rachelmanija: (Books: old)
rachelmanija ([personal profile] rachelmanija) wrote2017-08-03 05:41 pm

Brave Girl Eating: A Family's Struggle With Anorexia, by Harriet Brown

A memoir by the mother of a teenage girl with anorexia, written with her daughter's consent. (Her daughter is given the pseudonym "Kitty.")

There are a number of memoirs by people with anorexia (by far the best-written is Wasted by Marya Hornbacher, which is worth reading for the prose quality alone), but fewer by their loved ones. But a child with an eating disorder affects and is affected by the whole family.

This book attracted some really angry negative reviews, many of which took very vehement exception to Brown's refusal to take the blame for her daughter's illness, and for her saying that her family became temporarily dysfunctional due to the stress of it, but was doing basically okay before and after. I have no idea whether that's true or not, since all I can go by is the book itself. But I was struck by how pissed off a subsection of readers were at a mother saying, "This wasn't my fault" and "I think my family has good relationships," and how sure they were that this couldn't possibly be the case--that if a child has a mental illness, the mother and her family must be to blame.

Brown thinks the culprit is a combination of genetic predisposition and social pressure. She leans more heavily on the former as a factor in anorexia in general than I personally would, and if her account is correct, it does sound like that played more of a part in her daughter's case than it usually does. From her perspective, anorexia descended on her daughter like the demon in The Exorcist; while Brown herself had some mild issues with eating and weight that could have also affected her daughter, they're the sort of issues that probably 90% of white American moms have, and 90% of all daughters aren't anorexic. She might be in total denial about terrible problems within the family... but she might not be. Being a "good enough" family isn't a magic shield against mental illness.

As a memoir, it's gripping and well-written, and makes a convincing case for the family-based (Maudsley) approach to treating anorexia. (That approach also has very convincing evidence behind it.) But it's the response to it that fascinates me. Like I said, maybe the reviewers are right that she's lying or in denial. Brown does sound a little defensive. But who wouldn't sound defensive if she's constantly getting blamed for the illness that nearly killed her daughter? Could any mother have told her story without being blamed?

Americans are very apt to blame the victim. In every respect. And that goes one million if they're female. Were you raped? It's your fault for going on a date/wearing that dress/trusting your uncle/not buying a state of the art home security system. Do you have anorexia? You're vain/weak-willed/selfish/not really sick. Does your child have anorexia? You're a bad mother.

Brown's unknowable truthfulness or accuracy aside, there is nothing more infuriating to a big section of America than a woman who says, "It wasn't my fault."

Brave Girl Eating: A Family's Struggle with Anorexia
recessional: a small blue-paisley teapot with a blue mug (Default)

[personal profile] recessional 2017-08-04 01:29 am (UTC)(link)
This is one of those things where I'd have to go hunting for citations and I'm too tired, but: while obviously any individual case is individual, I would personally side-eye hard a family with an anorexic daughter insisting that it Happened Out Of Thin Air and has Nothing To Do With Them.

I would side-eye it even more if the family-based approach worked.

I mean, there's a lot to what you say, for sure. And there's also a lot to be said for cases where parenting would have been Good Enough . . . with a different child, one who was less vulnerable or in a less risky position because of other things, or whatever. It doesn't mean that The Parents Were Hideous Miserable Abusive People.

But to be honest like. I'm not going to get into huge specifics, but: the family my family is closest to that struggled hardcore with one daughter's anorexia? Would absolutely at their best frame it like "sudden demon that ate her" (at their worst they might decide to blame the behavioural problems of another child in the family for "causing the family stress").

And would absolutely say they had good relationships before and that it's the anorexia that made them dysfunctional and fall under that "good enough" parenting, etc?

And yet. It's a family where as part of her own attempt to work through her rehab the daughter does a really quite amazing landscaping project on the front lawn, and I go over to look at it, and she's showing it off, and on their way into the house one of the parents points at a tiny weed amongst the gravel and says "you really need to get on keeping that free of weeds."

And I WATCHED her go from shy pride showing it off to me to crumpled down defensive "I know I was going to weed after supper."

