January 31, 2011

Antique Response Show

We watch Antiques RoadShow sometimes, and not just to catch re-runs of my friend, Charlotte**, and her pillows. My husband watches for great finds. I watch for great reactions.

I don't care for the ones who keep interrupting with "yes" and "right" meant to imply the bearer already knew that... well, then, why be there? I don't approve. I'm not even happy for you if you're going to act like that.

I'm in it for the the "Really? REALLY???" reactions. Those you can keep the camera running, and in fact I wish they'd catch the next minute when the person pulls out the cell phone to call everyone they know and rents a limo to get home.

I don't know what to make of the "Oh." responses with no discernable emotion.

Here's the thing. If you schlep something to the Roadshow, and stand in line, we know you think it is special. We know you want to be surprised and delighted, and we do, too! You wouldn't show up for the Oscars without a speech, so please, prepare something. Have a speech! Fainting is fine. Weeping allowed. Woo-hoo!

Watch the full episode. See more Antiques Roadshow.

**Charlotte, I still haven't seen it!

January 30, 2011

Stone cold treasure

My charming daughter invited me down to Richmond for a weekend sleepover. We took in a dance performance and went to lovely restaurants that moms can afford more than college art students can.

She took me on a dreamy walking tour of the historic and breathtaking Hollywood Cemetery. She took pictures and I just enjoyed and we talked and walked and talked. And then we happened on the find of a lifetime - something that could have been designed just for me to find it: a huge dry-stack Confederate memorial pyramid that has to be seen, and touched and stood next to, to be believed. It was so appropriate to this novel I'm writing that entire scenes were re-written before we got back to the car. It was staggering even if you're not a stonemasonry fanatic and writing about the War Between The States. It was awesome - in the original sense of that word - even without knowing that 18,000 confederate soldiers were buried around it. Or knowing that they didn't have cranes capable of putting the capstone on so they paroled a prison inmate in exchange for his guiding the stone into place without getting killed.

That thing has NO mortar. It is standing there stone upon stone, a heart-stopping still avalanche of rock. The art and craft of doing that is, well, an craft of art. And physics. It was built a few years after the war, while the grief itself must have held those stones in place.

She and I did have one incredulous moment when some putz decided to climb up onto it for a photo op. We imagined a line of spectral Fayetteville Rifles trained on his disrespectful backside as he went up, and on his grinning mug as he waved.

What a beautiful day, with my wonderful fierce daughter and dear friend.


vegetarians over the edge

I thought my skim milk post might stimulate some appetites! Mary sent me this - Why Bacon Is A Gateway To Meat For Vegetarians I think you'll enjoy it. (My week of teenage vegetarianism had its Waterloo in the face of a Thanksgiving turkey)

I know I've been awfully sour lately. I can tell because the sour comment quotient has gone up as well. So, something lovely to think about...

What are your most satisfying foods?

January 29, 2011

Skim milk tastes gross

I dutifully switched to skim milk in the 80s, but switched to real milk some years back even though I know people look askance. I've read the data and I have lost my own fear of fat - dairy and otherwise.

These days it is a radical act to actually eat food that is satisfying, and to BE satisfied.

And guess what? I feel better physically, emotionally, athletically, and medically. I feel confident that eventually people will increasingly join me.

Got milk? What kind?

January 28, 2011

Dysmorphic caregiving

I'd love this even if it wasn't written by my favorite science writer, Carrie:

More Than Meets the Mirror: Illusion Test Links Difficulty Sensing Internal Cues with Distorted Body-Image: Scientific American

Dysmorphia is when the brain gets its signals crossed between observation and perception. We need a name for when society observes an illness and mistakes it for something else. Like this: it seems so obvious that society loves thinness and so that is why some people 'take it too far' and become phobic about fat and see even very small bodies as too large. This is a mistake. People with dysmorphia - a common but not universal symptom with eating disorders - are not making a mistake. They see and feel what you don't believe is there.

