February 27, 2015

What page is this on in the parenting books?

Happy to point to a piece I was asked to write for Social Work License Map blog:

I Had No Idea: It’s Not In The Parenting Books

I distinctly remember my shock and terror when I realized how unprepared I was for the topic of eating disorders. I believe most parents feel the same: this is not something we thought we'd have to learn and we certainly don't realize that our learning curve is more important than any other thing we do for our kids.
  • Learn about this illness.
  • Learn the difference between the good and bad information out there.
  • Act with resolve and courage and humility.
  • Do not expect anyone else to make it easier, pay for it, make our decisions for you, make the best treatment available, or pat you on the back later.

February 5, 2015

Tell your mom

I am so deeply moved by a comment just received. It was on an older post, but where a very frightened and confused young person said her mother "can't know" about her eating disorder. I responded to her, but THIS response is so beautiful and deserves a post of its own:

"tell your mom, she loves you and she doesn't want you to hurt. I wish I understood this when I was your age and got help, now that I have children of my own I understand that there is nothing that would make me stop loving them. Your mom will do anything to help you, don't keep it a secret tell someone all you have to do is reach out. & I think you just did."

She's right. She's exactly right. Tell your mom.

February 4, 2015

A drug treatment for eating disorders: BIG NEWS

Big news day for eating disorders. A drug treatment just approved, alliances between eating disorder concerns, and a new public figure steps forward as a spokesperson. Any of these items are interesting, but all together it's going to all the chatter for a while, I think.


Drug treatments for eating disorders are always going to be controversial. Many sufferers and advocates rightly worry that their problem is being reduced to a simple issue that can be fixed with a pill. I'm sure Vyvanse will be no different. People don't like being told something may be wrong in their brain and pills seem like a cop-out. For people who frame their disorder as "I eat to stuff my feelings when my boss mistreats me" know that the pill isn't going into their boss. Pills also bring up uncomfortable questions of whether eating disorders are psychiatric, whether BED is different from other eating disorders, and the role of experience and psychotherapy.

A drug for one eating disorder gives hope that there will be more coming, for more eating disorders. BED is the most common ED, so this is likely to affect more people quickly but if we've teased out the mechanism for one area of the spectrum this is surely glad tidings for the rest as well.

Pills are not magic beans. No matter what the purpose -- diabetes, the flu, ADHD, cancer -- drugs are blunt instruments with side effects and confounders. They should be used thoughtfully and in context. But medicines also save lives and transform them. Reflexive pro-drug or anti-drug sentiments leave me cold.

I am excited that there's a new tool in the toolbox to consider and look forward to the debate and discussion and what it might lead to for all eating disorders, and for mental illness in general where too little is happening in terms of pharmaceutical research.

But make no mistake: this is going to be controversial and MUCH discussed. Lines will be drawn and  brawls will ensue. It has to happen. We will survive. Let's try to remember we are all on the same side.


I am a dreamer. I dream of a world where mental health advocacy is paid for by rainbow unicorns and not sponsorship money. I believe in a world where drug ads can just be what they are and not disguised as public health messages. I fantasize that a drug for BED will not be touted as a weight loss "solution." I dream that alliances between organizations represent a trend toward inclusive collaboration. I dream of world peace and worldwide wifi...


I've groaned plenty about the use of celebrities as spokespeople for causes. I'm not shy to say that I wish ED organizations would find some astronauts and senators instead of the riding the coattails of people famous BECAUSE their mental illness made them compulsive or thin. The lesson there is often "my ED made me rich and famous and here's how you can, too!"

So having Monica Seles as a representative for a drug company selling meds for an eating disorder is of note. She's an athlete, but she's not claiming that her BED enabled her to achieve athletically. She's not "obese," which the public associates with BED. It's an interesting choice: busting myths about mental illness at the same time as reframing the disorder as a treatable medical condition. These are not random allegiances or public service. Money and reputations and alliances are currency. Shire believes, surely rightly, that people with BED will feel more comfortable seeing themselves as like an elite athlete than the usual (inaccurate and harmful) image of Binge Eating Disorder. They are selling their product but we all benefit from breaking that stereotype. I only hope this does not set a new stigma for higher weights even among those with BED.

It's all going U-shaped

We have a problem with exercise. We praise and laud folks for more of it no matter how much. Exercise has to be pretty extreme before we say "whoa... maybe we shouldn't be cheering here."

MORE exercise is always seen as better, healthier, more virtuous, and inspirational. We cheer, we admire, we give prizes.

Evidence that optimal activity levels are actually quite moderate is not only counterintuitive it will piss a lot of people off.

It leads to incredulity, as in "You can, in other words, potentially run too much."

This goes double for the eating disorder world. Openly restricting or bingeing would never be accepted but it is still considered healthy to do pretty much any level of exercise except when acutely ill. Exercise is considered a reward for good health and the more the better. Compulsive exercise is normalized as "about heart health" and for mood management and positive body image. Take out the heart part: if we said that about any other activity or substance it would be....

For many people the idea that optimal health is found in moderation will offend and worry. Moderation is HARD. But we need to start talking about it more.

January 31, 2015

Eating With Your Anorexic reissued

In a fresh start to the new year, I am delighted to announce publication of an updated version of my memoir, Eating With Your Anorexic. It has a new foreword, by Dr. Cindy Bulik, a new cover, and annotations reflecting on the last 10 years of being an eating disorder activist.

