Monday, November 22, 2010
To Eat or Not to Eat:living with anorexia nervosa
As a physician who frequently sees patients with eating disorders, I am always looking for a better book to help parents learn about ED and pilot them through very destabilizing times. Harriet Brown, a journalism professor, writer, blogger and mother, has written a very personal story. Brave Girl Eating:a family's struggle with anorexia, follows Brown and her family as they learn about and manage her daughter, Kitty's, anorexia. Specifically, Brown chronicles her research and the practice of appyling family based treatment (FBT) also known as the Maudsley approach, to managing anorexia. Although this method requires a great deal of commitment and patience and some seriously impressive parenting skills, it is the only method which really has shown to be successful in treating this terrible disease.
Brown reminds us that anorexia nervosa is a biologically based illness, not simply a willful, bratty misguided attempt to be thin or a failure of otherwise good parents. She deftly describes the theories of this "encapsulated psychosis" and better than in most accounts manages to explain how disordered thinking about food is a result of starvation. As they evolved, prehistoric people who were starving became single minded and frenetic--one might say obsessed-- in their search for food. This phenomenon is often seen in patients with anorexia nervosa who seem to have extraordinary energy and drive for exercise and scholastic pursuits in spite of an obviously wasted body.
Perhaps Brown's greatest contribution is her description of the stress and strain on her husband, their marriage and Kitty's younger sister Emma as the disease takes hold within the family. Besides the fact that ED runs in families and one has to worry about the impact of living up close and personal to someone who is so "successful" at dieting is the fact that the illness drains energy, time and compassion from the engaged parents. Of course, the "unaffected" siblings are deeply affected by the stress, tension and outright fighting that inevitably goes on in a home rent by anorexia.
More than one parent has come to my office holding onto this book as if it were the guidebook. And in many ways it is. But it is not a hands-on manual and not a substitute for the team of people-doctor, therapist, dietician- who need to be marshalled to care for these patients and families. However, it will help parents seek out and ask questions of providers to ensure buying into a treatment that has a better chance of success than a punitive, psychodynamic approach. Food is the remedy and "if you do intensive psychotherapy with someone with anorexia, you wind up with an insightful corpse, because without enough glucose the brain can't process or think properly."