Parents REALLY need to know this. We get stuck in this belief that the body image distress is a response to massive doses of messages from the outside. I believe the dose probably doesn't matter much - a drop is as potent as a truckload. Most of this is internal in those with mental illness. Do mentally well people ALSO experience body image distress, and some degree of dysmorphia: yes, of course. Do people with anorexia with dysmorphic symptoms (not all do) also have to deal with society's body issues: yes, of course. But confusing them is in my opinion a tragic mistake and a cruel disservice to those with mental illness - treatable mental illness. Effective treatment and loving caregiving require us to know what we're seeing.

A map of caring

It's a frequent request: "where are the parent support groups?"

Except for rare exceptions, the answer is: "there aren't any here."

Odd. Pretty common illness, usually shows up during childhood or adolescence, terrific care-giving burden, but, no support groups? There are support groups for everything! Yet no worldwide network of caring fellow parents willing to lend a shoulder and a book?

It's time. F.E.A.S.T. has reached about 700 families and individuals around the world, and the Around the Dinner Time forum has 1200 registered members and it seems about time to connect the dots. On a map. So we're doing it:

FEAST Coffee Breaks

It's VERY exciting to see that map fill up!

January 27, 2011

Not in a boat, not with a goat

I have a question on compliance.

Can I get some examples of whether an anorexia patient you know continued to refuse to eat according to plan when hospitalized or in residential care.

What I hear is on eating disorder units there is no choice, and resistance is short-lived. 

But a friend in the UK tells me that even on specialist units patients can and do successfully resist and go on losing weight.

Could use the benefit of examples in different care environments. I'm wondering if my impression is wrong, or there is a difference between different countries.

Prescient Science

I love that the Times "predicts" outrage in a piece on how a Journal’s Article on ESP Is Expected to Prompt Outrage.

Yet there are some great points here. The whole idea of science being a matter of scientific method and hypothesis and data is so easy to say but in real life ends up being just as political and emotional and interpersonal as anything else.

This is a perfect lead-in to this New Yorker piece as well.

Science students: you can learn more from these controversies than from a semester of stats!

January 26, 2011

Liberal leave applies

No, I'm not referring to the President's speech last night. It's our school system's way of announcing:
All schools are closed today, Wednesday, Jan. 26. Administrative offices open at 10 a.m.; liberal leave applies.

My son is overjoyed, and back to bed, visions of game controllers dancing in his head. I am picturing a day of teens coming and going and me holding my hand over the phone saying "Shhh!" as I try to pretend I work from a tranquil cubicle in some office park...

January 25, 2011

Why Some Mothers Feel Superior

I read Why Chinese Mothers Are Superior with several hats on. As a mother, of course. As a student of Asian language and culture. From the perspective of having lived in Taiwan for two years, and teaching English as a Second Language here in the US.

And: as a writer. That is where I get most of my insight into this. If you say something reasonable and nuanced and balanced and complex in public you might as well be silent. To get the public's attention you have to have something big to say that will anger people. Better still, make sure that apoplectic anger will look ridiculous because it will expose the critic's own biases.

Not all Chinese, or Asian, or immigrant families are the same. Yes, they often share certain traits, the greatest being that people don't leave their countries because they wandered out of their house by mistake: emmigration requires a very different set of motivations or - when involuntary - coping skills than in the general population. Or the second generation. I know plenty of Chinese people, and Asians, and immigrants who share some of the (pointedly exaggerated) values in the article. I know a good many who don't.

I'm not going to excuse or even explain these abusive values with an argument of cultural relativism. These ideas are all too common but still wrong. I actually share several of her critiques of modern parenthood, but living as I do helping families struggling with pathological and painful perfectionism I can not be less charmed by this gleeful display of it.

But here's the question: how could Chua, or I, have started a conversation about these issues - some of them truly important - without her writing a horrifying article that received 7372 comments (as of this minute) in a few weeks mostly just because it is deliberately provocative? After all, *I'm* using her piece as a springboard for discussion, too.

I don't actually believe Chua is a child abuser. I believe she is a good mom but an even better writer: she's getting people talking about things we really do need to talk about. But please: quietly.