And that's a NORMAL interaction for this family. Like no: they weren't the kind of Toxic Horrible that you'd make a good movie out of for Lifetime but this is still what this girl was surrounded by - hypercritical, perfectionist, totally lacking in validation or celebration by her family - not "never good enough" in the sense of being endlessly berated, but definitely never good enough in the sense that the driving underly of the family was "well you could do better" . . . etc etc and you could see every bit of it reflected in how her anorexia worked.

So.
Edited 2017-08-04 01:33 (UTC)
recessional: a small blue-paisley teapot with a blue mug (Default)

[personal profile] recessional 2017-08-04 01:44 am (UTC)(link)
Oh for sure. And I mean in the case of the family I'm talking about I locate the cause of family dynamic in the father, hands down, SO THERE'S ALSO THAT. (And actually while not universal in the case of other anorexics I know where I KNOW their families contributed or at least exacerbated like crazy, it's relatively FREQUENT that the root of the crappy family dynamic was pretty clearly in the dad: HE set the family Tone, and the worst the moms did was get swept along by it.)

I just sort of suspect that part of the dynamic in this specific case is that in addition to the Blame The Woman/Victim thing that totally goes on, that's running into and combining with the part where like, okay, no, more likely than not, family dynamic has a huge contribution in these cases and I myself have a knee-jerk scepticism, because I know that the family in question (in my case) would say exactly the same thing.

(And it's not because they're bad people: they're not, they're quite the opposite, it's just . . . welp.)
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[personal profile] kore 2017-08-04 05:29 am (UTC)(link)
'But I was interested by the fact that if a hypothetical mother really didn't cause their child's mental illness, she would still get blamed for it.'

Well no mother "causes" a child's mental illness. There are lots of different factors ranging from genetic predisposition to environment to outside influences to plain bad luck. But every parent is a contributing factor to some extent just because they're the parents to a child who became mentally ill. That does not necessarily mean they are to blame. I think you and the author are kind of mixing up responsibility and blame. Parents can have the best intentions in the world and think they are "good enough" parents and be held up as models of parenting, and if it isn't what their kid needs, it doesn't mean they are actual good parents for that child, or their contributions should be dismissed if the child becomes mentally ill. I think a lot of mothers have been blamed by bad psychiatric theories and society for illnesses. That is different, and more a manifestation of sexism in society.
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[personal profile] kore 2017-08-04 05:35 am (UTC)(link)
BAnd that's a NORMAL interaction for this family. Like no: they weren't the kind of Toxic Horrible that you'd make a good movie out of for Lifetime but this is still what this girl was surrounded by - hypercritical, perfectionist, totally lacking in validation or celebration by her family - not "never good enough" in the sense of being endlessly berated, but definitely never good enough in the sense that the driving underly of the family was "well you could do better" . . . etc etc and you could see every bit of it reflected in how her anorexia worked.

Yeah, I think there's an unfortunate pendulum swing from "let's blame everything about this kid on their parents and home environment" to "well clearly this illness was caused by GENES ~handwave and the parents get an A+ for Good Parenting and don't have to feel guilty or change their behaviour." There are good parents who do a great job and their kid effectively gets struck by lightning, there are abusive parents who basically torture their kids, there are regular parents who struggle to do a "good enough" job but for whatever reason wind up making choices that are disastrous but not that conscious -- it's not like they were hiding a vowel from the kid's building block set.

Based just on personal observation there is a huge unwillingness to accept the role that luck, good or bad, plays -- which is just human, we like to think we have control over the things that happen to us, but this is multiplied exponentially when it comes to mental illness. It must be the parents! No, it must be the kid! No, it must be the genes or the Alar in the apple juice! There's a certain kind of insanity in trying to find The Absolute Root Cause of something so that not only can we assign the proper blame to various actors, but also fantasize about ending it once and for all. Anorexia is caused by 10% shit parenting and 20% adolescent rebelliousness and 30% genes and 40% lack of this vitamin, hallelujah. I think this is caused in large part by the mechanistic thinking resulting from the so-called Decade of the Brain, but people really are terrified by the idea that you can do all the "right things" and life can still fuck you over.
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[personal profile] asakiyume 2017-08-04 01:50 am (UTC)(link)
I **hate** the tendency to blame parents and especially moms for things. I think about how they used to blame parents--and especially moms--for autism, for not being loving enough. It really does feel to me like a case of "is something inexplicably awful happening in your family? It must be because you're defective in some way/not doing it right."

