Secret terror of parent activists

The "Secret Terror of Anorexia parents" article just out in the Australian Sunday Telegraph is a sad and, well, terrifying example of good thinking run amok and causing real and preventable harm.

I know, and respect, some of the people quoted here but I suspect they have been misquoted and misinterpreted. The article is a wretched and embarrassing case study in poor science literacy. I imagine this is what it was like when germ theory was gaining currency but people just didn't really understand it. Now we seem to be in a transitional period where people are acknowledging biology and genetics but just CAN NOT let go of their myths about the environmental piece so they fit them in to the new science knowledge as if one gave credibility to the other.

Folks, you didn't cause your son or daughter's LIFE THREATENING MENTAL ILLNESS with your off-handed comments and by having had body image concerns or even by your own eating disorder. There is zero evidence that you even CAN do that if you set out to. Can you affect your child's self-image, weight concerns, and self-esteem? Yes, of course, but not to the level of mental illness and there is no evidence that ED patients have had more or less of these influences than anyone else. Why do people keep saying there's evidence of this? Because they have personal investment in these ideas and have weak science literacy. Eating disorders really are qualitatively and quantitatively different than the normal spectrum of brain functioning.

By way of analogy, look at schizophrenia. There was a time when we thought that the thoughts and behaviors were caused by traumatic experiences and secretly terrible mothers and that we could push people into madness and "drive people crazy." Now we know that the delusions and compulsions and deficits are almost entirely biological and pre-wired. There are psychological and experiential influences but they are not this facile accumulation of psychological assaults that even popular culture has largely abandoned.

Look at OCD. Will the parents of patients be more likely to display some of the same traits? Do we examine how orderly and fastidious and anxious the parents are for clues on why Johnny washes his hands dozens of times a day, or see great meaning in how Mommy "has" to color-code her shoes? We do, but not to assign cause but to inform diagnosis and plan treatment.

Children don't live on some precipice between normal and the abyss of dire mental peril that parents must perform perfectly to avoid.

I am the first and loudest parent in the bunch to CONDEMN the weight shaming and body-hating and negative influences by parents and society and would have them STOPPED as terribly damaging for all children -- for all of us. But I would not measure that damage by the incidence of mental illness nor would I allow myself the logical error of seeing those symptoms in the mentally ill as some barometer of the environment.

Kids with EDs develop these thoughts and behaviors independent of environment, coincidental to environment, and in concert with environment. Weight concerns and food phobias and body image distress don't have to have anything to do with environment and most kids suffer the onslaught of horrible environments without becoming mentally ill but they, too, deserve not to have to.

It is natural that parents new to an ED diagnosis would look to their own behaviors and words to understand "what happened?" It is our job as a community to shout, loudly, that such explanations are almost childlike in their logic and very nearly evil in their effect. 


  1. Not to contradict you, because it may well be true for anorexia, but as a recovered bulimic, a lot of it did have to do with abuse, at least in my case. I gained a lot of weight as a kid. I got up to 246 lbs. I was ok with myself until people said rude things to me. My dad would call me tub of lard and tons of fun. My mom would call me fatass or blimp or thunder thighs. My brother did all the same things. In school it was constant harassment for my weight. No one cared about my awesome art, or the fact that I was an awesome friend. All they saw was that I was fat. I begged my mother to help me and we found a program that was hospital based. I was restricted to 800 calories a day and had to eat these nasty pre-packaged meals and these disgusting shakes. I was a fat kid and that stuff tasted horrendous. I would try to restrict myself and I found that I couldn't stick to it. My mom got pissed at me and I was called more names and told that I was wasting her effing insurance and all of her money because I was such a fatass. This led me to feel extremely guilty. I went to a sleepover while I was on that program to one of my friends houses. The topic of conversation somehow got to the ways in which they have gone to extremes to lose weight. One girl said she would starve herself for a few days and drink only water or tea. Another girl recounted about how she could eat anything she wanted and that if she gained weight, she would throw it up. Another girl told of hours spent at the gym while only consuming Gatorades. All of these girls clearly had EDNOS, but those words stuck with me. Especially the part about eating anything and everything and not gaining weight. Thats every fat kids dream. I fell into the trap and I fell in quick. At first I was sticking to my hospital stuff and only eating one relatively larger meal and then secretly throwing it up. That spiraled out of control within 3 months. I was actively bingeing and purging everyday. I admit that it did become an illness. It isn't something I was born with, not anymore than a drug addict is born addicted to heroin. It was a product of circumstance. Whereas the heroin user turns to drugs to escape the pain of their life, I turned to food growing up, and then it turned into a horrid ED that I needed therapy to beat. I don't know any girls that haven't thrown up at least a few times, or "fasted," or worked out for hours on end in order to lose a few lbs quick. You can look everywhere and see fad diets promising to make you lose 10 lbs overnight and other such non-sense. Our society makes people more inclined to choose fast and irrational solutions. I never wanted to be super thin or to see my bones. I just wanted people to stop calling me fat. Back then, I would do anything to have that. Now I realize that my health and longevity is not as important as a "quick fix." I have been binge/purge free for over 3 years now, and I am so thankful that I was able to free myself from that disordered thinking, but to say that abuse and bullying has nothing to do with the reasons that someone might go that route as a generalization isn't accurate.

