Bailing out the boat

Thoughts on food, and the rest of the story.

I consider any eating disorder treatment that does not include immediate, consistent, and retained full nutrition to be, frankly, immoral. If it were my choice, it should be actionable malpractice to treat a patient - or tolerate other clinicians who treat patients - without that as a bottom line EVERY DAY after diagnosis. In the six years since my daughter was diagnosed I've grown stronger and stronger in this belief - because the science is consistently clear: lack of consistent full nutrition both causes and sustains eating disorder thoughts and behaviors in those with that genetic predisposition.

There is a delay, even after full medical restoration and vigor, before full psychological, cognitive, and emotional recovery. Reaching target weight is necessary, but only the first step. Then begins the work of holding there long enough for brain damage to repair. 6-12 months by most estimates. And learning tolerance for that condition during real life and real stresses.

But no less important than the above: food is not enough.

People who develop eating disorders almost always suffered previously from anxiety, depression, OCD, or other symptoms, and will do even after recovery. Often sub-clinical, these issues are helped but often not fixed by regaining brain health through nutrition.

Getting someone up to target weight and then going back to normal life is not treatment: it is torture and doomed to repeated failure.

Even if there were no pre-illness issues, the patient has to learn where the fault lines are and get strong in avoiding them: dieting, unrelieved stress, unhealthy living environment.

I emphasize the food part because the majority of clinicians still considers it unimportant or incidental until there is observable damage. Without the food part, all else is futile and cruel. But only food? That just bails out the boat - you've still got to patch it.


  1. Besides re-nourishment I believe that setting new goals can be powerful medicine. We spend way too much time looking back. All of us, not just those with mental health issues. Of course those anxieties need dealing with but NEVER over a cup of coffee. LOL

    My husband and I, okay mostly me, were talking about how amazing it is that there are people who are born knowing they want to be a truck driver or an airplane pilot or an artist. How wonderful that there are people who want to wash windows on a sky scraper (not me!!!!)We are born almost knowing to use our brain differently. Sometimes we have too much pressure and "snap" we need to learn how to be ourselves again. We've yet to send people off to meditate and learn how to relax and just be but I hope in the future it becomes not only an option but an essential place for all of us to go and restore our sanity if we need it.
    Don't know where I'm going with this Laura but I'd like to see treatment outside the damn box. I think it helped my daughter to go meditate with the monks at her college. She found her way back. Maybe sometimes the way out is too simple for us to believe.

    Happy New year!

  2. Thank you Laura for posting this - it is good to see that even MM parents can recognize this -- I read the forum every day (yes, sadly I am obsessed, don't ask me what I am looking for there) and sometimes I think a focus soley on refeeding as the cure for an ED is dangerously simplistic. . .

    Sadly, most treatment programs for adults do not recognize this -- and if they do, they provide second rate support, but it is rarely enough to help someone who has been anorexic for years. . .

    Thanks for posting this -- hopefully clinicians will read this blog and think.


  3. Laura,

    This is such a timely post for me.

    My daughter, as you know, has been weight restored now for 5 years. However, she still suffers from anxiety and moodiness, to the point where she recently went, on her own, to a psychiatrist and asked for an antidepressant. This was a good first step and came after much prodding from me, but then she came home from school without her prescription and having missed 5 days of meds. Not so good.

    Laura, what do you see as a parents role (if any) in addressing this end--the non-food end-- of the issue? My husband feels, as you say in your blog, that '...the patient has to learn where the fault lines are...", emphasis on the patient (and not the parent using tough love to cue their adult child).

    When she was younger, I felt she was depressed prior to the ED. She refused meds back then. The doctors allowed her to choose not to take them and did not support me. I felt they were needed (along with talk therapy).

    What is a parent's role here? In some ways I'd like to take the same approach with this as the MM does with food. It gets sticky though. And, when anxiety/depression or other co-morbid conditions linger on afterwards, you feel as though your child/adult child is at continued risk of spiraling backwards. It may not be as immediately life threatening to live with as AN, but is isn't fun.

