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Friday 28 September 2012

Nobody does it better

There is little point trying to paraphrase  Carrie Arnold.  Her article for Slate  is pretty self-explanatory and Laura Collins has already covered the arguments.  Meanwhile, I am toe tapping in anticipation of the arrive of Carrie's new book.

Decoding Anorexia: How Breakthroughs in Science Offer Hope for Eating Disorders

Just the editorial reviewers (let alone the reviews) are enough to plan two days off just to read it.

“How can eating enough seem so simple and yet be so difficult for some people? This book simplifies the difficult enigma of eating disorders by interweaving up to the minute evidence with experience. A resource for both the professional and lay audience.” - Professor Janet Treasure, PhD, FRCP, FRCPsych, Kings College and South London and Maudsley Hospital, London

“Finding out that anorexia is a biologically-based mental illness is liberating. It sets you free to develop skills and embrace life. Decoding Anorexia explains why in a language that we can all understand.” - June Alexander, Anorexia survivor, Australia; Author, A Girl Called Tim; My Kid is Back; and A Collaborative Approach to Eating Disorders

“With turtles, deer, dandelions and orchids, Carrie Arnold deftly weaves her own experience of anorexia with the best biological science. This powerful and compelling book will help anyone gain a better understanding of a most complex, challenging and too often deadly illness.” - Susan Ringwood, Chief Executive, Beat, United Kingdom

“Carrie Arnold has done an outstanding job of translating complex and difficult research findings into understandable concepts. This book should be an essential guide for individuals with eating disorders and their families who would like to know more about how brain processes contribute to eating disorder symptoms.” - Walter Kaye MD, Professor of Psychiatry and Director, University of California, San Diego, Eating Disorder Research and Treatment Program, USA

Or as my friend, B, puts it

"No, I am not a perfectionist with control issues who is overly influenced by thin models in the media dealing with overbearing parents you douchebag. I have a $%#@#$%^&&%$#$%$#$ing biological/neurological/somecrapgoin'on disorder"

Thursday 27 September 2012

Parentism II

So let's talk about  aetiology or etiology - the science of causes.  The origin of aetiology is the Greek word, aitia, which is commonly translated an explanatory factors but is also translated as "responsibility".   

Medical history is full of "causes" and "blaming".  We don't have to look far back in history to see the rise of the concept of eugenics, improving the genetic composition of the population through selective breeding.  Those unfortunate parents who gave birth to an intellectually disabled child were positively encouraged not to have any more children.  They were somehow "tainted" and would be "tainting" the genetic pool.  Aside from that, vast swathes of the population were condemned - the Jewish people, the Romany people, homosexuals, promiscuous women (?), the blind, the poor.  All these children born this way were "unfit" to breed.

Extreme parent blaming?

Eugencis fell out of favour after the Second World War, which is a GOOD thing.  However, to take its place, aetiology turned its attention towards parenting as a "cause" of various afflictions, including mental illness.  "Bad parenting" was thought to cause autism, schizophrenia and a myriad of other conditions.  Although advances in science has disproved the theory that "bad parenting causes mental disorders", the truth is that many clinicians still believe it and practice therapies that subscribe to the "root cause" being parenting.

As I have said so many times before, of course environmental factors can play a part in the onset of mental disorders.  Of course, the world is not populated by perfect parents.  Of course, parents have a huge influence on their developing child.  However, the simplistic theory of attributing a patient's mental (and often physical) distress to "bad parenting" is not proven, not evidence based and not correct.  All mental disorders seem to have no one single cause.  Drug induced schizophrenia?  Why was the patient abusing illegal drugs in the first place?  Anorexia?  Why did the patient have an energy imbalance?  The advances in the studies of genetics (and epigenetics), neurotransmitters and neurobiology seems to be evening out the environmental "blame game" and swinging the pendulum against purely environmentally driven mental disorders.

Why am I still coming across discussions on the internet entitled "How do parenting styles cultivate symptoms of BPD?".  Hold on a minute there, researcher.  I think that is a bit of a loaded question and *I* am offended.  Here is the NHS definition of the causative contributors to BPD.  I  like using the NHS definitions because they have nothing to sell by way of treatment.

One of the most important factors that seems to be missing from the continued research into the effect that parenting has on mental disorders is this:

Most of what mental health professionals know about parenting of people with mental health disorders comes from the patients themselves.  When people are suffering great distress they tend to focus on, and recall, negative events, rather than positive ones.  In recovery, or when less distressed, patients often change their focus and their recollection.

