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

[rachelmanija]

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

Comments

[em_h]

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...

[asakiyume]

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.

[em_h]

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.

[rachelmanija]

Thanks for commenting. Interesting that you mention gender dysphoria, given a couple other comments - I've never seen that mentioned in formal literature as a contributing factor, but it clearly is sometimes.

[em_h]

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...

[rachelmanija]

Oh, you're right! I have read lots about that. It just completely fell out of my mind as something that could be related to gender dysphoria or being trans, because it was written about in a way where those weren't even considered possibilities - it was considered the denial of a fixed and inherent femininity.

[em_h]

Oh my God was it ever...

[em_h]

Is that still part of the current thinking, do you know?

[rachelmanija]

I'm not sure.

[indywind]

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.

[loligo]

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.

[em_h]

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.