June 28, 2007

Uninterrupted by the natural curves

"Apparently some designers feel their clothes are shown to best advantage when uninterrupted by the natural curves of a woman's body."

Diana Salvatore, Editor-in-chief at Ladies' Home Journal, P. 14, Welcome page, April 2007.

Let me get this straight. If they show us clothes the way they really look on the people who buy them we won't like the clothes.

So disordered.

June 25, 2007

Family Training vs. "Family Week"

"family therapy" "family-based therapy" "Family Week" "family training" "Maudsley approach..."

They are not all the same thing.

An opinionated, and irreverent, primer:
"Family-based therapy" and "Maudsley approach" are almost the same thing. These terms refer to a approach that puts nutritional rehabilitation first, and parents in charge. The family is not the problem - the illness is the problem. FBT is the manualized, research term. Maudsley is the hospital where the concepts originated but is also a place where other approaches have originated. Many people associated with FBT don't like the term Maudsley, and some people at Maudsley don't like the term Maudsley approach, either!

(I use the term Maudsley because parents looking for this type of treatment need a term to use, and a name that googles.)

"Family therapy" for EDs is an older and looser term that can include the above. Originally the idea was that the illness was an expression of problems within the family that the therapy seeks to identify and fix. That idea was supposed to have been abandoned, but many clinicians did not get the memo.

"Family Week" is a standard feature of ED residential treatment where families are invited to come to the center and be spanked for all the things you did wrong and be schooled in what you must now do - but mostly: not do.

I'm a fan of approaches that train the caregivers instead of the patient until a later stage of recovery where the patient can take that on. Here are a few that lean that way:

University of California at San Diego boasts a state-of-the-science program directed by no less than Dr. Walter Kaye, the researcher who is going to crack the very DNA code of this illness for us.

Dr. Nancy Zucker at Duke U. gives you homework and hope when you attend her parent training.

A quick look at the web site for the Kartini Center in Oregon will convince you that if you step up - they'll back you up.

The Boswell Center in Florida combines hands-on with virtual reality by giving you intensive multi-disciplinary support and then follow you home via camera phone support.

Stephanie Millstein is empowering the parents of Michigan in a supportive group setting. (Beaumont Hospital, Royal Oak, 248-551-2385).

Multi-family group training is also offered at the Maudsley in London, at the Westmead in Sydney.

June 22, 2007

Why don't insurance companies pay for mental healthcare?

Why don't insurance companies pay for mental health care the way they do for other physical conditions? Is it because we don't deserve it? Or maybe because you didn't ask nicely enough?

The Eating Disorders Coalition needs our help to get us help:

"Mental health parity is on the move in Congress. There is a good chance
that a mental health parity bill will soon pass. The Eating Disorders Coalition
is working to ensure that Congress passes the strongest possible mental health
parity bill.

There are two versions in Congress now, one in the Senate and one in the House. The Senate bill is good, but it can be stronger. The House bill is excellent and we strongly support its immediate passage without amendment. The EDC supports BOTH the House and Senate bills.

We need your help TODAY! Members of Congress want to hear from YOU, their constituents.


1. Contact your U.S. Representative and ask for "support for the immediate passage of the Paul Wellstone Mental Health and Addiction Equity Act of 2007, H.R. 1424, without amendments."
2. Contact both of your U.S. Senators and ask for "support of the Mental Health Parity Act of 2007, S. 558."

Talking points:
Insurance costs will NOT soar.When federal employees received mental health parity coverage starting in 2001, the cost to provide benefits increased by less than
one percent. In addition, productivity increased and absenteeism dropped. (Report on Parity for Federal Employees)
Managed care will STILL ensure that benefits are used wisely.Insurance companies will still play an important role in determining how resources are allocated.

To contact or support the Eating Disorders Coalition, go to eatingdisorderscoalition.org and get involved!

June 19, 2007

Why no one has heard of Maudsley and how you can help

When parents first hear about family-based Maudsley care for eating disorders they often ask "Why didn't anyone tell us about this?"