(Good old Hilde - you know how much I like to tear her work apart.  Her clinical observations of patients who were severely malnourished and taking their "ramblings" as a truth did so much harm.)

Here is an extract from the Minnesota Starvation Experiment, which helped me to understand the effect of malnutrition on mood:

As semistarvation progressed, the enthusiasm of the participants waned; the men became increasingly irritable and inpatient with one another and began to suffer the powerful physical effect of limited food. Carlyle Frederick remembered “. . . noticing what’s wrong with everybody else, even your best friend. Their idiosyncrasies became great big deals . . . little things that wouldn’t bother me before or after would really
make me upset.” Marshall Sutton noted, “. . . we were impatient waiting in line if we had to . . . and we’d get disturbed with each other’s eating habits at times . . . I remember going to a friend at night and apologizing and saying, ‘Oh, I was terrible today, and you know, let’s go to sleep with other thoughts in our minds.’ We became, in a sense, more introverted, and we had less energy. I knew where all the elevators were in the buildings.” The men reported decreased tolerance for cold temperatures, and requested additional blankets even in the middle of summer. They experienced dizziness, extreme tiredness, muscle soreness, hair loss, reduced coordination, and ringing in their ears. Several were forced to withdraw from their university classes because they simply didn’t have the energy or motivation to attend and concentrate (3).

My view is that the continued devotion of too many clinicians and so-called therapists to attribute the blame for mental disorders on parenting is detrimental, life threatening and about as useful as a chocolate teapot.  Treating mental disorders, without ascribing blame, partly involves keeping the patient in a warm, stable, loving environment as much as possible.  The majority of parents offer this for no fee.  Whilst some patients may need to be moved for their personal safety and the safety of others to a more specialised facility, most patients benefit from being in the security of their home, with their parents.

To highlight my argument for stopping the blame game, this piece of research popped up on Google.

Ascribing aetiology of mental disorders to bad parenting should be, and must be, a thing of the past.

Wednesday 26 September 2012


Par­en­tism is a less dis­cussed cousin of racism, sex­ism and clas­sism.


parentism (uncountable)
  1. discrimination against parents
  2. resentment felt by parents towards people who have chosen not to have children


Discrimination against parents:  In the world of psychology and psychoanalyis, into which I occasionally dip my big toe (and inevitably get pinched by a crabby "qualified" person), I come across extreme prejudice against parents.  The website I discussed in my previous blog is probably at the extreme end of the scale but, where mental illness is concerned, parents seem to have to shoulder the burden of blame, as well as the burden of care.

Times are supposed to have moved on from this type of study.  But have they? The answer is that there are still Bettleheim disciples peddling tripe about bad parenting causing autism.  The newest incarnation is a Canadian called Dr Gabor Mate, who has such gems to impart as this.  I particularly liked this rebuttal - speaking my kind of language.

Then you get the alternative poison from the other end of the spectrum.  David Allen, author of the wonderfully encouraging book "How Dysfunctional Families spur mental disorders", who writes (NB horrible graphic and unnecessary picture at the end - avoid at all possible costs) a relatively benign blog post about parents of schizophrenics.  Should you then search "parents" on his blog, well don't bother unless you are feeling particularly strong

Psychoanlysists refer to this interpersonal phenomenon asprojective identification. They speak of "superego lacunae" or holes in the parents' conscience that prevent them from expressing certain feelings but which lead them to indirectly validate the expression of those very same feelings in their children, even while criticizing the children unmercifully for having done so.


Should you care to Google "Do parents cause eating disorders?", I am delighted to see the Fairy Blogmother's film comes out No 1. But then you get this sort of article, which drives me mad.

the home lives of people suffering from eating disorders tend to be difficult and conflict-ridden. Adolescents may be highly defiant and resist parental control as to what and when they eat. Concealment of eating disorders is just one aspect of this defiance so that parents are often shocked and devastated to learn that their child suffers from a serious illness. By that time, the problem is well beyond the competence of the parents as clinical psychologists and psychiatrists are consulted. Researchers do not know whether such conflict is the cause, or the result, of an eating disorder.

With the cosy summary of

In summary I do not believe that parents should blame themselves for their children's eating disorders

Well we all know what you believe then......

This particular study is only 5 years old.  Still banging the Bruch drum some six years after this tripe.  In a funny way I am almost grateful for this particular study, which blames the media instead - it's still tripe though.

Look, we are a long way from sorting out mental illness, brain disorder, brain arrythmia, whatever you like to call it.  We are still shaking off the long, menacing shadow of Freud's more outlandish theories and the poison of Bruch's clinical observations.

