Juggling Life

On FBT and How it Worked Out For One Mother and One Daughter

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. 

Fighting Stigmatizing of EDs: Anorexia is NOT a style statement!

Me and my girl, summer 2014

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. 

 

 

 

 

 

 

 

In Which I Encounter A Masshole . . . Again and Again

So I went to this amazing conference in Boston (International Conference on Eating Disorders) and I have about 3,500 words pending about it in other spaces that talk about the important stuff. 

This story is not the story of what I learned and who I met and the amazing work that we are doing. 

This is the story of how I became a lead player in an insane Groundhog-Day-esque encounter and learned firsthand what a Masshole is.

On Wednesday morning I sat in the reception are of the upscale Marriott Copley Plaza, waiting for my compatriots to arrive, tethered to an outlet because my iPhone decided that a cross-country trip and a few days in a strange city was a great time to begin draining the battery at lightning speed.

I was approached by an androgynous woman I initially mistook for a man. She definitely picked the wrong target for her panhandler spiel (I will buy food cards if I am moved by someone's plight; I don't do cash ever) of: "My kids and I became homeless today and a room at the Y is $63 a night and I've got $8--can you spare a few bucks." I smiled politely and said "Sorry."

On Thursday night I sat in the lounge area of the (still upscale with a professional, business vibe) sharing drinks, appetizers and energy with three of my fellow advocates and good friends.

The woman from the lobby approached our table and delivered the aforementioned spiel to which I replied for the table, "Sorry, we are on cards." I would not have been shocked had she whipped out a card reader, but she did not. As she walked away, I, thinking she was out of hearing range leaned over and shared with my friends, "I heard that exact same story yesterday in the lobby." My intended meaning being, "Hmmmm, she JUST became homeless TODAY, when she told me yesterday she just JUST became homeless TODAY."

Whether she wasn't as far away as I thought, or my voice was louder than I intended or whether perhaps she just has amazing hearing, she heard me. 

And wheeled around.

And proceeded to deliver, at shockingly high volume, the following diatribe in a classic Boston Southie accident. She would have been the tomboy sister in the movie "The Fighter." 

"You fahkin' bitch! Who the fahk do you fahkin' think you are? You don't have a fahkin' clue! Fahk you ya' fahking bitch! (Chorus repeated several times before the concluding line). And why don't you get a fahkin' dress that isn't three sizes too fahkin' small ya' fahkin' bitch."

Let's let that sit for a moment . . . 

I was body-shamed for my weight and style choice at an eating disorder convention. 

So that was fun. 

But hey, a blogger is always a little happy about any encounter that makes a great anecdote.

And the bar manager did tell me that in his opinion I looked really good. 

The fahkin' outfit I was wearing 

Two encounters does not, however, a Groundhog Day-esque experience make, amiright?!

I am right. 

Sunday morning as I walked to the lounge, with a friend who had been there for incident #2 and an acquaintance from New Zealand, we were approached by my apparent stalker who opened with "My kids and I became homeless today and a room at the Y . . . "

That's as far as she got before registering that the "Are you motherfahking kidding me?!" expression on my face was a result of our previous encounter. I said not one word but began to walk briskly to the nearby hostess stand while casting my eyes about for security. While I did that, she began, once again, to involve the entire hotel in our little tableau by unleashing the following torrent of anger and profanity at me.

"You fahkin' bitch! I will fahkin' kick your fahkin' ass right fahkin' hear and fahkin' now! I will fahkin' beat you down right. fahkin'. here you fahkin' bitch!" (Repeat x 5 with little variety).

(The story of how security was nowhere to be found and how the hotel employees at the hostess stand were nonplussed by this scene to a rather shocking degree and how I was charged for the drink I ordered when the waiter checked to see if I was okay after the 2nd verbal attack and how the person who handles Twitter for Marriott and I are bffs now and what the corporate response to this was is a different story for another time).

Not only does this California girl know exactly what a Masshole is, she will be fahkin' happy to never meet another one. 

