When Parents are Partners by Judith Brisman and Judith Ruskay Rabinor

Blame versus Forgiveness, Redux

  First, in response to emails, let me say that  I don't think we will ever be able to know exactly why an eating disorder develops in one person and not another-- but I do think it always helps to be curious about one's family whether there is an eating disorder crisis or not.  Curiosity and understanding allow for change and more opportunities for each person to feel heard, connected and able to grow individually and in relationship to others. It also allows for the possibility of moving on from one's family and taking hold of one's own life, even if other family members remain unchanged. (I always say this with the caveat that this kind of change cannot happen until someone is medically stable-- we can't expect this of someone who is starving). 

But with these thoughts as a base, here's the research study I would like someone to do.  I want to find 1000 families who will be tracked over time and measured on standard psychological variables having to do with communication, boundaries,  anger management, substance abuse, eating behaviors... and a myriad of other issues that over the years have been associated with anorexia, bulimia and binge eating disorders.  I want these families to be tracked before, during and after the adolescence of any kids in the family.  And then I want to measure for the development of eating disorders.   

        Here's why.


        Early studies indicated that substance abuse, poor boundaries, parental over-involvement-- and parental neglect-- all led to eating disorders of one sort of another. (see Minuchin's early research for example).  But these studies didn't have controls and were done by the very researchers who were trying to prove their points.  The research was biased at best.

       At worst, it basically said that parents were to blame for eating disorders. 
 
        I have seen thousands of parents over these last almost (gulp) 30 years.  There is not one family that looks like another--I have seen an extraordinary array of pathology.  But I've also seen an extraordinary array of health and resilience.  What I am betting on is that if we look at the families in which there is NOT an eating disorder, we will absolutely still see an array of concerns with communication, emotions and interpersonal issues, many of the same issues that plague families in which a disorder exists.  As gratifying as relationships and family can be, the natural terrain is filled with rocky roads and complicated ground to travel. Parse through ANY relationship or family and there will ALWAYS be things to fix. 

No question, some families are more extreme than others. And in those families,  when there IS turmoil, abuse, neglect or difficulties (and yes, that is real for many families), the symptom of choice in our culture is disordered eating.  Therefore, for many people, if they have been hurt, damaged or abused in their family, if their feelings are overwhelming and if they don't feel like there is anywhere to turn, they almost inevitably will turn to an outside substance or extreme activity (drinking, drugging, food, starvation, cutting, for example) to dull and contain the unbearable pain.  In our culture, focusing on one's body and weight is a way for any kid to manage feelings.  A lot of kids will try this. If there is intolerable pain or complication in one's family, it is likely that the use of bingeing or starving will temporarily work to manage emotions -- and the potential of an eating disorder will be set in place. 
     

       However for some kids, there is absolutely a genetic link to obsessional thinking, shyness and perfectionism (see the work of Dr. Michael Strober).  For those kids, the galloping emotional and social complications having to do with hitting adolescence may be all it takes to jumpstart what can turn out to be a severe problem with anorexia.  For these kids, it is really unclear what in the family may -- or may not-- have contributed to the heartbreaking disorder that can destroy a teen's-- and a family's-- life.

    Our work is not to jump to answers-- but to allow for ongoing questions-- as to what can help with prevention-- and what can help with recovery.  We know alot more than we did 30 years ago when our culture was shaken to the roots with the onset of eating disorders.  But there are still more questions than answers. Let us not forget that it is only in the unknown that discovery takes place.   jb

When a Kid has an Eating Disorder: Are Parents to Blame?

Recently, my blogs were responded to by supporters of FEAST and the Maudsley approach to re-feeding anorexic children or teens.

It is interesting to me how much fire these advocates of family-based treatment inspire. Their responses almost always result in an an outcry of protest and inflamed feelings. That's a shame because FEAST and the supporters of family-based treatment have something critically important to say.  As a result of their work, we now know to include families in treatment and we know that there is an important genetic component to anorexia.  We also know that it is extremely harmful to blame parents for their child's eating disorder. 

But I think that blame and curiosity are two different things.  And I think it is important to question the role of the family with any symptom arises, be it genetically-based or not. Every family should take a look at itself and see what is working and what isn't, to allow for growth, independence, intimacy and exchange with all family members.  We take better care of our cars then we do of our families. I would posit that even in a family with a schizophrenic child or an autistic child, there are many things that can be done to help the family operate more effectively.  Indeed I would say that of any family, including my own. This isn't a mandate to blame. It's an opportunity to help families consider what might need to change to better meet the needs of everyone involved.

So in that spirit, and in total agreement with FEAST, parental involvement is critical when any child, adolescent-- or for that matter-- young adult has an eating disorder.  But the point is to look at what is going wrong and what can be fixed (even if what is going wrong is difficulties handling a very severe illness).  The goal is NOT to assess blame.

What inflames many people about the FEAST push for NO family blame is that this leaves no room for any curiosity about the family at all. Since when is talking to one's kids about problems in the culture suddenly a BAD thing??  I still insist that parents should talk to their children about eating disorders.  For some children or adolescents, this will have no effect on the development of an eating disorder.  For others, it will allow for an open dialogue which may indeed influence how food is used to deal with feelings.  If that isn't the case, why are we talking to kids about drugs and alcohol?  Alcoholism is now proven to have a genetic base.  Does that mean that parents shouldn't talk to their kids about drinking because talking won't stop someone from being an alcoholic?

So, after all is said and done, I still think that parents should talk to their kids about eating disorders and about developing ways to listen to and attend to one's needs without turning to food or starving to do so.  Will this help everyone? Absolutely not. 

But, on the other hand, I would like to think that parents can be actively and thoughtfully involved in the lives of their children, guiding, directing, encouraging. That has nothing to do with blame.  That's just good parenting.  Talking to one's kids doesn't prevent a disorder from developing.  Life is rough and things way beyond our control happen.  But trying to have an open dialogue with our kids is one way we can try parent as best possible.  In a world where just about anything can occur, that's the best we can do