No one would deny the impact of the environment on every single person.  Our experiences colour our reactions.  However, it is facile in the extreme to continue to spend valuable research money on pursuing an avenue which continues to be a dead end.

Is it wrong of me to long for a world where blaming parents for their children's mental illnesses will be as shocking and as distasteful as blaming the Jewish community for the Holocaust?

Monday 24 September 2012

Destructive, triangulating, cruel and unusual

and they were just the adjectives that didn't include either threats or swearing.  I have discovered the most horrible website, posing as a psychotherapeutic healing programme.  It contains such wonderful gems as this:

Most people were not loved as children the way they needed or wanted to be loved.  These children grow up into adults who are unable to completely love themselves or their own children.  This lack of love can show itself in many different ways, for example:  negative love relationships, fears, depression, poor parenting skills, inappropriate anger, inability to grow toward one’s potential in career or in creativity, or perhaps through the absence of a spiritual connection in one’s life.

The Institute for Personal Change takes you on a journey back to your self.  After completing the Process for Personal Change, you will:
  • Understand how your childhood affects the way you are now.  
  • Understand the dynamics of the family you were raised by.  After completing the Process, you will no longer be driven by the need for love and acceptance from your parents and others, because you will find it in yourself. 
By the end of The Process, you will be in a place where you can understand your parents and their own motivations, develop compassion for them as imperfect human beings, and forgive them for the ways in which they failed you. As a result, you will no longer blame your parents for your own issues. You will have the knowledge and tools to resolve your issues yourself.

Unbelievable stuff eh? But, but but, according to the website, this is all free.  However, if you want to donate to the institute, you can transfer stocks and shares to tell them how grateful you are that they have completed destroyed your family.

Only in California......

Sunday 23 September 2012

Anorexia Nervosa: An Anxiety Disorder with a Specific Set of Rules?

Okay, so the awesome Charlotte has invited me to write a blog post related to the title above. Some of you may have previously read my own blog: ‘Extra Long Tail’, which I decided to make private a couple of months ago. I may activate my blog and write some more posts at some point in the future, but at the moment I am enjoying the anonymity.
Charlotte and I often chat and debate (and have a giggle...) via Skype. We are of a similar age, but have had very different life experiences – including our experiences relating to anorexia nervosa (AN). Charlotte has a family and has worked hard to help her daughter recover successfully from AN. I do not have a family (unless you count felines...) and lived with a 28 history of restricting AN (age 12 – 40 years). I started to recover 6-7 years ago and am now quite well recovered from AN. However, I do still have high levels of anxiety and OCD.
In some ways I was considered ‘high functioning’ for most of the time I was anorexic, in that I completed my education, I have a PhD and have taught and undertaken research in universities. However, while I was anorexic, my life did not progress in other ways whatsoever. I was somewhat socially isolated and I eventually became very physically ill as a consequence of living with AN for so many years. At the point I was eventually referred for treatment, I could barely get out of bed each morning and my weight was critically low.
So why the title: “Anorexia Nervosa: An Anxiety Disorder with a Specific Set of Rules?”
For as long as I remember, I have been perpetually anxious. My mother tells me that (unlike my older brother), I kicked like crazy in utero and was difficult to settle as a baby. I jumped at every sound, was hyper-vigilant and very sensitive to the world around me.
At age 3-4 years I started showing signs of OCD, phobias and autistic behaviours. I became frightened of eating any food that was white in colour, lest it make me vomit. I spent time ordering things in my bedroom – e.g. lining up the books on my bookshelf in order of size. When I started primary school I became distressed because the teacher taught me to read and write in a different way that my mother had taught me. (I could already read and write fluently by the time I started school – because I had begged my mother to teach me..). I couldn’t eat my school dinner because I thought it might make me vomit. All-in-all I was very rigid, obsessive and over-anxious.
My AN started at age 11. I was a geeky, but very sporty kid (yes the two can coincide...) and had no interest in glamour or looking pretty. I had always disliked ‘girly’ stuff and was quite a ‘tomboy’. This led some of my peers to bully me. I also have ginger hair and some kids love to tease redheads. My anxiety escalated to the point of despair. I was already training for athletics and started to do extra training outside of club sessions. I found that hard exercise reduced my anxiety. I then discovered calorie counting and found calorie charts fascinating. (See, I told you I was a geek..). I decided to set myself a daily goal of consuming 1500 kcal/day as a challenge. However, I didn’t want to lose weight; I didn’t think I was overweight or too fat - and I was actually underweight for my height.
Very soon I had become well and truly stuck in a pattern of over-exercising and food (calorie) restriction. I got stuck because these behaviours made me feel less anxious. I described this as feeling ‘in control’. This ‘control’ had nothing to do with wanting to control other people and I didn’t have controlling parents (sorry, Hilde Bruch..). What I was controlling was anxiety, by adhering to a set of rules I had somehow developed around how I ‘should’ live my life. Although I was treated for AN as a child/teen, I never gained enough weight to menstruate and I remained in a pattern of rigid exercise and eating behaviours for the next two decades.  Yet, in so many ways, this pattern of behaving and thinking (i.e. adhering to a set of self-created ‘rules’) had been with me since early childhood. My AN was merely an extension of childhood obsessive-compulsive behaviours and thinking that were driven by anxiety.
One point I attempted to make on my blog is that different people experience and articulate AN in very different ways. Some people with AN experience extreme body dissatisfaction and body dysmorphia; others become obsessed with the idea of eating and exercising ‘healthily’; some gain satisfaction and a sense of reward from losing weight. I never had body dysmorphia or gross body dissatisfaction. My AN was never driven by a desire to change my physical appearance or a wish to be very thin. It was merely an anxiety disorder with a specific set of rules.
Because I never ‘felt fat’ or was ‘fat phobic’ while anorexic, many doctors failed to observe that I had AN. If they asked me whether I was ‘feeling fat’ I said ‘No’. I answered ‘No’ to most of the questions on EDE-Q ( – simply because these questions included the phrase ‘weight and shape’. As a consequence I remained very underweight with compulsive behaviours around eating and exercise for well over two decades. My physical and mental health deteriorated badly during this time. Thankfully, I have had very good treatment over the past 6 years and have gained and maintained a substantial amount of weight.
I urge professionals treating those with AN to ‘think outside of the box’ and to recognise that people with AN do not fit into a homogeneous group. Not all patients have ‘weight and shape concerns’. AN is not a ‘disorder of body image’ – at least for every sufferer. I would like professionals to recognise that anxiety, and behaviours that develop to control such anxiety, are key to some people’s AN (or other eating disorders). The fixation with ‘weight and shape concerns’ can lead some anorexic patients to be denied treatment, or given a treatment regime that is inappropriate for their needs. Effective recovery from AN requires adequate weight gain through good nutrition – and such treatment applies to every anorexic patient. But apart from good nutrition, the psychological needs of each patient may be quite variable.