One of the many, MANY problems with that line of attack is that if you take it, you can always find supporting evidence, since there are always impossibly high standards for how much attention/discipline/freedom--whatever the Thing Du Jour is--you should be giving.

That said, I know it's possible for a family situation (by which I mean, say, both parents under a whole lot of stress from work, or there's a sick grandparent or sibling, or whatever), the parents' and child's personalities, and the surrounding milieu to create an overall bad environment that could lead to mental problems--oh, and add in physical contributing factors, too. But that stuff doesn't equate to IT WAS MOM'S/PARENTS' FAULT.

I wonder if this country will become genuinely more fat-approving, and if it does, how that'll affect rates of anorexia.
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[personal profile] sholio 2017-08-04 02:03 am (UTC)(link)
I **hate** the tendency to blame parents and especially moms for things. I think about how they used to blame parents--and especially moms--for autism, for not being loving enough. It really does feel to me like a case of "is something inexplicably awful happening in your family? It must be because you're defective in some way/not doing it right."

Yeah, this one in particular feels extremely regressive/reactionary to me because it's a disorder that's heavily associated with teenage girls, ergo with the moms of teenage girls. Whereas so many other disorders that don't have those gendered associations are not usually tied to motherhood in that particular way -- e.g. we don't automatically assume it's your mom's fault if you have depression, if you are bipolar, if you're an alcoholic. Lousy parenting might certainly exacerbate an existing tendency towards any of those things, but we don't usually have this knee-jerk tendency to assume that someone is an alcoholic because their parents, and their mom especially, fucked up. (I mean, the assumption might be lurking there in a low-grade kind of way, and for similar kinds of reasons to why it comes out so strongly with eating disorders, but it doesn't usually come out that strongly, at least not in my general experience.)
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[personal profile] asakiyume 2017-08-04 03:01 am (UTC)(link)
I don't know, it seems like people are always saying how their parents screwed them up. But I guess that's different from saying that parents caused a particular psychological condition. I guess when it comes to strict diagnoses of things like biopolar or whatever, people don't blame parents--because they have better understanding of what does cause the thing. ... So maybe parents are a fallback in cases when there's not good understanding of the actual physiological cause of something.

(Not sure if my comment makes much sense as a reply. I started off thinking that maybe I disagreed with you because I hear people blaming their parents all the times for their hangups, but then decided that's different from actual diagnosable conditions--so I've ended up pretty much agreeing with you, I think.)
sholio: sun on winter trees (Default)

[personal profile] sholio 2017-08-04 05:37 am (UTC)(link)
What you're saying does make sense, though! And you're right that people do say things like that a lot.

... I guess maybe one difference, besides the clinical diagnosis thing you pointed out, is that it's talking about your own family vs. talking about other people's families? I mean, LOADS of people talk about how their parents screwed them up, but it's a lot less common for people to do that to other people -- "I have this problem because of my parents" is not that uncommon (and it might be based on actual reality, childhood resentment, or some combination of the two), but "YOU have this problem so your parents must have done [x/y/x thing wrong]" is a lot less common for most disorders. In the past, yes, but not so much these days, especially if you're talking about strangers whose parents you know nothing about.

But eating disorders tend to be an exception to that. And I can't help thinking it's got something to do with how heavily gendered they are, in general public perception if not in actual reality.
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[personal profile] oursin 2017-08-04 08:26 am (UTC)(link)
In the days not so very long ago when homosexuality was considered a psychiatric category, there was a pervasive 'blame the mother' theme in a lot of the literature, and even after it was removed from DSM.*
*(hence the graffito: 'My mother made me a homosexual./If I paid for the wool, would she make me one too?')
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[personal profile] em_h 2017-08-04 02:38 am (UTC)(link)
I've struggled with anorexia most of my life (nearly died of it thirty years ago -- it's better controlled now, but still there), and I feel confident in saying that my mother, though as flawed as any other human being, was an uncommonly loving and supportive parent, "good enough" even on her worst days. I've thought about it a lot, and I'm inclined to see a conjunction of several causal factors, including two years of vicious daily bullying in junior high, low-level gender dysphoria, and probably a couple of different genetic quirks -- I read a fascinating article last year which suggested that people with anorexia not onlyhave high anxiety (everyone knows that), but are constituted such that starvation actually reduces anxiety significantly, which feels true to my experience, and would have been a useful evolutionary adaptation in food shortage situations. On some level, you cannot be hardcore anorexic unless you actually get some kind of pleasure out of starving, and I can easily see that as a genetic twist which takes the temperament which could go many other ways, and channels it in the starving direction specifically...
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[personal profile] asakiyume 2017-08-04 02:56 am (UTC)(link)
Wow, that's a large weight [wow, and I didn't get the irony of that phrasing until after I'd posted] to bear. I'm really glad it's better controlled now, but I understand how that's not the same thing as gone. Your insights make a lot of sense.