University of Minnesota doing therapy and medication clinical trials

Some new clinical trials have been added to the F.E.A.S.T. Clinical Trials page:
Eating Disorder Clinical Trials currently recruiting or in progress

Do you struggle with binge eating and purging? Is your sense of self-esteem strongly influenced by your body shape and/or weight? The Eating Disorders Research Program is testing a new type of therapy for the treatment of bulimic symptoms. Individuals ages 18-65 who are interested in learning more about this University of Minnesota research opportunity and  determining eligibility should email anpalm@umn.edu or call: 612-627-1991  (all calls confidential).
The University of Minnesota Eating Disorders Research Program is looking for adult men and women who regularly binge eat (i.e., eat large amounts of food in a short period of time and feel a loss of control) to serve as participants for a study testing a new medication for binge eating disorder. Interested individuals will go through a screening process to determine eligibility. Those eligible will be randomly selected to receive
the study medication or placebo pill (an inactive pill) and take the medication daily for 6 weeks. In addition, participants will attend several monitoring visits which last about 1 hour each. Finally, participants will complete one follow-up visit which would occur 2 months after starting the medication. Participants are paid $40 for each study visit they complete. If you are overweight/obese and not taking any mood-altering medications
(e.g., antidepressants), please contact us for more information: 612-627-1991 or anpalm@umn.edu.


January 23, 2011

Being a Brick Wall

My good friends over at C&M Productions have created a new tool for parents to visualize the way to stay calm and focused in the face of confronting behaviors: they've LITERALLY animated the authoritative stance:


I'd love to hear your impressions, positive and negative, of using this format.

I especially want to hear from parents who are new to supporting an eating disorder patient, because you are the intended audience.

January 18, 2011

I see angry people... - ED Bites

As usual, Carrie explains it so well: "I feel I live in a hostile world"

So many parents observe this, but we often misunderstand it by believing it and waving our arms - angrily - in denial. I have a really bad habit of actually getting angry when people wrongly think I'm angry at them. You can imagine how helpful THAT is when a loved one is very sensitive to my anger.

Imagine seeing evidence every day that others are angry with you and dislike you. Imagine your parents trying to talk you out of this. You are not comforted by these denials; they make you feel even worse and less trustful. Your disconnect with those around you increases as others actually do become frustrated by your repeated misunderstandings.

It is vital that parents be prepared to be treated as if we are angry and hostile even when we're not. This is why remaining calm and emotionally neutral is so helpful. It is why words sometimes are meaningless and it is all right to remain silent and present. My friend, Dr. Tomas Silber at National Children's hospital once told me that the only language that really works is emotional: true unconditional caring.

I have read that adolescents go through a period of what Carrie is describing, just as a function of growing up. I wonder if the malnourishment of an eating disorder can amplify or calcify this state. I wonder if the history of blaming parents for being hostile and angry and distant is, in part, a function of patients misinterpreting the emotions of those around them.

January 16, 2011


Please take a moment.

A moment to think of a mother who last night in Scotland had to walk away from her 16-year old daughter's body in a hospital and go home to a life without her.

We cannot hide from this. Not in anger, or in fear, or impatience. This is why we're doing what we're doing: families, doctors, therapists, dieticians, friends, activists. Another horrible tragedy deserves at least a moment to reflect on what we're doing and why we do it. A moment to resolve to prevent as many of these moments as we can and celebrate all the ways people are reaching out to one another to help.

The two Maudsleys - mutually exclusive or complementary?

It may be that me and my friend Marcella are the only ones hung up on the distinction between the two "Maudsleys" but I continue to believe it matters.

I notice that many, many people still don't know that the "New Maudsley" is distinct from the "Maudsley" that I and most of the media are talking about. They have nothing in common except:

They originate from the same physical location in London (the Maudsley hospital)
They do not conflict with one another

I am seeing a growing number of people who mistake the two approaches and I'm starting to realize there is a good reason: they are complementary. I have been talking to clinicians who employ both sets of tools at the same time without finding a conflict. I know LOTS of parents who are endlessly grateful to both approaches in their own work to support their kids.

So while I continue to stew over the naming issue, I'm very glad to see all these very good ideas being used.

"Old Maudsley," as Marcella cheekily refers to it, is a method for aligning parents and siblings and the patient and clinical team productively toward the eating disorder behaviors.

"New Maudsley" is a very useful set of ways of personalizing our responses as parents/carers to the behaviors.

I think of New Maudsley as a way to optimize the work of Old Maudsley, myself. Old Maudsley assumes that parents are ready to be Dolphins and St. Bernards, when we often need help getting there. New Maudsley assumes the patient is being monitored and fed and that there is a safety net in place.