Wednesday 19 September 2012


(Picture courtesy of "Nanny Goats in Panties")

This made me laugh:

"If you're going to get flak for anything you do it is time to do anything you like! Re-paint their rooms in paisley. Institute lights out at 9:30. Watch 1980s chick-flicks all day. Invite over squadrons of mums for 30 hour bitching sessions over teens. Oh! Oh! Start a support network for teen mums and have them stay at your house all day feeding crying babies!!!! Start a rescue league for guinea pigs in your kitchen. No: develop a passion for bottle-feeding orphaned Pygmy Nubian goats beside the Aga!!"

Now where did I put that Paisley paint?

ECHO FEAST Maudsley Carers Conference

Register Now!
I can't make it

ECHO, F.E.A.S.T. and Maudsley Carers Conference, Nottingham, 23rd and 24th November 2012
organised with the kind permission of Professor Treasure
by F.E.A.S.T. UK

We are delighted to announce a two day conference, on Friday 23rd and Saturday 24th November, in Nottingham for all families and professional teams involved in the ECHO (Expert Carers Helping Others) project, members of F.E.A.S.T. (Families Empowered and Supporting Treatment for Eating Disorders) and Maudsley Carers.  

The objective of the conference is to meet, learn, discuss and exchange ideas and offer support, help and advice in a warm, relaxed and friendly atmosphere.  

We will be having a keynote speech on Friday 23rd November by Professor Janet Treasure, Professor South London & Maudsley NHS Trust Director Eating Disorder Unit and Professor Psychiatry Guys', King's & St Thomas' Medical School, London and a member of the F.E.A.S.T. Advisory Panel.

Susan Ringwood, CEO of Beat and a member of  Professional Advisory Panel for F.E.A.S.T. will be talking about what carers can do and how families can help as well as the Beat Carers Workshop project.  

Gill Todd, retired Head Clinical Nurse of Eating Disorders Unit in the South London and Maudsley NHS Trust will be doing Carers Workshops for both professionals and families.  

We will also be having a presentation and discussion with Dr Maria Finnis (John Radcliffe) and Dr Rachel Polonsky on the power of the internet and parents.