I had a brush with something that sure looked like anorexia as a teen, but after that one brush, I never went down that path again .... so maybe it wasn't anorexia, because I know for most people, it does linger on. Whatever it was, it definitely had NOTHING to do with my mother. My father could be, and still can be, pretty annoyingly opinionated about women's weight, but I don't think that had much to do with it either.
Edited 2017-08-04 03:02 (UTC)
em_h: (Default)

[personal profile] em_h 2017-08-04 10:17 pm (UTC)(link)
Well, there's lots of different kinds of disordered eating, so whether or not your experience was anorexia pretty much depends how you define the term (I can't remember how long the DSM figures you need to starve to qualify for the diagnosis, but it certainly doesn't have to be long-term/chronic. Women get enough shitty messages about their bodies that it's not surprising that disordered eating is super-common, but it probably takes several more factors for it to become, as it were, a lifetime project.
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[personal profile] em_h 2017-08-04 07:47 pm (UTC)(link)
I haven't kept up on the current literature, but back when I was in treatment they got about halfway there, in that they acknowledged that many people start starving themselves in an attempt to make their bodies less assertively female. But this was treated as something which needed to be fixed by making people accept their assigned gender, rather than investigating for inchoate gender dysphoria (which was pretty deeply pathologized at that time as well, of course).

If contemporary thinking about gender had been available to me when I was fifteen, my whole life might have been different, but there's too much water under the bridge now...
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[personal profile] em_h 2017-08-04 10:18 pm (UTC)(link)
Oh my God was it ever...
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[personal profile] em_h 2017-08-04 10:20 pm (UTC)(link)
Is that still part of the current thinking, do you know?

[personal profile] indywind 2017-08-08 02:16 pm (UTC)(link)
I dunno what's the current consensus, but at least the therapist I saw for my gatekeepr of services pass gender dysphoria, interrogated the relationship between it and my history of disordered eating.
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[personal profile] loligo 2017-08-05 12:25 am (UTC)(link)
I read a fascinating article last year which suggested that people with anorexia not onlyhave high anxiety (everyone knows that), but are constituted such that starvation actually reduces anxiety significantly, which feels true to my experience, and would have been a useful evolutionary adaptation in food shortage situations.

That really is a fascinating way of looking at it.

I went through a phase in grad school where I obsessively read all the current clinical literature about anorexia. (It was roughly the during the period that you summarize below, where rejection of femininity was one of the hot ideas.)

What triggered it was a chance encounter with some research study that listed the characteristics of who was most likely to develop anorexia, and I ticked pretty much all the boxes they listed -- and I became terrified it would happen to me. I was, what, maybe 23 or 24 years old and really had no insight at that point in my life as to how any kind of mental illness worked. I thought that maybe I would just wake up one day and it would *happen*, like an alien taking over my brain. What was most especially frightening to me, besides the physical danger, is that I have always found hunger to be upsetting and anxiety-provoking way out of proportion to its actual physical sensations, and I imagined that there would be a "real me" partitioned somewhere, feeling all that terror, while the alien impulse to not eat continued.

On some level, you cannot be hardcore anorexic unless you actually get some kind of pleasure out of starving

Anorexia long ago dropped way, way down my list of things to worry about; I'm almost 48 -- if it was ever going to happen, it would have happened by now. But that one sentence of yours just put that fear permanently to rest.

