Blame is the new racism

I recently heard from an eating disorder treatment professional who says that she does not blame families, but says that "all" of her patients' families have problems that played a role in causing the illness. She doesn't consider that blaming the family, just explaining the illness.

I'm hearing this sort of thing more frequently now. The word "blame" is unacceptable; saying that someone is blaming someone else is almost like calling someone a racist. No one thinks of him or herself as a racist. No one seems to think of him or herself as "blaming" anyone for causing an eating disorder.

Here's the problem. It's still "blame" when you use more polite terms like "contribute to" and "part of the picture." A "family disorder" makes it seem so much more like everyone's in it together than "your toxic family caused this" but it's still saying that the family behaved in unhealthy and avoidable ways that had they not done, the eating disorder wouldn't have happened. It's still saying that you are broken and need to be fixed - just on the basis of there being an eating disorder in the family.

A LOT of the problem here is seeing an eating disorder as a set of ideas and thoughts and behaviors and not the presence of a distinct brain problem. In math and statistics it is the difference between discrete and continuous data. If you see an eating disorder as an accumulation of experiences and thoughts then of course you would logically see the cause as being environmental and cumulative. It also means that digging someone out of that accumulated experience requires examination of all those influences and integrating this into the whole person's experience and self-knowledge.

Well, I don't see eating disorders that way and I think the above conception of the issue leads to demonstrably poor treatment, iatrogenic harm, and poor results. Because I see an eating disorder as a discrete problem with the brain that is environmentally influenced, I see the symptoms as just that. The drive to avoid food looks like a logical progression from environmental pressures to be thin, but I believe the drive is biological and the explanation is one our society provides. We used to provide other explanations, like religious asceticism or Freudian sublimation or feminist embodiment. The poor self-esteem looks like influence from environment but can also be seen as an expected symptom of the depression that often accompanies malnourishment. The distancing from others, misinterpreting the motives and social cues of one's family, these are also brain phenomena very common in people low on food.

The cognitive symptoms of an eating disorder, the proprioceptive problems, the body schema issues, the emotional swings - when there's an eating disorder it is hard to distinguish between people who have suffered from a high load of environmental influences and those with none. The symptoms are very similar in people from all over the world, different cultures, different ages, men and women. Recovered people, by contrast, are genuinely individual and unique.

People are so afraid now of the word "blame," but breaking it up into little parts and saying "you didn't mean to" or "one part of the bigger picture" doesn't make it more palatable. Better to go back to the word blame, which it is, so we can go back together to the drawing board here:

Parents don't cause eating disorders. Patients don't cause their own eating disorders. They're an illness, and they are treatable - but not if you're on a witch hunt for causes that have been thoroughly discredited.


  1. I know many people with eating disorders, some who have been abused by their families, some who have had normal but imperfect families, some who had families who looked like they had jumped out of some lovely TV sitcom until the eating disorder turned up. If the triggers and the environmental factors differ from person to person with the same illness, the underlying biology of that illness has to be the common factor and the cause in the most literal sense, not those individual influences. Therapists should tread extremely carefully around the interpretation of behaviours in people with eating disorders. It's reprehensible to tell people with eating disorders that their family or the media or XYZ other random scapegoat of the moment "caused" their biologically based illness.

    I always seem to say "I agree" in the most long winded way possible :P sorry about that!

  2. Totally agree. I'm the only one of four children with an ED - all raised in the same house at the same time by the same parents. If I hadn't been born and the other 3 did not exhibit any ED symptoms would that make my parents better parents? Or are they worse parents simply because I was born?
    I think they are the same normal, fallable, lovable parents either way you look at it :)

  3. I second everything you saiod Katie and a wholehearted Thank you once again to you Laura for articulating this very real and deeply troubling issue that all of us parents of children with ED have to face daily.
    Its hard enough to learn and integrate the truth and knowledge ourselves that we are not at fault for the biology of ED and then have to fend off the world who find new and more subtle ways to find to blame us all over again is exhausting and depressing.

    Thank you for continuously keeping us all aware of the newest scientific data and reminding us to keep working hard at helping our kids and not blaming ourselves.

  4. "They're an illness, and they are treatable - but not if you're on a witch hunt for causes that have been thoroughly discredited."