In 2004, I knew no one in the eating disorder world. I had no voice but that of one mom both amused and angry at the state of  treatment and research. Each of you, dear mothers and fathers, have that one voice. I've found it both satisfying and terribly frustrating to use mine. It's been an honor to do so alongside so many other fierce and fascinating people: parents and patients and clinicians and researchers.

Also, for those interested in my other work, visit the new website: LMWriter.com where you can read a poem about hair, see me tap dancing, and learn why you shouldn't put me on your gift list.

January 28, 2015

Epigenetics: old parent blaming in new shape?

stretch! stretch!
I note with interest, reminded by a lovely snarker in comments on my last post, the new interest in epigenetics and eating disorders. It's coming up all over the place.

I'm fascinated by epigenetics and the promise that it will yield insights into the underpinnings of eating disorders and human health in general. This is some of the most exciting stuff in medicine right now.

I'm amused by those who were not all that interested in genetics before but have leapfrogged over the well-known 53-83% heritability factor for eating disorders and jumped headfirst into epigenetics in a sort of "see! see! you parents DO cause eating disorders" late embrace of science.

Most people who are interested in the promise of epigenetics are genuinely interested in the role of environment and predisposition. Even the role of parenting. I am.

Some, however, are just unable -- even in denial, maybe? -- to accept that eating disorders are really not a sign of society's ills and parental perfidy. Do some parents suck? Yes. Do some parents of eating disorder patients suck? Duh. But are the symptoms of eating disorders a reflection of a person's  parenting? Not that we know of. So why do we keep going back to THAT aspect of environment, I wonder?

Epigenetics is not the Usual Suspect that you are looking for. There is still no reason to think that an eating disorder diagnosis says ANYTHING about the parents or the sufferer's life. It's just a diagnosis. It's a real brain disorder that ravages lives and families but can be successfully treated by those with genuine and complex interest in the science.

Here's the litmus test. If you didn't believe in genetics and EDs before, you think parents are probably contributing to the causation of most eating disorders, you think eating disorder sufferers are telling us something about society and families, then you may just not be as interested in epigenetics as you think.

January 26, 2015

Really? Really? How far have we come, really?

I have been at this ED advocacy long enough to have seen a lot of people come and go. Early on I assumed I would move on pretty quickly. I honestly and naively believed that the top issues I feel most passionate about could and would be solved if only people stepped up and made them a priority.

But I realize not much has been achieved. I know, I know: we've done so much. But I guess there was far more to be done than I'd considered.

I thought by now that:

  • The link between nourishment and the psychological symptoms of an eating disorder would be obvious and well-incorporated into treatment.
  • Parents would not have to fight to be included in, not to mention not be pathologized, in the treatment of their beloved children.
  • Standards for care based on current science would exist and be followed, and those who did not do so would be under pressure to do so
  • Nature and nurture would be understood as part of causing the illness but not in equal measure
  • Environment would be understood to include nutrition
  • EDs would be seen more like OCDs, where the "environment" part of the picture would influence the presentation but not the core disorder
  • Patients would have a range of options for treatment which would be coordinated and share common principles
We're not there, though. We're still fighting over basic stuff.

Progress is good. No, it's welcome and great. But jeez Louise, it is slow.

January 23, 2015

multi-syllabic way of saying “we don’t know:” Insel

As usual, I cheer all the way through Thomas Insel's thoughtful and meaningful blog posts. His most recent, What Caused This To Happen, is a good example. It is okay to say "we don't know." In fact, when it comes to issues of such import to so many we damned well better start saying "we don't know" when we don't.

rorschach blot
Mental illness treatment is way too comfortable with offering answers to questions that haven't even been properly formed not to mention answered. Our clinical environment is resplendent with answers that have little or no basis.

Most mental health care out there is baseless. It's well-intentioned and deeply believed but absolutely without grounding and the public deserves to know it. If we were to stop paying for and spending time on anything but that which has been clearly established I wonder:

1.    Would the burden of mental illness be much affected?
2.    What would happen to all the resources saved?

The problem with "not knowing" is less the lack of knowledge -- that leads the way to finding solutions -- but the burden of all the treatment that is based on false knowing. There is far too much unaccountable certainty and hubris: being motivated by genuine caring, this is the most dangerous care of all.

yes, this is what you think it is.
I'm not saying that treatment has to be well-researched to be of value. I'm saying that not knowing the difference is a disservice to the point of cruelty because in the end it is the patient who suffers and is blamed for not getting better. We are failing sufferers of mental illness in so many ways.

We need to get comfortable with saying "we don't know." Only then can we see clearly what we do know and make a better map to look for answers.

P.S. in the interest of "keeping it real" must note that while Dr. Insel's blog is up to date the NIMH site is not. The eating disorders page is pre DSM5 and while not terrible is still riddled with thinking of the past about EDs. If it was written more to the tune of the Anxiety Disorders page (also a bit out of date) I would be happier. The NIMH should be cutting edge in all ways. Advocates and activists need our top experts to walk the walk for the public so that we can refer people to them with confidence.

January 19, 2015

be nice, but not too nice.

Most of us have read Martin Luther King, Jr.'s Letter from Birmingham Jail. If you haven't it is well worth it.

What I went looking for today, on MLK Day, was the editorial that King was responding to when he wrote that letter. That letter is terrifying, really, in retrospect. Not because it says anything frightening but because it is meant to seem reasonable and appropriate. These were moderates, allies in their way.

This is a lesson that activists have to learn. Do not judge your cause by its critics. Do not work too hard to make sure people find your message pleasing or even that they understand it. Do not gauge your success by how offended it may make those who resist.

