainly seniors, and today I was asked by some folks in another part of the university to administer a health survey to my classes, to gauge the effectiveness of some "healthy living" efforts they've been working on for the last few years. I couldn't help noticing, as I collected the surveys, one line in particular. It was one of a series of questions about where these 22-year-olds get their health information. There were many choices (the internet, magazines, newspapers, classes, health initiatives on campus, etc.), and many of the students indicated that they didn't get health info from very many sources. The one source that almost unfailingly scored high: their parents.

That's right. Their parents. These young women (and a few men) have been living away from home for the last four years. They've been independent. They've traveled to Europe, many of them; they're close to starting their own adult lives. And yet they trust their parents more than almost any other source of health information.

I must admit that tears came to my eyes as I looked at survey after survey (just that one line, honest!).

This was especially moving and poignant given what I'd been reading earlier in the day: A book called Psychosomatic Families by Salvatore Minuchin, one of the founders of family systems therapy. Minuchin's work with families is often cited as one of the inspirations for family-based treatment of anorexia and bulimia. Until Minuchin's work, patients were routinely separated from their parents and treated (usually ineffectively) individually. Minuchin was one of the first to see patients as part of a bigger family system.

Unfortunately, his view of families was anything but positive. The title says it all: Instead of psychosomatic patients, he believed in psychosomatic families--families that through enmeshment, conflict avoidance, triangulation, and other unlovely psychodynamics created children who expressed their emotions through illness. Interestingly, Minuchin writes that he developed the idea of psychosomatic families after treating diabetic children who managed their blood sugar fine in the hospital but who had crisis after crisis when they were at home. His theory was that emotional stress at home was affecting the kids' blood sugar levels.

It's an interesting theory, and I think there's some merit in it, but not for the reasons Minuchin believed. As this rather technical article discusses, stress early in life can lead to permanent changes in physiology--in this case, rats' guts became more permeable, leading to more gastrointestinal symptoms. The idea is that some of us (rats or humans) may be more genetically predisposed to such stress mediation than others. Genes load the gun, environment pull the trigger.

For Minuchin, though, it was all environment. He blames parents for pretty much everything. For those of us who have parented children with eating disorders, his book is painful reading. For instance, Minuchin describes a family at the table with their anorexic daughter. Each parent tries to cajole, threaten, and inspire the child to eat. The child does not eat. Minuchin deconstructs the parents' behaviors as "enmeshment."

He was way off base on that one. By the time a child is in that kind of trouble with anorexia, of course parents are going to be trying to get her to eat. And of course they're going to be unsuccessful, unless they're empowered or supported by the treatment and/or professionals. Sitting in a room with a one-way mirror, pleading with their child to eat, most parents will look enmeshed and ineffectual.

Which is why I was so moved to see those answers on the surveys today. One of the fundamental principles of the Maudsley approach is that families love their children and are best positioned to support and help them through one of the most devastating experiences of their lives. Critics of Maudsley say the treatment fosters an inappropriate "enmeshment" (that word again) between parents and children. Proponents say Maudsley leverages the asset that already exists: the strong and loving relationship between parent and child.

Not all families are healthy. Not all families are functional. Not all parents love their children. But most do. And if those surveys are correct, for many adolescents and young people, parents are still an important part of the picture. And not in the way Minuchin imagined.


Anonymous said...

Aw, it's so nice to hear that college students rely on their parents for health information. It's been my experience that my daughter trust me in that regard, even though she's away at school and handling her life in an independent way. Helping each other is part of what families are for, right?

Katy said...

It seems only rational to me that kids would rely on their parents for health info. Mom and Dad are the ones who fixed our boo-boos when we were little, who insisted we wear our seat belts and doled out Tylenol and chicken soup when we were sick, stayed up with us with the stomach flu, took us to the pediatrician for strep throat and ear infections, to the ER for broken bones and stitches. In a way, parents have been their children's doctors all their lives--why should that end at 18? If you have someone you already trust, of COURSE their opinion will hold more weight than someone you've never met!

