Monday, August 16, 2010

Jezebel on parents and eating disorders

Jezebel writer Anna North put up a piece today based on an interview we did last week about not just my new book, Brave Girl Eating, but the whole notion of family-based treatment.

The comments, sadly, reveal some of the biases against FBT (the Maudsley approach). Take a look and leave a comment if you are so moved--I think Jezebel readers would benefit by hearing from some who have had positive experiences with FBT.

I'm off to do some deep breathing.


Andra Hibbert said...

I'm curious what your answers to some of those very real "anti" FBT comments are... My mother did teach us to go around the table as children and say how many fat grams we'd had in a day. She actively praises us when we are skinnier (3 girls, 2 with EDs), and when my ED was most active in my early twenties my plan was to lose weight until she noticed. I think that getting her onboard with FBT would have meant really really hard work on her part (work I'm skeptical she would be willing to do), but I also think that if just once I heard her say "I love you, and I'm not going to let you starve" my recovery would be different.

Harriet said...

I'm glad you asked, Andra.

What the research shows is that you don't have to be a perfect family to use the Maudsley approach. The studies didn't select only "good" families; families were assigned to a research protocol randomly and blindly. The clear result was that teens in the majority of families got better and stayed better.

That's still not good enough, of course, because what about the other 10 percent? I think FBT would be more challenging in a family where one or more parents is actively eating-disordered, for instance.

I can't speak to your experiences, except to say that they sound very hard and awful, and I'm sorry you had to go through them. What I do know is that with support, most families are not just able to do this; they're the only ones who can do it. Because as you may know from your own experience, you've got to go home sometime. And for most teens, home means parents.

Most parents love their children deeply and are willing to make sacrifices on their behalf. They may need a little help at the beginning wrapping their minds around the whole issue--which is why I think overall, more people need to know and understand more about EDs in general.

The whole "You can't be too thin" mentality is way too prevalent in this country. But from my own work I know that when people learn how destructive this can be, they often change their tune.

Beth Kanell said...

I've looked at the site and the comments are indeed shocking -- and for today, I'd rather comment where I'll be understood (that is, HERE) than where I may be exposed on YouTube (if I read that site correctly ...). Briefly: Autism and schizophrenia were also blamed on mothers. It's time to stop blaming families for illnesses. If a family is in good enough shape to help a teen, hurrah - and if not, a little self-awareness and stepping out of the way for a seasoned treatment team would be nice.

A:) said...

Some of these people do have points however.

I mean, my parents are alcoholics and my mother has anxiety issues. We did do Maudsley and it ended up as a stand-off between us. Now this may be usual for most families, but you introduce another factor when alcohol is involved. I was beaten by my father (punched, dragged out of bed by my ankle, thrown to the floor, etc.) and had orange juice dumped over my head/food thrown at me when I refused to eat.

My mother called me names and selfish and told me if my father died from a heart attack it would be his fault. We HAD maudsley therapy. There was an extreme effort made to make it work -- it simply didn't and the relationship remained damaged.

I was terrified to tell the Maudsley therapist because as a 17 year old child with a 15 year old sister I did not want to be taken by child services or my parents who I LOVED to get into trouble.

However, when I tried to hint at things that were happening, it was interpretted as ED talk.

Maudsley puts children in a very scary position of not being heard and on occasion when it is not the ED talking, they may have something important to say.

I went into a program, became weight restored, relapsed again and this time recovered myself with an outpatient team. I've gained 22lbs over the past two years and only have a little ways to go before I reach a BMI of 20.

I think you need to remember that YOUR story and YOUR experience is not everyone else's experience.

Maudlsey may NOT require perfect families, but the collorary of that is not that EVERY family should do Maudsley.

Parents do not cause EDs (because EDs are multicausal) but that does not mean they should be the treatment providers in every case.

This kind of black and white thinking is dangerous. It would be like preaching one SSRI for all depressed individuals.


Harriet said...


Where do you see me saying that every single family in the universe should be using family-based treatment?

I'm not going to cop to black-and-white thinking here, because I really don't see things that way.