For myself, I'd like to see families supplied with a great number of tools at the outset - personalized to what they need. Mr. and Mrs. Dolphin St. Bernard may be able to skip certain "New" lessons. Magic Plate Parents may need extra Rhino-reducing sessions. Dollops of DBT and injections of IPT could be prescribed 'as needed.' Respite by the hour or day, at home or in hospital, 'on demand.'

Old and new, borrowed, too: families need far more than they're getting now - and it probably isn't all going to come out of one toolbox.

January 14, 2011

SYTYCD, Joan Crawford?

I posted one of the videos below last night because I invited my tap class over for a little party (noisy foods and bubbly beverages, naturally) and we swapped favorite movie clips.

Joan Crawford Goes Gaga For Dance cracks me up because it it absolutely NOT what I would think of as "Joan Crawford." Another example of how the image we create, or let others create for us, is just a slice. My tap friends had never been to my house and I remember before they arrived thinking "what on earth will they make of my house, my pictures, my inability to gather three identical glasses..." Well, whatever they had gathered of "me" after years of Friday nights together at the studio I can't have come off any more goofy and variable than Joan Crawford in that mashup!

Other highlights of the evening:

January 12, 2011

Anorexia history = Never serve in military?

I believe in full recovery. (Also known as full remission**) I believe fully recovered eating disorder patients are often mentally HEALTHIER and have better life skills and resilience than those around them!

So, here's a question. What if a young person recovers and then wants to join the military? In Australia, apparently, it's a deal killer. I think that's wrong, and I want some help to gather some information and support for this amazing young woman:

Dear Laura,
My name is S.-, I am a 21 year old university student in Australia who suffered from anorexia nervosa for five of my teenage years but have subsequently recovered, and moved on to pursue a healthy and happy life. Anorexia took away a substantial portion of my adolescent years and now its repercussions are threatening to affect my future employment hopes; it is for this reason I am contacting you to ask for your opinion, as I know you are a strong advocate of full recovery being possible...

I suffered from severe anorexia between the ages of 14 -18 and spent a large portion of that time in hospital, sectioned under the mental health act and being fed via an NG tube. Unfortunately, as you are well aware, eating disorder treatment is often poor and the hospital I attended was no exception (more due to funding than anything). The treatment kept me alive when I was at the verge of death (for which I am eternally grateful) but did little else. When I was 18, and facing the reality of being locked up in an adult psych unit, my parents sent me to Stockholm, Sweden for treatment at the Mandometer clinic. By the time I commenced treatment I hadn’t eaten anything other than liquids in months and hadn’t picked up a knife and fork in several years. I was so emaciated and malnourished that I was hallucinating and unable to even get onto a train without having a massive panic attack and bashing my head on the wall screaming that I was ‘being contaminated’. My situation was dire and my mother didn’t know if I would ever make it home to see her again.

After eight months of treatment at Mandometer I returned to Australia in 2008. After years of living in a ‘malnourishment cloud’ I had been fed back to sanity. With huge amounts of hard work, help from the staff and proper food (as opposed to NG feeds) I came home eating a full diet without any fears or restrictions. Within a few months of being back at home I was up to my full healthy weight and had dealt with the emotions that came with being healthy and alive. Since then I haven’t looked back. Life is so much more amazing than I ever imagined and I love it.
The fact that I have recovered, and recovered so well, is truly fantastic. I am hoping soon to start along the path that I have always yearned to travel; I am waiting for medical school offers to be released. My goal is to be sponsored by the Australian Defence Force (ADF) for the latter half of my degree and then work for them as a Medical Officer. It’s not a goal that I’ve decided on lightly, it’s taken serious deliberation but, regardless of the downsides, it’s the path I am drawn to and I feel it suits me to a tee.

I decided to apply as a soldier in the part time Army in order to get an insight into life in the forces. Unfortunately, as soon as they found out I had a history of anorexia nervosa, it was an instant ‘no’. I sent a letter of appeal, along with a letter from my previous case manager (stating I was fit, healthy and happy) but received another adamant ‘no’. This time it also came with a letter explaining the fact that, having previously had AN, the stresses of military life could cause a relapse or another mental health issue.