There will be presentations by various F.E.A.S.T.members, including Fiona Bromelow (FEAST Board Member and BEAT Carers Ambassador) and Charlotte Bevan (C&M ED Productions on You Tube).

Programme for the ECHO F.E.A.S.T. and Maudsley Carers' Conference

Friday Programme 23rd November 2012
8.45 Introduction and housekeeping Charlotte Bevan
“F.E.A.S.T. and what we do” Fiona Bromelow

9 - 10.45 Keynote Speech Professor Janet Treasure

10:45-11:15 Coffee

11.15 Plenary
 “Boys Get Anorexia Too” Jenny Langley
“The ECHO Project” Pamela McDonald
“Professionals, Carers and the Internet” Dr Rachel Polonsky and Dr Maria Finnis

12:30 Q and A Session with the morning’s speakers

1- 1.45 Lunch

1.45 Plenary
“First Steps Derby” Danielle Sinclair
“Freed Beeches” Yvonne Broughton
“Beat, the UK’s leading Eating Disorders Charity” Susan Ringwood

3:00- 3:30 Tea

3.30 - 5.30 “Skills Based Learning for Carers” a presentation for professionals. Gill Todd

Saturday Programme 24th November 2012

8.45 Housekeeping and Introductions Charlotte Bevan

9.00 - 10.15
B-EAT our work with carers Susan Ringwood
Succeed 15 minutes

1030-11 Coffee

11.00 - 12:30
C&M Films Charlotte Bevan
Practical Skills for Carers, Workshop, Part One  Gill Todd

12.30 - 1.30 Lunch

1.30 - 3.30 Practical Skills for Carers, Workshop, Part Two  Gill Todd 

(With many thanks to the wonderful Fiona Bromelow for all her hard work)

Thursday 6 September 2012

Shame on you Kookai

Do I need to say anymore?

Nothing to be guilty of.....

Guilty Puppy

See more funny pictures and videos at Fugly.

So today I am musing on anorexia at two ends of the spectrum.  I had a long conversation with some parents in Europe.  They have discovered that their daughter, at university the other side of the world, has anorexia.  In a desperate panic, prepared to fly to the other side of the world on the first flight out, with no clear plan, but determined to DO SOMETHING, they came across as good, loving parents who would do anything to help their daughter now.

So I asked them to tell me a little bit about themselves and their daughter.  I stopped the conversation on more than one occasion to tell them that this was not their fault.  It didn't matter that one of them had to lose weight for a medical condition 8 years ago.  That did not cause their daughter's eating disorder.  How were they to know that the desire to go vegetarian was linked in to her anorexia?  A lot of people, especially young people, go vegetarian for any number of reasons - usually ethical.  The fact that it is a well-known sign of an eating disorder is totally irrelevant to 99 of 100 parents.  It is not their fault that they both have jobs and are at work every day.  Nor is it their fault that they live in a country very hostile to people who are not stick thin.  Environment impacts in different ways on different people.

At the other end of the spectrum I am dealing with a lovely lady in her '80s, who has developed anorexic symptoms (no diagnosis yet) after diverticulitis (or however it's spelt!) and various medical procedures (too squeamish to talk about) to investigate anemia.

When I presented this lady with the Maudsley Eating Plan, after a lunch where she ordered a beef sandwich "with no bread" (HUH?), she looked terrified and declared it was at least double what she was eating now.  (That was kind of obvious after lunch.....).   She has begun to understand that she is malnourished, very malnourished, but has reached that manic stage of carrying on as normal, or even doing more than before, to prove that she is "fine".  She also is quite positive in her mind that all the stuff about starvation, eating disorders and health risks don't apply to her.

I know for a fact that her family didn't cause this eating disorder.  I know that runs in her family and that, for 80 odd years, the environmental hasn't had all its cards in the right place, at the right time, to pull the gun.  Until now.

Words fail me

Sometimes there is stuff I know and I am unable to explain it in any coherent way.  I get distracted and wander off on another tangent and get bogged down in epigenetics.  Sometimes I need to borrow Science of Eds' wonderful brain and fluid writing style and from now on, when someone asks me about why people find the idea of an eating disorder having a genetic component harmful, I will send them here.

For me, the idea that an eating disorder is heritable but not solely responsible makes a lot of sense. It stops an eating disorder being an "ongoing behavioural choice".  It takes away the blame.  However, I have never looked at the flip side or understood it as clearly.  I never regarded it as a disincentive to recovery.

When I grow up I want to be Tetyana.