  2. Anonymous,

    I hear what you are saying and believe we largely agree but are using different vocabulary.

    What I hear you describing are real (and deeply disturbing) environmental pressures toward disordered eating: having a higher normal weight than peers, teasing, bullying, parental mistreatment, and damaging pseudo-medical weight loss programs are all very damaging and patently wrong.

    The question is whether the eating disorder that you developed as a result of that disordered eating and that environment were due to your wiring or just natural consequences for anyone in those circumstances.

    I would argue that some of us are wired to develop a certain mental illness, called an eating disorder, when we diet. Most people are not. You mention heroin addiction and that's actually a good analogy: some people are born with a predisposition for addiction when they take heroin and some are not. The one who becomes addicted isn't necessarily the one with the worst life or the greater "reason" to avoid life.

    The reason one starts dieting and having disordered eating patterns isn't necessarily the "reason" they can't stop. Dieting is bad for EVERYONE, as is bullying and weight shaming and teasing and abusive parenting, but some people are more at risk than others for mental illness as a result and the treatment has to take this into account.

    Because I believe eating disorders are not about the initial "reason" for dieting but rather about the overwhelming mental illness that the dieting sets into motion I agree with you that the environmental assaults you experienced are deeply disturbing and wrong but not just because they may have triggered your ED descent but for their own sake. No one should suffer such circumstances and your recovery despite those influences is a genuine, brilliant triumph.

  3. Laura, I find your words most clearly explains what I have come to understand and see about this illness. Anonymous, my heart breaks for the torment and cruelty you have endured and you are a beautiful, valuable, brave, human being who has found the strength and the right help to gain recovery.
    I have for a very long time and still find myself questioning my role in development and maintenance of my daughters illness. I look at my son who does not have ed but does suffers from debilitating anxiety and depression and wonder, 2 kids, maybe it was by mothering? Its kind of hard NOT to feel responsible in some ways. I think if I could have found the kind of support and understanding of these illness earlier, our lives would have been much different and for that I feel great pain. I also know that I am a committed loving parent who put my family first not out of obligation but out of love and desire, I absolutely loved raising my children, watching them grow and planning our lives together. My husband is the most loving committed father you could ever know. He would do anything for his family. But we also have inherited traits. Depression on my side (not me although I did struggle with self esteem as a ya)My husband has anxiety trait whichI would guess is a much lesser degree of disability than my kids. Its this genetic nature than changes environment. Thats what I see. My response to my kids anxiety as they grew was to remain calm and patient. I believed that they would learn that by osmosis. I was wrong. It was not enough. I wish I knew then, what I know now. Our lives could have been different.
    Im an optimist though, so I believe that we have a greater drive for survival and my children WILL find a better life.
    I only wish we didnt have to navigate the mine field of parental pathology to find the right kind of help

  4. Lisa, I too regret not having found the right kind of help for my child much earlier in life. I also regret having believed those professionals who told me that she would grow out of her problems when in fact they became a lot worse, especially with puberty. I have failed, as yet, to find the right help or indeed the right diagnosis for her. The fact that her diagnosis is one that can often attract blame of both the parent and the patient doesn't help either of us to find that help, it hinders greatly.

  5. by that I mean the diagnosis that she does have - that of an eating disorder - attracts blame and shame and ridiculous articles like this one. If it didn't just MAYBE we wouldn't be thinking of trying to find another to go with it and actually offer some useful help to go with it.

  6. So, if I hear you correctly, you are saying:
    If an eating disorder cannot develop without a biological predisposition, than biology is an essential cause of EDs.