And this: take care not to dilute your beliefs even to allies. One of the most lasting legacies of MLK came out of a letter not to his enemies but to those who were the moderates about his cause.

The guide to activism is the cause. The judge of your methods is your own conscience. Success is not declared by winning people over but by actual change.

January 14, 2015


Socks? What does that have to do with ED?

Who is ED?

Suffice it to say that ED won't like it and you will. Read on.


"United effort for a common goal"

January 13, 2015

Charlotte: One Year anniversary

Charlotte Bevan died one year ago today. Since then her friends have done what she wanted: got on with getting things done to improve life for families facing eating disorders. Specifically, we have supported the Charlotte's Helix project named for her.

Today's Helix blog post reviews the news and accomplishments of the year. Read it (and don't weep). Gratitude and hugs to the marvelous people, especially to Erica Husain and the other wonderful Trustees, to Kings College London's DNA team, and to Cindy Bulik at UNC. And to Charlotte and her marvelous family.

Sometimes people just have to make something happen.

"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has." Margaret Meade*

*Actually, it wasn't. But everyone thinks it was. It could have been Charlotte, though!

December 18, 2014

a hard stop, Daddy

My dad died. I still find that so shocking to say, even two months later. I struggle to speak of him in the past tense. I have the sense of falling when I allow myself to think it: my dad died.

It was a good death. We all hope for that peaceful scene surrounded by family and deeply loved, and that happened. Daddy died with his beloved wife and his four children around him - and their families, too. The hospital was sincerely, generously, compassionately, and professionally wonderful.

But Daddy is dead and that can't be mended. My mourning is so deep and layered that I have to shelve it daily in a variety of ways. I surround myself with strange relics and wear his watch and sweater. I have embarked on the rest of my life missing my dad.

What Daddy left me is rich and even lively: ongoing debates, grounding values, a chuckling curiosity and wonder. He left me and my brothers a stubborn legacy of what dads are and what they do. I will always, to some degree, be sitting next to him in the front seat of the Chevy, back when kids could sit in the front and slide around without seat belts. His right hand is drumming on the seat back behind my head. When he has to brake quickly he will fling his arm to brace me: always believing that he can protect me from harm. From hard stops and windshields, from bullies and bad decisions, from the laws of physics and time.

It's a hard stop Daddy. A hard, hard stop.

December 12, 2014

"The diet feels good: they feel calmer"

If I could choose the first thing you ever read about eating disorders, this should probably be it.  Many of my friends are talking about it and for good reason.

It's not fair, but some people have a
paradoxical response to hunger.
It is long since time we stopped, as Cynthia Bulik puts it so well: "psychologizing" anorexia nervosa. That goes for all eating disorders, of course. We need to start our thinking about these mental illnesses by seeing the symptoms as neither natural nor willful. What looks like a "desire to control" or a "desire to be thin" is neither. These are biologically driven psychological symptoms with a predictable trigger: energy imbalance.

Imagine a group of sixth grade girls who decide to go on a diet. Or imagine a boys’ wrestling team that decides to engage in some serious crash dieting before weighing in for a meet. Most of the girls and boys find the period of negative energy balance unpleasant and can’t wait to break the diet and go out for pizza and ice cream. For a few, however, they find that they actually feel better under negative energy balance conditions. The diet feels good; they feel calmer. The anxious chatter in their heads diminishes enough to suggest that this might be an escape route from the pervasive discomfort with which they have been living. The positive biological reaction to negative energy balance lures them into continued and escalating dieting in a quest for the paradoxically improved sense of well being that it confers. It is simultaneously seductive and destructive. It is seductive because of the promise of calm and control it holds; it is destructive because it has the power to kill.
from "Negative Energy Balance: A Biological Trap for People Prone to Anorexia Nervosa," by Dr. Cynthia Bulik

We need to start seeing energy imbalance itself as a risky state for certain people, whatever the "reason" it starts.

December 6, 2014

Throwing Starfish interview at Gurze catalog

I was delighted to do an interview about Throwing Starfish in the Gurze Catalog. I love talking about Charlotte Bevan, parenting through an eating disorder diagnosis, and the guilt and fear of caregiving.
Can you offer some wisdom for parents on guilt and fear? 
Guilt is a very self-centered state of mind. It is about us, and when a loved one is ill we need to focus on their needs. Fear, too, is very narrowing. It makes every moment difficult and gives too much influence to the present when we need to be thinking about the bigger picture. Guilt is inevitable, of course, as is fear, but they are indulgences that we cannot afford to spend much energy on if we expect to have the stamina it takes to face this kind of challenge. Guilt and fear undermine the parental stance our kids need us to have, and our partners need us to have. 

It may seem harsh to a parent to be guilted about feeling guilty, I know. It is the most natural emotion in the the world when your beloved child is in harm's way. Parents are MEANT to feel responsible and indeed we can't be good parents unless we stand ready to do that and do it at a moment's notice.

Fear, too, isn't something that is avoidable nor is it dysfunctional. Who isn't FRIGHTENED OUT OF THEIR MIND by having a child develop a life-threatening and mind-altering brain disorder?
All this is why it is so very heroic and PARENTAL when we quell the fear and stuff the guilt and stand in the storm. While fear and guilt are natural, knowing that they are probably your greatest foes is an even higher level of Super Parenting. It's really hard. It's the hardest thing most people will ever do. There's moments when it just isn't possible. But it still has to be done and the harder it is the more critical it is. I am filled with admiration and humbled by parents standing in the storm.

November 21, 2014

Dirty Laundry?

