I get it now.

As the debate went back and forth on this blog, the Around the Dinner Table forum, and in my email about yesterday's exchange with Rachel I learned some things. I started the post in search of a reality check on, well, ME. Asking whether - and if so why - my words and record are taken as insensitive or diminishing. It was a self-centered request, and everyone duly ignored it and went on to the philosophical debates at hand: FBT/Maudsley/Biology/Parents do-don't cause EDs.

And then I finally got it: no matter how nice a person I am, no matter how sensitive, nuanced, balanced, positive I may see myself - my guess is that Rachel (and other people) feels insulted, minimized, trivialized not by me but by my beliefs about what causes and treats eating disorders.

Just by believing, and saying, that eating disorders are biologically based I am being insensitive to those who do not. My understanding of the mechanical function of nutrition in recovery denies the hard work of achieving it. My conviction that parents do not and can not cause an eating disorder in their child obviates the grievous wounds some parents DO inflict on their children.

I probably could devote my work from this day forward to repeating all my additional beliefs about this illness that don't include the above but it wouldn't help. And we could bat these issues about all day and get no clarity, because none of this is 'black and white.' There are no easy answers and as comforting as it might be to pretend otherwise NO ONE KNOWS what causes eating disorders and we AREN'T SURE what the best treatments are.

But most important: it doesn't matter. Because the end results are the same. We are all for recovery, full recovery. We all know that without full nutritional and behavioral restoration, people aren't recovered. We all agree that all people deserve stable, caring home environments and healthy relationships. We all know that recovery is INCREDIBLY hard work whatever the method. We agree that no one is perfect and that all relationships can be improved. No one excuses or discounts the impact of abuse or neglect or unkindness or insults.

Where is the disagreement?

Rachel, I do believe eating disorders are triggered by biology. But environment acts on biology - and the reverse. It takes psychological and cognitive WORK to recover. It took my daughter as much work and pain and heroism to fight her eating disorder as anyone. Her challenges were hers, and yours were unique to you. I admire you and her and all the wonderful recovered patients I'm honored to know.

Believing in a biological basis to the illness does not invalidate your work, your beliefs, your recovery story. Believing that most families whose kids have eating disorders are perfectly normal does not minimize that yours was perhaps not. You don't need an eating disorder history to deserve credit for working out your relationship with your mother and getting redress for your pain.

I respect and admire you. And I thank you for this exchange and the others we've had on this.

And for clarity's sake, I'll restate my beliefs. These should not be confused with what other parents believe, or what "Maudsley" is, or any other theoretical framework - just me:

  • I believe eating disorders are a TREATABLE biologically based genetically transmitted brain disorder with environmental triggers - (e.g. dieting, overexercise, extreme stress, illness, metabolic/hormonal issues). Once triggered, the cognitions become self-perpetuating.
  • I believe eating disorders temporarily control patients so that the person is unable to accurately perceive their physical state, interpersonal relations, and functioning.
  • I believe restoring full nutrition and normal eating behaviors is the first and fundamental treatment - but in most cases adjunctive assistance or therapies are necessary to deal with co-morbid conditions and to deal with problems in the person's life that impede recovery or risk relapse.
  • I believe families are the best resource in helping the patient regain control over the eating disorder and go on to healthy normal lives.
  • I believe patients have to take on responsibility for their own health and continued recovery when they are ready to do so.
  • I believe all families need a LOT of help learning to do the above, and some families need a LOT more help, but only in the rarest exceptions do families need to be separated in order for a patient to recover. And in those cases intervention was needed anyway.


  1. Hi Laura

    That is a very humble thing to post.

    I think and hope that your beliefs are helpful to families and to sufferers, even if the way you phrase them is not quite how I would put it.

    Take care

    cq x

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