Sunday, July 25, 2010


When it comes to talking about eating disorders, there's no end to the distortions that often get trumpeted as "new." If you've had a loved one suffer with an eating disorder you know what I'm talking about. One of the things I teach my magazine journalism students is the fine art of taking a press release and turning it into a compelling and accurate piece of journalism. It's the toughest lesson we do all semester, which is no reflection on them. I think it's a challenging task to pull off, and very few news or public relations entities do it well.

To wit: This story from PR Newswire, whose headline trumpets "Mommy Not Always Dearest During Treatment for Eating Disorders." If you read only the headline and the first paragraph or two you'd come away with the idea that mothers were devastating, damaging, and destructive factors in their daughters' recovery from an eating disorder.

If you can force yourself past those first paragraphs, you'll be able to intuit a slightly more nuanced story. The family therapist quoted in the story, Catherine Weigel Foy, makes comments like "The mother-daughter relationship can be a complicated one." Um, yep. There's nothing particularly ground-breaking or earth-shattering in that statement. She goes on to say, "A mother's love begins before a child is born, and can create an unrealistic expectation that the connection between mothers and daughters will be as strong and free from limitations in adulthood as it was in early infancy."

I'll buy that, too, though perhaps I'm a bit more optimistic than Weigel Foy about the potential for good relationships between mothers and daughters.

Read down another paragraph or two and you find this:

Weigel Foy endorses an introspective look at this unique relationship and believes temporary distance from family members allows many adolescent and teenage girls to feel safe exploring the mother-daughter relationship in ways they haven't been able to during prior treatment for anorexia or bulimia. Weigel Foy and her colleagues at XX XX Residential Treatment Center work together to foster a nurturing environment that helps teen girls gain a realistic view of their relationship with their mothers. In turn, the girl and her mother are better equipped to support each other on their path to recovery.

Aha. Here, ladies and gentlemen, if we are attentive readers, the light bulb goes off. We understand that the piece we're reading isn't journalism at all but PR on behalf of XX XX Residential Treatment Center (I've deleted its name because I don't want to give it more publicity). Weigel Foy may be a good therapist or she may not; we really can't tell from this paraphrasing of her work in the service of publicity.

But certainly, the average reader will come away from the headline and opening paragraphs thinking, "Wow, this doctor thinks mothers are responsible for their daughters' eating disorder and/or get in the way during recovery."

Later in the piece, the writer concludes, "Through residential treatment and therapy this relationship can be explored and these young girls can come to better understand its affect on their diseases – and in turn help build a foundation for lifelong recovery." The mother-daughter relationship is being offered up as a reason to send your child to residential treatment.

Here I must point out that not only is there no evidence whatsoever that the mother-daughter relationship plays a causal or continuing role in eating disorders, but there is also no evidence whatsoever that exploring this relationship helps anyone get over an eating disorder. To the contrary: The most effective treatment for adolescent eating disorders is family-based treatment, which enlists the support of the family--mothers included--to help teens and young adults recover. And when I say "the most effective treatment," I am referring to real studies with real results, not one therapist's opinion (no matter how good she may be).

This kind of media deconstruction is important for everyone these days, as we're bombarded by information. But it seems to be especially imperative in the murky, vague, profit-seeking world of eating disorders treatment. Caveat emptor.


Anonymous said...

Fabulous, thought-provoking post (as usual). ...The dominant narrative of mothers somehow "causing" daughter's eating disorders contributed - in my case, at least - to a mother who was terrified/ defensive with nearly every treatment professional we encountered and who worked to control which professionals I saw, based on her sense of whether they blamed her. Now granted, my mother has other issues. (Um, who doesn't?) But I think her (somewhat valid) assumption that she would be considered a contributor to my disease (rather than -- perhaps more accurately -- to my disease AND my recovery) really cut at her. And it set up several of the professionals I saw to either hurt her further or fall into a "your mother is the fabulous exception" pattern that denied how many mothers align with their daughters in recovery AND distorted the complexity of my relationship with mine.

All of that said, I do have some concerns regarding the growing "embrace" of FBT/ Maudsley. I know the research supports it, and I'd do anything to see more people receive the most effective treatment... but from a youth rights perspective (as well as one of personal memory), it concerns me somewhat. One of the most empowering moments in my own treatment was when my therapist allowed me to opt out of family therapy, on the assumption that I knew best what participating in that therapy would mean in my home. And the distance I got from my family in residential -- while devastating in many ways -- was also one of the first major steps toward recovery, not just "from" my ed but "of" myself.

I realize my experience is not everyone's, and I wouldn't want it to be held up as a prototype. But I'm concerned by how often the term "most effective" treatment is used to imply "universally applicable." 9 years ago, I was ready to get better. Sadly, my family, in many ways, was not.

Anonymous said...

Well said.
Thank you.

Harriet said...


I think what you are describing is the confluence of eating disorders with adolescent development. Most people develop an eating disorder at precisely the time they are working on psychological issues of autonomy and individuation, which is why professionals have conflated the two for so long.

The way I see it, it's the eating disorder that disrupts normal adolescent development and individuation. The goal of treatment is to ditch the ED as fast as possible so the person can get back to developing in her own way. It's very empowering indeed to begin to understand your instincts and trust them, and to get distance from your family--every teenager needs this.

But you really can't get too far in this process while you're sick with an eating disorder. I respect your experiences, but would like to suggest that for most sufferers most of the time, family support is a positive, nurturing thing. And it helps them get on with the business of living, which includes separating from that family in an appropriate way once they're well.

I would also suggest that one reason for the abysmal recovery rate of "traditional" treatments with adolescents is that it has tended to separate the adolescent from her family. As a parent, my feeling has been, let's sort out the guilt, blame, shame, etc. later on, but first let's get down to the business of recovery. Then we'll have the time, luxury, and emotional ability to do the rest of the necessary work.

I'm glad you found your way through. And it sounds like your family was helpful much of the time.

Kat said...

I was very disappointed to read that article/ad for the treatment centre, too. It's irresponsible to just throw implications around like that - especially as you point out, Harriet - it just seems to be this one therapist's opinion. Apart from anything else, a patient's relationship with her mother is just one of a myriad of factors which may or may not be relevant in her ED, why pick on that one, especially as it's going to create blame/guilt/tension in families.
It's so transparent it's manipulating families' and patients' hopes and fears and it's really got nothing new or relevant to say. Reminds me of the bad judgement of ths treatment centre and their advert:

However, I have to say I think journalistic treatment of EDs has improved overall.

Mary B said...

I am currently recovering from an eating disorder using a very family-centered approach so this post certainly hits close to home. Harriet, I follow your blog closely and, as one dealing with the devastation that is anorexia, I really appreciate what you have to say!!
This particular post is interesting to me, because when my mum accompanied me to my first therapy session my therapist told her there was nothing she could do to help; the therapist went so far as to say (without getting to know me at all) that my family may in fact be part of the problem. We couldn't work with own mum was not going to watch me starve myself, she was instead (despite what my awful first therapist said) going to be there for me. We're are working through the recovery process together and honestly, I could not do it without her. While at times I wish she'd leave me alone and let me exercise the day away without so much as a bite, at the end of the day, she is my biggest advocate, and first source of encouragement and support.

Harriet said...

You are lucky, Mary B., and your mom is lucky too. And I look forward to hearing that you are recovered and back doing what you want to be doing with your life. Stay in touch!