Being a Brick Wall

My good friends over at C&M Productions have created a new tool for parents to visualize the way to stay calm and focused in the face of confronting behaviors: they've LITERALLY animated the authoritative stance:

MODELLING EFFECTIVE PARENTING FOR EATING DISORDERS BY C & M PRODUCTIONS

I'd love to hear your impressions, positive and negative, of using this format.

I especially want to hear from parents who are new to supporting an eating disorder patient, because you are the intended audience.

Comments

  1. Wonderful! Keep them coming. I've no idea how you make these, but they are great.

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  2. I love these films. They're very clever :)

    You wanted responses from parents, but I couldn't resist commenting as a former sufferer of AN...

    The girl sounds like I did as a teen, although I am embarrassed to admit that I didn't use the word 'Freakin' but rather, another 'F' word...

    (I have mellowed with age and recovery - thank goodness!).

    I'm not sure how I'd have responded if my Dad had been so calm... He used to get very angry with me (which didn't help), but occasionally he was calm, which still upset and frustrated me because I thought he was being condescending.

    It's actually quite difficult to watch when you've been a sufferer of AN...

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  3. Cathy, I got pretty emotional watching it as well. My husband started out okay but after a minute or two got visibly upset - he remembers it well.

    I like the way it shows the range of ways the anxiety displays itself: dismissal, derision, anger, fear, helplessless. I think if parents can see that remaining a warm and non-reactive parent no matter what ED throws out they can try it out. We were AMAZED at the power of that stance to make it possible for our daughter to do what needed to be done - a terrifying and brave thing.

    Cathy, one critic of the film felt that it might be seen as making light of the sufferer's plight, or humiliating. I'm wondering if you think others might get that sense?

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  4. I'm a former sufferer, and watching this video was a very strange experience for me. Without inflection, the exchange seemed so surreal . . . and, yes, humiliating from this perspective. But I haven't gotten over my shame in general about my illness, so I imagine my perception is skewed. Above all, I think if the video is a helpful tool for parents (is it? really?) then it's worth whatever icky feelings it raises.

    When I couldn't bring myself to eat, I wanted SO MUCH for someone to make me.

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  5. As the father of a young woman who developed anorexia nervosa several years ago as a teenager (and is now fully recovered) I wish someone had shown me a video like this back when we were working to beat the illness. When my behavior was like this dad's, our daughter was more empowered to eat and recover psychologically. On the other hand, when I became engaged in debates with the illness, the illness seemed to take on more power. The key, in my opinion, is illustrated in this video: persistence, consistency, and a calm, unyielding approach toward eating. PS Thanks for remembering that there are dads out here too, in addition to moms!

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  6. I would be interested in Cathy's view (and that of anyone else who has suffered from an eating disorder). As a parent I can see that it might be considered not to show the true emotions and fear of the sufferer. It doesn't show the emotions of the father either, but then again as he's modelling the "brick wall" technique so perhaps that's OK.

    This lack of reality, of emotions in the figures was a problem to me at first with all these films. It is now the main reason why I think that this is such a good medium to use to illustrate all these points. Film of real people in real situations is nearly always voyeuristic. I understand film makers' and journalists motives to expose the horrors of these illnesses, but I have never felt that any of them have done justice to the subject matter. Autobiographical accounts, even ones like yours and Harriet Brown's run the risk of being too personal, revealing too much about the individual and not being generalisable. Generalised "vignettes" like those in the manuals run the risk of being too trite, too general.

    That is not to say that these media should be ignored. I think that there is very much still a need for autobiography and manuals and compilations of personal stories such as June Alexander's and Becky Henry's. If anyone ever does a film of real people in a real situation which doesn't end up as exploitative or voyeuristic I'll applaud that too. This media however adds another dimension - short, accessible but not condescening, personal but not intrusive.

    C&M I thank you.

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  7. In terms of Laura's and Marcella's questions, these are my personal thoughts...

    1. Is the film humiliating to the plight of the sufferer?

    I guess I can identify with the frustration of the sufferer, that no-one seems to understand her absolute need to do what she is doing and how scared she is of eating the meal. Her fear is displayed as anger, which can be misconstrued by others as 'hate' towards the parent. But then there is also the confusion of the sufferer. I, at least, didn't really understand why I felt compelled to starve - and so I would come out with statements like "you only want to spoil my fun/control me/make me fat...". I wasn't actually fearful of any of those things, but I simply couldn't verbalise my feelings. Neither could I actually understand or make sense of what I was feeling. I just felt overwhelming fear.

    So, I can understand why it may appear that the father is being condescending and ignorant of his daughter's fears. The sufferer has all these pent up fears and emotions, yet no-one seems to understand her. I know I felt very misunderstood and alone, and at times humiliated.

