Advice for Parents by Doris Smeltzer

A brief comment on the psychological / biological debate

In a response to my "We need your Perspective" blog, a reader stated in part, "I don't believe eating disorders are psychological illnesses; I believe strongly that they're biological illnesses that a sufferer cannot "choose" her way out of."

This is not an uncommon stance. There are many who believe strongly one way or the other-with evidence to support either view.

I tend to believe that individuals are born with a genetic predisposition to the development of obsessional behaviors which become expressed when triggered by a multitude of other factors. This view is supported by the oft repeated eating disorder adage, "Biology loads the gun, environment pulls the trigger." Yet, I also know that the distorted thoughts common to eating disorders are embedded deeply in the brain. It is the brain and the mind that holds the keys to changing these deeply embedded hurtful thoughts and destructive, repetitive behaviors.

Although one cannot simply "choose" their way out of an eating disorder, I would never want to minimize the power we have to "re-wire" our brains. Recent brain research discoveries have given me great hope and convinced me of the brain’s plasticity and how, with "directed attention and mental effort [it is possible] to systematically alter brain function." 1

I will not abdicate the power I have to affect changes in my brain, nor would I ask my child to give up that power either. Once physically stable I can, with conscious, determined and directed choices (often guided by a skilled therapist), create brand new "over-and-over-again" brain loops. It seems to me that is what anyone who has healed from an eating disorder has done. They have overridden old behaviors with new behaviors and skills that have created fresh neuropathways in their brains. Each time they choose these new behaviors over the old, the newly created pathways are strengthened until they become an "automatic response" to triggers and stressors in the same way that the ED had been an "automatic response."

Eating disorders are illnesses with psychological, biological, environmental, personal and spiritual components. Anything this complex would take more than just one simple approach to overcome. We cannot will or choose our way out of an ED but throughout the complexities of healing we also cannot relinquish the power the mind can have over the brain.

Blessings until next time,

Doris

1 Philosophical Reactions of the Royal Society of Bilogical Science "Review: Quantum physics in neuroscience and psychology: a neurophysical model of mind-brain" Vol 360, No. 1458 June 29, 2005, p 1309-1327

Thoughts on Mental Health

In last Sunday’s San Francisco Chronicle there was an article by Martha Woodruff titled, “Let’s treat addiction like the disease it is.” Ms. Woodruff was writing about an HBO executive who was seeking treatment for a substance abuse relapse. Woodruff asked, “When is this country going to relax its judgmental grip on the throats of addicts and alcoholics?”

The question of whether or not an eating disorder can be classified as an “addiction” in the complete sense of the word is open to debate. In my opinion, they are most definitely psychologically and emotionally addictive behaviors, but no matter what label we give them, the very same question can be asked, “When is this country going to relax its judgmental grip on the throats of eating disordered sufferers?”

Ms. Woodruff states,

“Addiction to drugs or alcohol is not an inconvenience, a lapse of willpower, a character flaw, anything to be ashamed of or any form of divine judgment. Addiction is not something that needs to be whispered about or shrouded in euphemisms when you are among polite company. Addiction is a … disease – in the same way that diabetes and asthma are … diseases. ”

Indeed.

We all have physical health….sometimes we’re physically well, sometimes physically ill. We often want to ignore that we all have mental health too and that sometimes we’re mentally well and sometimes mentally ill. It’s that “mentally ill” that gets the bad rap. It is difficult to heal in a culture that does not even want to recognize that one is truly ill.

An eating disorder is a disease. It “is not an inconvenience, a lapse of willpower, a character flaw, anything to be ashamed of or any form of divine judgment.” It is also “not something that needs to be whispered about.” 

Sometimes coming to these realizations can be a very slow process for parents.  I, too, am a part of this culture…it took me a very long time to be willing to stop whispering and to relax my judgmental grip—I did not want to have a child who suffered with a mental illness.  I did not realize that my attitude contributed to the stigma I was attempting to avoid.  I now understand that I must first change my thinking before I can ask that of my child  or of my culture.

