Demystifying Anorexia & Family-Based Treatment: Part 2 with Harriet Brown
Below is part two of my interview with Harriet Brown, author of the recently released Brave Girl Eating: A Family’s Struggle with Anorexia, a memoir about how Harriet and her family helped their 14-year-old daughter Kitty recover from anorexia. Harriet also co-chairs Maudsley Parents, a fantastic resource for parents who’re struggling with eating disorders.
In Brave Girl Eating, Harriet shows parents that no matter how difficult – and at times impossible – seeking recovery can be, there is always hope. Even in the scariest moments, keep fighting.
She teaches us the importance of educating ourselves about eating disorders. In fact, she encountered many practitioners who were either clueless about how to treat eating disorders or espoused outdated information. It’s safe to say that by researching anorexia and its treatment, Harriet saved her daughter’s life.
And – one of the most important points – that the person is not their illness.
In part two, Harriet talks more about family-based treatment, the many myths surrounding anorexia and eating disorders and how her own perceptions of weight and shape have changed.
If you missed part one, please check it out here.
Q: Even though it’s highly effective, family-based treatment (FBT), also known as the Maudsley approach, is viewed by some as controversial. Perhaps this will start to change, especially considering the recent study that showed that FBT was the most effective treatment for anorexia. What would you like parents to know about FBT?
A: I’d like parents to know a couple of things. First, FBT is the best treatment we’ve got right now for teens and children with anorexia. If your treatment providers aren’t familiar with it, or discourage it without a thorough discussion, run don’t walk to another therapist who is at least willing to discuss whether it’s appropriate for your family.
Second, FBT lovingly supports kids and teens toward recovery; it’s never punitive, harsh, physically forceful, or abusive in any way. Some people describe it as “force feeding;” it’s nothing of the kind. FBT is based on the premise that parents know and love their kids best, and when they’re empowered and supported, can find ways to help their kids eat.
Third, FBT has three phases: Phase 1 is weight restoration, when parents temporarily take responsibility for their child’s food and eating. During Phase 2, that responsibility is slowly transferred back to the child. Phase 3 is resuming normal adolescent development. Many people think FBT is just about food; it’s not. But there can be no recovery from anorexia without food, so weight restoration comes first.
Fourth, I’d like parents to know that teens can and do recover fully from anorexia using FBT—and typically much more quickly than they do with other treatments. Studies have shown that recovery often takes less than a year with FBT, compared with the five to seven years associated with other kinds of treatment.
Finally, I’d love parents to understand that while FBT is hard—no question about it—it’s by far the easiest path to recovery. Unfortunately, recovering from anorexia is a miserable process; there’s no way around it. You have to go through it. FBT is the shortest path we know through the nightmare, at least right now. The first few weeks are the hardest, and things do get easier after that.
Q: Throughout Brave Girl Eating, you share critical research about anorexia and debunk a variety of myths. What are some of the most pervasive myths about anorexia and eating disorders?
A: Where do I begin? ☺
Myth number 1: Eating disorders are psychodynamic in origin. That is, they develop because a person lacks autonomy, or has been criticized or neglected, or wants attention, or fill in the blank.
Reality: Eating disorders are largely genetic and biological in origin. They run in families and also overlap with anxiety disorders, which are known to be heritable.
Myth number 2: Eating disorders are caused by families.
Reality: There’s no evidence to support this.
Myth number 3: Eating disorders are caused by the media.
Reality: If this were true, we’d have much higher rates of eating disorders in this culture! Media, environment, and families can all trigger or exacerbate an eating disorder, but they don’t cause such disorders.
Myth number 4: A person with anorexia must get to the root cause of the disorder first; then she will “choose” to eat and recover.
Reality: A person with anorexia is in the grip of a profound terror and severe compulsions about food and eating, and suffers tremendous guilt and anguish when she does eat. There’s no “choice” involved. Physical recovery must come first, then psychological recovery follows. Therapy is ineffective when the brain and body are malnourished.
Myth number 5: Teens with anorexia need to be treated away from their families, in residential treatment centers or clinics.
Reality: Home-based treatment for teens is preferable for a number of reasons, including the fact that teens at residential centers learn all the tricks and deceptions from one another—they often learn how to be better anorexics.
Myth number 6: Once you’ve got an eating disorder, you’ll have it for the rest of your life.
Reality: Many, many people recover fully, especially if they’ve been sick for less than three years. It’s not like alcoholism.
Q: In the book, you also talk about your own battles with food, weight and body image. In an interview for SMITH Magazine, you said, “It was Kitty’s illness that radicalized me in a lot of ways, around eating disorders, and sensitized me to the kind of interchanges we have all the time about appearance and body image and food.” In what ways have your earlier perceptions changed?
A: I come from a family that’s somewhat obsessed with weight and appearance, so much so that it took me many years to even begin to question the thin-is-good, fat-is-bad paradigm. And for a long time it seemed absolutely natural that the first thing you’d say to someone you hadn’t seen for a while would be a comment on weight or appearance.
Now I see that we are so much more than our looks and that number on the scale, and I see how devastating that emphasis on appearance is, not just for people with eating disorders but really for all of us. I make a point never to comment about other people’s appearance now, or rarely—I slip up occasionally. It’s such a deeply ingrained habit.
Q: What message do you hope readers walk away with after reading your book?
A: That anorexia is a serious, life-threatening disease, and that families can and should be part of the cure. And that recovery is possible!
Q: Anything else you’d like readers to know about eating disorders, family-based treatment or a related topic?
A: I do worry that the current war on childhood obesity (as Mrs. Obama puts it) will not only trigger those susceptible to eating disorders, but will encourage body image problems and dieting among kids and teens. So long as we’re talking about weight and not health, we’re barking up the wrong tree.
Again, a huge thank-you to Harriet for speaking with me! She and her family are truly an inspiration.
Today’s favorite post. Remember this is the second month of our Self-Discovery, Word by Word series. This month’s word is vulnerability. Here’s how you can participate. And please check out these powerful posts by some pretty amazing women:
- Vulnerability Isn’t a Choice at Being Joy
- On Being Naked: The Great Paradox of Vulnerability at Health for the Whole Self
- You May Not Know That at Honoring Health
- The Illusion of Control at Nourishing the Soul
- The One Where I Get Really Vulnerable at Medicinal Marzipan
Tartakovsky, M. (2010). Demystifying Anorexia & Family-Based Treatment: Part 2 with Harriet Brown. Psych Central. Retrieved on September 29, 2016, from http://blogs.psychcentral.com/weightless/2010/11/demystifying-anorexia-family-based-treatment-part-2-with-harriet-brown/