Letting parents off the hook? Not hardly

I've had some of the most productive conversations about parents and eating disorders lately - with people who really do represent the opposite end of the spectrum. For years it was hard to get anyone to really discuss this debate from the other side - the conversation was just between like-minded folks.

What keeps coming up is if you say that parents don't cause eating disorders then you are "letting parents off the hook" for things they may have done wrong. That parents can do no wrong and are untouchable during treatment.

Can I put that to rest? It is so far from the truth and all the proof you need is in how parents like me advocate using that information: to ACT. "Parents don't cause eating disorders" isn't a "go take a nap and feel better." It's a "you didn't cause this so stop cowering and get to work: this is going to be the hardest thing you've ever done and you are the difference between success and failure here."

The message "you didn't cause this" goes with the "your loved one didn't cause it either, but all of you have a heap of work to do together, and NOW.

Off the hook? Hardly.


  1. Oh, gosh. Not sure what to say! "letting parents off the hook?" This sounds like there is a need to punish parents for their child having an eating disorder.

    I do think that parents don't intuitively know how to care for a person with an eating disorder. So true. Just like parents don't know how to take care of a child with diabetes or cancer, etc. UNTIL SOMEONE TEACHES THEM SOME SKILLS.

    Diabetes is actually a pretty good analogy to an eating disorder. So, for example, if a child has the genetics for diabetes and that child became quite overweight from eating candy bars all day long, would the professionals want to punish these parents because the child had this disease? No, they would tell them not to feed candy bars and they would teach the family how to provide the right diet and medications, etc. And they would or should keep helping them until they get it right.

    Soooooo, I don't know why the eds are so different, with the professionals whispering about what the parents are doing wrong without actually teaching them how to help their child. Or why is it that ed professionals don't even talk to families at all, they just criticize them behind their backs, or they might just keep asking the child for more and more information about what the parents might have done wrong. Continuing the analogy, what if the diabetes nurse asked the child if they were still eating candy bars, then asked about M & M's, then sugary cereal, etc, and kept going, but NEVER told the family what type of diet the child needed, just expected the family to know this? Well, that's ed care in a nutshell. And it needs to change.

    ED professionals should consider it their duty to teach their families how to help their child and they should assume they need the help and the information rather than assume the families know how to help but they just aren't doing it.

    Janet Treasure has it right-ATDT has it right-give parents the help and support they need so they can then support the normalization of eating and the development of positive ways for kids to care for themselves. And keep helping and teaching parents until they get it right. And please assume that most parents want to learn and that they can learn what to do and be successful!

  2. The more and more I get involved with FEAST and its ideas, the more I wish that FEAST had been there for my parents when I developed AN in the 1970s.

    I have previously voiced my doubts that re-feeding at home by my parents would have ever helped me - simply because it didn't. My mother tried her best, but like my father she was basically of the opinion that I was a 'difficult' child who was going through an adolescent phase of rebellion. My parents either got angry with me, or wept over me, neither of which was helpful.

    I don't blame my parents for having this opinion, because that is how my behaviour must have appeared to them, and no-one was able to explain why. To be considered by my parents as 'rebellious' or 'difficult' didn't help my sense of self either. I concluded that I must be very bad to be behaving as I was behaving - and that perhaps I had been 'born difficult' because I had always struggled so much with anxiety, change, obsessions and compulsions.

    I now recognise the cause of my difficulties; that of combined ASC traits, OCD and AN - i.e. inherent brain characteristics exacerbated by starvation. I cannot turn back time, of course, but I do think that if my parents had recognised that I was not 'choosing' to behave in the way that I did, and that I hadn't blamed myself so much for my perceived 'bad behaviour', that I would have recovered from AN sooner and would have been able to work around my other difficulties more effectively. External factors such as bullying and abuse by someone outside of my family didn't help either - because they exacerbated my innate anxiety and made me distrustful of other people. But perhaps those issues could have been resolved had I been able to express myself better and tell the people who loved and cared about me (i.e. my parents), that these things were happening to me.

    Hindsight is a wonderful thing. *Sigh*.

  3. Laura,
    What is it that these folks think parents have "done wrong" for which they shouldn't be let off the hook? That's what puzzles me.

