By Rabbi Shea Hecht
[Click here for Part I.] It’s extremely painful to see someone we care about struggling with an eating disorder. The illness is all-encompassing, causing them to view every aspect of life in the context of what has or has not been eaten that day. If left unchecked, an eating disorder can and will destroy physical, emotional and mental health.
As parents, siblings and friends, we cannot sit silently and let someone we care about harm themselves. On the other hand, involving ourselves in this battle can be overwhelming. What is the right way to help? Will we only make things worse? What can we do?
Off the bat, we have to understand that even with our most loving and committed intentions, we cannot “cure” this sickness or make it end. That’s something that we’ll have to leave to responsible professionals and, ultimately, to the suffering individual. However, with thoughtful and loving involvement, we can help a friend to make sound decisions about their health.
An approach that can encourage someone to break the cycle of self destruction and reach out for help is one that I will refer to as “Near and Far.” Essentially, we can encourage our friend, in a loving and supportive way, to get professional help (Near); and deny the rationale and self-image that fuels the illness (Far). In other words:
Near…
First of all, it’s important to stay cool and relaxed when speaking with her about your suspicions. Even though it’s difficult, do not let yourself get frantic or upset. If you are too upset to contain your emotions, it is simply the wrong time to talk.
Explain to her in a direct way what it is that makes you believe that she has a problem. Without talking down or taking an accusatory tone, speak explicitly about changes you’ve observed in her behavior or disposition. Emphasize that as a parent, friend, sibling etc. you’re concern is only for her own health and happiness.
Your goal should be not just to air your suspicions that she has a problem, but to recommend specific help. Do some basic footwork as to what therapists, clinics or support groups are out there so that you’ll be able to suggest a specific course of action.
…and Far
Do not say anything about her physical appearance, whether in a positive or negative way. No matter what, she will understand everything you say in a way that validates her obsession with her self-image, and this will only fuel her illness. For the same reasons, don’t get into the hard details of calories, nutrition etc. You simply cannot win.
Do not put forth any demands or issue ultimatums: stress and shame are what drove the illness in the first place. Throughout her struggle, she has trained herself to deal with bullying, shame and pressure. There is little, if anything, you can do to “force her hand.” It will take much patience and persistence before she starts to come around. There’s no “silver bullet”.
Do not give in: Someone with an eating disorder is a “master of manipulation.” She may unexpectedly shift the blame for her condition to you, or perhaps try to ridicule your “naïve” desire to get involved. She may ask you to help her keep her illness secret. Do not accept any responsibility for her emotional or physical ailments – your role is not to be a punching bag or a crutch, your role is to encourage her to seek professional treatment.
It’s important to come to terms with the fact that we cannot heal our friend’s illness. That is something that demands much time, professional help and a supreme effort on their part. Our job as friends and family is to help her to imagine a better life for herself and lovingly encourage her to seek out the professionals that can help her to heal.
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An excellent article. However, we should remember that not all people with anorexia are women and girls. There are also boys and young men with body-image problems including anorexia, and we should be concerned about them too.
stupid article, because eating disorders (anorexia, bulimia) are psychiatrict issues. Usually the child is rebelling against the parent, and eating is the only way to gain control. So for a parent to try and handle the situation is pretty useless really. A third party needs to step in and help the child.
Galiah’s comments about how parents are somehow to blame for their children’s eating disorders reflect the thinking of the therapeutic community– of about twenty years ago. Today, most professionals realize that to a large extent, anorexia and bulimia are genetically based disorders; a recent article in Time Magazine even linked the gene to a form of autism.
Just like the parents of a child who has cancer, r”l, goes to great lengths to ensure that their child get the appropriate treatment (chemo, surgery, radiation, etc.) without relinquishing ultimate control over the child’s well-being, so the parents of a child with an eating disorder need to assemble a team (psychologist, psychiatrist, dietician, medical doctor) that respects the parents’ position as being the ones best suited to supporting their child through and helping their child recover from this terrible illness.
The most important breakthrough in the field of the treatment of eating disorders today is the new-found acceptance of Family Based Therapy, often called the Maudsley approach, which far from reflexively blaming the parents, as does Galiah in her comments, sees them as the key to the childs recovery. The folloing is taken from their excellent website, F.E.A.S.T., which I recommend to anyone ho has a loved one struggling with this “machlah”:
“A 2008 paper published in the Journal of Clinical Child & Adolescent Psychology makes it very clear: “At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa.”
The authors of another 2008 article (available by special permission on the FEAST site) describe published research on family-based interventions showing “at 4-5 year follow-up, the majority (60-90%) will have fully recovered while only 10-15% will still be seriously ill”… “Outpatient family therapy compares quite favorably to other treatment modalities such as inpatient care where full recovery rates vary between 33% – 55%.”
Put simply, the Maudsley Approach sees the parents of the ill person as the best ally for recovery. The effects of dieting (or insufficient food for a person’s activity level) are for many people a self-perpetuating cycle that requires intervention. In this evidence-based approach, parents are seen as the most committed and competent people in the patient’s life and therefore best qualified to find ways to fight the illness, to regain healthy weight, and end unhealthy behaviors.
Without question, the Family-Based Maudsley approach represents a very different way of looking at eating disorders and treatment from traditional approaches. Some in the eating disorders community are shocked and even offended by the emphasis on nutrition and behaviors instead of insight and motivation. Still others remain skeptical of the role of parents in the treatment. Yet the results are clear: there is no other scientifically-validated treatment approach for adolescents with anorexia living at home who have been ill fewer than three years. The approach is also appropriate for bulimia and for older patients whose families are able to take on this role, according to leading researchers in the field.”
Please, parents– hang up your guilt and don’t allow other people who are sadly misinformed to push you out of the equation. Your child needs you to help him or her recover!
Find the appropriate providers who support you in this approach: the F.E.A.S.T website is a good place to start,as is the official Maudsley website, or give me a way to contact you and I will get in touch with other options.
It is a long and difficult journey, but it can be done.
I know, because we have done it.