In response to their letter I sent a second appeal. I argued that, due to what I had been through, I was a mentally stronger person and less likely than others to succumb to mental health issues due to ‘the stress of military life’. Obviously nothing in life is certain; there is always the small possibility that I may relapse, but there is also the possibility that your average, healthy Joe Bloggs is going to develop paranoid schizophrenia. At least I can prevent relapse by acting sensibly (ie staying in a healthy weight range and not skipping meals).

As well as my own letter I spent an inordinate sum of money to be assessed by, and receive a thorough and persuasive letter from, a psychiatrist who confirmed that I had fully recovered and that a relapse was highly unlikely.

Unfortunately, none of this has worked thus far. I just recently received a two page letter rejecting my appeal yet again. It saddens and angers me that people are so misinformed about eating disorders; yes, if treatment is poor then outcomes can be expected to be unfavourable but, with appropriate treatment, a full recovery is achievable; I am proof of that. Unfortunately the ADF seems to be functioning under the assumption that employing a person who has previously suffered anorexia nervosa is too much of a high risk endeavour; I think of this as discrimination. I know that some previous sufferers are still plagued by issues and are not suitable candidates for enlistment but we shouldn’t all be thrown into that same category, each case should be looked at on an individual basis to prevent such generalised discrimination.

I have decided to pursue this via a legal avenue; I am healthy in mind and body and detest the thought that an illness I fought so hard to recover from could prevent me from pursuing my goal of serving my country. I am aware that even if I they say ‘yes’ and let me proceed with the enlistment process, I may well be knocked back at some other stage but that is irrelevant; it’s the simple injustice that, as a healthy individual, I can be denied the honour of serving just because I was unwell in the past.

In this latest letter they referred to high relapse rates; do you know of any research papers that show relapse rates are low, specifically for those that suffered as adolescents? I’m also looking for evidence to back up my claims that people can fully recover and go on to lead normal lives. I’ve tried to search online but all I can find is articles that portray outcomes very negatively and I thought you may know of articles that portray recovery in a positive light...? It’s rather disheartening to read ‘20% make a full recovery; 40% of these relapse’!!

I know that we are both aware that those who have suffered from anorexia can go on to recover and lead healthy, happy lives; I would be interested to hear your opinion of an ex-sufferer serving in the army.

(edited for privacy and brevity)

(**Remission is the more accurate term, because the biological predisposition remains even when a person is living mentally well the rest of their life, but people seem to hate the term because they think it means not being completely well or that it means having to spend every day fighting to stay well - and that isn't what I mean.)

January 11, 2011

A new way to "google yourself"

Even my mother has done it! I know you've done it: googled yourself.  It's kind of vertiginous the first time, and can be like waking up in a nightmare that you can't erase: "Why is THAT still there?" "Did I really say that?" "Oh, no, I wonder if X will read that..."

Well, I am tickled to discover a new way to google oneself (and yes, that is officially a verb, now) that is, interestingly enough, less personal:

New From Google: The Body Browser

I used it a few weeks ago to explore my sinuses, because I had a nagging head cold and realized I had no idea what goes on up there. Fascinating stuff. (the structures, not the stuff stuffing it up) My head's better, but I can never look at my nose the same way...

You'll probably need to update your browser, I did, it's worth it.

January 10, 2011

Fitting the solution to the problem, or the problem to the solutions?

Once a problem shows up I want to know how to to fix it. THEN I figure out what is available.

But I see a lot of people doing the opposite. They start with what is available and then cram the problem into it.

If the local providers don't offer it, the national health service doesn't offer it, the insurance company won't pay for it, the law doesn't support it, the family doesn't have time to provide it, and the ex is going to actively oppose it... those are real problems but they don't change the basic fact that RECOVERY may require it.

I spend a lot of time talking about what is required or recommended or good for treatment and keep hearing reasons why those things are not available. I know that. What we should be concentrating on is why, and how to fix that: not trying to argue that treatment shouldn't need those things.

