When Food is Family and Family is Perplexed

At the risk of bringing more pre-publication buzz to a book I will not be promoting, it would be silly to ignore the very telling furor that When Food Is Family has created. I'm delighted to see this tumult - I really believe that sunlight is the best disinfectant. These ideas need to be aired and discussed. There's a reason this promotion is making some people SO angry and others so defensive.

A few years ago this kind of melee - on the Academy for Eating Disorders online forum, Around the Dinner Table Forum, another private professional forum, on blogs and on Facebook simply could not have happened. A book would get published, people might grumble, people might cheer, but those on different sides of interpreting it would neither meet nor hear the other side. Or, in this case, sides - as there are a few. When this book is published and media stories come out, that social networking will no doubt follow it: these are indeed controversial ideas and SHOULD BE.

This unpleasantness has been good because it has reached people who consider the premise and pre-publication materials "shocking" and also those who were shocked by the shock. The author herself got involved. The conversation keeps feeding back into former arguments - making those conversations have more meaning.

My opinion of theories of eating disorder causation that focus on parenting are well-known. I think they are nonsense, demonstrably so, and do more to tell me about the science and history and training education of the theorist than anything. I'm not distracted by the code words "contribute to" or "trigger" or "help explain" or "can be prevented by." I'm not even offended by them - I'm past that. What I do feel is deep concern for the families who encounter these ideas without the benefit of a larger knowledge of the field and eating disorders. The unprepared parent - and most of us are - can be not only distracted but genuinely crippled  - leaving them disempowered to find and use the information and support they really DO need.

Here's what's great, though. The debate is maturing. People with whom I've debated these topics before have come forward and their arguments have developed and changed - more progress. Unfortunately, most of this debate is not going on in public. I wish I could show you the comments on the Academy for Eating Disorders website, in particular, but I can't. I believe the parent community would be apoplectic to hear what is being said about families on that forum - not only that it is said but that the AED membership and administration find it acceptable. I think you would be furious. Yes, there are dissenting views - several professionals have come forward to speak clearly and cogently against attachment theories and dysfunctional families and "what the majority of clinicians know to be true."  The backlash against those comments has been bitter and filled with affront and not that great a grasp of the issues.

These theories would never be tolerated on a professional forum about autism or schizophrenia or depression - but they are there because they truly aren't controversial there, but objecting to them is.

I wish the conversation was going on in public so we could really clear up some mistaken ideas about what people like myself believe. If I could really engage these people and get them talking to the professionals I know best we could defuse some of that reactivity and get a real conversation going - and I might learn more. Now, thought, the distortions and misunderstandings of the argument against parent causation of eating disorders are so many and so often repeated that I hardly know where to start.

Yes, I do. I've been doing it for years. The difference is that those of the other point of view just weren't listening or deigning to discuss it. I'm happy to report that is starting to happen. I'm sure one or two of you reading this now are only doing so out of anger at what you've heard I said. Welcome to the community. Meet some of my friends and really hear them, too. We're not the chronically angry, misguided people you may think.

I welcome you to truly hear what I and others are trying to say to you: "attachment issues" where they exist are an expected effect, not necessarily a cause of the phenomena you are observing. You are, very often, making it worse and leading families away from the help we really need to help our kids recover. The witch hunt to find reasons to hold on to parent-blaming needs to end. Patients die for lack of appropriate treatment. It's not a matter of opinion, it's life or death decision-making.

When Books are Wrong
Around the Dinner Table Cicada calls


  1. My son got worse with traditional treatment, but got better quickly using a family-based approach. I suspect that practitioners just aren't able to see the evidence of success like my son because their heads are so heavily glued in the texts of a past generation.

    It's just like the suggestion that doctors needed to wash their hands to avoid spreading disease. The contemporaries of that day laughed them out of practice. Now we shake our heads with disbelief.

    I suspect we will be shaking our heads similarly at some point.

