The Maudsley Approach to Anorexia

Last year my husband and I spent most of a year refeeding our older daughter, who was diagnosed with anorexia. I wrote an essay about our experiences, which will be published in the New York Times Magazine tomorrow, 11/26/06.

The approach we used is called the Maudsley approach. It was developed at the Maudsley Hospital in London in the 1980s, and is very successful at helping teens with anorexia (though I know of families who have used it to help young adults in their 20s too) recover. It's not easy, but then nothing about this disease is easy, especially for the person who suffers from it.

If you're interested in finding out more about the Maudsley approach, visit www.maudsleyparents.org, a website run by parent volunteers. There's a lot of great information on the site, including a basic introduction to Maudsley and a couple of personal stories from families who have used it. There's also a link to an online parents forum, which has been invaluable to me and my family as we have gone through this experience.

Another great site is www.eatingwithyouranorexic.com, which is run by Laura Collins. Collins wrote a book about how her family helped their daughter recover through Maudsley; I recommend it highly. Her book of the same name is available on Amazon.

I've begun to do some coaching and guidance for families who are going through this re-feeding process. If you're interested in finding out more about coaching, or just want to get in touch for whatever reason, please e-mail me at hnbrown@tds.net.

Anorexia Study Volunteers Wanted

It seems appropriate on Thanksgiving Day to post about anorexia, a disease that's all about starvation in the face of plenty.

One of the most astonishing facts about the disease is that there's been very little research done on how to cure it. As in almost no studies. As in, anyone can call themselves an eating disorders therapist, and offer his or her own concoction of treatments, with predictable resuls.

If you've seen the movie THIN, you know what I mean.

There's only one way to make sure that compassionate, practical, and good treatments are developed--and that's with well-designed, controlled studies.

If you're a parent reading this because your daughter or son (yes, boys get anorexia too) is anorexic, you have the chance to enroll your child in one of the biggest studies that's ever been done on anorexia. It's being run by researchers at the University of Chicago, academic home of Dr. Daniel Le Grange, one of the leading practitioners of the Maudsley approach. The five-year study compares the Maudsley approach with another treatment approach. It's designed for teens ages 12 to 18 and their families, and involves either 24 or 32 treatment sessions over a year, with follow-ups down the road.

Treatment is FREE if your family is in the study. Of course you have to live within driving distance of Chicago.

For more info on the study, see http://psychiatry.uchicago.edu/research/volunteers/anorexia.html, or call 773-834-5677, or email anorexia@yoda.bsd.uchicago.edu.

I know it's hard for parents to make the choice to enroll a child in a study. I know you don't want your child to be a guinea pig. The great thing about this study is no matter which half your child gets randomized into, parents and families are involved with the treatment--which is a huge and important difference from most other treatments out there right now. To my mind that's crucial. I wouldn't post about the study if that weren't true.

I also like the fact that treatment is free if you're in the study. God knows most health insurers don't cover much (if any) treatment for anorexia. Ours certainly didn't. If you live in a state without mental health parity (as we do), you'll be stuck footing most of the treatment bills because insurers seem to consider treatments to be a frivolous luxury. They seem to think kids can somehow think themselves out of anorexia without all that expensive treatment.

If you're a parent of a child with anorexia, my heart goes out to you. You're not alone.

News Flash: Anorexia Is a Brain Disease, Says NIMH

The press release below will hardly be news to those of us who have had personal experience with anorexia. But to the rest of the world, it's a news flash, all right.

And to families who are struggling to get sleazy insurers to cover the cost of their children's life-saving treatment, this could make all the difference. Note to insurers: All the recent research on eating disorders shows a strong genetic and biological component to the disease. The suffering of those with anorexia is real and based in biology. Pay up--or have the suffering and deaths of children on your corporate conscience.
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NIMH Director States Anorexia is a "Brain Disease"
Today NEDA released a letter received from Thomas R. Insel, MD, Director of the National Institute of Mental Health. Dr. Insel wrote the letter in response to a request made by participants at the 2006 NEDA Conference. The landmark statement issued in the letter that anorexia is a “brain disease” may well help thousands of families struggling with insurance companies to pay for their loved one’s treatment. For details or to link to today’s NY Times article, visit: http://www.NationalEatingDisorders.org. Please thank Dr. Insel for taking the time to assist us in our efforts to improve access to quality treatment! He can be reached c/o nimhinfo@nih.gov.

Wise Words from Fair Wisconsin

This speech was posted by Fair Wisconsin, the group leading the charge to defeat the so-called marriage amendment.

Wise words, though I'm still ashamed of living here.