I wrote the book because I want families and treatment providers to KNOW about FBT. To consider it a first-level treatment for teens, because that's what the research supports. Most people have no choice because they don't know this kind of treatment exists.

I'm sorry for your suffering and experiences. But I don't think you actually had true Maudsley therapy. No real FBT therapist would EVER support parents abusing their children, either physically or emotionally, in the name of ED recovery. That's not what this is about at all. FBT is loving and supportive, never punitive, and certainly never abusive.

In true FBT treatment, parents are NOT the treatment providers; the therapist is. Parents are more like the ground troops, the ones in the trenches making sure their child stays safe minute-to-minute. And by "staying safe" I mean being fully nourished, not allowing their child to starve, purge, binge, or otherwise harm herself through an eating disorder.

It is also the job of the FBT therapist to pull the plug on things if they're not working. Your therapist seems to have failed on all counts.

I am deeply sorry for your suffering. But most families are neither alcoholic nor abusive. And the research clearly shows that most families are not just capable of benefiting from FBT, but that it's the best choice.

There is no single cure for eating disorders for everyone. More's the pity. But FBT happens for now to be the only evidence-based treatment out there. And I'm going to keep on letting people know about it.

Danielle said...

I was surprised at the level of anger (or pain) in the comments on Jezebel- it seemed as if many related to the subject, and had strong reactions to your information. I wonder if they stopped for a minute to consider that ED has such a bleak recovery rate... that they instead might welcome another tool? If other avenues have been tried, why not this one?

I spent time at an intensive outpatient treatment facility (we lived in houses donated to the program), and I saw that many of the friendships formed between the women in treatment were detrimental to recovery. They forged a bond to resist: this is also highlighted in the HBO documentary THIN...

A:) said...

Harriet, I just wanted to illustrate the point that which family is abusive and which is not can be a tricky issue.

My parents are NOT normally abusive (though they are chronic alcoholics). However, they both hold down white collar jobs of their own and drink in the evenings. They are very much high functioning and well-educated.

Our Maudsley therapist was the inpatient director of an internationally respected hospital, working directly on a pilot study with James Locke through collaboration (the same multi-site study that is STILL going on now)

He was dismissive and rude -- both to my parents and myself and DISCOURAGED seeking more intensive treatment when it became clear that we weren't make any progress because he didn't want us to drop out of the study.

I guess I am trying to say that this was not some PhD psychology student doing Maudsley for the first time and my parents are not obviously alocholic or abusive.

I agree with you that it is first level treatment for adolescents and I agree that it is more helpful than the other treatments out there. I just think the screening of the parents should be better. And I am at a loss as to why a clinical director with 30+ years experience was not delivering the Maudsley that you and Laura Collins seem to describe. . .


Anonymous said...

Let me start by saying that we started with the Maudsley approach but were met with such resistance, head banging, hair pulling and threats of self harm we finally gave her 1 week to make decisions about food without our input. Needless to say we had to take her to UCLA because she restricted even water.
She was admitted for 2-1/2 weeks, discharged then immediately moved to a residential program.
I do NOT regret starting with maudlsey, I would have had it no other way. My daughter is only 11 years old...
From the moment I admitted her to the hospital we were treated like we had no rights, visitation was limited and it was the most heartwrenching experience of my life - but they saved her.
Upon moving her to a residential program we were face again with NO contact. A 10 minute phone call once a week for 2 weeks, then a 2 hour visit once a week - so on and so on.
Again - the seperation of Mother and child - when I only wanted/needed to feel I was somehow taking care of my baby. My wish is that these centers treated the families with more compassion and invovlement - they dont.
SHe has now been home for 5 weeks and is doing great, we are still on an exchange plan and my hope is full recovery so she can be a kid again...
Anyway, long way of saying - FBT is NOT for everyone and it does NOT always work but for us it was what HAD to be done. It didn't work for us but we were so blindsided by this illness and stigma associated with it and a sense of urgency to take care of her ourselves - she is our daughter and we had to try - NO regrets

Anonymous said...

