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

[asakiyume]

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.

[sholio]

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.)

[asakiyume]

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]

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.

[oursin]

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?')

[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.