We can't change availability, law, opinion, and practice without actually identifying the tools we need. We can' progress at all if we keep saying "we don't have that." If eating disorder patients need, for example, a year of supported recuperation in order to have a chance to recovery then they just do. Giving them some fraction of that and then dropping it isn't "better than nothing" it's failure. If FULL weight normalization is necessary to restore brain function then getting halfway there is NOT better, it's cruel. If hospitalization is needed, then getting a once-over and release at the ER/A&E is not a step forward it is a step back.

I'm weary of fitting the problem into the solutions. It is time to focus on finding solutions that fit the problems.

January 9, 2011

Animating the real questions and best answers

I am so delighted to point you to the first of what will be a wonderfully helpful series of animated discussions with parents. I'm looking forward to more by C and M Productions!

Anorexia in adolescents

January 8, 2011

Is there a need for one-week family interventions?

Kartini Clinic has a question for parents:

"We have just launched our Kartini Maudsley Outpatient program (where a medically stable child is treated at home, with our team support, using our nutritional plan). We already offer inpatient medical stabilization and Kartini Day Treatment, as well as tailored aftercare/outpatient treatment. We welcome one-time consultations to determine presence or absence of an eating disorder as well as one-time consultations for the purpose of helping a family determine appropriate level of care. We also welcome phone consultations with parents only, when parents feel the need to talk about their own child’s situation with one of our doctors. We can do distance follow-up (via phone or skype) for those of our graduated patients living or going to college within Oregon and Washington.

So, is there a need for an intensive week-long program for parents who want to do Maudsley in their own home town"

Give your thoughts to Dr. O'Toole

January 7, 2011

Anosognosia Workshop

 Reasons to watch Anosognosia Workshop July 3, 2010 (NAMI Conference) from Treatment Advocacy Center on Vimeo:

  • To dispel the notion that I made up and that I'm the only one who uses the term anosognosia.
  • You'll end it knowing how to pronounce anosognosia. Well, at least two ways of doing so.
  • You'll realize, if you haven't been convinced yet by my constant barking, that eating disorders involve anosognosia to at least if not more than the level it is seen in bipolar and schizophrenia.
  • That there are practical tools for us, as caregivers and society, to cope with a patient's anosognosia.
  • That Assisted Outpatient Commitment may be the perfect tool for eating disorder treatment compliance.
  • That the eating disorder world needs to join, and be welcomed in, by the general mental illness world.
  • Change takes time, but good ideas can float to the top.
  • That mental illness doesn't have to be a grim, dull, plodding issue.
Thank you, again and always, to Catherine for this link and discussion!

    January 6, 2011

    Keep loving. Keep going.

    Eating disorder patients often suffer from a difficulty interpreting emotions - their own and those around them. Why? Is this an adaptive response to malnourishment - enabling certain individuals to leave the family group to seek nourishment? Is this a background trait in certain people that is ramped up by low nutrition? Is it permanent?

    This we know: it helps with the "maintenance of the disorder" and cannot be dismissed as a choice to isolate or just a case of poor social skills. Parents facing an angry, resentful, frightened loved one need to know that this may be a symptom of the temporary brain state of the active eating disorder, not the real potential and personality of their loved one. Parents need to know not to give up or give in - with anger or argument - and to press for full recovery regardless of the present dysfunctional responses of their ill child.

    I cannot tell you how many times I see a parent paralyzed with fear that their beloved child will hate them forever. I want them to know how often I see a family who pushes through that - and "keeps going" - and ends up with a loving child who often doesn't even remember those thoughts and words. Knowing this, a parent can summon the courage to be hated for a while, to cause temporary distress, to keep the long view.

    January 5, 2011

    Modified Maudsley - what's up with that?