For fahkin' realz. 

It may be a fahkin' while before I watch Good Will Hunting, The Town or The Departed again. Just fahkin' sayin'.

 

 

 

 

 

 

 

 

 

 

 

 

On Health and Family Wellness

I often get pitches to post on my blog. I've made some great relationships through social media so I always give a quick peruse to anything that has my name right. If you call me Jenna and say you've been reading and love my blog, you're a liar. It's actually a decent system.

I get far fewer pitches and I accept even fewer of those in the last couple of years; this post was written because the folks at Oscar, an New York based health insurance company, had actually read my blog, and were interested in my take on Family Wellness as part of Family Wellness Month; they have a focus on using technology in a variety of ways to support the health and wellness of their insured. Wearing my advocacy hat for a moment--I think it's time for the eating disorder community to reset our relationships with insurers--with a mutual goal of saving us lives and them money. Early diagnosis and prompt aggressive appropriate level-of-care with family training and support saves lives and money.

My first message about family wellness and healthy living is to understand that thin doesn't automatically equal healthy and fat doesn't automatically equal unhealthy. Confused? Poodle Science explains it well.

 

Internalizing that message will set you on the path to Family Wellness and increased happiness and contentment. 

My other recommendations for Family Wellness? 

Limit screen time. Do this from day one and do not fall prey to the siren song of a moment's peace. Now, I am not saying don't have TVs or computers or iPads or phones--I'm not a Luddite and I don't want your kids to be either (unless you do, in which case it's unlikely you are reading this blog).

I was lucky to be able to raise my kids in a cul-de-sac in a lovely suburban San Diego community. I had weather on my side. The families around us had the same values regarding childhoods spent in the great outdoors. Plus, I was a stay-at-home-mom. It was clearly a supportive environment in which to stand firm of limited screen time and I recognize my privilege.

And I would still encourage everyone to do their best to do the same on screen time limits.

Two simple rules (one mine, one my neighbor's) made it possible to stay sane(ish) and not have to deal with the dreaded attempted parental wear down (also known as nagging/begging). 

Ours was no screens during the week. We recorded shows all week and Sunday night was early dinner and family TV viewing. We had a couple of GameBoys for car rides and as the kids got older we finally got a game system (when our youngest son was about 10) and marathon game sessions on sports-free Saturdays were definitely a thing. Today our four adult children have thanked us for our rules and vowed to do the same (or stricter!).

My neighbor's rule was no TV at all during the school week and no TV during daylight hours on weekends and in the summer. 

Another neighbor had no screen restrictions, but the kids were outside with ours all the time anyway so that was a natural limitation there.

Play--with bikes, balls, bats and wheeled contraptions of all type (one year Santa got all the kids in the neighborhood Razor Scooters) was never thought of as exercise and yet movement was constant.

It wasn't just the kids that cavorted either--I play a mean tetherball and game of HORSE. Pickup basketball games with kids on dad's shoulders brought everyone out on summer evenings. Games of catch were a way to stay connected through the teen years. 

Nutrition is a hot topic these days and on that my thought is cook at home as much as you can. In the elementary school years I often prepped dinner right after I dropped the kids at school. Don't buy Uncrustables--make your own on Sunday night and put them in the freezer for the dreaded school lunch packing grind. Throw in a cookie or some chips. Probably better not to throw in ten cookies. Hitting fast food occasionally is unlikely to hurt anyone, but seven nights a week not so good. Reserve soda for sit-down restaurants and drink milk or water at home. 

Sleep is important; for you and them!

And know that you can do everything "right" and sometimes things will happen anyway--it did for us when our youngest daughter developed anorexia (she is doing fantastically well today). If and when it does, all the above tips will hopefully have you in a place where you have the energy to do what you need to do and the loving relationships that eating together and playing together build. Make sure you put the "Family" in "Family Wellness" and odds are good for things to work out just fine.

My people! I sure do love them!