Two trains, same track, no collision

In an emerging field it is natural that we'd have a lot of uncertainty about how to treat an illness.

What is perplexing in the eating disorder field is how two completely opposing viewpoints on the role of parents could keep steaming toward one another without a crash: whether parents should back off or be engaged is one. Because this is a complex set of conditions and there are so many elements to debate, what often happens is we find allies in one area who disagree on another, derailing the issue at hand. Or a debate on one aspect of theory gets blown off the rails by a skirmish over another.

Most painful to me is when the debate on the parental role pits parents against parents. I often ask eating disorder professionals to take a stand in their field against other professionals and clinics operating poorly. But I myself try not to confront other parents - even those out there promoting ideas antithetical to my own message. Ouch. Hypocritical much?

I just watched a video of a mother advising parents to do the exact opposite of what I do. She told parents to fix themselves, let their children control their own food, back off, and realize that it is not about food but about deeper psychological issues. Had this message come from a clinician in the field I'd have been blogging it. But it is a fellow mother so I'm queasy. So much so that I'm not even telling you who or where it is.

There probably is a way to respectfully engage this mother's point of view, and I lack the skills to do it. I have a really thick skin now about critique from the profession but still get all weepy when parents criticize me. Earlier in my work I would have said "who am I to judge?" and now I feel that as a part of a huge community of families of like mind it would almost be bullying to call down that community on an individual. I have all kinds of justifications for not calling out parents and there do need to be boundaries on this - parents can't be expected to be held accountable in the same way as professionals. Parents - especially those who have lost their children to death or estrangement - deserve a special consideration, period.

Yet a sad truth is that much of the message out there for parents to back off, watch from a distance, leave food and therapy to the patient, and see the illness as a sign of failure or trauma in the family is coming from fellow parents. The message is no less damaging coming from moms and dads: perhaps more so.

The trains need to get close enough to see one another, or maybe they need to crash. I'm struggling with this.


  1. Laura, I agree that parents who have lost children to this illness need special consideration, including respectful silence where appropriate.

    Beyond this, though, I must ask you: who is still promoting this outdated approach (parents fix themselves and back off about food)? Sorry, but do they also believe the earth is flat?

    At some point, professionals need to look at the evidence even if/when it contradicts what they learned during their professional training. LOTS of things that were taught us in medical school are now disproven/outdated and unless I want to become a fossil, I need to update my database. Strong recommendation that others do the same.

  2. Laura

    I came to say much the same as Julie, before I had read her comment.

    The myths are perpetuated by those who have not/have chosen not to keep up to date with the latest research.

    It also brings to the fore the arguments about the same treatment model not working for everyone. This should not preclude the most successful treatment model being tried first but this seems to be the case at the moment. There is no treatment that is 100% effective for 100% of the sufferers but surely nothing should be excluded on this basis.

    It is time for some clinicians to read up a bit more and not rely that what they learnt in medical school. If they behaved in this way about, say, cancer or schizophrenia, they would be laughed out of town.

  3. Actually they DO behave like this over schizophrenia, and many other mental illnesses.

  4. I've been thinking about this subject of (some) doctors blaming parents, and (some) parents blaming themselves for their child's ED rather a lot recently.

    My poor mother spent many years questioning 'where she had gone wrong' with me, even though no doctor ever blamed her for causing my AN. As a child with AN, no doctor ever asked me about my relationship with my parents. They just pushed food at me and emphasised weight gain. This was in the 1970s/early 1980s.

    However, if a doctor had asked me as a child with AN about my relationship with my parents I would probably have said "they make me do things I don't want to do" - which actually they did. However, what they 'made' me do was nothing out of the ordinary. The problem was that I was a hypersensitive, hyperanxious, obsessive-compulsive kid who needed to have everything 'just so' (and unchanging) to feel she could cope. My parents tried to broaden my horizons and to encourage me to try new things (rather than always doing the same things the same way), and sometimes they pushed me a bit because otherwise we'd never have gone out anywhere as a family.

