Why words matter, and whose job it is to clear it up

I've operated under the assumption until recently that the professional ED field needs to get its act together. I've pleaded and moaned about the need for professional standards and common terms and for the end of angel-on-a-pinhead internecine struggles that serve individual practices but not the public. For some reason I kept looking to them, pressured them, felt disappointed at them...

Just this week it finally really dawned on me that this is not only not working it probably CAN'T work and maybe it doesn't need to. Maybe instead of mobilizing the parent community to pressure the professional community - trying to herd all these cats into a corner - the thing to do is mobilize the parent community stop asking and start just doing it.

Maybe WE need to define the terms and use them properly and start expecting others to follow!

So while I've moaned for years about the sloppy use of the term Maudsley, for example, and the damage that sloppiness has wrought, maybe it is time for us to make sure WE use the terms consistently. I've ranted endlessly on this in my blog and on the ATDT forum and on stages - but I've always thought of parents as victims at the mercy of poor usage and that we needed the professional field to fix it for our benefit.

Guess what? They aren't going to. There is no "they" anyway - the "field" of eating disorders isn't a monolith or an organized body. There is no authority or standards or even a way to define who is or isn't part of the field. There is no field!

But there is one group that has both interest in and a clear definition: parents and caregivers. We don't need a league or a guild or even a F.E.A.S.T. WE care about whether a term means something, or it is being used or sold safely. We have a life-changing set of decisions to make around our loved one's care and WE CARE.

Want a view to the kind of thoughtful discussion and importance of this? Visit the Table's recent discussion. Love to hear from some of our non-parent readers on this topic.

Or cruise my past rantings:

The two Maudsleys - mutually exclusive or complementary?
Modified Maudsley - what's up with that?


  1. Off to read the discussion on F.E.A.S.T.

    Were your "past rantings" supposed to be links? I would like to read those too.

  2. I love the phrase "there is no "THEY". It is empowering, and can be applied to so many areas of life, along with its cousins "Rights and responsibilities are exercised, not granted" and "If not me, then who? If not now, then when?"

  3. That's really interesting NS - I have heard similar statements about empowering families before and see this as very much the basis of much of the manualised Maudsley Method. I guess I'm just a wimp looking for someone to fix everything for me - I find the fact (and Laura's right, it is a fact) that there's no "THEY" frightening. I'm glad for you that you are empowered though - go you!

  4. Marcella - Oh, I'm frightened too, beleive me. But I think that empowerment probably cannot be separated from scariness when the stakes are high.

  5. I agree there is no "they" in the eating disorders field. Instead, there's a hodgepodge of people representing different fields, including medicine, psychology, psychiatry, dietetics, faith healing, spiritual gurus, and others. I don't see much reason to think these professionals will be able to get together and agree on terminology, or much else for that matter. In my opinion, parents are best advised to research the treatment options, decide for themselves what treatment model they believe will likely work best for their kid and their family, then either implement the treatment approach themselves or find a professional who will help them implement it. If the latter, parents should be very specific about what they expect from the provider, rather than simply giving a label to the approach they wish to use. Otherwise, there is bound to be confusion. CB

  6. Are there any professionals out there who would like to comment? Do you want parents coming to you demanding tailored approaches for them as individuals, have you spent years learning and developing specific techniques that you know to be evidence based, do you know or care what the methods you use are called? I would love to hear it from "the other side" of the client/professional relationship.

  7. I personally don't care what the various treatment methods are called, but I certainly do appreciate the need for standardization of terms to facilitate better communication.

    Parents often come to me asking for specific treatment modalities and I am happy to accommodate them. For instance, parents often say that their child cuts herself and needs me to do DBT, or has AN and they want Maudsley, or they want a modified Maudsley approach for their 20 year old daughter. The only reasons I would NOT do the type of treatment parents want are 1.) I am not trained in it (e.g., psychoanalysis) or 2.) I do an evaluation of the patient and determine that there is some specific reason why the treatment they want is contraindicated. Both of these situations are extremely rare in my practice.

    Most therapists I know, however, would be offended and get defensive if parents told them what to do or had too many demands. Most ED therapists have the "leave it to me, I am the professional" attitude.

  8. Laura, there is no harm in challenging professionals to get it right! When I see professionals who are more interested in getting it right than they are in making something up or doing their own thing, then I know these are the people I want working with my daughter and our family.

  9. I am happy to hear Dr. Ravin's comments! Would love to hear from more MD's and some therapists and RD's.

    As a parent I am constantly saying those of us who love someone with an eating disorder need to look at what the families of those with breast cancer have done. If it weren't for Susan G. Koman's family we still wouldn't be saying the words "breast" cancer...it was not spoken of.

    Let's get vocal and rally the troops!!!
    Becky Henry
    Hope Network

  10. I APPLAUD Dr. Ravin for her honest and humble feedback. I agree that most therapists want to convey the attitude that "leave it to me and I will take care of the problem"
    rather than appreciating parent feedback.
    After all, parents have the wisdom of knowing and observing their child over time and on a daily basis.
    We had the former therapist who were ED experts in our area for over a decade. Many blamed our D for not being motivated to recover or parents which is what many clinicians do.

    It takes a strong clinician to be able to hear what parents have to say, and to state what their shortcomings are. Or that they might have made a mistake in assessing the situation.

    After all - nobody's perfect
    Not even clinicians.

    Wish we could clone Dr. Ravin and send her throughout the US and abroad.


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