August 15, 2012

breastfeeding, and FBT

Many of the arguments about Family-Based Maudsley Treatment feel familiar.

I was probably well-trained for FBT advocacy from years in the breastfeeding gauntlet. I've heard the "well, I could never have done that!" and the "well, it isn't for everyone," and "Well, your success at that makes me feel guilty for not doing it."

Not "succeeding" at breastfeeding isn't a mark of poor parenting and not "making a success" at FBT/Maudsley isn't an indictment of anything.

You cannot make someone successfully breastfeed, or homeschool, or bake fresh bread, or love fresh apples. None of these choices work if they are NOT choices, consciously and thoughtfully volunteered. This is also true of FBT/Maudsley. It is less likely to work for those who have it forced on their family  without options. None of these lovely things ARE right for every situation and anyone who says they are is a mindless zealot (I actually haven't met any).

I don't want everyone to have to engage in FBT; I want everyone to have the opportunity.

The point of offering parents a choice isn't about browbeating people it is about opportunity and judgement. If we believe in a certain idea the best way to promote it is to truly believe that people will choose it in the right situations and then to respect them when they do NOT make the same decision you did.

P.S. In case you're about to comment on this (people always do) with "but aren't you telling people they have to do FBT/Maudsley because you say it is "the only evidence-based approach for anorexia and has the highest rates of success for adolescents ill for under 3 years" but I'm not.  Just as "penicillin has the highest rates of success on certain infections" isn't saying that all infections should be treated with penicillin or that no other antibiotics can be used. Citing the actual success rate is important information in making choices, not telling them what to do. Insurers, national health systems, and parents who think higher rates of success equals no other choices need to sit in the naughty corner and reconsider.

8 comments:

  1. You talk to a very important point. I'm afraid the message gets confused some times by peoplea own fears and feelings. When someone is reaching out for answers, information and support, it can be easy to confuse sharing experience and information as the only solution. I do think as indivI duals it's just as important to listen to the message and not REACT. Guilt is a common feeling most patents feel when their child suffer. Or or we are led to believe we are not doing everything we should. I remember feeling like a failure when I couldn't find fbt support for my then 19 yr old daughter. I fought the illness and the providers and my daughter was losing. I had to recognize on that's meant the next best thing to do. And I did. I'm very lucky to have the opportunity to work with a fbt treatment team now. For us it is a key element towards recovery and rich independant life

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  2. Unfortunately, where FBT is concerned, the patient is often a minor, which means they ARE forced to participate in treatment regardless of their desire to do so or not. Perhaps someday this issue will be addressed.

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  3. Yes, babies are often forced to be breastfed as well: it's a scandal!

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  4. Lol re the breastfeeding.

    Re FBT (which we followed the vague outline of but did not "do" as we had no therapist etc etc etc), as a parent of a minor, you are kind of responsible for them and it is your loving duty to try and ensure that they do not:

    drive under the influence of alcohol
    be under the influence of alcohol
    mainline heroin
    jump off tall buildings
    get murdered
    get raped
    plug the dogs into the mains
    buy porn
    have under age sex

    oh and, er... yes, starve themselves to death.

    Sigh

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  5. We could strap them to a bed and shove a tube down their throat to feed them, too (and, in the early days, this was not an uncommon form of treatment). Of course, that usually traumatizes them and almost guarantees instant relapse as soon as that 'intervention' is over.
    There are many ways to recover, and to support someone in recovery. They don't all involve taking away the patient's voice and rights in order to make the parent feel better.

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  6. I don't know of a single sanctioned , evidence based treatment that would sanction anything like what you are suggesring anonymous. Certainly FBT specifically cautions against any criricism, lwt alone hostility towards the patient

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  7. Yeah right - strapping our children to a bed and shoving a tube down their throat happens like all the time - sigh! Just in case you don't get Brit irony, that sentence was entirely sarcastic!

    As you say "early days" treatment - for starving suffragettes as well - and I am interested that you imply, by changing your tense, that this sort of practice still happens, or that you have undergone such treatment.

    There are indeed, many ways to recover. I have yet to meet a minor patient who is not pretty vocal so I fear the loss of voice argument is completely lost on me. As for patient's rights, as a minor, here in the UK, we are signed up to the United Nation's Charter.


    From 15 January 1992, when the treaty came into force, every child in the UK has been entitled to over 40 specific rights. These include:
    the right to life, survival and development
    the right to have their views respected, and to have their best interests considered at all times
    the right to a name and nationality, freedom of expression, and access to information concerning them
    the right to live in a family environment or alternative care, and to have contact with both parents wherever possible
    health and welfare rights, including rights for disabled children, the right to health and health care, and social security
    the right to education, leisure, culture and the arts
    special protection for refugee children, children in the juvenile justice system, children deprived of their liberty and children suffering economic, sexual or other forms of exploitation

    The rights included in the convention apply to all children and young people, with no exceptions.

    Which particular "right" are you suggesting parents of eating disordered children are not complying with?

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  8. I think it should be an option, with an understanding that it is not only not for everyone, or the best choice for everyone, but, like breastfeeding, impossible for some. (It seems like there is a lot of shame of people who don't breastfeed - but what about all the women that can't produce enough milk to do so? I suppose it is similar situation here).

    I generally just think we need better information, and not get too extreme about anything, without justification, anyway. People feel cheated when they didn't have the best information.

    Maybe I'm nit-picky, but "underage" and "age of consent" are arbitrary numbers. Some 20 years old have the maturity of a 5 year old, and some 15 year old have more maturity than their parents. So, I was under the influence of alcohol when I was under 19 (legal age here, but it is 18 just a few hours away from here, in Quebec, and 21 if I cross the border. How arbitrary). Maybe I'm just really close to that age, that I just feel that, yeah, I can see why we need laws for that, for the general population. But, I think good parents know their kids and how much to trust them. Underage sex is also such an odd concept to me - does it only apply to heterosexual people? I'd rather teach responsibility and educate people on the risks, than make arbitrary age laws. Has the idea of "underage sex" really stopped anyone? Does anyone really go? "Oh shit, you are a few months older than it stipulates in our provinces/state's laws, we can't be doing this". Maybe I'm REALLY wrong here (very possible), but that's the same fallacious idea that abstinence works. No, it doesn't work. Safe sex education works much better.

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