  2. I think that the new Treasure/Russell paper may help your cause, my friend.

    Here is the conclusion:

    The first RCT of family therapy highlights the detrimental effects
    of prolonged untreated anorexia.We have illustrated how anorexia
    nervosa can interfere with brain function and how this can make
    the disorder more resistant to treatment.
    What lessons can be learnt from this? Early recognition and
    intervention are vitally important and family therapy can play a
    special part in the young. Since the original Maudsley trial, family
    therapy has become diversified, including conjoint versus
    separated types and multifamily interventions. The essence of
    family therapy, the Maudsley model, consists of mobilising
    parental resources by:
    (a) exonerating parents from causing the illness;
    (b) getting them to take joint control of their child’s eating until
    the child becomes able to keep his or her body weight at a
    normal level.
    There remain obstacles to be overcome as it is the rule that
    people in the early phase of anorexia nervosa do not accept that
    there is anything wrong.Ways need to be found to engage resistant
    patients such as working within their social network and overcoming
    the barriers to help-seeking within the health services.
    Early recognition in schools and family support may reduce delay.
    Correcting malnutrition and the secondary consequences of brain
    starvation are essential in parallel with psychosocial help.

    If the clinicians who still refuse to let go of their feathers and beads arguments and get with the evidence based scientific approach of treating eating disorders, would like to take up the argument that finding "a cause" is necessary for treatment perhaps they would like to enter into correspondence with Professor Russell and Professor Treasure (preferably in public) and explain clearly and succinctly such evidence that would refute the conclusions of this paper.

    I am glad the conversation is happening. I suspect that those who are passionately defending FBT and all the Maudsley (new, manualised and old) methods and similar treatments would be happy to have this conversation in public. I find it hard to believe that we are unable to even view this so-called academic debate, let alone take part.

    BTW, from the reviews I have read of the book and its crass conclusions, I would not deign to buy it or read it - it is uneducated, self-interested silliness - no science to speak of, merely conjecture and opinion (and over-inflated self importance, methinks).

  3. How are the agnostics doing in this debate?

  4. A book like this is absolutely harmful like therapists who continue to practice talk therapy theories without weight restoration. There are serious consequences - the lives of precious children are too important for this false dribble! I would love to see data on the number of individuals this therapist has actually cured not treated if there are any at all.

  5. In light of all that we now know about eating disorders, the continued propagation of these theories about families as the cause are sinister and dangerous. They also represent a grave injustice to sufferers, whose lives are at risk, and to the families who can help to save their lives. It is also profoundly sad that these discussions are still conducted in secret. Thank heavens for evidence, and the Internet.

  6. As a Mum in the thick of it currently (9 weeks into re-feeding my 19 year old AN daughter) I read an extract from Food is Family and immediately considered whether my obvious misery when she left to go to Uni had somehow precipitated her descent into AN. The thought lasted one nano-second. Only because I have had the benefit of learning from other families who have shared the same struggle and I know it's not my fault. Without that exposure and support, I can imagine how traumatised, guilty and desperate I'd feel reading such garbage. Please don't publish non-evidence based , anecdotal, subjective , ill informed musings which have the potential to ruin even more lives.

  7. Yes, emilysh, that is one of the very sinister aspects of these fantastical theories about how too-attached or not-attached-enough parenting causes EDs. It makes us look back at the most innocent everyday expressions -- or even just unexpressed feelings -- of parental love, or parental frustration, or mere humanity -- as pathological, harmful, deadly.... That nanosecond of fearful thinking could have gone on for years and done so much damage on so many levels if you had not had access to logical, scientific information, and a humane approach to families. As it is, you are empowered to get your d better so that she can go back to Uni and an independent life again.

  8. Reading the blurb for When Food is Family linked to in Laura's blog, I noticed this weird sentence announcing that the book will teach families: 'how to go about repairing [...] relationships so that food (and the eating disorder) is replaced by healthy relationships within the family'. I wonder whether the author really wants us all to 'REPLACE' food... I, for one, would rather enjoy our family's healthy relationships -- and normal run-of-the-mill squabbles and tensions too sometimes -- around the sharing and enjoyment of food...
    A strange and creepy attitude to food, that: seeing it as something that should be 'replaced' in ideal circumstances!

  9. I agree with you, Laura. I believe that when it comes to matters of recovery vs. death or a shortened lifetime of chronic illness, both physical and mental, the only responsible way of helping families of those who have EDs (who are often minors) is to give them information about ALL treatments and whatever scientific study results there are about those treatments right away, before any treatment starts.

    To me that would be the minimum requirement of any clinician involved in the diagnosis of a person with an ED. At least they should share the most up-to-date information and then give referrals based on which type of treatment the parent/carer wants to go with. There are some adult sufferers who seek treatment on their own, and the same would go for them.


Post a Comment

Popular Posts