I've seen this in action with my little brother (who is a HUGE hypochondriac)--my parents' phone rings with every lump and bump and ache and pain. He rarely ends up in a doctor's office, but he always calls my parents!

Fiona Marcella said...

Minuchin's ideas were straight in the garbage can (along with a couple of others) in Dr Ivan Eisler's talk at the carers' conference I attended at the beginning of the year. He was particularly offended by Minuchin I think, because of his work with diabetes which Dr Eisler described as totally wrong headed.

Kristin said...

It's true. I'm 26 and have been living on my own for over eight years. Whenever I'm concerned about an ongoing sore throat, or drippy nose, I still call my mom for advice--even though I already know she's going to tell me to gargle with salt water, and stop eating so many milk products.

mary said...

I used to tell them to take vit. c for so many things it became a joke even though it was for viral type infections or allergies. Salt water is an excellent cure and is so important when a tooth is infected. Yes,they do hear us even when they tease us.
I have a few old books(40's-50's) which outline the psychotic/neurotic families and they loved to paint mothers and fathers with big long words that creeped me out. Matriarch was almost a dirty word in these books. Perhaps there are some Dr's. who have issues with their mommies. Could it be they are transferring their life story to our children? Yep, there are good families and some bad ones out there and usually we are a mix of both as we aren't perfect, TG. Last I heard it was Marcella's fault we're all messed up as she's quite neurotic. One nutty mum can take down the whole world if she means to.: )

Anonymous said...

Yes, indeed, blame the mother, blame the patient, enmeshment, dysfunctional dynamics, etc, etc, etc. My 25 yr old daughter and I have been subjected to all of those assumptions and judgements by health care professionals. After the sudden death of her father when she was a fragile 14,
my daughter descended into major depression and self-destruction. The diagnosis was eventually bipolar disorder and we both believe that it would have been triggered by some other stressor/event later in her life, due to a significant history of depression and mental illness on both sides of her family tree.

When my 14 yr old daughter was hospitalized and was so sick, suicidal and sad, she was clinging to me for dear life. The two of us had just been through a devastating loss and were only 6 months into the shock and raw pain of grief. When I stood by her, advocated for her, encouraged her, loved her and tried to give her hope, I was berated by a highly recommended psychiatrist: "How is your daughter EVER going to get better if you're always around??" And therapists talked about us being too enmeshed and having a dysfunctional mother/daughter relationship. Of course, I had lots to learn and I'm sure I made a few "mistakes" but I followed my heart and my gut because I knew my daughter better and longer than the so-called experts who met with us briefly at best.

It's been a hellish roller coaster ride for the past decade. But my daughter is now stable, working full-time for a national non-profit and is engaged to a wonderfully supportive young man.

I believe that one of the major reasons she is alive today is because of my love, advocacy and tenacity. She's agrees. And it's also because of her own courage, perseverence and taking charge of her health/life.

But just recently, when she suffered with a brief bout of depression, her psychiatrist was anything but supportive and instead implied that she was "at fault" for not communicating with him. She begged for phone calls and an office visit and he never called her or spoke with her in person until she called his answering service after hours. All of that made her anxiety level go through the roof and also made her feel worse about herself. She is an articulate, pro-active advocate for herself and I think her doctor doesn't know how to handle a patient who's informed and intelligent. Needless to say, she's looking for a new psychiatrist, which alas is always a challenge. (any recommendations for a good psychiatrist in the Milwaukee area?)

The blame game is still alive and well and I'm so g-d tired of it. Thanks for letting me and my daughter know that we're not alone.

Anonymous said...

I had to endure a Minuchin-inspired family therapy session when I had an eating disorder in the 1970s. It was horrible. Yeah, my family and I had problems, but who doesn't? They didn't cause my eating disorder, and I didn't cause their problems.