    ...and not if you have a therapist who tells you you're too old for FBT, friends who have enough going on in their own lives that supporting you would ruin theirs, and no family. At that point, it's residential treatment, and that's if you're lucky enough to have health insurance.

  5. Katie said the 'longwinded thing' very well, so I needn't say it :-)

  6. Laura, this was EXACTLY my point from you last blog. Many therapist and treatment programs use the "slogan" parents aren't to blame or parents don't cause Ed but then go on to use their responses to Ed as contributing causes, giving power to the damaged family dynamic theory. I really really wish that the treatment of Ed grows in the FBT way of true caregiver teaching and education for long term support of the Ed sufferer. the second cruelest part of many current Ed treatments after separating parents as a vital part of the team is telling sufferers That they must take control of their meal plans way before they are really ready and encouraging them to take on too many stressful responsibilities before they are ready. To me this is a very damaging aspect of the present accepted treatment modalities for Ed.

  7. I have been reading a lot of cockamamie bs written by clinicians who honestly believe that families do cause eating disorders. I am sorry to tell them THEY ARE WRONG.

    We are a good parents. We are not perfect parents, by any means but on the scale of 1 to 10, we are getting towards an 8.5! We did not cause our daughter's eating disorder. She has been sick, really sick. She is now better due entirely to our work, as a family, to help her repair her brain and overcome her illness. We did not have the luxury of any support and, quite frankly, when I see what is on offer, I am glad we didn't.

    I find the whole "blame game" scenario destructive, ignorant and, in some cases, lethal.

    When I wrote the C&M film about "modelling effective parenting" and sent it to M, she rang me straight up and asked me how I knew what her daughter said. I had never met her, or her daughter and we live a few thousand miles apart. Some parents find the film too distressing to watch and I find it difficult to watch now as it gives me post traumatic stress. How come that I can reproduce a scenario that is played out in thousands of households every day all over the world between parents and children who have never met? Are there just so many of us really bad, harmful, toxic parents out there? Or this a brain disorder that plays out with similar signs and symptoms the world over?

    Oh, I am just SO cross, I can't write anymore but I am with Katie and Carrie and everyone else, Laura. I agree.

  8. Laura, to use one of your favorite expressions, let's "reframe" this.

    Perhaps therapists aren't to blame because our kids don't get better when they are treating them. Of course they are good hearted people who want to help. Well, most of them are, but not all of them are good. But if they are using ineffective and outdated methods, or making something up based on their own personal experience, well then, they are "contributing" to the lack of recovery and they are "certainly part of the picture". That's a bad dynamic, a child with an illness with a poor prognosis and a practitioner who is using an ineffective method of treatment. Toxic treatment.

    There is a conflict of interest in giving ineffective therapy to someone who is not getting better. They are serving their own pocketbooks to continue, not the best interest of the patient. That is an uncomfortable feeling and I'm sure the only way they can justify this to their own soul is to blame the lack of improvement on someone else-the parents. I could see this happening with my own daughter, nothing they were doing was helping so they turned on her father and I. I could see what the problem was and changed teams. Same parents but child is now getting better.

  9. Often our own perception is our reality. If that clinician worked in a setting with patients whose families were generally uninvolved, recognize this as her reality.
    Your reality is that you are a parent who was involved and cares chose a different method. The work comes validating someone else's version of their truth and helping them see our truth.

    For some, irrespective of age, the right residential program can be life saving. For others, FBT is the first choice. We have to be thankful for so many choices and keep our eye on the goal.

    If we see only one true choice for ED treatment (FBT) we are no better than the clinicians who cling to their antiquated views.

  10. Leslie, I am not thankful for the choices. Evidenced based treatment is quite far and few between in the field of Ed treatment. There is still a pathetic number of treatment programs that make very sick children and adults responsible for their own recovery and ignore the research that points to education and involvement of caregivers for long term recovery. They blame the nature of the illness for their high relapse return rate instead of their failure to recognize the need for FBT in whatever ever form that might be. Of course there are some and I'd venture to guess the overall number is small, that cannot be a part of FBT but long term support is crucial to recovery and WAY
    too many residential and out patient Ed programs limit
    caregiver involvement and encourage sick patients who are far from ready to manage their illness to be independently responsible for their recovery. It's not only lacking evidence of effective treatment, it's cruel!

    from ready to manage their illness to be independently responsible for hei recovery. It's not only lacking evidence or effective treatment, it's cruel!

