October 31, 2009

"Stereotypes and negative expectations play a powerful role in bad psychotherapy"

Oh, what an insightful blog post:

"The Power of Expectations" by Dr. Ravin

And a heartbreaking reality:
"The therapist tells the patient that she must unravel the roots of her problems, and that it will take many years for her to recover. It does. "

The ending is profound:
"Bad therapy is not just ineffective – it has the potential to be every bit as harmful as a surgical error."

Now, for a moment, imagine the power of GOOD therapy!

October 30, 2009

Dieting mothers have anorexic daughters, study suggests

Dieting mothers have anorexic daughters, study suggests...

Okay, I should not take the bait on this, but since I subscribe to a lot of news-feed services this "study" keeps landing in my inbox with a trail of increasingly offensive headlines.

I am painfully aware that families often get their information about healthcare issues from articles like these, and worse still that these types of pieces are what help form public opinion and mother-in-law conversations and the tsk tsk over coffee among one's friends when one is not there.

So, I'll take the bait.

This is not a "study." This is a poll of magazine readers. Polls are not science, they are not representative of the population; they tell you something about the market of that magazine.

Correlation is not causation. Both moms and their daughters are under similar and related pressures to diet.

The culture of dieting runs in families and social groups.

Eating disorders run in families - one's risk is 50-80% determined genetically.

Dieting is not the same as eating disorders.

Why do I expend so much energy trying to refute this kind of thing? Am I just hellbent on defending parents no matter what? Have I no sensitivity to the toxicity of a dieting environment and the influence of mothers on their daughters?

I spend energy on this because I AGREE that no one should be dieting, that some parents are terrible role models, and that an environment of dieting and body hatred is toxic. The question is whether an eating disorder is a sign of those things - and I would argue that an eating disorder is not a sign of anything except a predisposition to respond to dietary restriction/energy imbalance with a self-perpetuating mental illness.

When we admonish moms for dieting - something that our entire society is actively and delightedly and almost religiously ENCOURAGING - because it causes eating disorders we make two mistakes. One is that an ED diagnosis becomes a witch hunt for the bad influences in one's life when there is no evidence whatsoever that this helps prevent or treat an eating disorder: none. The second mistake is in mistaking dieting for an eating disorder.

Dieting is a choice, but the eating disorder that may be activated by a diet is not. None of us should be choosing dieting, in my opinion. Dieting is well-known to be futile, unhealthy, depressing, and sucks the life and fun out of life and our relationship with our body. Using food to change our bodies, our appearance, or our emotions is an inherently unhealthy activity whether or not you have the genes and biology to become horribly mentally ill as a result.

Moms need to be freed from the overwhelming pressure to diet and feel aesthetically inadequate, period. Moms need help learning and learning to model loving their bodies and their appetites and their biology - as do dads. Eating disorders cause horrible suffering for a small percentage of the population, which we then go on to blame on being too influenced by toxic surroundings - a horrible injustice. But dieting and our body-hating food-phobic culture hurts us ALL, and it needs to be stopped for its own sake.

I fear it is futile to rant like this, though. Even my friends and family don't get it. But thank goodness for blogging, it lets me say it anyway.

In parting, I'll leave you with the sidebar articles to the piece above - which tell you more about the reality of the blame-mommy-for-dieting-tell-mommy-to-diet culture we live in:

Related Articles
Hospital admissions for obesity more than triple
Junk food as 'addictive as drugs'
Exercising with a friend 'helps to lose more weight'
Diabetes jab better than obesity drug at cutting weight
Anorexia victim offered place at Cambridge University dies at 18
Blame Mummy, not Madonna, for low self-esteem in girls

October 29, 2009

Liking Sweets Makes Sense For Kids

More fodder for Halloween thinking: Liking Sweets Makes Sense For Kids

With a picture of scary Laura from a recent Halloween:
And yes, that is green flourescent eyeshadow. You'll have to imagine the black velvet hooded cape. Always wanted one as a child, but now I have an adult-sized credit card.

October 28, 2009

The pain-relieving powers of cuss words

Ever given birth? Passed a kidney stone? Smashed a finger with a hammer?
Well, there's a reason for bleeping out the words we use on those occasions: cussing is a pain-reliever especially for women.