    How then, do you explain that individuals with identical biology do not always have the same eating disorder status? Why do some develop an ED and others don't? It would seem to me that someone with a pro-ED biology could not develop an ED without the right environment for that trait to manifest itself.
    So why do you continue to insist on dismissing environmental causes while hammering away on how biology is everything?
    Perhaps distorted thinking is genetic?

  7. I don't know if you are not hearing me or I'm not being clear but no, that is not what I'm saying.
    Perhaps your confusion is in not understanding that biology is more than just genetics, and that environment is more than just experience?

    Even identical twins have different biology from conception on. Environment includes many biological factors (like nourishment and illness, etc.) and even psychological factors ARE biological in their effects: like stress. You can't really separate out nature and nurture as they are interdependent.

    That said, the burden of proof on what parts of environment play a role in the onset of a mental illness is a grave one indeed. Choose or overemphasize the wrong ones and you not only risk harm you get distracted from what is important. There's no research evidence that parenting plays a role in that risk despite DECADES of dogged interest in that angle.

    All environments, all life experiences, all levels of influence can result in a severe life-threatening eating disorder. We need to concentrate on giving patients a safe and loving environment and excellent clinical care, not going on witch hunts for "the usual suspects."

  8. You said "Even identical twins have different biology from conception on. Environment includes many biological factors (like nourishment and illness, etc.) and even psychological factors ARE biological in their effects: like stress. You can't really separate out nature and nurture as they are interdependent."
    So, if I am understanding you correctly, environmental inputs eventually cause biological reactions, which means that environmental inputs are really just biological?
    So, if a parent fails to feed their child (perhaps not even feeding them at all), that's an environmental circumstance that causes a biological consequence (death by starvation). Therefore, the parents played no role-- it was all biology.

  9. "Just biological?" Everything is an interaction involving biology and environment.

    What you are trying to do is make my arguments ridiculous, I assume? But you are either missing or don't like the point, which is that mental illness is not biology OR environment it is an interaction. But the interaction is not accretive nor is it random. Mental illness isn't something people can MAKE people get. Can you imagine saying that someone made someone schizophrenic? Or autistic?

    Environment matters, but not in the facile way you may think. Barking up the same Parents Suck tree, in particular, is a hypothesis that is exhausted and wants a long holiday.

  10. "mental illness is not biology OR environment it is an interaction."
    Exactly. So why are you saying that these are biologically caused illnesses while minimizing the thought that environment plays a role?
    Environmental inputs act on a person's biology to produce the end result. If there's a dysfunctional or harmful input, the results will be affected. How on god's green earth can you say that the culture or environment that a person lives in cannot make them develop an eating disorder? In what way is that possible?

  11. Anonymous, I don't believe the recipe for an eating disorder is as simple as that. It isn't an accumulation of influences or a measure of the environment. I know that's an attractive, seemingly obvious theory but it just doesn't bear out. Just as it didn't with schizophrenia, which also has some not well understood environmental component.

    Dysfunctional and harmful parenting is just that: harmful. It may not have the power to cause a mental illness but no child deserves it or can be expected to thrive under those circumstances - and for a child with mental illness, well, that's devastating.

  12. Laura, I need to note that in schizophrenia, there is evidence that life-stress and high expressed emotion in families can cause psychotic episodes and onset of psychosis. . . Your idea of schizophrenia being equivalent to autism in terms of heritability is also incorrect. Autism has a 90% heritability and can be diagnosed at ages as young as 6 months. Schizophrenia is likely to be neurodevelopment and has a heritability of 55% (i.e. similar to the lower estimates for AN).


  13. A:), high EE is associated with relapse but not the incidence of schizophrenia. Life stress is a non-specific risk factor for all mental illness.

    I didn't say that EDs and schizophrenia and autism are equally heritable. Actually, EDs are by most estimates more heritable then either. But that's not my or your point here - my point is that these are highly heritable, largely biological disorders that we really still know little about.

    What we do know about all of them -- because of decades and decades of intense interest in this direction -- is that parenting isn't causal in any meaningful way. Good parenting is still good parenting and bad parenting is still bad parenting and parents need some of their best parenting plus a hell of a lot of information and help when a loved one has a mental illness.

    All I ask is that each individual family be treated as they would if their loved one had any other grave illness: given information, competent professional guidance, and the benefit of the doubt. You want to blame an individual parent for abuse or neglect or poor parenting: have at it -- but we have to stop seeing mental illness as a marker for bad parents and hidden trauma if we REALLY want to help the field move forward.