A mother I know has started  The "Dirty Laundry" Project in response to a friend who called it "dirty laundry" to discuss her daughter's eating disorder on Facebook. I am posting this picture as my profile picture all this week to show solidarity and say very clearly that no illness should be treated as shameful or to be hidden. Stigma only serves the purpose of isolation and lack of information. The person who should have been ashamed is the one who thinks talking about illness is something to hide. Hooray for the Dirty Laundry Project and boo hiss to the haters!

November 20, 2014

Research study: Are you a mother who has had an eating disorder?

I believe strongly in the importance of research and I have great hopes for the future when families are better prepared and able to act when it comes to eating disorders.

Researchers in the UK are looking for mothers who have suffered in the past (or currently) with an eating disorder who have a healthy daughter between 11 and 15. Travel costs are covered if you decide to participate.

If this describes you, please consider joining the study being conducted by the UCL Institute of Child Health? Research is so important in understanding and better treating eating disorders. If we could learn more about those at risk before they become ill it could lead to advances in treatment and even prevention.

BREDS (Brain in high risk for eating disorders study) 

We are currently recruiting mothers who have had an eating disorder in the past or have one now, and who have a healthy daughter between the ages of 11 and 15. 

Research has started to study whether the way someone thinks and brain characteristics are linked to the development of an eating disorder, however, we still don’t know if this differences were there before the eating disorder; or if they are a consequence of the disorder. 

We are currently recruiting for a study to understand why young people develop an eating disorder. The purpose of this study is to look at the brain structure and the way of thinking of healthy adolescents who have a first degree relative with an eating disorder. This study will help us figure out if these healthy adolescents have a similar way of thinking and brain characteristics to those shown in patients with eating disorders. If this is the case we might be able to understand what brain characteristics increase the risk for eating disorders. 

What’s involved? - Computerised brain games and IQ test- Questionnaires- Saliva sample Inclusion criteria - One half-hour MRI scan

You are eligible to take part if you:- Have a healthy daughter between the ages of 11 and 15.- Have had an eating disorder at any point in the past, or have one currently this could include Anorexia Nerovsa (AN), Bulimia Nervosa (BN), Eating Disorder Not Otherwise Specified (EDNOS), or Binge Eating Disorder  

We are also recruiting control participants who have never had any mental health disorder and have a healthy daughter between the ages of 11 and 15. 

Compensation You will be reimbursed for travel costs and your daughter will receive a £20 voucher as a token of our appreciation. 

Contact - Tel: 02079052166   - m.martinez-barona@ucl.ac.uk

The study was approved by UCL Ethics Committee (5487/001) and Dr Micali is the principal investigator.

Click here for more details.

November 18, 2014

The picture wall is growing: where's your pic?

I'm having a great time every morning checking out the picture board at F.E.A.S.T. - every day there are new entries and they move around so I love seeing my family in different constellations with other families.

Are you on the board yet???

Fund Drive Updates - Families Empowered and Supporting Treatment of Eating Disorders

November 11, 2014

Principles and Scenarios, and a Bungee Jump

Staying calm and consistent while caring for a loved one suffering from an eating disorder, that is the question. I've spent a decade being shouty about the WHY and the WHAT parents can do. I've been more cautious about the HOW. The truth is: parents want the HOW. NOW.

So, Eva Musby, another parent writer, has rolled out the HOW that so many families are begging for in a new book. She does so with wonderful analogies, references, and some mad animation skills. Check out her video:

In a perfect example of how Musby has thought through what you, the parent, need and are going to ask, she's worked out all the formats you might want to access the book!

Here's what I like best. I have observed, over the years, a growing knowledge base in the parent community. Parents are sharing what they've experienced and tools they've stumbled on and sharing them with others. There is no formula for all, no recipe that will work for more than one family - but what a parent does need is a pantry to walk into and read ingredients and pick up ladles and pans - this book is like that pantry. Dip in anywhere -- and there is a lot here - and find a concept or a tool you would probably only stumble over long after you needed it.

Thank you, Eva, for taking your experience and listening to others -- to other families, to the professionals, to the literature.

And thank you so much for the Bungee Jump analogy!

November 7, 2014

I hate fundraising. But I hate ED more.

When a group of parents around the world started F.E.A.S.T., the first internatonal group OF and SUPPORTING parents of ED patients, we didn’t just want to copy what others were doing. We wanted to change the landscape of what families find and how they respond to these life-draining and life-threatening disorders.
We believed two things were essential:

Focus on what parents can DO.
Follow the science.

We knew we wanted to be a unique voice and that we might stir controversy. For that, we needed financial independence. You see, most advocacy is funded by sponsorships by those selling services to families. This is not to say that providers would tell us what to do, or that what they do was wrong, but an acknowledgement that financial independence would leave us free to focus on the message and not keeping sponsors happy.

So, being financially independent means F.E.A.S.T. depends on the very people we represent: families. We depend on contributions from the F.E.A.S.T. community to do the work we do. Those contributions are not just how we pay the bills for our services but how we know what we do matters. Since 2007 parents and other supporters have been donating what they can to F.E.A.S.T. and by doing so they make the Around the Dinner Table forum possible, they make sure that there are parents represented at eating disorder events, they fund the written materials that families bring to their schools and doctors, and those kind donors make sure that the lonely mother at her computer in the middle of the night finds a place that assures her that it is not her fault and that she can, indeed, get her child back.

F.E.A.S.T. is independent but also frugal. We don’t have an office or paid staff. Everyone at F.E.A.S.T. is a volunteer working from a kitchen table or their laptop in the den. We don’t spend donations on stationery or pens: we spend it on supplying services and providing information.