Two stalwart moms I know mentioned the therapeutic need to yell a blue streak as things "went pear-shaped" yesterday. In their honor I declare today as Curse at ED Day. For all the parents around the world who could use a good yell into a pillow, cry in the shower, speaker-damaging decibels on the car radio, or just a bracing round of 'f*&^%$ you ED' today, a tutorial:

(cover baby's ears)

October 26, 2009

Halloween candy scares parents more than any horror film

An approach to Halloween candy that I really like: Ellyn Satter

Student looking for parent to interview

***A student at Johns Hopkins University is looking for a parent to interview. Here is the description of her project:

"I am interested in interviewing an individual for a class assignment who has either been directly affected by an eating disorder and/or a professional who is working in patient advocacy regarding their experiences surrounding prevention, recovery and the disease itself. The interview can be conducted in person if they are in the Baltimore area or over the phone, whichever works for the interviewee. The interview itself will last about 30 minutes and will be completely confidential. This is only for class purposes and will not be published. Thank you so much for your help!"

If you are interested in helping this student, I'm happy to pass her information on to you. First come first served!

*** Added: Found someone. Thank you to those who volunteered!!

October 25, 2009

October 23, 2009

First newsletter for F.E.A.S.T. members!

If you got an email today telling you how to access the new F.E.A.S.T. newsletter, then you are a member of F.E.A.S.T.

If you didn't get that email, it's time for you to become a member.

The newsletter has information on an exclusive audio interview with an author of a new book by a Maudsley family, and announces a new service available at the F.E.A.S.T. site - you don't want to miss it!

October 21, 2009

Glenn Close must read my blog!

I normally frown upon the custom of getting our news and health information from actors, but this one caught my attention: Glenn Close: Mental Illness: The Stigma of Silence

Is Close reading my blog?

(And if so, why can't people add "eating disorders" to the list of serious mental illnesses when they list them off. Too many syllables, I guess. We need a shorter name, people. Work on that.)

October 20, 2009

October 18, 2009

Waddle we do, Fat Mummies?


What I love about the otherwise silly and irrelevant 'designer,' Karl Lagerfeld, is that he's right: the low weights of fashion models are not a sign of or a cause of anorexia.

He's wrong about pretty much everything else, of course. His clothes and his industry and his ability to get people to prance about in his clothes and get other people to watch all disgust me. His belief that beauty belongs only to the ectomorphic is patently wrong. His disparagement of 'fat mummies' makes me want to change my blog name to "Fat Mummies Unite" and wonder if being a Fat Mummy bestows some special wisdom to see through the nonsense.

But: low weight is no more a thing to be disparaged and pathologized than small ears or unusually red hair. It doesn't solve the problem of our bizarre fixation on a very small sliver of the population (very tall, very lean, large eyes and heads) to turn it back by insulting those body types. Thin is not anorexia. Fat is not an illness. Hate, however - and snobbery - may indeed need a DSM number when it gets this ugly.

October 17, 2009

Congratulations!!

Sending congratulations to Jeanine at EDC on the birth of her daughter!

Welcome to the world, Nicki!

October 16, 2009

Reviewarama

Want to help other families? Here's a free and simple way: there are so many books out there, it can be daunting to choose. If you've read a book about eating disorders that helped:

Review it or add it to the list on the F.E.A.S.T. site. http://feast-ed.org/bookreviewsbyparents.html

Another important place to write reviews is on the Amazon.com site. These reviews really do matter to buyers, and are widely distributed.

One quirk of Amazon is that you can't write reviews for a book if you didn't buy it AT Amazon. For that reason I can't review my all-time favorite book for parents: "My Kid Is Back" by June Alexander. I highly recommend this book, and ask you as a favor, if you have bought it there and found it useful, go review it: My Kid is Back.

October 15, 2009

Good links from good organizations

Passing on some good links from the University of Chicago, The National Eating Disorders Collaboration and AED:
  • Lisa Brownstone, the research coordinator for the University of Chicago Eating Disorders Program under Dr. Daniel le Grange, recently contacted me about a study comparing three approaches: family-based treatment, cognitive behavioral treatment, and supportive psychotherapy. This study provides free treatment to adolescents suffering from bulimia. Interested families can reach Lisa at (773-834-5677)."LINK to the NEWS RELEASE. (For more information on clinical trials, visit the F.E.A.S.T. site.)
  • The National Eating Disorders Collaboration Youth Survey is looking for young people under 25 years to fill out a survey that "will be used to shape recommendations to the government on how we can best prevent and treat eating disorders in young people. TAKE THE SURVEY.
  • The Academy for Eating Disorders is offering a Patient/Carer 2010 Conference Scholarship Program, thanks to a generous donation from AED member Donna Friedman and her husband, Randy. Two scholarships of $1000 each will be awarded to defray the costs of conference fees, travel, and hotel accommodations for the 2010 ICED. For more information please click here.

