So I got this Mother's Day present . . . and I realized it could be not just a present for me, but other mothers/fathers/carers out there. When we began Family Based Treatment (FBT) for our daughter's eating disorder (we were lucky to have a doc who was up to date on evidence-based treatment and sent us straightaway to the UCSD Center for Eating Disorders Treatment and Research), my greatest concern was what would happen to my relationship with my daughter. This is a common refrain and I also hear about clinicians warning parents about the destructive potential of FBT and doubting the ability of most families do do FBT.*
My daughter and I had a close, loving relationship throughout her childhood. She was not a perfect child, but she was definitely a good kid. We had normal teen/mother discord, but at the point of her descent into anorexia, she was a self-sufficient, mature, smart young woman of 17 and was already "raised." It was all over but the check-writing her father and I thought.
We were wrong as it turns out.
FBT requires of parents that they become, in essence, a caricature of all things popular culture tells us causes eating disorders.
Things I had to do to help save my daughter's life included being controlling about her food and activity, monitoring her both physically and online, being willing to have her taken by the police for a psych hold over meal refusal (we got close, but it never happened) and being present in her life to a degree not seen since she was two years old. It was not fun for either of us. Not even the teensiest little bit.
Things my daughter's eating disorder (That Bitch Anorexia in our home) said and did during the time I was doing the above? Let me just say that when I relayed the day's post-mortem to my husband (working out of state at the time of refeeding), this clip often informed my reporting--"And then her head spun around and venom spewed from her mouth." There's a reason parents and sufferers often externalize the psychosis of eating disorder behavior as "The Beast."
Now for the good part.
FBT worked for us. We embraced the counterintuitive "food police" nature of the treatment. We accepted the idea that this was short term pain for long term gain. We trusted the research that showed FBT to be the most-effective treatment for adolescents with anorexia. We found hope in seeing others further down the path than us and from the light we saw in their children's eyes. We were cruel to be kind, in the right measure.
We leaned in. We pushed when we were told (by her/ED) to back off. Even after her initial recovery, we put a safety net in place that, if you don't understand eating disorders, made it sound like we didn't trust our own adult child (we do, we just recognized the tentacle-like nature of an ED and wanted to help her help herself--which she did). We chose to shape the path so that we could choose recovery for her in the event she was unable to choose it for herself. We were hard-asses of the first degree.
Now for the great part.
That relationship worry so many of us have? For many of us the intense battles between parent and child during refeeding didn't ruin our relationships with our children; in fact, they made the relationships closer and stronger. Fighting for your kid's life--first without their help and then, after their brain is no longer malnourished, alongside him/her, can be a powerfully bonding and affirming experience.
This is our story and it is also bigger than just our story--because it also the story of so many other families who choose FBT to treat their child's eating disorder. To me, FBT shares common ground with parents giving insulin injections to their diabetic children and with parents of children who have cystic fibrosis and requite at-home percussion therapy and with the many parents who make myriad medical decisions for their kids every day that may require both the family and child to endure unpleasant times in the service of life-saving treatment.
To my baby girl, you of the twinkling eyes, gorgeous smile and all-over glow seen above--you are rocking life at every level and to have had a part in your metamorphosis from seriously ill to physically and mentally healthy was my honor, my privilege and my purpose as your mother. XOXOXOXOXOXOXO.
*FBT doesn't work for everyone; in fact, there is as yet no one treatment for anorexia that does. There are valid reasons why FBT isn't the best choice for some families and many parents fight just as hard as I did, using other treatment models. That said, the resistance to FBT by clinicians is puzzling in light of the fact there is no treatment that has better outcomes or works for a larger swath of people. Not educating patients and families on ALL treatment approaches, modalities and the evidence for them, is malpractice as far as I am concerned.