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My friends, tonight we came up short in our struggle.

So many of you gave everything you had.

You pounded the pavements.

You emptied your wallets.

You forced yourselves to go up to the doors of strangers and ask them how they feel about something many of them had never discussed so openly before.

Many of you came out to more people than you wanted to because you knew telling your personal story was one of the best ways to change people’s minds.

Some of you have been giving this your all for almost three entire years. And many of us have made many personal sacrifices to make this campaign a top priority.

What I am most proud of most of all is how all of us dared to hope.

And we must not lose this hope and we cannot ignore what we have accomplished.

Because despite the results I still believe in a fair Wisconsin. I refuse to stop believing.

This debate was forced on us at a time and a place not of our choosing.

This fight against the amendment was never just about what happened today. All of us committed to a long-term struggle for equality and fairness for everyone. We cannot give up on Wisconsin, and there’s good reason not to.

We know for certain that many of the same people who voted for this amendment today are the very same people who will support equality for gay families within the next 5 or 10 years. That change might not have been on the timeline forced on us by our opponents, but we cannot ignore the fact that we have laid the foundation for long-term change in Wisconsin. Because of our work, more people in this state than ever before understand that gay families exist in this state and discrimination hurts them.

We may not have won the election, but there were so many victories along the way. We achieved many things that have drastically altered attitudes about gay people, gay families, and the way we do politics around this issue. We transformed a “gay rights” issue and made it a Wisconsin issue.

Our accomplishments are not in vain.

Two and a half years ago, it was unfathomable to most people, including myself, that we could wage a strong fight against the ban.

People said we couldn’t raise enough money. But we raised over $5 million from over 12,000 people to help us communicate with the people of this state.

People said we couldn’t recruit the volunteers necessary, but over 10,000 of you exploded that myth from day one.

They said elected leaders wouldn’t stand with us, and if they did, voters would reject them. But our leaders challenged that notion in fact, leaders like Gov. Doyle never wavered in his opposition to the amendment whether at a UAW rally or editorial board meetings in Baraboo.

Again and again, we proved the cynics wrong.

I know we have changed something fundamental because I saw it unfold in our offices every week of this campaign.

When I saw a standing-room only crowd of Fair Wisconsin supporters sitting in a church basement in Wausau back in March, I knew we were making change.

When I saw an ironworker stop by our office to take literature back to his local labor union because they had taken a position against the amendment, I knew we were making change.

When I saw clergy in their collars in Appleton explaining why the teachings of Jesus compel them to speak out, I knew were making change.

When I saw business leaders move from expressing private concerns to issuing press releases, I knew we were making change.

We set a high bar for ourselves and met it. This changed our campaign but it also changed the way people view gay families and gay issues in this state.

We transformed this so-called wedge issue into an issue that united Wisconsinites of all backrounds. We have made equality and fairness for gay Wisconsinites something that is embraced by many organizations, leaders, and average citizens.

Thank you to the thousands of gay and lesbian people who did not ask for this fight, who did not want to become poster children. You chose to interrupt your lives so that one day our children will know a world without discrimination.

You bravely stepped up to put your lives on display.

Thank you to all of you who like me aren’t gay but made this issue your own. Thousands of you refused to stand by silently while your friends, families, and citizens we will never meet were attacked with this amendment.

Together, all of us stood shoulder to shoulder—grandmothers, farmers, ministers, school teachers, and many, many more of us from all walks of life.

And although we didn’t win we ran a historic effort that changed Wisconsin.

Ashamed to Live in Wisconsin

Love, Food, and Money

Tonight I am ashamed to live in the state of Wisconsin.

We've joined the ranks of states that have now written into their constitutions prejudice. We've institutionalized discrimination--not just made it legal but mandatory.

It's a sad, sad day for Wisconsin, which has a long and rich history of progressivism, of valuing all people equally.

Our so-called marriage amendment may have passed, but they can't make us believe it. They can't make us believe that people who are gay deserve fewer rights than the rest of the population. We'll fight this. We'll overturn this amendment.

Next time.

The Madrid Models Controversy

I applaud the designers in Madrid who banded together to insist that every model in the Fashion Week show had a BMI of at least 18. As theater, it was a highly effective device. As a way to call attention to eating disorders, it succeeded. The blogosphere is now abuzz about stick-insect models and irresponsible designers.

But those of us who have had personal experience with anorexia know that the controversy over runway models is something of a red herring. Yes, the media has power and influence; yes, images of cadaverous models in the pages of magazines, on billboards, and TV make for unhealthy role models. But fashion doesn’t cause anorexia, any more than critical mothers cause schizophrenia or food coloring causes AIDS.