Independence means F.E.A.S.T. is focused on our mission and not cultivating donors.

I hate fundraising, myself. But independence has its cost. If we don’t want to have to worry whether Hospital One wishes we wouldn’t talk about evidence-based outcomes, or worry that parents at one of our conferences will feel more trusting of XYZ Clinic because they paid for a conference breakfast then we can’t play the sponsor game and we have to operate on less and get it from our own members.

Notably, we rarely ask folks for money. We don’t pepper our members with fundraising appeals, nor do we make donations a condition of membership. We believe parents and caregivers have a great deal on their minds and don’t need to see a fundraising message every time they hear from us.

But F.E.A.S.T. isn’t made of fairy dust and we do need to get donations to continue our work.

Donating to F.E.A.S.T. in any amount is more than a money thing. It’s a vote of support for the parent perspective, and for good science. It’s paying it forward to the parents who will need F.E.A.S.T. for the first time tomorrow morning, or next month, or next year. If what we do matters to you make sure it is there for others. Be part of making the world a better place for families facing eating disorders.

November 5, 2014

Wait, why DON'T we all get along?

I've been fascinated, and of course saddened, by an increase in unfair personal attacks in the ED world. Many people are telling me they feel attacked, shouted down, bullied, unsafe.

Wait, this isn't new. And, oh dear, it's not just in the ED world.

It seems to happen when certain elements collide:

Ideas and people.

I am skeptical that this is really about what any one person did or said or thinks or wants. The interactions are too similar and the outcome is formulaic: shunning of the person and anyone who doesn't shun her and her ideas. Yes, there are a scattering of really maddening people, but they are the exception. I believe these scuffles are not personal but ideological. I believe these battles end in defensive wounds more often than not. And: I believe the conflict is inevitable and necessary and healthy. For that last sentiment I will be roundly spanked, I know. This is a world that fears and loathes conflict!

#realtalk: there is no safe space when you are expressing your opinions in public. There's not supposed to be.

That's the price of being in public. And with Facebook and Twitter and blogs and even email we are now in public a LOT. If your opinion is more than a fluffy bunny affirmation surrounded by rainbows you will hear grumbles. Before, people just smirked and you never knew. Now even fluffy bunny affirmations may be criticized. (Note: I'm not a fluffy affirmation fan.) Bring it!

"But, but, she wasn't nice!" No, she probably wasn't. People aren't always nice. Sometimes they are angry, and sometimes they are just crabby people, and sometimes you've made them jealous or didn't show them enough respect or you look like their mother-in-law. Sometimes something is important enough and delayed long enough to make people really, really, really, really angry. If you require nice 100% of the time you will need to stay home and read bunny books alone. The Internet, your book club, your town council are all closed to you. Also: don't attend any family events.

"But, but, I feel threatened." Many of us feel under threat when criticized or put on the defensive. We care SO MUCH about what we're doing and we work SO HARD to claw a place for what we believe in and we've been brave and kind and patient and WTF! Why is someone damaging my reputation? How could anyone think that I'm anything but right and righteous and good? But are we really being threatened? Isn't it really more that we're not being appreciated and we are being thwarted in our good works? Isn't it that our intentions are being questioned and that is deeply painful?

"I'm a nice person!" Yes, well, my mother thinks I'm a nice person, too. Doesn't make me or my beliefs or my causes nice, too. Nice people can be wrong, even harmful. Rotten people can be right.

Honestly? I think we all need a bit more courage and strength of our convictions. It is okay to disagree. It is okay to be disagreed with. If we are all truly to see one another as equals with the expectation of mutual respect we need to own our place and know that it is JUST our individual place. Being right alone in a room isn't advocacy. We need to be vulnerable, too, and allow ourselves humility.