  14. I do feel like crying when I see the same old exchanges time and time again. I have found reading Alan Marshall's paper ( helps my understanding the pluralistic nature of eating disorders.

    Continuing to argue (without listening) that eating disorders are not "just biological" (when no such thing has been asserted) and continuing to produce the same tired arguments bourne out of personal experience, rather than being experienced in dealing with parents and patients from across the spectrum of parenting (as well as the world), is becoming tedious. YOUR experience is not that of other people and your continuing insistence that we are saying something we are not just makes you look rather narrow minded and shrill.

    I particularly like this quote:

    Humanity–nature is not dualistic as orthodox Marxists and capitalists perceive
    (where there are two ontological categories, definable by being a member of either
    humanity or nature). Humanity–nature is not monistic as Gaian environmentalists
    perceive (where there is only one ontological reality—that of unity—from which
    you can not escape). Humanity–nature is indeed pluralistic, whereby there are as
    many ontological realities as there are members of the world. Maybe more, given
    the plurality of the self.”

    “A Postmodern Natural History of theWorld: Eviscerating the GUTs from
    Ecology and Environmentalism” Alan Marshall
    Stud. Hist. Phil. Biol. & Biomed. Sci., Vol. 29, No. 1, pp. 137–164, 1998

  15. I am often torn between continuing to patiently explain -- assuming there is goodwill and genuine interest by those asking the questions -- and humbly accepting that there may not be enough intellectual common ground to work with. I am also mindful that those asking the questions may never comprehend but others are listening who have not spent years hearing the same misinterpretations and, at times, outright hostile manipulation.

  16. I particularly enjoy hearing how parents can be amazingly helpful in terms of recovery from an eating disorder, while simultaneously hearing how parents can't possibly affect their children's eating habits/attitudes prior to developing an eating disorder.
    Logic-- it's not for everyone.

  17. LOL Am I being told off?

    It has been three years now since our family was pole-axed by anorexia. In the early days I clung to the idea that this was NOT MY FAULT and it got us through. As I have grown and learnt and understood so much more, and as a result of understanding things like difficulty with set-shifting, alexithymia, anosognosia and other "traits", it has enabled me to help my daughter to move on to a "new normal".

    I could not have done this if I had not been prepared to listen, discuss, debate, interact and empathise.

    Just saying.....

  18. "Continuing to argue (without listening) that eating disorders are not "just biological" (when no such thing has been asserted)"

    I seem to recall quite a few vehement arguments that we should adopt the language "biological brain disorders" to describe eating disorders, in order to avoid blaming parents (parents being an environmental factor).
    I'd say that pretty much counts as acknowledging the biological aspects while dismissing anything non-biological.

  19. Yes, Joy, parents can be amazing caregivers without having broken their children in the first place.

    Yes, I do refer to mental illness as biologically based. So is diabetes. That doesn't mean environment isn't involved.

    This, though, this is the statement that you keep repeating and it perplexes me as I feel sure you must know that you are distorting our words. " hearing how parents can't possibly affect their children's eating habits/attitudes prior to developing an eating disorder" Joy, no one says that. Of course parents affect their children's eating habits and attitudes prior to developing an eating disorder.

    If we were talking about peanut allergy this might be simpler to grasp: parents who feed their children peanuts without knowing they have an allergy are just being normal parents. Parents who continue to expose a child to peanuts after they know about the problem are incompetent or neglectful caregivers. Parents who force-feed peanut butter to ANY kid, with or without an allergy, are abusive. But the allergy is not caused by the parent and the latter family is in grave trouble even without an allergy situation and completely road kill if the child is allergic.

  20. I am probably being very thick here but aren't all illnesses biologically based?

  21. Maybe I'm being thick too Charlotte but I believe you are right - all illnesses are biologically based but that doesn't mean that the environment has no impact, not least on the biology.

    One problem with these particular illnesses appears to be the history of blame and ignoring the biology (both genetic, for example the heritability of the illness, and environmental as in the effects of suboptimal nutrition on the brain) in favour of analysing families for fault while the suffer continues to suffer the self-perpetuating biological effects of damaging behaviours.

    Asthma is a biological illness with environmental triggers Bad parents can make their child's asthma worse but no parents can actually cause asthma. In what way are eating disorders any different? I don't see that they are, but I don't see articles like the one here on asthma. Why not?


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