In her early theoretical work, Hilde Bruch argued that anorexia nervosa (AN) is caused by the failure to develop a diverse set of identities or self-definitions.(1, 2) Highly controlling and perfectionistic parenting was believed to limit the child's opportunities to function autonomously and to interfere with development of a clear and richly elaborated self. Bruch suggested that the adolescent turns to body weight as a viable source of self-definition and as a means of compensating for the lack of a clear identity and for associated feelings of powerlessness and incompetence. From this perspective, the adolescent's fixation on body weight and exaggerated desire to be thin are a maladaptive way of coping with identity deficits and of striving for a sense of self-definition, competence, and control.
By Karen Farchaus Stein, PhD, RN and Linda Nyquist, PhD
January/February 2001 Volume 12, Number 1
So I have had to have my mother admitted to hospital. A very nice, cheery cottage hospital in the town where she lives. She has heaps of visitors and flowers and cards, knows all the gossip and is allowed out for excursions with friends. The nutritionist has rung and talked and suggested. The nursing staff have acknowledged the MARSIPAN report (I am not sure they have read it cover to cover but it is very long) and placed the Restoring Regular Eating Plan and the Guide to Medical Risk Assessment in her notes. Her notes read Anorexia and, as her GP laughingly noted, she is the only person he knows who has come in to be "fattened up" on NHS food.
I tried very hard to do FBT here, at home with her but failed dismally. The Fairy Blogmother hit the nail on the head when she said "re-feeding an elderly patient has no roadmap and doesn't have lifetime parenting effects".
There is a very different relationship when refeeding one's child when compared to refeeding one's parent. As two very wise girls pointed out to me last night, there is a natural feeling somewhere that believes that your parents may be right and it is instinctive to follow their rules. For parents, to believe that their children might be right and to blindly follow their rules, goes against the natural order. To enforce any kind of consequences for not eating upon one's parent is...well.....absurd really.
Do I blame myself? Yes. Do I think that she will be "cured" before her aging organs give out? Probably not - a sort of hope over experience wishes she does. Do I expect anyone outside of my immediate family and my circle of internet eating disorder friends to even begin to understand? Not really.
The scary thing is the manifestation of an eating disorder "personna" in its cruelest form is there. The personna that tries to alienate those who can help most, is definitely present, correct and fully functioning.
As for dear old Hilde's arguments: sorry, sweetie, this is no teenager with controlling parents who has not been fully able to develop a clear and richly elaborate self. Nor is it an identity crisis or a self-definition problem. It's an eating disorder that doesn't do tick box diagnostic criteria, international boundaries or only affect middle class white teenagers.
It started as an energy imbalance. I hope it doesn't end that way.