The Dos and Don'ts of Parenting a Child in an Eating Disordered World

It is a telling sign of privilege when family life revolves around what's best for the children. In the stereotypical household, adults organize their time, night and day, around entertaining and enriching children's activities. The underlying sacrifice is unacknowledged, even expected, because who would dare not follow this parenting model. Brushing aside any remaining adult desires is a given, although the most pressing, if subconscious, ones become incorporated into the often unspoken family philosophy, thereby creating the myth of unity, as if the disparate personalities and needs of the family members can come together as one. Unity of purpose may have been an evolutionary benefit, but unity of mind--a cult of family--certainly was not. It is a dangerous precedent to equate psychological well-being with toeing the family line but that is exactly what the cult of family dictates. The ultimate conceit of the privileged family--the socioeconomic class most at risk for producing an eating disordered child--is not just the goal but the inalienable right to raise a happy and, using community-based measures, successful child. And that somehow, inexplicably, this must be what the child wants too.

Not particularly long ago, but long before the disordered eating epidemic, children were expected to fit into adult life. This was a time when there was living memory of a brood of children raised primarily to improve family survival. The pressure to make it far outweighed the luxury of nurturing a child's identity. Providing for children--maybe just surviving to adulthood--was enough; moderating feelings, massaging egos and micromanaging personal growth were not even on the table. They became who they were to become and, hopefully, followed the path laid out before them. Children were psychologically free since no one was terribly interested in what went on in their minds, unlike the current norm when nothing is private or sacred. These days children, burdened by the expectations meant to overcome their parents' personal disappointments, have their identity crafted like a shell made to order by their parents' exact specifications. Sadly, this happens long before developing any self-awareness, let alone a fledgling sense of identity, themselves.
This default view of involved parents has been seen as a sign of the evolution of the privileged family. No one questions the benefit of parent as de facto child psychologist, subtly questioning the kid like a little adult and unconsciously teasing the impressionable mind to tell the parent what he wants to hear. Parents used to know, instinctively, that kids simply played and learned for many years; the struggle for self-awareness, internal stability and personal direction, thankfully, came later. Now the false premise of making mini-adults co-opts the freedom of childhood for the personal satisfaction of needy parents. The inevitable pressure that builds between the desire to please with the innate drive for independence and identity has clear consequences, one of which is the temptation of food restriction and thinness.
It is humbling to see the well-intended parent guide children into the chaos of an eating disorder. It is daunting for the child not to see a way out. But the anti-tropes of the privileged family are never spoken: not every child is a prodigy; some kids get C's; different children have different strengths and weaknesses; achievement is not guaranteed from hard work; any difficulty in school is not by definition a learning disorder. Most importantly, a child's life is his to lead, not a second chance for parents to correct their mistakes or move past their regrets.
The path from prolonged, encouraged dependence on family to a focus on thinness and weight is a theme of this blog. The reward and praise for weight loss both satisfies proud parents and opens a new but false direction of independence and identity. The underlying message of a burgeoning eating disorder is clear to any adult who will listen: "No one can tell ME what to eat." This tidy package satisfies the cultural norm, especially during adolescence, while providing the simple solution any child craves. There is no gray area around disordered eating and weight, just a simple right and wrong. Encased in the pre-fab shell of identity and expectation, draped in the mantle of hope and unlimited potential, this child desperately seeks an escape. An eating disorder can be just that way out.
The attitude towards food and weight taught at home is a critical part of helping a child avoid the risk of an eating disorder, but the family message about identity and expectation is perhaps less obvious but equally important. The rise in the incidence of eating disorders has coincided with the transformation of family. Ironically, fostering the growth of a child's identity takes away from the freedom to explore and learn. The creation of the hovering, over-involved parent has stifled the experiences of childhood that lead to a sense of identity, with both accurate and flawed parts, that grows with time. But this ever changing sense of who we are is a freedom of being human, a right akin to the basic self-awareness and consciousness we take for granted every day. Recreating a world where we just pay a little less attention to the inner workings of a child's mind, where we grant kids a little privacy, may go a long way to stem the tide of eating disorders.