    2. Lack of emotion

    The girl is as 'deadpan' as the father. But I agree about the voyeurism thing associated with real people in real situations. Yet, the fear and frustration of the sufferer doesn't (and cannot) come through in this film as much as it would in real life. She sounds too cool. Perhaps there is a danger of her being viewed as a brat rather than a distressed and fearful sick girl (?)

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  8. As a person in recovery, I was cracking up watching this. I found it hilarious... because it was like a REALLY HUMOROUS look at myself through the lens of this video. I found it hilarious. I really did.

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  9. My comments, good and bad, for what they are worth (and they are based entirely on my own experience) are as follows.

    I think the content, the medium and the length is good and I too love that it is a dad in the picture. The scenario really helps to show how long the discussion can sometimes be between putting out the food and getting anywhere near eating it. Emotionless as the participants are (through no fault of their own!) it definitely stirs some emotion. It doesn't mirror my own experience exactly as we never reached any kind of verbal resolution that the food would be eaten in similar circumstances - once this kind of dialogue was in place there was never any feeling on the part of my d that she could be reconciled to starting/finishing the food in front of her; the food only ever got eaten after this point through tears and extreme distress and we/I needed to continue to model calm throughout this too.

    Being really nit-picky, could it be made clear once the timer has been introduced that it is now ticking - otherwise dad seems to lose a bit of credibility.

    In spite of any minor reservations, I think that it is the most helpful illustration (quite literally) of how an eating disorder manifests in real life and how carers might manage what some would consider impossible. I think it will be enormously helpful to parents and carers - streets ahead of the dvds that I received as part the collaborative care research.

    Well done to the producers. Hope you don't mind my critique - I think you have done a truly fantastic job and am in awe of you both.

    Erica (B)

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  10. Boy, I thought the video was awesome and yes, it's seemingly void of emotion but anyone living through or suffering with this gets that emotion loud and clear. I believe as parents we need tremendous support during these huge emotional challenges and painful exchanges so that ultimately we can make the most effective changes and responses. Keep them coming...we need more tools!

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  11. I too was reminded of the DVDs from the research project. I agree these are streets ahead of them. Whether real actors rather than research assistants could do better I'm not sure. I wouldn't mind seeing Colin Firth as the dad but think that the part of the girl would be too stressful for any real actress. On balance I think that this media has certain qualities that make it better than real-life simply because it IS stilted and animated - they can be "everyman", or at least everysim, and it doesn't matter that the situation is not exactly like ours because it's not exactly like anyone's - it's an illustration, litterally.

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  12. The idea of Colin Firth as the father actor is so appealing that I might even volunteer to be the girl actress. I think he could get me to eat the meal :)

    The only additional comment I would make, which I have discussed with one of the film-makers, is that for me, personally, this approach wouldn't have worked that well given the nature and background to my AN and my co-morbidities. But that is no criticism of the film-makers; more of the approach - which they have simply animated in what I think is a brilliant film.

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  13. This is an excellent educational tool for parents of ED patients and for clinicians who work with families of ED patients.

    I think the video would be more realistic and more informative if it depicted the sufferer's intense emotions and extreme resistance. Many, if not most, families who do home-based refeeding deal with screaming, crying, thrown objects, self-harm, hour-long standoffs, filthy language, threats of suicide, running away, patients locking themselves in rooms, etc. I believe that families need to be fully informed about these potential reactions and coached in how to handle them effectively at the beginning of FBT. Families need to be informed that such behaviors are temporary, brain-based reactions to intolerable anxiety, which will subside and disappear after weight restoration.

    One criticism I have of the FBT manuals (intended for clinicians) is that they fail to explain the extent of these reactions to referring, which are very common and perhaps unavoidable. I think most clinicians have no idea what
    families go through.

    I think it would benefit parents and clinicians to show more typical (e.g. Emotional and explosive) patient reactions.

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  14. I think the lack of emotion makes this video tolerable to watch. The ED unit of our local hospital gave us a meal coaching video to watch. They used meal support staff as actors playing the parts of two anorexic girls and the coach. It was extremely painful to watch; I was so jittered and anxious after just a few minutes of it I could hardly breathe. The 'actors' played their parts too well! Even watching the outtakes where they cracked up didn't relax the tightness in my chest. I hardly learned a thing about the coaching because my own emotional reaction got in the way.

    Having said that, I do agree with Dr. Ravin that it might not prepare parents for the real McCoy. Could there be something at the end, scrolling text or something, or maybe the dad could turn to the camera and talk, that would say, "This is one possible scenario. We are robots without emotion. In real life, you may see tears, screams, swearing, tantrums, flying plates, etc. It can be frightening, but don't be alarmed; stay calm like me. You can do this." Something along the lines of Malia's "Your mileage may vary."

    I agree that most clinicians have no real idea what refeeding your child is like. It can really make you doubt yourself when the s*** hits the fan. This is a great tool to help and I could actually watch it without hyperventilating!