Despite the fact that family based care has decades of data behind it, is evidence-based, and is recommended by the leading experts as the first line of care for adolescents living at home, FBT/Maudsley is still rarely discussed in the media. One reason is that media outlets need actual people to interview. They need to put the face to the story.

Recently, I have talked to producers at two networks who want to cover this story. One needed coverage that I feared would be exploitive and sensationalist. This week, however, I spoke with producers at a PBS show that want to include FBT/Maudsley in a look at evidence-based treatment on the show Keeping Kids Healthy on WNET in New York.

The producers need a family who will do an on camera interview to discuss their experience. They are looking for people in the Tri-State area, but so far have not found one. Their deadline is coming up in the next two weeks. This is a rare opportunity to make sure Maudsley is included in ED coverage. To see an example of the producer's approach and sensitivity: http://www.keepingkidshealthy.org/topics/bipolar-disorder-in-children/ and http://www.keepingkidshealthy.org/topics/clinical-depression-in-children/

No family should feel an obligation to change the media. Our family, for example, has chosen not to do this kind of interview.

I hear frequently that just learning about Maudsley set a family in a whole new direction and "saved my child's life." A show like this will save lives.

Please, please contact me if you or someone you know might be willing to talk with these producers. I would consider it a personal favor.

June 13, 2007

It's not about the food

It's not about the food... unless you're not eating.

Tasting Rachael Ray is a happy, joy-filled, reminder that eating can be fun!

Warning: lower your audio first if you are in public, otherwise people are going to think you're watching another type of inspiration altogether!


June 7, 2007

Man bites dog. Anorexic bites burger. Stop the presses!

In between banging your head on your desk in frustration about understanding eating disorders, finding treatment, and doing the hard work of supporting a loved one through an eating disorder let me offer this reassurance that you are not imagining that the media is against you:

"Articles primarily covered those who are female, young and white, and mentioned mainly environmental causal factors. Only 8% of patient profiles discussed treatment and recovery within a medical context."

Most popular media about eating disorders is distorted, sensationalist, and just plain wrong.

Write letters to editors: they listen. Write letters to writers: they are looking for stories that buck trends. Write your story and go to the media with it.

Man bites dog is a story. Anorexic bites burger is a story too!

Thank you to SK O'hara and KC Smith at Johns Hopkins for their work!

June 3, 2007

Farewell, Ann Litt

With great sadness, today my family attended the funeral of Ann Litt, the renowned nutritionist. She wrote books, she lectured, she appeared on television. She was the trusted advisor of many, including famous athletes, eating disordered children and adolescents.

She was also my daughter's nutritionist.

Ann's death at 53 was sudden and unexpected, and it is a ferocious loss. I can barely manage to refer to her in the past tense.

I say Ann was my daughter's nutritionist, but she was more than a nutritionist and she really treated our family as a package deal.

During the service, the rabbi reminded us that one is remembered not for what one says or does, but for how one makes others feel.

Ann made us feel competent and prepared. She allowed us, in vulnerable times, to feel strong as a family. Ann helped us feel hope.

We are deeply grateful to have had the chance to work with her, to know her.

We were surrounded today by hundreds of mourners who will miss Ann for so many reasons. Hers was clearly a rich and well-lived life. Thank you, Ann, for everything: past, present, and future tense.

June 1, 2007

This message has nothing to do with EDs

This article has nothing to do with eating disorders: "Mixed-handedness an indicator of PTSD susceptibility"

Or does it?

One brain reacts to a war zone with PTSD. Another can witness horrific events without a blip. Is it weakness? Lack of training? Culture? Morality?

I'm sorry, but I think we underestimate the uniqueness of each brain. It probably isn't any more a matter of strength (or good parenting) whether you get a mental illness than it is what day of the month it is.

Some of us have brains that will employ depression as a reaction to life-threatening stressors. Some are tuned to turn on depression for no reason at all.

Anxiety can be a reaction to boredom, or to a horrific experience.

When we concentrate on the events, and not the reactions, we miss the opportunities to truly help.