This post addresses the freedom for children to be allowed to become their own person. Part of the prescriptive approach to raising children stems from unhappy parents looking for salvation in future generations. That salvation is no longer something attainable, like the antiquated belief in the American dream. The family expectation is to become something great, something beyond one's imagination: the bar has been set much too high.  Under this pressure, the suggestion for a parent not to do something falls on deaf ears, especially in a culture which insists that something can always be done, someone can always be blamed--society, media, government, big business or parents. Then is it not just the moral but legal obligation of a parent to guide children through the maze of the modern world? The next post will address this vacuum: if a parent doesn't micromanage, then what should a parent do?


The Tangled Web of Identity and Eating Disorders

In a recent meeting, a colleague, speaking about her work with children over many decades, recounted the story of a patient she has treated for thirty years, starting at age six, for "the most profound anxiety disorder I have ever seen." Just the other day, the patient, deliriously happy but exhausted, called to recount the story of the birth of her first child. "Imagine me," she said, "dealing with needles and so many doctors examining me! But I just explained to them my longstanding anxiety and fear of doctors, then they helped me through it." My colleague paused for emphasis, clearly proud, and then presented the moral of her story: if you know yourself and are clear with others about your limitations, anything is possible.

As she went on to expand her thesis into play therapy for children and even parenting advice, I found myself thinking about identity. This patient's sense of accomplishment was momentous and her ability to recognize her achievement moving, but I felt something nagging at me nonetheless. Although self-acceptance is no doubt a critical part of maturity, an identity--the reflection we see both in the mirror and through our family and friends--cloaked in symptoms and limitation seems like a misguided message for kids. Isn't childhood a time for hope and promise? Won't the humbling lessons of adulthood only limit a child in need of perseverance and confidence? All of this left me stuck on the larger question: what are the implications of an identity based largely on the extent of our deficiencies?
The individual accomplishments of my colleague's patient were something to celebrate, of that I was clear. The intended message, though, explored one way of addressing kids' struggle to find identity in today's world: find oneself through difference or limitation and fashion a life from the options remaining. But the implicit advice was cautious if not undermining: avoid challenge and even confrontation to do what you're capable of. Satisfaction comes not from hard work but from the most manageable path in front of you. This reeked of a self-help approach to the world, or the opening salvo of a daytime talk show special, not a potential solution to helping kids build a sense of who they are and certainly not a philosophy of expectation or hope for change. But when the pursuit of happiness becomes the prevailing life philosophy--an unfortunate consequence of the banal advice-giving media spawned from its roots in psychotherapy--progress, hard work and challenge all seem to go by the wayside.
The infiltration of psychiatric symptoms and diagnoses into our self-image is a given in many pockets of society. It used to be that only medical students during their psychiatry rotation nervously thumbed through the latest DSM--the bible of psychiatric diagnoses--terrified to find their deepest secret staring back at them from the criteria of a mental disorder. Now, the DSM is widely available through a mere search of the web, and identifying with mental illness a rite of passage for adults and youth alike. The trying, social process of overcoming shameful secrets has been supplanted by the now commonplace but brazen announcement "That's just my OCD." Your own personal psychiatric symptom is almost a part of the social resume: hometown, religion, race, socioeconomic background ... current mental illness. Or perhaps it's a permanent crutch, a built-in limitation for what one can achieve.
Of all the psychiatric symptoms, manipulation of food and weight create purpose, attainable goals and success out of thin air while simultaneously obliging those looking for children to just be happy. In the cloud of psychiatric symptoms, weight loss and the subsequent positive attention--including the hushed whispers of "is she anorexic?"--is almost a badge of honor, not a crutch in the least. It feels like the sky is the limit as the pounds come off. The demoralizing expectations of a life hampered by a series of psychiatric symptoms evaporates. The world figuratively and literally feels a little bit lighter. The growing epidemic of disordered eating and pursuit of thinness is a simple solution for the directionless child compelled to find meaning in the world. At least for a little while.
Caught between the adolescent drive for purpose and the lure of losing weight, many girls find solace in identifying as eating disordered. The formative years from middle school through college, if nothing stops the onslaught of the disease, can leave one's identity intertwined with the disorder itself. A bright, quick mind, when consumed with the fear and intensity of an eating disorder, will create a vast and complex array of rules to follow in this hidden world. While being controlled by the details of calorie-counting, avoidance of terrifying foods or the search for culinary perfection, the consummation of identity and the disorder is complete. In the end, "you ARE anorexic" is the accepted statement, not "you have anorexia." The grammatical difference may be subtle, but the meaning is crystal clear. Treating an illness is one thing; treating an identity is another.
This post brings up as many questions as it does answers. How do adults help children form identity? What avenues for self-exploration and achievement don't exist for kids? Without other available options, weight loss and food manipulation are powerful tools easily at a child's disposal. Whose responsibility is it to open new doors so at least there is competition for a child's attention and drive? I'll start with these ideas in the next post.