  11. I would like to add that a good residential treatment program may be lifesaving but often falls short in one of he most important aspects, long term support and caregiver education support and involvement.. This is a common failure of these Ed treatments.

  12. In reading all these posts, it seems that all the available treatments are somewhat lacking, but instead of admitting this and all working together to find better cures, the history of this illness has been to blame the parents and blame the sufferers when a given type of treatment doesn't work. I wonder if this culture of blame all stems from the lack of effective care.

    As an example, if a new drug treatment is only working, say for example, for 20% of people with an illness, we shouldn't blame the patients should we? Either it is an ineffective treatment or it is too difficult for most people to use or has unpleasant side effects and caregivers and researchers should go back to the drawing board to find something better.

    I wish ed caregivers would think like this, if their treatment doesn't work, then why not think it through logically--it's either not a good treatment, it's too difficult for the sufferers to use (it's not the sufferers fault, it's the treatment's fault) or there are unpleasant side effects. Next step, devise something that gets around these problems, study that and move on. We are in a quicksand of blame that is preventing the development of good care and there shouldn't be any reason for it!


  13. I see many posts that are against residential treatment. How many actually utilized their services? Before doing so, did you ask if FBT or a family component was incorporated in the treatment? The more families that ask and request this, the greater impetus it puts on centers to learn these treatments and incorporate families. We cannot bash venues of support. The residential treatment centers do in fact family sessions to help with issues. For some, the presence of a therapist is vital in saying words that could not otherwise be said. It took outside intervention for my healing to begin. I can honor that everyone has their own path. I implore you to see that.

  14. Leslie, right now, everyone may have their own path but I think that is because no one really knows how to treat this illness very effectively. FBT is a good treatment but even the researchers for FBT see a need for improvement. For some people, residential has been the help they needed, but for others, it's one in a string of residential placements where ed thoughts and behaviors may be reinforced over and over again. People shouldn't have to try every possible option that accepts credit cards to find good care, and then end up finding their own way out.

    As a mom, I believe that a lot of damage is done to sufferers and their families with professionals doing business as usual in this ed world. Blaming families at the first diagnosis, IMO, sets up a lot of the dynamic for the future as it is discouraging and offensive for the families. I think that's another reason the blaming issue becomes a problem.

  15. Leslie, I want you to know that I am so glad that you found a place that supported you and helped you in your time of need. My daughter did get something she really needed in a residential setting. I believe it lacked some very important things that I, for one would like to see change. They did not seem to believe in FBT and held to the concept that family therapy is a real equivalent. It's is not. I believe that there will always be exceptions, parents and caregivers too ill or physically unable to be a part of the family based treatment team bt I have seen so many wonderful young women thrown back into their lives outside of treatment without the support that is crucial for their full recovery. I've seen these young women fall back into their disorders, their families scared and confused with treatment professionals telling them it's the nature of the diseae.
    Most residential programs to not support their patients returning home to continue the process of learning to eat and live without Ed . This process takes much longer than any Residential program can allow and for so many financially unable to continue for more than a few weeks or months. Clearly working with their families who can continue to support the recovery plan is a major key to long term recovery. It is just so cruel to start the process and then pull it away because of cost when it can be used effectively in conjunction with the need for ome to have a residential setting.

  16. Laura, you know I agree with you and always have. But what, do you think is this about?:

    "It is the position of the Academy for Eating Disorders (AED) that whereas family factors can play a role in the genesis and maintenance of eating disorders, current knowledge refutes the idea that they are either the exclusive or even the primary mechanisms that underlie risk."

    How ambivalent can it get? Play a role in the genesis?

  17. "play a role in the genesis" is blaming. No question. Harmful, incorrect, and wicked.

    I protested it, F.E.A.S.T. protested it. We were called extreme.

    I wonder: did anyone else protest? How many AED members protested? Objected? Questioned? NOTICED?


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