  4. Mary, I'm with you - we need to get outside the box.

    A:), Often this is a matter of emphasis over content. I don't know of anyone who believes in "food only" if only because the getting in of food is also cognitive and emotional WORK of desensitization and distress tolerance and emotional regulation and interpersonal. The difference is that while the nutritional approach includes emotional and cognitive work, most ED treatment is ONLY those elements and leaves out the necessary but insufficient full nutritional rehab. Until that changes, you ARE going to continue to see that emphasized by parents - and rightly so. Like a bleeding artery, all the rest is a luxury until it is fixed.

    Anne, tough questions. I tend to think of recovery from EDs as encompassing the whole of mental wellness - not just fixing eating behaviors. I think until we've overcome the anxiety and the depression we're just not done as parents and clinicians. And I think of my child's whole mental and physical health as part of my responsibility as a loved one - regardless of age. I'm not going to settle for sub-clinical illness in my child, and to the degree that I have any agency in it not in my friends or my neighbors either - mental illness is often far more visible and calculable to others than it is to the patient - as you know my favorite vocab word is "anosognosia."

    Yes, I think you have a parental role here, if only because if NOT you then WHO?

    Mothers are very good barometers of the health of loved ones. It is what we do. I honor and celebrate that in you!!

  5. I wanted to post a Happy New Year message to all Laura's readers. I have been reading this blog for a few months, and am definitely on the other side of anorexia. I starved myself for years, putting a tremendous strain on my physical and emotional self. I lost my period for 4 years, and am proud to say I got it, finally, on Christmas day.

    Laura, thank you for writing this blog - it really does help, and I am the bearer of good news! Here's to New Years resolutions that have to do with appreciating and loving and celebrating who we are, instead of diminishing ourselves!

  6. I'm one of Laura's readers so thank you anoyn.! I hope you continue forward on this journey. I'm committing to some delicious self centered focusing in the year(s) to come and I even updated my own blog (instead of just responding everywhere) I never bother with resolutions so this time I better follow through...or as Ed Grimly says..I'll be doomed as doomed can be. LOL
    Happy new Year to All.

  7. I had a little epiphany here tonight.

    My daughter is home from college for the holidays. I am often still in tears (privately) over her moodiness, "push away" and sometimes just plain rude behaviors. Tonight she came up to me, kissed me, and said, "You're a good mom. You're both good parents. Don't you know I do this because I'm 20 years old?" I thought, "Yes" and then I thought "NO!" Darn it, I don't care, I didn't do anything to deserve such treatment and I'm tired of the push me, pull you junk. It occurred to me that her sudden 'insight' into her own behavior was not unlike her occasional insights into needing help when she was eating disordered (few and far between as they were for a long while). I also thought of my other, quite self-confident daughter. Not that I want to compare, but at times its hard to wonder why kids turn out so differently raised by the same parents in the same house.

    The thought I had was: when you HAVE self-confidence (my older daughter), there is nothing you need to push away hard from--or at least much, much less. You don't need to fight to find your own self, to believe in yourself. You don't feel threatened. You just DO believe in yourself, so much more easily.

    And, if you are anxious and less confident, you push the hardest against those that love and support you the most (or so it seems).

    Perhaps you must, because its more a fight from within, to force yourself to stand on your own two feet and to be your own person-, to 'find youself' on your own terms.

    Am I making any sense? If you've got it already, there is no issue, no fight. If you don't have much, you are fighting to find it. This may be where all the separation and individuation ideas come from. But I don't think its from smothering, overprotective parents. I think we are all just born different, with differing abilities and differing degrees of confidence. Life experiences do shape us some. They can build up or tear down that confidence.

    I am going to try a modified Maudsley approach here. I am going to try separating the behaviors from my 'real' daughter. I don't have to like the behaviors, but if I can see it as a search for her own self and self-confidence, not a hatred of me, then I think that may help.

  8. I find this VERY convincing. You formulated this so well - and thought provokingly. I've saved it to savor it the next few days - I really like this.


Post a Comment

Popular Posts