  4. whoever said that this debate lets parents off the hook...hmm, I guess it is where they are at in their life-thinking thus far, and I can appreciate that's where they're at. But, it's hard not to read that & argue back (and I'm not even an 'official' parent of someone with ED). That said, I think it's a helpful thing to know that there are people out there who are at 'that end of the spectrum' with their current thinking. Being aware that kind of thinking is out there is helpful so that as you go forward educating physicians, parents, etc., Laura, you can continue to spread the healthier message of: "this concept of parents are not the cause of ED is not about "letting parents off the hook", it's about moving past the causes and into action/recovery." ~ I feel that people who are affected by ED, whether carer or sufferer, have a desire (or maybe for some, a need) to be validated that they are not the root or sole cause of the pain that ED inflicts. I certainly had been told that I WAS the cause...and that was a terrible burden to carry. Removing oneself from being the "cause" helps heal from and remove guilt. And when guilt is healed from and removed, the former "causers" are able to move forward in healthier ways. (Whether that moving forward and healing happens as a family or individual within a family unit isn't really concurrent with if recovery can happen. <--meaning: whoever you are, carer or sufferer, release yourself from worrying if you were part of the cause or not; release yourself from guilt. Maybe not everyone will come along with you in those release-celebrations, but you deserve to...and need to in order to fully heal)

    ps: As a former debater: I suggest that "discussion" is used rather than "debate", so that the implication of 'winning' is removed from this...discussion ;-)

  5. The last two posts both touch on the interaction between professionals and family - a challenging and important topic that has been on my mind.

    While it may be true that "the doctor (or therapist, or nutritionist) doesn't have more power than the parents", they may have DIFFERENT power, by virtue of not being the parents and hopefully by virtue of training and experience in communicating with their patients. Kids - especially adolescents - will often respond differently to something said by a non-parent adult than to the same thing coming out of the mouth of mom or dad. I know that for my kid, doctor and therapists have had information and good strategies for communicating with her that were invaluable. This does not mean that I had no faith in myself or that I "overestimated the power of a medical degree". It means that they have skills that are essential in working with patients (and this is not limited to ED). It also does not let me off the hook. It just means I needed help.

    Parents and the professionals have to be on the same team to fight an ED. This requires that they share information with each other, and this communication - between professional disciplines and between providers and parents - should be built into the full course of therapy. This sounds simple, but it seems it can actually be very hard.

    On the one hand, there are ED "centers" which advertise comprehensive teams of docs, therapists and nutritionists who work together and coordinating their strategies. But these centers do not always make parents members of the team.

    A parent may be able to find individual therapists, physicians and nutritionists who are willing to support family-based treatment, but these individuals may have never met each other and may have differences in their approaches, or mis-assumptions about what the other disciplines are doing, that cause conflicts and gaps. Even with good professionals trying their best, it may be hard for them to communicate. This has been my experience, and I am learning that this team needs a project manager, and that probably means me.

    In my day job, a project manager:
    • has an expert overview of the subject at hand.
    • has a handle on all the tasks that need doing.
    • knows which team member is responsible for each task.
    • adjudicates conflicts between team members.
    • is able to judge when things are going as they should and to make adjustments when they are not.
    • maintains records and status updates and distributes them to the whole team.
    • anticipates setbacks, never forgetting Professor Moody's admonition: "Constant Vigilance!!". Especially when things seem quiet, too quiet.
    • boosts morale when staff is flagging
    • brings the donuts. :)

    Of course in my day job, a person is expected to grow into the role of project manager after some years of experience and mentoring with the specific project type. When your realize your kid has a medical emergency that you know nothing about, you jump in without the benefit of that background or the realization of what you are getting into. And the morale thing, well...... You bet I needed help.

    I am by no means bashing docs and therapists. I often wonder what these circumstances are like from a provider's point of view. I have to believe it is difficult, topped with insurance problems, the limited time they have to spend with each patient, the that fact that family-based treatment is new to many, and the wide variety of patients, families, and other disciplines they juggle. Also - of the people I have known who wanted to go into a child-specialized field - teaching, or pediatrics or social work - none of them ever said "It's because I really want to work with parents!" But here we are - every child (if they are lucky) comes with one or two attached - and trying our damndest to do the best we can.

  6. This is so true, Laura. We must give both those messages alongside each other. All of us - clinicians, parents, carers, other loved-ones - have the same ultimate goal, that is, to bring the sufferer back to lasting health. We need to drop the blame-game and work together.


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