    I have always maintained that my AN was about 'control' (not body image), but what I was trying to 'control' was anxiety and the constancy of my environment, not my parents, or other people.

    I wonder whether the descriptions used by some children with AN have been misunderstood by some people who interpret the child's need for control to result from their parents being over-controlling, when instead the issue relates to the child's innate temperament and character?

  5. Laura I completed the study you mentioned in the December 19 post. I found I was feeling pretty effective as a parent, my mood is decent and though life is objectively not the best, I don't feel dragged down by it. But, I don't blame myself for my daughter's illness. It's funny you brought this up today because while I was completing the study, I realized that HAD I blamed myself for her illness, lack of progress at times, etc., well this would be a whole new ball game! I would not feel comfortable in advocating for her needs or participating in her care and I would be stuck in a blame cycle. And my answers to the effects on the family would have been much different. I wonder if thinking of this as a biologic illness from the beginning might be a very effective way to help parents outlast the disease and keep helping their child even when things aren't going so well....

    And then backing off would be like slinking into a corner feeling guilty and powerless to help forever after....


  6. Very well said Cathy. Right on Julie!.. We have a long way to go to expanding the field to current and new evidenced based treatments.
    Laura, I have to tell you that every post I have every seen from you has been clear, non judgemental, extremely helpful and honest. You are a bright kind intelligent women. I don't know what affect your honesty would have on this mother but I do believe it is healthy. Having someone give you insight is always a gift, even when you can't see it at first..

  7. Who, Julie? Most!

    Cathy, I think you've nailed what is going on pretty clearly. Especially in our US culture of psychotherapy.

    What I'm struggling with most in this post is my seeming hypocrisy in facing other PARENTS who are spreading older and to my mind damaging ideas about the parent role. I'm really trying to face this in myself and deal with it.

  8. Cathy,
    Every time I read one of your comments, I think to myself -- she is so right on! My young adult daughter has suffered from an ED since the age of 14 and all the things you say about yourself and the ED are so closely aligned with the things I've been able to discern about my daughter, her anxiety and depression and the ED. Just wanted to thank you for your very well-articulated thoughts because it helps me to know that I'm not way off-base as I contemplate the course of my daughter's illness.

  9. Cathy,

    Great post - thank you for being so open about your experiences and the insights regarding your relationship with your parents. I do think that professionals working with ED have a difficult time knowing when and how to incorporate the parents in treatment, which could be due to fear or simply ignorance of the complexities of eating disorders. Working in the field, this frustrates me and really denies the parents of critical opportunities to be an ally in the process.

    Cathy, you describe your experience and perspective regarding your relationship with your parents perfectly... I think many girls and young women struggling with an eating disorder feel this way. I think that family cohesion, communication, etc are often looked at in research... when it may be more accurate to research the variable of client's "perceived" family cohesion and client expectations of self and others. As Cathy mentioned, her parents did not do anything out of the norm in terms of parenting techniques - they did their best - as most parents do. What I like is that Cathy brings up the very important, and often overlooked, concept that she was not always comfortable and looked for ways to manage the related anxiety and discomfort... enter ED.

    Although this is often easier said than done, it would be nice if we could stop being scared of each other... recognize the important roles we play in each other's lives and the benefits of working together... parents, clients, clinicians. I have not been on this blog before, but have enjoyed reading the posts and responses this morning... I just like the idea that people can take a deep breath and really talk candidly about eating disorders. I think, at times... particularly in the field of mental health... we want to promote resiliency and progress but treat people with kid gloves... people are strong and want to make meaningful connections. People (of all ages) want to be heard, recognized for their struggles and admired for their strengths... unfortunately not everyone receives these things in their life so they look for ways to meet these needs on their own... unfortunately the ways people sometimes go about doing this can be harmful to themselves and others. Thank you, Laura, for your blog and all of the work you are doing...


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