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  15. Eating enough to gain weight during recovery is hard (and I think any FBT therapist would acknowledge that), but it's difficult to predict how an individual child/teen will react. Attempting to "fully inform" parents might scare them enough that they reconsider FBT (I have seen this happen on the forum--the mother almost decided on residential but gave FBT a try and later reported that it wasn't nearly as bad as she'd been led to believe) and create negative expectation on the part of both parents and child. Honestly, I think FBT therapists have a very good idea what families go through (and I'm a parent.)

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  16. I have to agree with Dr. Ravin. My daughter was very emotional and explosive, so much so (and it was so unlike what I'd ever experienced with her prior) that she ended up hospitalized back in 2003. I didn't know this was actually typically. I had no one at the time that could tell me that. I was scared to death by her behaviors and so afraid she'd hurt herself. I only can wonder in retrospective if we could have all survived and 'ridden out the storm' if I'd known to expect it and how to handle it.

    The only other thing I noticed...and maybe this is crazy because I darn well KNOW you can't tell if a person has an ED by looking at them...but, the father looks as thin as the daughter. Maybe put a little 'healthy' weight on him? I don't know how easy that is to do with cartoon figures. Otherwise, I think the whole concept is wonderful. It helped me to, just to remind me of what 'calm' is....

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  17. Dr Ravin, I agree with all that you have said and I am relieved to hear you say that most clinicians may not have any idea of what we go through - even if they do, without experiencing it day after day, month after month, it is hard for them to put themselves in our shoes and know what it is like to live this.

    I would also like to add that it's not just the explosive stuff and the foul language sometimes used that are hard to deal with - there are some things that are even harder to hear from your child: "I can see you hate me", "I can't live in this family", "When I leave here, I will never come back", "you/we are not normal"... ; these things are not necessarily accompanied with any type of violence (of action or tone) but are hard not to react to as if they don't wound us deeply when they often do - and yet we must.

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  18. While I agree that this is tame compared to what having an eating disorder makes many poor children do, I actually quite like the "flat" effect given here. Really showing the kind of violence, self-harm and bad language that CAN go on might just get the film banned from certain sites and frighten parents who are lucky enough not to be going through quite such extremes of emotions with their children. I wonder whether this film could end with, the meal having been successfully eaten, the child sobbing in her mother's arms saying something like "it's so hard" and the father taking a breather outside (to be realistic he'd probably be kicking something or smoking a cigarette but we want to model good behaviour ;-) ) saying exactly the same thing.

    For dealing with the real extremes of behaviour and with parents' very real struggles actually putting into practice the brick wall approach perhaps we could have another film with both parents consulting the therapist explaining how the ED is affecting their child and family life and the therapist really listening, acknowledging that it is very common and very hard and giving advice.

    Sorry to give you more work C&M.

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  19. I am in the middle of preparing for a VAT inspection here (Arghhhh) but M sent me here to look at these comments.

    I agree with the fact that the full plate-throwing, self-harming, violent reaction that some of us have faced is not portrayed as realistically as it could be. However, when writing this, I wanted a film that was watchable and suggestive, rather than a full blown voyeuristic remake of "Texas Chainsaw Massacre". M and I have to bear in mind that some of our fellow ATDT contributors have had no such reaction, more sorrowful resignation and no self-harm or violence.

    I was also very aware that clinicians may use this film to help educate parents about FBT and refeeding problems. One clinican wrote to us that, although they face it everyday in their facility, the staff found this very painful to watch.

    We were trying to portray the anxiety and instinctive flight or fight initial reaction, followed by the anger, followed by the fear and the need for help. We didn't want to offend anyone with the salient swearwords (which I didn't know my daughter knew!) or the graphic self-harm which I, personally, witnessed or the violence to which I was subjected, for fear that eating disorder sufferers would be seen as even more "freaky" than they already are. To be fair, anyone who has no experience of this situation would not BELIEVE that someone could behave this way about something as "normal" as food! Those of us who have lived through it know that it does not go far enough.

    This all came about because there was a consensus on the forum that there was no realistic portrayal in the current literature.

    But both M and I LOVE that you have been watching and I am hoping that this will go some way to preparing new parents for some of the bumps in the road. Keep watching and keep commenting. It is very good for us to get feedback, rather than thinking we are putting stuff into the ether that no-one is watching.

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  20. My family and I have just begun this journey, so I thought I'd offer my opinion. I haven't seen any live action films on this subject, (now I'm not sure I want to) but my first impression was that it wasn't real enough. ie. easy enough for a cartoon dad to do that - but much harder in reality. On the other hand, I loved how the girl tried a variety of approaches to get her dad to back down. My d has yet to yell and scream, but she does get sad. The only other behavior I'd add to the video is the gagging as she eats. "I just don't feel well enough to eat." For me, that has been the hardest "argument" to overcome.

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