Blessings until next time,

Doris

We need YOUR perspective

I received an email from a mom today whom I'll call Tracy.  Her teen is 18 months out of treatment and is doing okay, although weight is not at a level for proper hormonal activity and there are still some eating disordered tendencies: “…Drink[ing] diet soda, measure[ing] out … cereal, wary of fat/carbs, dessert [only] occasionally ...”

It was evident from Tracy's letter that she was aware that her child was not yet fully recovered. I felt fortunate that the Gurze e-news had just arrived. Coincidentally they included a response to a question about healing and provided a list of possible indicators of wellness.  I shared this with Tracy suggesting that it may give her an indication of how close her child may be to "healed":

(Every issue of the newsletter Eating Disorders Today contains a question and answer column, "Nutrition Hotline," by Diane Keddy, MS, RD. This question appeared in the Spring 2007 issue)1

Q. How will I know when or if I am recovered?
A. Experts cannot agree on a set of criteria for recovery from anorexia, bulimia, binge eating disorder, or eating disorders not otherwise specified. However, factors to be considered include:
•Maintaining a healthy body weight with normal menstruation (for females)
•Maintaining a healthy body weight with normal testosterone levels (for males)
•Normal laboratory data including protein and iron levels
•The ability to eat any food without guilt, anxiety, or the need for compensatory behavior (i.e., purging, restricting, or exercising)
•The ability to use alternate coping mechanisms when stressed
•The ability to eat when hungry and stop when comfortably full
•The ability to eat a varied diet with 3 meals and 1–3 snacks per day
•Being able to live a joyful life where eating disorder thoughts and behaviors do not interfere with enjoyable activities
•Being able to eat restaurant meals and feel comfortable
•Accepting that no body is perfect and having a positive body image

Tracy asked if she should “just be happy” with where her child was in the healing journey or if there was something more she could do.  What concerned me most about all that Tracy shared was that her child was about to transition from high school to college:  a time when many eating disorders either begin, return, or worsen.

I asserted that it is difficult to know what to do or how to respond in such a situation.  Tracy knows her child best.  Because she asked for advice I shared with her what I thought I might do if my daughter Andrea had been in the same situation:

I would line up a therapist skilled in eating disorder issues as well as a dietitian skilled in intuitive eating who were both willing to work with Andrea. I would then sit down with my daughter and share my concerns.  I would talk about how those who suffer or have suffered with eating disorders need to be especially conscientious during transitions in their lives such as: high school to college; college to profession; single hood to marriage; childlessness to parenthood; young adult to mid-life; mid-life to senior, and any other momentous transition or life event.

In this scenario, prior to allowing Andrea to leave for college, I would want her to continue her doctor's visits but to also begin seeing the therapist and dietitian. It would be important that Andrea exhibit the ability to gain the weight needed to support menstruation as well as increase her ability to eat food without guilt, anxiety (no measuring or tabulating calories), or the need for compensatory behaviors.  If these markers of health were not evident by September, I would tell Andrea that we would need to defer the start of college until they had become evident.

Most importantly, I would want to initiate family therapy so that we could be working on improving the dynamics between us.  If needed, I would get help for myself around whatever issues I may still have concerning weight, body, eating and food as I would want to model for my daughter the self-love and body acceptance I had asked of her.

Those were my suggestions, but I know that mine is just one perspective.  I invite all who read this blog to respond with their own suggestions and perspectives.  No one of us has all the answers, but we all benefit from hearing each other's thoughts.  I look forward to hearing yours.

Blessings until next time,

Doris

1 Diane Keddy, MS, RD, FAED, Nutrition Consultant, Newport Beach, CA, dkeddy5555@aol.com (949) 552-2385

A response…

Katie, a blog reader, wrote with some excellent questions regarding my previous blog titled, “Sometimes it’s hard to see what we’re looking at.”  She asks:

As a parent, if she [Amy Winehouse] was your child what would you do? As an eating disorders expert now, knowing that she has these problems, other than writing the blog entry, what can you do? By that same token, when you see an obviously anorexic young woman at the market, do you say anything? How do you feel about this? The feeling I get is helplessness.

