Organizing principle

If I was to sum up my approach to eating disorders - and the main way I differ from the mainstream, it is this:

The agent of change needs to be those around the patient, not the patient.

The parents need to keep treatment going, and the clinicians need to use the parents to do so as well. The school, the community, the family's friends, the faith community, everyone around the patient needs to stand together to keep the patient moving toward recovery. Eating disorders thwart motivation and insight and clarity - but by focusing on supporting the patient by creating a firm support system that does not depend on the patient's motivation or insight or judgment we have the chance to put ED away and let the patient free.

Carrie with an, as usual, excellent description of the rabbit hole.


  1. ahhh... so that's why i feel like i'm treading water in the middle of the atlantic! -- Tasha

  2. That's why I want you to climb on the life-raft and let others row for a while! Then, some day you'll row for others.

  3. The minute I found you and understood that this is what you were saying, it made so much more sense!

    Tasha, I'm rowing for you. Take a breather.


  4. I agree whole-heartedly. This is true of so many serious illnesses, and EDs require more and for a longer time than most. Somehow we have to pound the message into the heads of clinicians that these patients don't have insight and clarity and that treating them as if they do won't change things. Even WITH insight and clarity, sufferers are rarely able to make the changes in their behaviors that are needed to get to physical health without heavy duty monitoring/support/requirements from others. And physical health is a requirement for true recovery. They need a vigilant, caring, determined cohort of adults around them requiring what is necessary for health, not allowing them to avoid their anxieties with their ED behaviors.

  5. Beautifully stated! I couldn't agree more. From the clinician's standpoint, I can't tell you how often it feels like I am swimming upstream against parents who are not ready to hear those firm limits that need to be set or physicians, who don't know enough to set appropriate limits and are still stuck at looking exclusively at BMIs (which could be normal, of course, in spite of a very active eating disorder.)
    Yes, we have our work cut out for us.

  6. I agree Laura this is very necessary. It is very very important to keep the brain and body nourished so that the person can recover enough to keep that going on their own. Losing weight, particularly for adolescents, is bad for their brains. Brain injury from malnutrition is bad for recovery, bad for motivation, bad for insight, bad for school work, bad for social life, bad for everything.

    I wouldn't want people to wait till I had brain injury before they got food into me! Mentally ill teenagers shouldn't be making choices about eating when not eating causes injury to the brain (and all sorts of other organs too). There are plenty of data on malnutrition induced brain injury and we really don't need to keep re-inventing that wheel. Let's plug the loopholes instead!

  7. Laura,
    This post has only reinforced my "Tiger Mom" position ( I've quoted it to several pts. this week and it has only reinforced my already strong position on the subject. Your emphasis on the community as sole player really sticks with me; we can temporarily forget how impaired patient judgement is and focus on a team, inclusive of the undernourished one, forgetting that the rest of us need to pull the weight, so to speak.

  8. Thank you for writing this (oh, and everthing else on your blog!). I find it endlessly frustrating that I cannot keep my motivation going, despite really wanting to move past all this. I even have trouble maintaining the belief that there is a problem - even though I know there is! It defies all logic and explanation - and I am a very practical and sensible person. But you are so right. The treatment should NOT depend on the complicity of the patient. Food MUST be a non-negotiable rule - and the support people need to understand that the patient will, more-often-than-not, *not* agree with this assessment of the situation, but that should never alter the rule.


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