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Thursday, 26 April 2012

Guilt

My good friend and mentor, Laura Collins is taking one for the team on Saturday 5th May at the ICED conference in Austin.


Plenary Session III
Is it Time for New Language to Describe Eating Disorders?

Moderators: Carolyn B Becker, PhD, FAED, Trinity University, San Antonio, TX, USA; Kitty Westin, MA, LP, The Emily Program Foundation, St. Paul, MN, USA

This session will address the controversy in the field regarding the language we use to talk about eating disorders. In particular, this plenary will explore the pros and cons of the use of "brain disorder" language as well as the impact that such language can have on the ways in which we and our patients (and their loved ones) think about and respond to eating disorders. The overall goal of this plenary is to view this controversy from multiple perspectives and then try to move us forward as field with respect to this issue.

Learning Objectives:
• Explain why a "brain disorder" model is viewed as optimistic, supportive, and useful by many parents and carers.
• Describe the degree to which the experimental literature has noted potential problems with a "brain disorder" model.
• Discuss how language such as "brain disorder" may impact how people view eating disorders and potentially impact course.

There has been a discussion on the forum about it and the inimitable Christopher has done his research on the second speaker.  Laura has also blogged about it.

So whilst soaking up the mountain air in Italy, I asked myself how I justify using the term "brain disorder" (as per NIMH) to describe an eating disorder and I worked out that it boils down to appropriate guilt.


"Guilt and its handmaiden, shame, can paralyze––or catalyze one into action. Appropriate guilt can function as social glue, spurring one to make reparations for wrongs. Excessive rumination about one's failures, however, is a surefire recipe for resentment and depression." (Psychology Today)

By using the term "brain disorder" and avoiding the psychobabble of blame  ("attachment issues" for example or searching for a "cause" or believing that this is a willful act by the patient), a parent can move forward with refeeding to restore the patient to optimum function, a mental and physical state wherein the patient is well enough to move forward into recovery, where therapy avenues can be explored and where life for patient and carer begins to return to "normal".

Laura has empowered so many parents to help their children recover.  The most important thing for us, as a family, was to learn that this was not our fault.  Nor was it my daughter's fault.  It was a brain disorder.

2 comments:

  1. I would love to sit in on this session...

    I love Laura, the work that she does with parents and FEAST in general. I agree that parents can often play a huge and positive role in assisting their child's recovery from an ED, and I see parental blame as fruitless. To be wrapped up in so much unnecessary guilt that you back off and leave your anorexic child to starve him/herself to death is tragic.

    However, I find the term 'brain disorder' to define EDs both unhelpful and reductive. I absolutely agree with Christopher's comments on the forum re. restricting AN and the important role of starvation on the structure and functioning of the brain. But the term 'brain disorder' suggests abnormal brain development that could be attributed to brain damage (e.g. during foetal development), or a brain lesion that develops later in life. The term 'brain disorder' doesn't acquit parents from blame because it is well documented that children who have been abused or neglected have abnormalities in brain functioning of the type that Thomas Insel would define as a 'brain disorder'.

    Moreover, to describe mental illness (in general) as 'brain disorders' takes us back 50 years in terms of the moral treatment of people with such illness. The human mind is not only the product of the genes we inherit, but how environment influences gene expression - including interpersonal experiences. In the UK, at least, people diagnosed with mental illnesses in the 1960s and 1970s were subjected to horrendous and utterly immoral treatments in asylum where they were controlled and essentially abused.

    But going back to EDs... Did it help me, as a former sufferer of AN to learn the effects of malnutrition on the brain and to understand that re-feeding would assist my recovery? Yes. But did it help to describe my AN as a 'brain disorder'? No.

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  2. I'm carrying you, Charlotte, and you, long tail, to Austin with me.

    Charlotte because she gets me, and long tail because you are one of the people I haven't yet convinced.

    Longtail, you say "the term 'brain disorder' suggests abnormal brain development that could be attributed to brain damage (e.g. during foetal development), or a brain lesion."

    That isn't how I, or I believe Dr. Insel, are using the term. I believe we are just identifying the organ concerned and acknowledging that something is wrong there. How it got that way is an issue for another discussion. The term brain disorder, as opposed to what I think are far mushier and meaningless terms like "mental illness" is "just a compass, not a map" as I put it in my talk.

    "Mental illness" and "psychological disorder" are, to me, terms that lead to fuzzy thinking on these profound problems. Something has gone deeply wrong with the functioning of the brain - for some reason that almost certainly involves both nature and nurture. This distinguishes it from a problem of society, a problem of families, a problem of particular events. This identifies the organ that needs healing: through a combination of biological and environmental interventions - including therapy and professional consultation.

    If brain disorder was defined as you've done, I would agree with you and not use it. If the result of this term was going back to the horrendous treatments of the past I'd agree with you, too. But here the problem is that you and I are using the term differently.

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