October 14, 2009

84 meals, 56 snacks

A post with more question marks than my editors would ever have allowed:

At first I hesitated to comment on "Early response to family-based treatment", out of fear that it would discourage vulnerable families pursuing Maudsley treatment. One thing I've noticed is that it takes a tremendously optimistic environment for parents to do FBT. But: knowledge is power.

We already know that early response to treatment indicates with some accuracy who will respond to inpatient treatment (goes for AN, BN and BED). In this randomized controlled trial, "Weight gain by Session 4 of FBT predicts remission at post-treatment in adolescents with AN in a clinic
sample."

This is an important clue to the strengths and the weaknesses of a family-based approach - at least as manualized and currently practiced. I can imagine many scenarios: that some patients have illness too intractable to respond; that families who are well-suited to this task will come through early; that families unsuited to this show that early; that the method is simply too inflexible or underpowered to cover the full range of families and illness in need, or that this approach is simply wrong for a percentage of families. We could theorize all day, and I'm sure we all will.

I take from this that families who are not making progress after the first month need another alternative. It is also my sense that many families need a LOT more help than they are getting to be successful at home-based re-feeding. I look forward to data on what happens in terms of long-term prognosis for those patients who do not respond early to FBT. Do they go on to worse outcomes regardless? Do they thrive with some other intervention? What IS the alternative?

I'm left with the continuing question of what the active ingredients in FBT really are, and which of them fail these families. I wonder what parts of FBT will then be discontinued: nutrition, family involvement, separating the patient from the illness, symptom focused treatment. If all the alternatives to FBT are in opposition to the principles of FBT then how will we know what works and why? Is this about FBT being the wrong direction or too lightly applied? What if FBT was done in a whole-family way IN the hospital or more intensively (as is done in 5-day intensive programs)?

Yes, my heart hurts at the parent reading this information who has struggled with a home-based approach and now feels defeated in the hardest and bravest thing he or she has ever done. Yet I do not wish for families to continue to struggle fruitlessly. We can't ignore or wish the data away - these are some of the best researchers in the business - but until we know of viable alternatives we do need to continue to ask: if not Maudsley, then what?

October 13, 2009

Reading cultural signs

Among the names I've collected in my life, 李 淑 徳 may be my favorite. Chinese was my major in college and I lived in Asia as a young adult, speaking and reading Chinese as I made my living teaching English to other young adults. They were in my class because their moms thought they were enriching their minds. In truth, it was more of a socially acceptable group dating service.

Anyway, I used to speak - and sometimes dream in - a second language. Just enough to grasp the essential differences between Mandarin and English and to ponder the absurdity of my mother tongue. Chinese makes internal sense. English does NOT. The most common grammar question from my Chinese friends? "But, WHY?"

In Do Non-English Speaking Kids Get Dyslexia? we learn that dyslexia doesn't spare different writing systems, it takes a unique form according to the culture one is born into.

I have long believed that eating disorders are a brain malfunction that presents in different ways depending on the person's history and the culture around them. Notice I don't say I think these things "cause" the illness. I think it changes how it presents. Schizophrenia is similar: still a brain disorder, still real, but whether the person sees little green men or Guan Yin depends on the value system and myths of their environment.

Even the way we think of what "me" means has cultural influences.

Naturally, I bring this back to eating disorders. The fact that our society is in a self-satisfied crusade to criminalize body fat has an impact on those with a predisposition for eating disorders. It makes it harder for us to recognize ED symptoms AS an illness before it is too late. This morality-based campaign clearly confuses and makes recovery that much harder. We won't prevent eating disorders, and it may only reduce the suffering, but I think it is worth challenging the obesity hysteria as one of our time's most damaging myths.

In any language, Fat Talk Free Week is a good thing.

October 12, 2009

A Few Months of Journalism Class treats headline writers

A sad example of how science - interesting science - is digested by the public information stream:

A Few Months of Talk Therapy Treats Bulimia

No wonder people are confused. Headlines like this, that take something useful like "Bulimia-specific CBT 'takes around 4 to 5 months'" and turn it into a meaningless and global prescription.