I just wanted to say I appreciate your book, although I haven't read it yet, I intend to. Just the fact that you are giving a voice to something society likes to pretend doesn't exist is empowering to many of us who have been affected by this illness.
I guess I wanted to tell you that I sometimes find your comments about eating disorders and the necessary treatments to be (at times)offensive. I don't think you are intending to come across this way, but when you say that most families love their kids and are willing to make the sacrifices needed, it really doesn't factor in somethings which not all families have and the necessary resources it does take to really do the Maudsley approach.
I am a single mom of 2 kids and I receive no help from their fathers. I also have very little family support and very little support from friends. I tried the Maudsley approach with my daughter who is almost 18 (she has anorexia and bulimia) and found it to be extremely discouraging and disheartening and not realistic given our circumstances. I love my daughter very much and really want to help her, but there are limits to what I can do as one human being.
I think that at times proponents of the Maudsley approach take their circumstances for granted and assume that the benefits they are afforded are available to everyone and that is not true.
I hope that someday there are holistic approaches like Maudsley that are more reasonably applied, because I think that the burden that this places on the parents to solve the problem is oversimplified.
I hope to read your book soon and since I live in Madison, WI I am also hoping to come to one of your Book Talks. Again, I applaud you for writing a book about something that is rarely spoken of. I think it is great your daughter is in recovery. I do think that trying this first is a good step but I also think there need to be a lot more resources available out there for parents like myself that simply do not have what is needed. It takes more than just love and a little bit of patience to carry this out. I want to give a voice to those people because as a parent you feel guilty as it is and although I'm sure it is not the intent, making statements that you can do this if you love your kid, is hurtful to those of us who do love our kids but couldn't make it work because of circumstances outside our control.
Good luck and thanks,

Harriet said...

Dear Anonymous,

I'm sorry you feel that I'm judging anyone who doesn't use family-based treatment. The very last thing I would ever do is criticize parents.

I write about FBT because I want parents to know about it and have the option to try it. And you're right in saying that there are families it doesn't work for. And those families absolutely need better options.

I don't think I've ever written or said anything to the effect that parents who love their kid do FBT and everyone else doesn't. It's certainly not what I mean!

I'm truly sorry for the pain your family has gone through. I hope you and she can find effective help.

SW24 said...

I'm halfway through the book now. I picked it up because I am currently working with a 17 year old girl with an ED on the adolescent inpatient unit that I work on as a family therapist. We do not specialize in ED's, she is on our unit because she had suicidal ideation and self-injurious behavior, and we uncovered her ED while she was on our unit. We are at a standstill with she and her family right now because she is refusing to talk to them, and while the ED isn't the only thing going on with her psychiatrically, I am wondering if she is pushing them away as a function of the "demon" that you talk about in the book. This type of family (and they aren't the first I've worked with) makes me wonder about the effectiveness of this approach in a family who is dysfunctional before the ED. In your book you talk about some professionals mistaking the dynamics they see in a family with a child with an ED as what caused the ED, rather then the ED having caused the dynamics. But what if they family personally describes to you that they have had difficulty functioning for some time? Do you know of families who have successfully worked through this approach even if they are on shaky ground to begin with and are maybe not full of the unconditional love that your family has for your daughter?

Harriet said...

Well, in the research studies on FBT, families weren't vetted; they were assigned randomly to one protocol or another. I think the fact that the success rate was 80 to 90 percent speaks to your question.

Families don't have to be "perfect" to do FBT (and who is?). Clearly, certain kinds of dysfunction would rule out family treatment; any kind of abuse, for instance. But from what I know the vast majority of families can do this, even families with difficulties of various kinds. I think one of the wonderful aspects of FBT is how it empowers the whole family. I know in our family, we all grew as a result of going through this process together.

I also know that it can be very hard to know what's going on with a teen who's acutely ED. Parents who go up against an ED often wind up in an adversarial relationship with the child, certainly while she's ill. I think as a clinician you have to gather as much information as possible and follow your instinct.