Not many 10 and 12-year-olds are catching the latest runway show or reading Vogue. But they are walking the hallways of school, where—at least if their school is like my younger daughter’s middle school—they will see exhortations to lose weight. They take dance and gymnastics and cross-country, where their teachers and coaches will praise the “line” of a thinner girl’s body, the need to shed pounds to gain speed.

Most important, they’re in the backseat of the car, listening to their mothers and other adult women talk about how fat their thighs are and their latest diet. From the time most girls are old enough to feed themselves, they’ve listened to the women in their lives obsess about food and dieting. They’ve learned that there are good foods and bad foods, that it’s important to deny yourself, that there’s something shameful about the enjoyment of food. They’ve learned that hating your body is not only acceptable, it’s de rigueur, that physical self-loathing is a rite of passage among American women.

They’ve also heard the compliments that their mothers and older sisters get on a daily basis. They understand at a tender age that there is no more welcome or powerful phrase among women than “You look so thin!”

None of these things in and of themselves cause eating disorders, of course, any more than emaciated models do. But the everyday role models in a girl’s life exert a much more powerful influence than models on a runway in Spain. And that kind of influence can be part of how an eating disorder develops: A young teenager goes on a diet or gets sick; she loses a little weight, and the compliments come pouring in. She feels good about herself, so she loses a little more weight; maybe she runs a few more miles a day, does more sit-ups and push-ups. If she’s unlucky enough to be one of the 1 percent or so of adolescent girls who are genetically and psychologically susceptible to an eating disorder, she will find that the weight loss takes on a life of its own. It quickly becomes a compulsion, not a choice; it morphs into an obsession, something over which she has no control. It becomes full-blown anorexia, which stems not from cultural ideas of beauty but from the physiological, psychological, and emotional effects of starvation. It becomes a terrible disease that will cost her, on average, five to seven years of her life—if she recovers.

Recently my 11-year-old daughter got into an argument with a friend her age over being skinny. The friend (who, like most girls their age, is just starting to develop) often skips breakfast and lunch; her mother diets, and the family never eats pasta or potatoes. Now the friend was explaining to my daughter that being skinny was something to aspire to. My daughter, who is neither overweight nor skinny, replied, “I’d rather be too fat than too skinny.” Her friend insisted, “Thin is good. The thinner, the better!”

That night, as my daughter reported this conversation to me, she cried with frustration. She had good reason to feel upset; for the last year her brave, smart, funny, wonderful older sister has been struggling with the physical and mental hell of anorexia. Though we tried to shield our younger daughter, she, like us, had endured the hospital visits, tormented meals, suicide threats, crying bouts, and other symptoms of self-starvation. It was an awful year, but her older sister was now, finally, well into recovery.

I told my 11-year-old she’d said the right things. That it would take more than a comment or two to change her friend’s opinions. The Spanish designers have made a good beginning—now the rest is up to all of us.

Calling All Mr. Wrong Stories!

Mr. Wrong: he's the tug behind your navel, the guy who lights you up like a Roman candle, the danger you can’t resist. At some point in her life, just about every woman encounters one—or many.

He’s the fellow who lives on a houseboat (seasick sex, anyone?), the guy who can’t sweat. The one who’s thrown out of a restaurant because of the hideous orange coat that makes him look homeless or deranged (or both). The med student who says, at least once a day, “My body is my temple.” The banker who insists on eating kimchi before making love. The classical guitarist with inch-long fingernails on one hand. The guy with the banana-shaped penis (it hurts!). The man who thinks bathing once a week is enough (it’s not). The one who can’t get it up and the one who won’t go down. The married man who’s been having affairs for 25 years and says his wife doesn’t know. Right.

And those are just the ones I’ve run into.

These and other sordid guys inspired me to put together a collection of essays on the subject of, as my daughter calls it, "poopy boyfriends." The book is called--what else?--MR. WRONG: REAL-LIFE STORIES ABOUT THE MEN WE USED TO LOVE (Ballantine), and features essays from the likes of Jane Smiley, Marge Piercy, Audrey Niffennegger, Alicia Erian, Ann Hood, Whitney Otto, Roxana Robinson, and others about *their* poopy boyfriends and husbands.

But enough about them--I want to hear from ordinary women (and men) about their poopy boyfriends. Who was the worst boyfriend you ever had, and why? Here's a chance to tell your story. Tell a good one and I'll send you a T-shirt made from the book cover later this summer.

Yours in solidarity,
Harriet Brown
www.harrietbrown.com