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.