Laura's New Groundrules
  • Let's pretty please stop saying "people are saying" or anything like this.** This is a sly way of getting individuals to shut up, implying that they are out of line but in such a horrible way that the other person won't say it themselves and that some amorphous group of people is whispering out of earshot. It's creepy. If it's not in public and no one is putting their name on it let it go. Just say "This thing you said bothers me because..." and get on with the actual conflict.
  • Let's stop doing things back-channel. We can fool ourselves that it is being respectful but it is usually politicking and Mean Girling. Say the same things in person as to others. Don't talk about others behind their backs and don't repeat rumors. I know. It's hard. But let's try.
  • Let's stop calling it "attacking" when it is really just disagreement. Sure, it stings when people question or criticize us but let's practice mutual respect by assuming both parties are equals and can both handle the conversation. Let people think wrong of you. Let people BE wrong.
  • If it is an attack, whatever THAT is, let's deal with it. Won't kill us. If we hear the criticism and don't agree then keep going. If not, talk about it and consider change. 
  • Be nice, for goodness sake. Treat others with respect and expect it in return even when they don't -- and they won't -- but take the high road with sincerity for your own karma's sake. Also, it drives people nuts when you behave: they can't dismiss you as rude, which they really, really want to do.
  • Let's accept the fact of disagreement. It's there. We're living on the leading edge of a fast-moving wave: lots is going on, it's complicated, and we're all scrambling to figure it out. We do NOT all agree and we don't agree on some very basic points. Until we do better on that we will not work together, row in the same direction, find common ground, or whatever our palliative phrase of the month is. We do disagree, some of us are going to have to change or split, and while we're arguing things are going to change and we'll ALL need to keep learning. 
  • IDEAS NOT PEOPLE. Discuss ideas, not the people who hold them. It works!
  • Ask questions. Listen to the answers. People are not always saying what you think they are.
  • We're not friends, we're family. It's not about being liked it's about being linked by a cause. 
  • OMG: there are other ideas out there! People hold the most fantastical and bizarre belief sets! I didn't even know those where there! Exactly. Know the history, know the ideas, get to know the people. Be curious. Allow yourself to be surprised.
  • Hot kitchens. It does get heated. But no one can keep anyone out of the kitchen any more. It's a free and open potlatch of ideas and voices. Everyone is responsible for only one voice: their own. We can't make others not be "wrong on the internet" nor can we group people off and segregate them. We will hear things we don't like. We will say things that others don't like. It doesn't break anything. If you're offended or exhausted by it go do something else but don't expect a zen garden in the middle of the highway.
  • No more black and white thinking about individuals. There's too much "our sort" and "OTHER" going on. Reality: we are all in the same boat and but we're each picking which hole to patch and which part of the hull to hammer through but we're all sinking or swimming together. By designating a person on the boat as somehow UNACCEPTABLE what happens is the boat just gets harder to walk around in. I have to see and speak to and share mutual friends with a handful of people who make me terribly uncomfortable. They've hurt me personally and they've damaged my reputation. But I'm not getting out of the boat, nor should I need to throw them overboard. We're in this together. We don't all need to be friends. We don't all need to get along: we need to be alongside.
  • Babies, bathwater, boats... I hate the way people dismiss ideas by associating them with a particular person or group. It's lazy, it's intellectually shallow, and it hurts us all. If you think that I am a horrible person, fine, but don't dismiss the ideas I believe in because you don't like me. I've met too many people who treat ideas like sports teams: this is my set of beliefs because this is my team. Have your own ideas. And don't take the easy way out of rejecting anything I stand up for because I'm associated with it.
Dyspeptic rant over.

** Yes, I know I started this VERY rant saying something like that. Go figure. Believe me when I say I am speaking as much to myself as others as I rant, here.

October 31, 2014

What a little data can do....

You know, research can be such an abstract thing. I think people get overwhelmed by it, intimidated by it, and don't feel it applies to them.

Until it applies to them.

There have been two big "read this" moments in the news lately. Neither are getting the press I think they deserve, but both strike me as research milestones that will change the world in real ways for lots of people.

Paralysed man walks again after cell transplant

Scientists link 60 genes to autism risk

They also point to why we need to support research and support researchers, like hint hint Charlotte's Helix. Researchers and funders put in years and years to make any of these things possible, with little credit or kudos, until and unless it pans out. These are the rock stars we should be cheering for, following, and with whom we can choose to sing along!

October 23, 2014

DO something

I am a big supporter of the Eating Disorders Coalition. EDC is actively -- and successfully -- doing for all of us in the US what we hope is being done when we wake up down the Rabbit Hole in ED land: advocating for better research, training, treatment, and action on the legislative level.

This letter from EDC today movingly explains WHAT each of us can do, and WHY.

I just hung up from making MY call. I did something today. It took 60 seconds. PLEASE join me, and leave a comment below on why.

Dear EDC Member Organizations – 

If you think back to why you became a Member of the Eating Disorders Coalition, my guess is that many of you joined because you wanted to DO SOMETHING to fight back against these insidious disorders we call eating disorders.  I’m right there with you! I want to DO SOMETHING to help diffuse and transform the hell these disorders bring to far too many.  Today and tomorrow we have an opportunity to DO SOMETHING that will positively impact our entire field and every school-aged child in our Nation.  This opportunity involves school-based BMI screening, surveillance and reporting. 
Last week, as a result of Lobby Day, we garnered a commitment from Centers for Disease Control (CDC) to make changes to the school-based BMI screening protocols, but in order for that to happen we need Members of Congress to sign their name to a letter that instructs CDC what to do.  This letter is called a Dear Colleague letter.  The “DO SOMETHING” I’m asking of you is: make one phone call to your Member of Congress and ask them to sign their name to the Dear Colleague letter by Monday, October 27, 2014.   

I know you are all very busy.  You have my word that I wouldn’t ask you to take time to DO SOMETHING if this weren’t a goal that we can accomplish, together.  And, I wouldn’t ask you to make a call if each and every phone call weren’t super important. Every call makes a difference (and the opposite is equally true).  Rarely does our Coalition have an opportunity like this…let’s not let it pass us by.  Let’s DO SOMETHING. 

Here’s how to make your call: http://www.eatingdisorderscoalition.org/documents/FallAdvocacyandLetters.pdf 

THANK YOU so very much. ~Kathleen
_________________________________________Kathleen MacDonald, Policy & Communications Director Eating Disorders Coalition for Research, Policy & Action (EDC)
For a recap and pictures of the historic 1st M.O.M. March (Mothers & Others March) on DCand EDC National Lobby Day, click here:  recap: http://www.eatingdisorderscoalition.org/CongressionalBriefingFall2014.htmpictureshttps://www.facebook.com/EatingDisordersCoalition/photos_streamNBC video: http://youtube/j5EpQazGxuE

Direct Dial: 202.802.0777 Website: www.eatingdisorderscoalition.orgFB: www.facebook.com/EatingDisordersCoalitionTwitter: https://twitter.com/EDCoalitionInstagram: instagram.com/EDCoalitionGoogle+: EDCoalition1  

October 16, 2014

Atonement, humility, and the future of mental health care

It's no secret that there is enormous tension within the mental health community. As much as folks like to say we should all get along, row together, collaborate... it rarely works that way. We only get along when we're off in our silos not interacting or competing for the same scarce resources. We all mean well but there are actual ongoing disagreements that keep us from being on that mythical "same page" we all wish for.