I don't know if it would have been reassuring in exactly the same way in my twenties, because I have so much more experience now with the interplay of physiology and mental and emotional states. But thank you for that anyway. And I'm sorry that it's something that you still need to wrestle with.
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[personal profile] em_h 2017-08-05 01:08 am (UTC)(link)
People would describe it in different ways, and see different reasons for it, but I am pretty sure that anyone with an extended history of anorexia will tell you that starving is kind of like a drug. One doesn't want to dwell on that because, well, incredibly unhealthy to describe a potentially fatal condition in positive ways. But it's part of the condition, and the idea that there's a genetic quirk which accounts for that makes some sense to me.
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[personal profile] naomikritzer 2017-08-04 04:07 am (UTC)(link)
A friend of mine recently mentioned a friend of hers who struggled with anorexia for years ... and it vanished when this friend came out as trans. I sort of wonder just how many anorexics were dealing with unspoken dysphoria, and that was a piece of what was going on.

The thing that struck me after I read this book a few years ago: for decades, the belief about autism was that it was caused by "refrigerator mothers," and it was treated by trying to keep the mother out of the picture. And yet, I know so many parents of autistic kids where the mother is the kid's best advocate. Anorexia was similar: blamed on the mom, treated with "parent-ectomy," but in fact, family-based treatment works vastly better than inpatient programs.

I don't know. I mean, I definitely know friends with eating disorders who had parents who certainly set the stage for disordered eating in every possible way. But that's certainly not always it. I like the comparison to alcoholism; like, there are families that set the stage for it in various ways but there's also clearly a genetic predisposition factor and when a teen has a drinking problem, it's not treated in the context of, "obviously your Mom made you into an alcoholic, so let's try to fix what she screwed up."
kore: (Prozac nation)

[personal profile] kore 2017-08-04 05:25 am (UTC)(link)
Anorexia may also (sometimes) be a form or manifestation of OCD.

Mmmm no. Hornbacher talks about this -- she didn't have OCD when the anorexia was treated, but when she did, she sure as hell seemed to, what with the obsessing over steps in exercise and counting calories and so on. But that typically lessens as the person gets less dependent on stuff like weighing every scrap of food and figuring out if gum burns calories. What you're saying is kind of dangerous because people who actually have OCD can get misdiagnosed and mistreated for other conditions, and the OCD goes untreated. OCD can share symptoms with eating disorders, and disordered eating can be a symptom of OCD, but anorexia does not "manifest" as OCD. OCD can be comorbid with eating disorders, but people with eating disorders are, as mentioned elsewhere, a lot more concerned with gaining control over and reshaping their bodies. But there's a difference between disordered eating being a consequence of OCD, or disordered eating being a precursor to OCD-like behaviour. Ritualism and rigid behaviours are common to both but just because there are similar symptoms doesn't mean it's the same thing.
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[personal profile] rydra_wong 2017-08-04 07:30 am (UTC)(link)
I've seen some interesting mentions that people with anorexia are disproportionately likely to be on the autistic spectrum or have autistic traits:

https://spectrumnews.org/features/deep-dive/the-invisible-link-between-autism-and-anorexia/
https://www.sciencedaily.com/releases/2017/02/170202085719.htm

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[personal profile] shehasathree 2017-08-04 11:04 am (UTC)(link)
I've definitely come across this association between transness and anorexia before, and I think there's a bit more literature on it now than there was when I originally looked into it (maybe 8 years ago?). Anecdotally, it seems like there's a strong overlap, too, but obviously anecdotes != population data.

Wrt OCD potentially manifesting as anorexia, I remember reading some theoretical stuff about the construct of compulsivity as a link between OCD, OCPD and EDs (and also Jennifer Traig's memoir, in which (iirc), she linked her experiences of OCD and anorexia via scrupulosity).

Also: orthorexia.
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[personal profile] kore 2017-08-04 05:16 am (UTC)(link)
From her perspective, anorexia descended on her daughter like the demon in The Exorcist

My mother actually used to compare my adolescent years to both The Exorcist and The Incredible Hulk, heh. I would be very surprised if their family was "good enough" or even "basically okay" before the daughter became anorexic.

The model for anorexic family dynamics used to be that of a loved, absent father who knuckled under to a nagging, perfectionist, clingy mother (think Barbara Hershey in Black Swan) so my guess is she's at least partly reacting defensively to that, as well as "blame the victim/mother/woman" factor.
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[personal profile] brainwane 2017-08-04 09:06 am (UTC)(link)
there is nothing more infuriating to a big section of America than a woman who says, "It wasn't my fault."

