Brave Girl Eating by Harriet Brown

home, they invariably relapsed, because parents were traditionally told not to sit and eat with them. In fact, eating-disorders specialists often recommended (and many still do) “parentectomies,” physical and emotional separation between parents and a child with anorexia. Parents are still advised by therapists like Dr. V. not to pressure their child to eat, not to talk about food, not to be the “food police,” to find other subjects to discuss. They’re told to butt out, stand down, give their teenager space and autonomy.
    They’re told, in essence, to watch their child starve to death.
    Anorexia, parents are often told, isn’t about food; it’s about control. Their children need to feel that they’re in control of their eating, or, more likely, their noneating. They’ll eat when they’re ready. They’ll eat when the underlying issues that caused the anorexia in the first place have been resolved.
    Except a lot of them die before that happens. If it ever does.
    Like Salvador Minuchin, both Chris Dare and Ivan Eisler are family therapists. They believed from the start that families played a key role in the recovery process. Unlike Minuchin, they didn’t assume that families therefore caused eating disorders. On the contrary. “[Dare and Eisler] always had the whole family present,” explains Le Grange. “So there’s the kid who has anorexia, but you also see the other two who are perfectly healthy. It’s not that the parents don’t know how to raise their kids and feed them; something just went awry with this one.”
    I think I understand what Le Grange is getting at. For the last two months Jamie and I have been trying to get Kitty to eat, mostly without success. The process has felt adversarial—us against the anorexia—rather than supportive, both because we’ve been told by therapists like Dr. V. that we’re not supposed to get involved with Kitty’s eating and because we feel like we screwed up in the first place. That sense of self-blame and disempowerment is part of what’s preventing us from being effective. But what if we approach Kitty’s eating from a different point of view? What if we, like the nurses at the Maudsley Hospital, make it impossible for her not to eat?
    That was Dare and Eisler’s idea. Patients in the hospital ate with the support and encouragement of nurses; teens at home could eat if their parents supported and encouraged them. Parents love their children, and they have an enormous stake in their child’s recovery.No family’s perfect. But maybe they don’t need to be perfect. Maybe they just need to be able to get the job done.
    This perspective marked a paradigm shift in the treatment of eating disorders. Historically, anorexia has been viewed as a biological “solution” to a psychological conflict: a teen starves herself in an attempt to resolve emotional issues, including loss, family conflict, fear of independence, and confusion about sexuality. This case history, cited in 1984 by Pauline S. Powers, M.D., professor of psychiatry and behavioral medicine at the University of South Florida in Tampa, is pretty typical:
    Ms. E., age 21, could not choose a career, but thought she might become an airline stewardess. Her mother rejected this idea as “not good enough,” and described the job as “only a waitress in the sky.” This is an isolated example in a woman whose choices had been rejected as poor throughout her life. As a consequence, she felt empty and unable to direct her own life. *
    I wonder if there’s a mother anywhere in America who has actively supported every single one of her daughter’s choices.
    Or how about this case history, also cited by Powers:
    Laura is a 14-year-old girl…. Her father was a soft-spoken, highly successful lawyer. Her mother was a guilt-ridden woman with inflexible rules for her daughters and teenage