Personally, I don't think we're going to move forward on mental health advocacy until we do a better job WITHIN the community on communication and consensus. Unfortunately, that is largely taboo. Conflict among us is not welcome and is seen as divisive and, worse, unnecessary. All enemies of the cause are seen as outside, other. That attitude, of course, believes the answer is in everyone getting on OUR particular page. If only everyone saw the light, if only everyone saw that I am right!

I say, let's embrace dissent and disagreement. Let's actually talk with those with whom we disagree. Meet, eat, stroll, play checkers, eat cake. Let's get it all out there openly. Is that worse, really, than the politicking and the back-chatter? I'd be glad to be wrong, actually, if it led to change. 

I have a page. I'm on that page because I am intellectually and, no doubt, emotionally invested and convinced of it. It's a complex page, not quite like anyone else's. I write it. I edit it.

Happily, my page is 
in many parts shared by others. I'd have to say as time goes on more and more people are on my page, some on more lines than others. I feel these days as if I'm in a booklet if not a book, and no longer a nuisance flyer floating in the wind.

I'm proud to say that I read very largely from NIMH Director, Dr. Thomas Insel's page. I'd probably edit a few phrases or cram some things in the margin, but it's a darn good page to start from. This annoys some people I know and admire. I guess it would be impossible to get everyone, even all the well-meaning and thoughtful folks, entirely into the same book not to mention page. But for heroes, teachers, and fresh thinking I don't think you can beat him. And, happily again, the guy is the head of modern psychiatry in this country and widely admired around the world.

I am cheering for Dr. Insel's recent statement, one that many of us need: "on Mental Illness Awareness Week, my call is for humility."
Fear and distrust -- often justified and understandable -- can make people lash out in ways they otherwise would not. Kindness, and mutual respect, can be lost in the process. I have many friends with whom I disagree in part or wholly on mental health treatment and policy. That is expected and probably necessary. But humility and plain old kindness don't have to be withdrawn. 

I do not mean that people should stop speaking up, or avoid conflict, or walk away. The opposite:  my hope is in engagement not just in spite of but BECAUSE of disagreement. We may not have a choice. It used to be that advocates and providers could exist in little islands on their own. We are now more and more connected through various networks that intersect. Our various beliefs and methods and, yes, bad habits, are all in the mix. I celebrate that. It may not always be pleasant, but none of us are in it for the fun: we want patients and their families to suffer less, thrive more, and for the public to understand and support our community.

October 14, 2014

"Without a parachute" guest blog post by a mum

Thank you to mommarexic from Oxfordshire UK for this guest blog post!

"You have been told that in order to help cure you of your fear of heights you need to jump out of a plane. You have somehow been persuaded to get on the plane.  Perhaps you are an inpatient in a psychiatric unit because of your irrational fear of heights and you know that you have to comply with these ‘treatments’ to ever hope to be discharged.  You aren’t actually that sure that you have a fear of heights, but apparently you meet the national criteria for Acrophobia.  You actually think that a fear of falling off high things resulting in serious injury or even death is a healthy thing. Too many people are not afraid enough and the cost to the health service of treating the injuries these people sustain is a problem, so more people should be like you. You don’t see why jumping out of a plane is necessary to make you better, couldn’t you just look out of an upstairs window?  Heck, you could even open the window if you had to.

Anyway you have reluctantly agreed to get on the plane.  It is a twin engine plane, with only basic facilities on board.  No nice comfy airline seats, or in-flight entertainment.  As the engines start-up it is very noisy and the whole plane vibrates and rattles and you start to feel very nervous about the whole thing, wishing you had never agreed to get on the plane.  They buckle you in to your seat.
You start to tense up, holding on very tightly to the edges of your seat, looking around you, trying to see where the exits are. No-one has done a safety demonstration, you wonder how good the risk assessments have been and whether they have checked all the equipment properly.  As the plane starts to move you begin to wish you had tried to get off while the plane was still stationary and wonder if it is moving too fast to jump off now.  But you know if you do that they will say you are still no better and you will never get discharged.

The plane starts to climb to the altitude necessary, your heart is beating so hard you can feel it in your throat.  Your palms are sweaty and your stomach is churning.  The person with you is watching you to see how you are reacting so you try to appear calm but it is hard when you feel so scared.  They are saying reassuring things to you and you are trying to believe them.  They are playing some music over the loud speaker and you try to focus on that instead of the fear.

The assistant starts to unbuckle their harness and you realise with a lurch of fear that it must be nearly time to jump.  They come over and sit next to you and start to shout over the noise of the engines instruction about what is going to happen. 

It suddenly occurs to you that you have not been shown how to use the equipment.  To your horror when you point this out the assistant says “what equipment?”  The parachute! You need to know how it works and when to pull the string etc.  The assistant says “there’s no parachute, we are just jumping out of the plane”. You realise what you hadn’t noticed before.  There are no parachute like bundles in the plane, it is empty except for the odd bit of rubbish and a few old tools.   Everything goes into slow motion, the world seems to have paused for a moment, and you take a few seconds to register what you have just heard.  No parachute?  You must have heard wrong.  That can’t be right.  No you have heard wrong.  You ask them to repeat what they said.  It is no better the second time.  You heard right, no parachute.  Surely they are mistaken.  No they say, this is what they have been told to do, it is the current NICE recommended treatment for Acrophobia and is 100% effective at curing people’s fear of heights.  Everyone who has done it has not been afraid of heights afterwards. It occurs to you that that is probably because they are dead. When you say this they laugh at what they seem to think is a witty comment.