Every month or so some syndicated headline will declare eating disorders "biological" or "inadvertently caused by parents" or "on the rise" and everyone comments on it and then it is lost until the next headline. None of these headlines are accurate (disease is too complex to boil down to a single Eureka headline), and no one is convinced.These tag lines just get used by those who want to believe them or don't want to believe them as a "so there" against the other one. It matters not whether the headline stems from truth or good science or not: it is all blenderized into a tasteless sludge with every other pronouncement.

Anyway, don't stop at the headline here: go on to the abstract and the paper itself.

October 10, 2009

The Guilt-Trip Casserole

So many people sent me this link: The Guilt-Trip Casserole - Dinner and the Busy Family because I'm the Family Dinner Queen. What I like best about this article, though, is that it brings up the correlation/causation issue.

Families who are likely to be having family meals are different from other families in a lot of ways: demographically, culturally, religious. While I do believe family meals were both therapeutic and diagnostic in my daughter's case it does not follow for me that family meals are preventive or a moral judgment. We didn't do family meals routinely before our daughter was ill, and I regret that more because it is a lovely and family-building experience than out of guilt. I do now suggest normalizing and prioritizing family meals for many reasons, mostly because I think we've stomped out what would seem to be normal and many of us need permission to adopt it again.

I like the Ellyn Satter idea that kids deserve adults in their lives who are competent and confident and reliable in providing meals. That structure is, like other parenting responsibilities, very individual to the parties involved. I'm still not great at planning and preparing family meals, and probably won't ever be expert at it. I don't iron well, either, and I am just stupid on my son's Boy Scout merit badge requirements. My kids probably don't need me to be perfect, though, just trying - and I am.

October 8, 2009

Confidentially, I can't tell you

A wonderful, thought-provoking, and sorely needed examination of: Confidentiality in Adolescent Psychotherapy

I want to particularly endorse the following:
"I am relatively unconcerned when I meet an adolescent patient who lacks insight or motivation or who resists treatment. I am very concerned when the parents of an adolescent patient are unwilling, unmotivated, or unable to play an active role in their child’s treatment."

Parents need to be included and assisted, but we also need to Step Up.

October 7, 2009

Why Psychologists Reject Science

Well, if you haven't already joined the conversation, you may want to. Lots of people in my bubble of the twitblogadvocatesphere are reading and commenting about Why Psychologists Reject Science. The comments section alone is worth the trip.

Adding to the discussion, Psychotherapy Brown Bag (a great read always) has thrown this in about the role of the therapeutic alliance. **

It gives me happy chills that we even HAVE this conversation. I'm a big fan of therapy: think every baby shower should come with coupons for Play Therapy and we should swap out Algebra for Mindfulness 101 and marriage certificates should include the cost of an on- call Marriage Counselor. I think the world would be a better place if we all would engage in therapy at least as often as we get our hair cut and car washed, and some of my best friends are therapists.

But my good feelings about therapy are matched with my concern about BAD therapy. Therapy based on antiquated and damaging ideas. Therapy provided by people who are themselves unwell. Therapy done according to politics or fashion or good intentions uninformed by current research.

For all the good that can come of a person or family coming together in therapy to address problems - and I have personally experienced so much good in a therapist's office - there are potentially tragic risks as well.

Good for those who are really discussing how evidence and empirical knowledge can inform the art of therapy. Shame on those who find even the conversation unacceptable.

**P.S. Adding this: Shrinking the Shrinks

October 6, 2009

College daze

Following on yesterday's post, I found this interesting: Back to School With Bipolar?

I'm not sure why we think that 17-18 year olds are instant adults, even when in robust mental health. I cannot tell you how often I hear from parents that they are feeling helplessly worried about a kid at college who is in fragile mental health. The pressures on families to let a kid go to college, and then the pressures from the college to back off, can really be overwhelming. College is not, for most students in 2009, a community environment where people are living and studying with a tight cohort of peers and watched over by seasoned and attentive adults. Students are largely on their own, only as connected to others as their social ability and health allow. Colleges are environments where isolation is largely treated by way of alcohol, and teachers don't know the students by name until the third year. Mental health services must be actively pursued by the student - something both unfamiliar and unlikely for most young adults.

Parents play a much larger role in the daily life of students these days, right up until Freshman Orientation. What was normal in June is Helicopter Parenting in October. I think we need to empower ourselves and change that, especially when a loved one has a history of mental illness. That change is going to have to come from us.

October 5, 2009

Outgrowing, avoiding, and lessening the damage of mental illness

When I read Bipolar Disorder May Be Outgrown and add to that the knowledge that schizophrenia usually remits after a certain age, I wonder how much of the damage of mental illness is from the ravages of being left untreated or under-treated during vulnerable periods.