A True Moment of Reflection

Looking in a mirror is a trivial moment in most people's day. Whether to survey an outfit, observe a blemish or simply take stock, few things are more routine. Yet this nonchalance is symbolic of a life blindly led. It is common to mistake emotionally-charged moments, such as languishing in disappointment and self-criticism or relishing successes, for moments of true introspection. Deeper reflection means not just living in the moment but looking at what we hide even from ourselves: jealousy, greed, explosive anger and shame but also the most vulnerable love, dependency and tenderness. A person living without reflection is still driven by these internal, emotional forces but acts as if reasoned decisions and illusory control pave the way.

In its entirety, the community of people with eating disorders share the burden of empathy, as I described in the last post, and the concomitant role of society's emotional mirror, a thankless role for a world unwilling to take a good look at itself. With a quick glance, perhaps for something as mundane as checking its hair, the larger community may acknowledge what's in the mirror but has no interest in true reflection. Just as a family can heap responsibility onto an empathic family member, society can choose to blame the faulty reflection.
Many of the truths, even those too obvious to ignore, can be readily explained away. Obesity and diabetes in children: lazy, uninformed, uncaring parents. Homogeneous, unhealthful fast food: uneducated poor food choices of the masses. Epidemic of disordered eating: children making immature decisions. Explosion of eating disorders: ah what these crazy women will do to look thin. And the quick fixes are like patching a roof about to collapse from a deluge: misleading nutritional information on food items, Bariatric surgery, spa retreats to cure eating disorders.
The facile mind can always find a new explanation for the unusual or even the absurd. History is rife with tales of societies caught up in sheer folly on the way to destruction and chaos. The path lined solely with reason lands, sooner or later, in the muck. After crawling out of that mess, finally, one will have to really look in the mirror to see what happened. In that moment, the empathic women, silenced by eating disorders and filled with a different understanding of the manipulation and degradation of food and weight, might have their moment.
If empathy is the glue that binds humans into a complex, interdependent and ultimately fair society, then is a world without empathy worth living in? Modern living is about shared experience lived in isolation. We all live in our little bubbles, know a smattering of like-minded people and misuse our unfulfilled desire for connectedness to obsess about our own daily minutiae. The care and concern for others is routinely quashed: war looks suspiciously like the latest video game; natural disaster like the most recent apocalyptic movie. And if the empathizers, lost and ignored, have been wooed by calorie counting and the number on the scale, who cares about what's happening to people in need? Where is the mirror to steer us back to our collective responsibility to care for each other?
The most curious and disturbing aspect of our current food culture is that the well-off now starve while the poor are fattened up on food akin to garbage. This discrepancy is most notable in children. It's the right of passage for a suburban girl to start her first diet while the inner city kid only finds McDonald's in the neighborhood. The implicit government support--through lax regulation of the food industry--of this travesty and the blatantly unethical corporations which capitalize on the social forces (both the weight loss and various food industries) work hard to silence the reflection of empathy. Nothing can tamper with the bottom line. Instead, we all just continue to blame the reflection.
I fear that the silenced voice of empathy hides the ugly underbelly of our isolated world. The shameless celebration of the culture of plenty obscures the inequality, need and pain all around us. Surrounded by such abundance, the acceptance both of starvation and obesity-related illness--paradoxically in the well-off and poor, respectively--is unconscionable yet sadly has become routine. Meanwhile, the group of people most aware of the absence of social justice and most able to spearhead a revolution--an apt analogy during this time of upheaval in the world--suffer needlessly at home alone except for their food and scale.
The next series of posts will shift to food, children and identity. I will start by discussing how our relationship to food helps create identity in children and is closely intertwined with the development of an eating disorder.