You point out that they have not done a safety check and that you are not happy about jumping out of an unsafe plane.  They say they are happy to get you the log book that shows the plane has been checked and you say that you would like to see it.  They show you the relevant page and you ask them to talk you through all the ticks and checks  You are not really listening but while they are doing this at least you are not being pushed out of a plane.  They have stopped speaking, they have been through it all and are looking expectantly at you. You think quickly and thank them for that information, that it would appear the plane has been checked, but how about the pilot?  Are they sure he or she is appropriately qualified to be doing this?  After all they have the important job of letting you know when it is safe to jump so could they provide you with some credentials please.  They look confused but in the end seem to think it is a reasonable request and go off to the cock pit and come back with the pilot’s license and record of previous jumps etc.  You smile politely and thank them for their patience but could they also just double check that this was the right day for you to be doing the jump.  You had a feeling it was tomorrow and could they please check.  They have realised that you are just stalling for time and say the time has come for the jump so no more questions or checks. You argue that they must be wrong, you ask them to check with someone more senior, you ask if you can speak to the person in charge, you say you no longer consent to this treatment.  They say that they are the most senior person on the plane and that the other people are unavailable, but crucially, there is no radio on the plane so communication is not possible.  They tell you again not to worry, it is alright they have done this before. 

They don’t appear to be taking any notice of your concerns they are speaking to the pilot behind the closed door at the front of the plane to check how long before they are over the target area and if they are at the right altitude etc.  While they are busy you unbuckle your harness. You are pacing around the plane, looking out the windows.  The plane is extremely high, just looking out the windows makes you feel sick.  You say you don’t feel well. The assistant points out that that is because you have a fear of heights.  You reply that it’s a fear of death not heights and she should shut up because she clearly has no idea what she is doing and should be struck off.  Is she going to be jumping out of the plane?  She says no of course not, she doesn’t have Acrophobia.  You tell her you actually don’t have Acrophobia and never have done and they have all got it wrong. This gets no response.  It’s as if she was expecting you to say that.

You are getting desperate now.  You have to get off this plane but not by jumping out.  You try telling the assistant you don’t consent.  You can’t do it today, maybe you could build up to it. Perhaps today just being up this high is a good start?  Would it be enough just to stick you head out of the door?  No. What about you whole upper body?  Again no. You promise you will do it tomorrow, you just need more time to get used to the idea.  This is not acceptable apparently, it has to be today, while they have the plane available.  You tell her this treatment is not going to work for you.  You actually feel more afraid of heights now than you ever did.  It’s making you worse, can’t they see that!  You are pleading. Nothing is making an impact.  The assistant is still getting ready to have you jump out of the plane.

Your fear reaches a new height.  You are entering blind panic.  You start to shout and cry.  You move to the front of the plane.  You are hammering on the pilot’s door trying to get them to open up.  You are shouting through the door that the person in here is mad and they are trying to kill you.  You are begging them to make an emergency landing, you are having a heart attack, you can feel your heart nearly bursting in your chest.  Your chest is burning, you can’t catch your breath.  You say they must be too high, aren’t you supposed to have oxygen or something?  Your hands and nails are starting to bleed from the banging and scratching at the metal door but you don’t care, the blood seems to represent the horror of what they are doing to you.  Maybe the sight of the blood will bring them to their senses and stop this.  It doesn’t. The assistant is starting to look a little cross.

She starts to approach you warily.  She is calmly asking you to calm down, to breathe normally, to sit back in your seat.  She’s saying it’s ok, you can do this.  It’s fine, it’s part of what is going to make you better, it’s going to help you get closer to where you want to be – home.

She is clearly insane.  You tell her this. In order to make your point you add some heavy duty swear words.  She is unmoved.  She is clearly used to this.  You look around you and pick up the nearest heavy object you can find.  Some sort of a wrench.  You hold it in front of you.  You tell her not to come any closer, to make your point you hit out at the surrounding fixtures and fittings showing what damage you can do.  She is still carefully approaching you. 

You realise that the noise in the cabin has increased markedly and that everything is being blown around in a great rushing wind.  While you were trying to get the pilot’s attention, she has opened the side door and the sky and ground below are rushing past.  The noise is worse than ever so that you can barely hear yourself think. You are frozen with fear.  She had taken the wrench off you and is moving you closer to the hatch.  You know you have lost and what follows is inevitable. You try one last time to push her out of the door first but she has been taught some special moves just for this eventuality and the last thing you see is her receding face mouthing ‘well done’ as you fall.

Now replace the flight with meal time and the jump with food.  This is pretty much what it is like to have anorexia and be asked to eat a meal with carbohydrates, fats and protein in it, followed by a nice sweet pudding.  Everyone is insane, they don’t know what they are doing, they are trying to kill you (or make you fat which is the same thing).  What would you do to stop someone making you jump out of a plane without a parachute?  Lie, cry, scream, swear, use violence? So no surprise these are the reactions we see when we ask people with anorexia to eat.  The fear is overwhelming.
Of course in the case of the person with anorexia, they find themselves floating gently to the ground landing on both feet in a beautiful meadow where the sun is shining and the grass is green and birds are sweetly singing.  Then hopefully the next time they take the same trip, they won’t be so scared until jumping out of the plane will be just a normal part of their day, like eating meals for example."