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Anonymous

Dear Joanna

I appreciate that as a therapist, and as a caring human being, you want only to do what is best for your patients. That is why I read and re read your column trying to understand your perspective. However, in the end, I came away saddened and disheartened. I am the Mother of a young women who is in recovery from restricting anorexia. Without taking anything away from her bravery and courage in her recovery I can tell you with 100% certainty that what she said when she was in the grips of this terrible disease often bore little resemblance to reality. Her interest and ability to regain her health in order to lead a full and independent life was almost non-existent. You point out that all your patients have been cleared medically for outpatient care and that their perceptions are not altered from malnutrition. I can tell you for my daughter it took many months, and a weight well above the minimum defined as medical stability for her thinking to clear up.

Your premise that children develope anorexia because of abuse, boundary invasions and failure to recognize the child as a unique individual is insulting and without scientific evidence. The fact that children who are abused are more likely to develop mental health issues does not mean that the majority of those who suffer from mental illness have been abused. You assume that the involvement of parents in the well being of their young adult children is evidence for the assumption that these parents were over-involved. I can assure you that I, and most of those I know whose children have suffered from this horrible disease, want nothing more than for our young adult children to be able to lead healthy and independent lives. Parents of adolescents and young adults with cancer, severe heart disease, and other life threatening illnesses also assist their adult children in the search for appropriate medical care. And, like myself, they will step in to assist their adult child if their child starts to relapse. You may call it it invading a boundry--I call it saving a life.

I encourage you to look at the research done at Stanford and the University of Chicago on parental roles in recovery; Dr O'Toole of the Kartini Clinic would also be a good resource for you. There is also a lot of good recent work on the genetics of restricting anorexia.
I do not discount the fact that your patients may, in fact, experience their parents as over involved. Their families probably run the usual gamut of parents who had different levels of capability of dealing with a child or young adult with very unique medical and psychological needs. Most parents I have met would be very open to looking at anything they could do to help create an environment that was healthy for their children; working from that perspective might be much more fruitful than working from a perspective of blame.

Given that your work is with adults and not children and adolescents you may believe that most of what I have to say is not relevant to your patients. You may also be assuming that it comes from a defensiveness on my part. Most research has shown that coming from a close and loving family actually supports, rather than hinders, the ability of adults to function independently and to create their own intimate adult relationships. Your patients, and our children, deserve that opportunity. By vilifying the Mothers as both having initially caused the disorder, and then as having helped to maintain the disorder may be creating a family situation where future positive relationships are difficult. If the worst should happen, and the patient starts to relapse, it could also create a situation where the parents are unable to provide needed assistance leading to tragic results. The statistics for recovery from restricting anorexia using traditional psychotherapy and leaving patients to make their own decisions about food and recovery are grim. Only a slight majority fully recover, between ten and fifteen percent die, and the rest live a half life between sickness and health.

Maudsley treatment and other forms of intensive support which also include the family and emphasize full nutrition (such as the Kartini Clinic) have a much higher recovery rate. I hope you will take the time to learn more about them as well as to study some of the recent work on genetics and eating disorders.

I wish you the best in your important work.

sc

June 7, 2009 - 12:47pm

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