We know about the "kindling" effect of depression, and the known triggers of bipolar episodes (stress, drugs, lack of sleep).

I wonder if we will come to a time when we look at eating disorders as a vulnerability that, if we avoid activating it during childhood and adolescence and early adulthood, could be avoided altogether. If children at risk were protected from dietary restriction, unrelieved stress, and over-exercise - would it prevent eating disordered minds?

October 4, 2009

Hair of the racedog

This will annoy my allies who support these things, but I'd be a hypocrite if I didn't say that I'm uncomfortable with the growing trend toward exercise-oriented eating disorder fund-raising.

It is all about context, of course. Serving wine at an M.S. fundraiser doesn't alarm me, but it would at an AA event. Having a Fun Run to raise awareness around leukemia doesn't strike me as odd, but I'm positively perplexed by the trend toward Walks and especially Runs as recovery awareness. Would we hold a Fast for Anorexia? Compulsive exercise is one of the most common symptoms of an eating disorder, and the whole fitness world could use an ED intervention. Lest we forget, we live in a world where people think it is fighting eating disorders to do competitive eating and body building.

I'm not naming names, but even if it makes money and a good time, and even if it means saying no to a well-meaning big name celebrity - I wish we'd rethink this. Just thought I'd get that off my chest now, in case anyone else is queasy over this as well and need back-up.

May I suggest, as an alternative, group hugs or "Eat Ins" or "Fun Naps" instead?

October 3, 2009

Understanding the anxious mind


I've really never seen a more readable and comprehensive discussion of anxiety than this weekend's upcoming piece in the New York Times Magazine: Understanding the Anxious Mind.

In the constant badminton game between those who would see temperament as all nature or all nurture I find that people often want to put me on one side of the net just because they've placed themselves on the other. In fact, neither I nor others who point to temperament and biology as important in understanding eating disorders are interested in being on one side of the court. Nature and nurture are not opposing sides, nor do they need to be balanced in some way to be "fair."

Some things are primarily genetic, some primarily experiential, and the vast majority involve complex and interacting factors of both. I doubt there are many things we could say are only genetic or only experience.

Parenting matters. I wouldn't do the work I do if it didn't and in fact most of my work is about parents doing and not doing things. People get stuck on the finger-pointing and not the point. Parents need help in learning how to nurture and protect their dear children.

The point of not blaming parents for a child's innate temperament is not to make the parents feel better. The goal is for the parent to understand the child (and him or herself) and to respond in the best way possible. Parenting anxious kids, and parenting when we ourselves have anxious brains, is a topic we all need to discuss.

October 2, 2009

Go places, learn things, spread the word

Have you checked out the list of upcoming eating disorder events on the F.E.A.S.T. site? Here's what we have listed for October:

October 5, 2009
National Capitol Area Half-day Conference on Family-based Treatment
Working Together for Recovery: Families and Professionals as Partners in Eating Disorder Treatment
Bethesda, Maryland, US
http://www.maudsleyparents.org/

October 16, 2009
The 5th Wales Conference for Parents and Carers of Eating Disorders Sufferers
07854 239664 carwengriffith@yahoo.co.uk

October 17, 2009 Fifth Annual
UNC Conference on Eating Disorders
The Friday Center, Chapel Hill, NC, US www.med.unc.edu/cme/events

October 16-17, 2009
Eating Disorders in Children and Adolescents and Young Adults Conference and FBT/Maudsley Training
Stanford, California US
Brochure

October 22-24, 2009
KONGRESS ESSSTÖRUNGEN 2009
EATING DISORDERS 2009
The 17th International Conference
Alpbach, Tyrol, Austria
www.netzwerk-essstoerungen.at/

October 24, 2009
EDANN collaborative workshop in Canberra
www.edann.org/home

October 29, 2009 (continuing every Thursday for 6 weeks)
"BUILDING HOPE: SKILLS BASED WORKSHOP FOR CARERS OF A PERSON WITH AN EATING DISORDER"
Ballarat, Australia
leigh.hanham@eatingdisorders.org.au or phone 03 9885 6563

Have any events to add? Email F.E.A.S.T.
Or parent support group meetings to add?

October 1, 2009

Puzzled

Twitter / Remuda Ranch

“Families are very much a part of the puzzle of eating disorders. There are [many] reasons why a person has an eating disorder.”

I am going to quote my first therapist on this one.

Parents, "how does this make you feel?"