These are thought provoking queries and I thank Katie for taking the time to respond to the blog article.  Although I have learned a tremendous amount about eating disorders, I certainly do not have all the answers.  In fact, I have far more questions than answers.  I wonder the same things as Katie: What would I do if I had a 23-year-old daughter suffering with an eating disorder who happens to also be a performer?

Cry.  Pray. 

Those two would most likely be my initial reactions.  I would also get as much help and support for me as possible:  I would need to be held by a community of supporters so that I could, in turn, hold my daughter in a way that would aid her healing.

Katie wonders if I could do something to help Amy Winehouse, beyond writing a blog entry.  I don’t know.  There is a part of me that wants to save every sufferer with whom I come in contact.  The reality is that I cannot.

Katie’s final questions are important: “When you see an obviously anorexic young woman at the market, do you say anything? How do you feel about this? The feeling I get is helplessness.”   

I have seen people in public who look to me like they may be suffering with an eating disorder.  What I also know is that when I was undergoing chemotherapy, I, too, looked like I might have an eating disorder (when I wore my wig it camouflaged my baldness extremely well).  I cannot know, just by looks, whether or not someone is suffering with an eating disorder.  I also refuse to comment on weight, and given that the person in question is a complete stranger to me, there is nothing else I can comment on. 

I have a friend who recently told me that she fears for the well-being of the woman who always runs on the treadmill beside hers at the gym.  I’ve encouraged her to share her concerns saying something like, “I don’t know you.  My name is Doris—we workout side-by-side often. Over the last few weeks I’ve become worried about the intensity and length of your workouts—there’s an energy around the exercise that makes me worry for your well-being.”  I have no idea how someone would respond to these words. They might make the person curious about what it is we’ve noticed … or not.

I understand completely Katie’s feelings of helplessness.  When I feel that way, I try to remember (that’s the hardest part for me) to look at what I can do.  Honoring even the smallest of efforts:  I can refuse to engage in body bashing of either mine or someone else’s.  That counts.

Blessings until next time,

Doris

Sometimes it's hard to see what we're looking at

A few days ago, I was reading the San Francisco Chronicle’s Datebook section.  I rarely read concert reviews, but the title of this one caught my eye: “Winehouse seems fragile, but she’s a tough act to follow.”  This bay area concert featured Amy Winehouse, a 23-year-old British pop singer.  To me, the review made it glaringly apparent how easy it is to dismiss eating disorders and other psychological ailments in our culture, especially for those who are in the limelight.

The author of the review, Aidin Vaziri, described Winehouse’s appearance as “a bit like Christina Aguilera after being put through a shredder.”  The singer “stumbled onstage” and after dropping her leather jacket on the ground “revealed skinny arms covered with scars and tattoos....”  She wore a “dirty white tank top” and drank alcohol throughout her performance provided by audience members who responded to her continual requests for “a Jack and Coke” promising the provider “a kiss on the lips.”

According to Vaziri, Winehouse has admitted that she battles with many psychological issues: from eating disorders to manic depression.  Even the reviewer “got”, in a small way, that there was something very wrong with what he was observing when he stated, “You have to wonder whether she was essentially facing a roomful of enablers.” 

Because of this young woman’s talent, her audience, like so many factions of our culture, dismissed her obvious illness and in essence cheered on her destructive behaviors.  Winehouse reportedly sings well, in spite of her illnesses.  So many who suffer with eating disorders can do the exact same thing:  continue to perform well even while suffering with deadly illnesses.

This review prompts me to ask: What message is sent when we value a person’s performance over their health?  What would change in our culture if we did not “enable” those who are ill by either dismissing or cheering on their destructive behaviors?  Until reading this review, I had never heard of Amy Winehouse, yet sadly, I fear she may be emblematic of many such performers.  May we stop cheering and start learning from these young people’s lives.

Blessings until next time,

Doris