I was wondering whether you'd compare this book in any way to We Need To Talk About Kevin (which I see some people commenting on your journal have mentioned but which I don't think you've reviewed).
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[personal profile] vass 2017-08-04 10:24 am (UTC)(link)
Americans are very apt to blame the victim.

Isn't the person with anorexia the victim? Without going into whether or not Harriet Brown is at fault for her daughter's illness, and while acknowledging that, as you say, a child with an eating disorder affects and is affected by the whole family, I'm still uncomfortable with framing a child's mental illness as something that "happened" to the child's parent, let alone something that that parent is the "victim" of.

While family memoirs of anorexia might be rare, there is a thriving genre of mother's memoirs of their (Touching! Inspirational!) struggle with their child's disability, not always with the consent of or to the benefit of the child, and sometimes when the child's too young or too disabled to give meaningful consent. (In the case of autism in particular there is a huge volume of material posted online posted by parents that's very much not in the child's interests and is highly invasive of their privacy and dignity and even safety, which the parents justify as necessary to "raise awareness" of the "scourge of autism".)

In this case the child did give consent, but if she's still a minor living with her parents and has been the focus of heavy family-based behavioural therapy, I do have to wonder if she had much of a chance to refuse.

Even without disability or mental illness in the picture, who owns the narrative of a child's life, her or her mother, is kind of a fraught subject... Do you remember when Michelle Obama "bravely owned up to her own struggle with her daughters' weight" in order to Raise Awareness of childhood obesity? I generally like Ms Obama, but I think that was fucked up, because it's her daughters' bodies, not hers, they are teenagers, and they had very little choice already about being public figures.

The ethics of memoir and autobiography are a vexed subject, I know (and you have no control who lives, who dies, who tells your story), and usually I come down on Anne Lamott's "if they wanted you to write warmly of you they should have treated you better," but I think parents of living children have a higher responsibility to those children than most memoirists do to the other people in their memoirs. Especially when they claim to be telling the child's story or speaking for their child or for the family as a whole.
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[personal profile] naomikritzer 2017-08-04 04:38 pm (UTC)(link)
The daughter was no longer a minor when the book was written, and not living at home. She was either in college or post-college. (The final chapter of the book discusses a relapse she had while in college.)

I've read a pile of memoir, so I totally know the HEROIC PARENT STRUGGLES WITH THEIR CHILD'S TRAGIC DISABILITY school of narrative. This overlapped those books somewhat but was radically different in form and tone. It reminded me a bit of "Unstrange Minds" by Roy Richard Grinker, an anthopology professor with an autistic daughter who wrote a book exploring different cultural ideas about autism, which is radically unlike the "heroic mom brings attention to the tragic epidemic!" school of autism books. (Grinker thinks the "epidemic" is because we used to misdiagnose autistic children with intellectual disabilities.)
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[personal profile] landofnowhere 2017-08-05 04:17 am (UTC)(link)
(Jumping in to the middle of a conversation, if I may:)

Although I haven't really read them, my impression is that there's a (somewhat older?) subgenre of autism parent memoir which is "heroic mom stumbles upon the miracle intervention that cures kid's autism", I think the standard instance being /Let Me Hear Your Name/ by Catherine Maurice. (Where the "miracle intervention" may be a false positive because some autistic kids have symptoms that improve rapidly for reasons we don't really understand.)

That was the sort of thing that the description of this book reminded me of. And although I'm inclined to agree with the book that genetic/biological factors are important, the analogy to of "demon possession" does make me bit uncomfortable in the same way that likening autism to demon possession would -- though I'm glad to hear that this handles things in a thoughtful way.

That said, maybe having midly problematic attitudes about mental health is a normal thing, and does not make one into a *terrible parent who is at fault for all the children's problems*.
vass: Jon Stewart reading a dictionary (books)

[personal profile] vass 2017-08-05 06:09 am (UTC)(link)
However, the daughter was an adult and not living at home at the time of writing.

That is good to know.

she's not claiming to be speaking for her child or the family as a whole, but explicitly states that she's speaking for herself.

As is this.

On the flip side we also can't assume her lack of agency or inability to refuse.

True.