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The Only Way Out is Through

By Judy Krasna, F.E.A.S.T. Executive Director

A dad from my area called me last week seeking advice on how to advance his daughter toward recovery. She has suffered with an eating disorder for the past 7 years, and she’s only fifteen.  She’s in that familiar grey area between not being acutely ill yet not being recovered. She’s willing to eat, but she needs to control the quantities. She’s eating a reasonable number of calories daily, but she’s not getting enough calories to gain weight. She has never gotten to/stayed at a weight where the eating disorder voices have quieted. She will be inpatient for enough time to gain sufficient weight but then proceeds to lose it once she returns home. She will drink Ensure instead of eating because it’s more comfortable, so the calories are going in, but not always in the form of food. It’s a situation familiar to a lot of families out there.

I told the dad about “magic plate”—meals are all plated, without the person with the eating disorder being involved or allowed to be present during the food preparation, and the plate must be finished in its entirety. There is no discussion and no negotiation.

I told him about “life stops until you eat” and about setting conditions of 100% food completion in order for his daughter to be allowed to take a supervised daily walk as she has been doing. I told him that gentle exercise, if medically advised, should be offset by added calories beyond what his daughter is currently eating.

He kept saying to me, “I know, but we can’t do this, because…” every time I offered FBT (Family Based Treatment) based strategies. And I totally heard him. He’s afraid that if he tells his daughter that she must eat more calories, she will get angry at him and eat even less. He’s scared to push back against his daughter’s eating disorder because it will cause upset during meals that will make mealtime unpleasant for everyone in the family. He doesn’t want to take things away that make his daughter happy (like her daily walk) because so few things in life make her happy.

Everything he said was perfectly reasonable and in line with what a caring father would feel. And everything he said was essentially colluding with the eating disorder.

At a certain point, I told him that the conversation was too circular to continue. I would keep suggesting ways to get his daughter to comply during meals and to gain weight, and he would keep telling me why it’s not viable for their family.

I’ve been in his position, so I have nothing but compassion for this worried dad who is looking for a way to get his daughter out of the clutches of this insidious monster of an illness. I get it; I know exactly what I’m asking him to do, and how very hard it is.

What this dad was coming to realize is that ultimately, you can’t outsource this hard work. Residential treatment gets people on the right track, but it doesn’t get them to their destination. That work is a process, it can take a long time, and it needs families or other caregivers to be actively involved. You can’t get around difficult mealtimes or conflict around eating. Parents need to learn how to successfully manage these challenges if they are going to effectively help their kids.

If I forgot, even for a second, why I do what I do, this conversation served as a pointed reminder. It reminded me how hard it is to support a loved one with an eating disorder, how it saps your energy, how it challenges your sanity, how it wears you down, and how it makes you feel disheartened and powerless. At times, it makes you feel awful as a parent, and that is legitimately traumatic. Not to mention how incredibly scary the whole situation is.

It reminded me of why FEAST is here, of why we work so tirelessly to help as many parents out there as possible, of why parents need so badly to be empowered and supported, and of how impossibly difficult it can be to support someone with an eating disorder, especially an eating disorder that is enduring.

I hope this dad finds the energy and the strength to take some of the actions that I suggested. From my own experience, I think that they can help. But also from my own experience, I know the magnitude of the effort that it requires, and I know that not every family has the capacity to do what I advised, nor does it feel right for every family. I truly understand.

Let’s take a moment to recognize that what we do, and what we advise other parents to do, is brutal. It’s the most selfless and incredible act of love, but it doesn’t always feel like love to either side. Let’s offer ourselves a healthy dose of grace and acknowledge how difficult this journey is. And then let’s do the work; because at the end of the day, there are no shortcuts–the only way out is through.

7 Comments

  1. Shelley Stulken

    Such a great reminder. This is no way around this illness, no way around the great distress and trauma it causes. We have to walk through fire to get our loved ones well. And it is, in your words, brutal.

  2. Danielle

    Judy – this is on point and beautifully written with so much compassion. This journey of 6 years has been the hardest thing and now on round 2 with a young adult the boundaries that need to be set are painful and can be the difference between getting into recovery or a lifetime of living under the thumb of ED or worse. I keep reminding myself that I cannot have a relationship with the person my daughter really is if ED stays in the picture. So we keep holding the boundaries and using the leverage we can and hope she decides recovery is a better life than a life with ED who is not welcome in our family.

  3. Help

    Thank you for this article that instills confidence in my parenting. This is so true and so hard to do. The ED wraps itself into other parts of our child too and it becomes so difficult to decide what is real and what is the ED. A parents automatic response is to stop our child from being in pain and with ED we need to put them through pain in order to be well. It plays tricks on our minds and turns our homes and our parenting upside down.

  4. Tracey Clarkson

    Your advice is very measured and compassionate and you present it so well. Hopefully he will go away and something you said will stick with him to act as a support when facing those challenges. Thank goodness for FEAST. My family are forever endeared to the wonderful community here ❤️

  5. Lynne Tavera

    Completely agree with your advise, however not all families are able to commit to FBT due to a myriad of reasons and parent’s shouldn’t be made to feel inadaquate if they cannot drop out of their lives for 1 to however many years to take on the fun responsibility of curing their sick child. What about single working moms with other children to raise, parents with their own medical or psychiatric issues, families who have unstable living conditions. Come one not only wealthy people have children with eating disorders. My family was able to do FBT for over a year with our D. The stress it put on the family was enormous and we were fortunate to have a great team helping us plus family support. I stayed up with my D for night after night not leaving the table before until she completed a meal. After a year and a half, she unfortunately was not one of the kids who recovered. Finally getting help from a PHP program was so good for her and for us as a family.

  6. Judy Krasna

    Lynne, I fully understand that not everyone can do FBT, and I know that FBT does not work for everyone. But there are certain basics–like meal supervision, adequate nutrition (which is way more calories than parents expect it would be), getting weight high enough for recovery, etc.– which are all necessary components of treatment, regardless of which modality is used. These are all extremely difficult things to do, and there are no shortcuts. It’s been my experience that for the most part, parents have to do the work in one form or another at some point, even if their kids go to residential treatment or PHP. This is why it is so important for us at FEAST to give parents the tools, skills, knowledge, and resources that they need to do this work and the support to get through the extremely challenging times.

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