    The term "Modified Maudsley" is way too common. Unfortunately, it doesn't seem to mean what you think it means.
    1. It can mean "I'm a therapist who believes in the principles of Maudsley but doesn't use it strictly out of the book."
    2. Or "I involve parents in the treatment, but I don't put them in charge of food."
    3. Or even "I put parents in charge of food but I don't coach them or involve them in therapy."
    4. Or it can be what parents say when they're doing home refeeding without working with a professional at all - because they incorrectly think "Maudsley" *is* just refeeding.
    5. It can also be "I find the manualized Maudsley approach too reductionist but I don't blame parents and I do believe in re-feeding so I use "Modified Maudsley" as a shorthand."
    6. Infuriating use: "I hear this term all the time but haven't actually studied it or used it but it sounds nice and I'm nice, so I'm going to add it to all the other things I do without actually understanding it or how it might conflict with my other beliefs"
    7. There's another use, though, and this is what makes it really confusing, which is "We offer all the principles and tools of Maudsley but we ALSO offer other things at the same time - like access to a nutritionist, partial day treatment, a meal plan, cognitive behavioral and DBT techniques, support groups, and other therapies."
    The word "Maudsley" is used in way too many ways - many incorrectly - already. So is "family therapy." "Modified Maudsley" just muddies the waters even more. I really want to send everyone to the Naughty Chair while I come up with some clear terms for all these things and then make everyone use them.

     If I were Queen:
    • "Normalized nutrition" would refer to an expected first step in ALL eating disorder treatment. It would include optimal weight normalization and cessation of compensatory behaviors.
    • "Family-Based Maudsley Treatment" would be a term only used for manualized FBT by Lock and le Grange. No modification. NOT "Maudsley" or "Family Based Treatment" which would both be banned as indistinct.
    • "Family Therapy" would also be banned as indistinct, and people would have to choose between "Family-Based Maudsley Treatment" and "Systems Family Therapy" or come up with new terms that don't sound anything like the above.
    • "Magic Plate" would be the concept that parents choose, prepare, serve, and monitor "normalized nutrition" with the help of professionals. This concept would not be limited to Family-Based Maudsley Therapy.
    • "Inpatient" and "Residential" treatment would be a place for "normalized nutrition" as well as other treatment tools and therapies.
    • "Skills-Based Learning" would be used for Treasure's model for carers.
    • "Evidence-based treatment" would refer only to treatment elements that have RCT data to support them.
    • "Opinion-based treatment" would be everything else, not because these may not be helpful but because they aren't studied and should be.
    • Recovery would be re-named Remission and defined as free of behavioral, medical, cognitive, and emotional symptoms of eating disorders - NOT just weight normalization.
    That should clear things up so we at least were all using the same terms for the same ideas.

    Misconceptions about ostriches and vomitoria

    xkcd: Misconceptions:

    Here's the list.

    I dare you NOT to learn something. My face will be red all morning over two of them.

    January 4, 2011

    Just Tell Her To Stop

    I first met the author, Becky Henry, in her home state of Minnesota in 2009. A mutual friend, Kitty Westin, introduced us and it has been a lovely experience to get to know her. I had the honor of reading early drafts of her new book, Just Tell Her To Stop: Family Stories of Eating Disorders and I have seen the manuscript evolve and the community of families that Becky brought together to create it.

    I believe in the power of telling stories and hearing stories. Facts can only do so much to help us understand. What I hear from parents so often is that they need to hear about how it has gone for others. Not just so they can glean clues to their own solutions but also to feel heard and feel connected. The experience of an eating disorder in a loved one is so disorienting and isolating that our stories mean so much more. We crave a sense of beginning, middle, and closure. We crave a view from another angle than the one we are so gruelingly faced with every hour, every meal, every appointment, every first moment of the day.

    Becky has offered the gift of many families, many views - to the larger world. I had the pleasure of writing the foreword, and said this: "we stand on the shoulders of others before us." Progress is made when we speak up and when we listen.

    Thank you, Becky, for giving voice and connection to so many!

    January 2, 2011

    It is only metaphor

    I love me a good metaphor, I really do. Metaphors are a writer and a reader's nourishment and delight. Yet all good tools take judgment, and we can't lose sight of the fact that externalizing the illness is only metaphor.

    Externalizing the illness, used in the Family-Based Maudsley Treatment, Narrative Therapy, and most notably by Jenni Schaefer to improve the lives of countless people is best employed to enhance but not replace our understanding of the illness itself. The best explorations of the benefits - and risks - has long been Vitousek's Alienating patients from the "Anorexic Self". We need this tool in the toolbox, used wisely!

    January 1, 2011

    Healing After the Crisis

    Restoring weight and ending eating disorder behaviors are just the first step. I know, I talk about them a lot. But that's because they ARE the first step and still not agreed upon out there. But Healing After the Crisis is the next, and just as important.