Brave Girl Eating by Harriet Brown Page A

son. She bitterly resented her role as a housewife and mother…. The family interaction patterns commonly described in anorexia nervosa werepresent. There was an absence of intergenerational boundaries (e.g. the father covertly sided with the patient against the mother) and there were rigid fixed patterns of interaction (e.g. attempts to change Laura’s violin practice schedule met with overt resistance from the entire family). Enmeshment was present (e.g. when a cold remedy for Laura’s sister was prescribed, the father dosed both daughters “to prevent” Laura from developing a cold) and there was a lack of conflict resolution (i.e. either emotionally charged topics were avoided or occasionally there were prolonged unresolved quarrels). *
    More recently, here’s what clinical psychologist Richard A. Gordon, author of Anorexia and Bulimia: Anatomy of a Social Epidemic, has to say about eating disorders:
    Anorexics and bulimics draw upon the common cultural vocabulary of their time, through latching onto the contemporary mania about dieting, thinness, and food control that have become endemic to the advanced industrial societies. They utilize these cultural preoccupations as defenses that enable them to escape from—and achieve some sense of control over—unmanageable personal distress, most of which revolves around issues of identity. [S]imilar to hysteria, anorexia and bulimia are socially patterned, the fashionable style of achieving specialness through deviance. †
    It’s no wonder the clinical literature reflects this perspective, though, given that Hilde Bruch’s book The Golden Cage has been considered the definitive text on eating disorders since it was first published in 1978. Bruch, who was a professor of psychiatry at Baylor College of Medicine, described the typical anorexic as a sparrow in a golden cage, a child of privilege who seems to have everything but who deep down feels stifled by her parents’ expectations and often unspoken demands, unable to express her feelings directly. The classic anorexia patient, writes Bruch, “was not seen or acknowledged as an individual in her own right, but was valued mainly as someone who would make the life and experiences of the parents more satisfying and complete.” Bruch describes families where “clinging attachment” and “a peculiarly intense sharing of ideas and feelings develop,” where parents overdirect and overcontrol, pressuring the child to meet their expectations and heal their own emotional neediness. *
    The more I read Bruch and Minuchin and others, the worse I feel. Le Grange helps me put things in perspective by pointing out that by the time a family comes in to therapy with an anorexic child, the usual family dynamics no longer apply: parents are anxious, the patient is irrational, the other children are traumatized. So what you see in family therapy for anorexia is not a family’s typical modus operandi.
    Once upon a time, and not all that long ago, our family ate together, talked and joked and kibitzed at the table. At this point, though, we probably look pretty damn pathological. I think of our last month of family dinners: Jamie and I begging Kitty to eat. Tears and tension. Emma slouching lower and lower in her chair orbolting from the table. I wonder if we’ll ever have a normal family dinner again. Or at least one that doesn’t leave me shaking and sick to my stomach.
    Eisler and his colleagues understood the way family dynamics change when a child has anorexia. In the early 1980s, they developed a set of protocols for weekly family therapy that put parents in charge of their anorexic child’s eating, making them, in effect, the food police. Their findings echoed Minuchin’s: 90 percent of the adolescents treated with FBT were still doing well five years later, compared with 36 percent of the teens who got individual therapy. (A later Canadian study shows