Parents vs. Doctors
Are you the parent of an adult child with an eating disorder? Run, don't walk to this blog post by one of my favorite blogs, F*ck Feelings.
Actually, I'll save you the bother of clicking and just post the whole thing in its entirety below (the question from the parent is in italics. Everything else is from the blogger/psychiatrist):
People like to turn to an authority when they’re helpless, and if that helplessness only applied to 911-like situations, there would be no problem. For problems that don’t involve theft or fire but sadness and family, however, authority is useless; sure, doctors like me can give advice, but until medical schools start borrowing from Hogwarts’ curriculum, the best resources you have are your own. The sooner you realize that, the sooner you’ll learn to draw on your own authority to come up with the best possible management plan and execute it with confidence. You are your own best first responder.
I need to find a doctor who will tell my daughter she needs to take her medication. She’s always had a problem with depression, and she did well in high school when she took antidepressants. Now, however, she’s 24 and very reactive to however she’s feeling, whether it’s not getting out of bed, or not working, or feeling dizzy and deciding it’s the medication and stopping it. My husband and I can’t get her to stick with anything, and she won’t listen to us in any case, so our goal is to get you, or some professional, to tell her what she needs to do.
Whenever parents want a doctor to tell their kid what to do, you can be pretty sure they’ve lost faith in themselves and overestimated the power of communication/a medical degree.
And no, it doesn’t matter how old the kid is or how many Harvard degrees the doctor has; the doctor doesn’t have more power than the parents, no matter how powerless the parents feel.
In your case, I don’t know whether your daughter can be induced to take her medication, but I do know that she’s not going to be persuaded by the authority of a doctor at the age of 24 if her own experience and your words haven’t done it by now.
The probable reason for her unresponsiveness, by the way, isn’t stubbornness or a lack of respect, but a lack of control over her own impulsivity (probably enhanced by depression). In other words, it’s not clear she can make herself take medication regularly, even if she sincerely believes she needs it. At some point, other impulses take over, like the impulse to stay in bed indefinitely.
Fortunately, even though persuasion is probably useless, you have other tools that a mere doctor can’t touch. You can access them if you believe you know what your daughter needs, regardless of what she has to say about it.
For instance, if you believe that she needs to get up early and follow a daily activity regimen, then let her know that’s what you’ll pay for. If she says she’s too blah, tell her you know it’s hard, but she needs to try, and that she might be able to do it if she puts together a schedule and asks friends to help her keep it.
If she argues that she can’t do it until she feels better, tell her that you don’t know when she’ll feel better, so she’d better start trying to keep busy now, and maybe that will help her feel better later. Your tone should say that you believe what you believe, and there’s no point in arguing.
If she tells you that you don’t know what she needs, tell her that you’re the mother and you have a good idea what she needs. Don’t ask a doctor to be the authority– get whatever information you need from the doctor, and then assume you’re the authority. At 4 or 24, your kid needs to hear the same thing; you’re the mommy, that’s why. End of discussion.
If your incentives don’t work, don’t blame her or yourself, because, again, you don’t know whether she’s too sick to have the control she needs. By putting a priority on self-control, however, you provide her with a blueprint for moving forward that is not reactive to negative feelings or thoughts or painful side-effects.
You’re urging her to embrace goals that arise from her values and that she can stick with, regardless of how she feels or how much she accomplishes. Knowing medicine isn’t as important as knowing your daughter and what’s best for her. If she won’t listen to me, you can, and I’m telling you you’re the most qualified professional for the task.
STATEMENT:
“I’d like to think my daughter could respond to persuasion from someone she respects, but I suspect it’s not true. I’ll push her towards doing as much as she can, regardless of how she feels, and hope that incentives for good habits will take over where persuasion has failed.”
Excuse me while I go clone this guy millions of times over so that a) he can be all of our doctor and b) so that we can have him as our very own Psychiatrist Pocket PalTM.
8 comments:
that man is a genius. but I bet he won't find anyone else in the medical community willing to agree with him...
The Wizard of Oz! Dorothy didn't need the help from the wizard-she had the power in her own ruby slippers all along! She just needed to be empowered to use them. I think this is what FBT does, it empowers parents to use those ruby slippers for good.
But Carrie, I think there is a reason that parents are looking for someone else to help their child instead of relying on themselves.
I think this is because traditional ed treatment beats every one down and robs them of confidence-parents and sufferers alike.
One day I thought I was a normal mom struggling through life's ups and downs, just like everyone else I knew and before I knew what hit me, therapists were digging through our lives, throwing everything that ever happened to us up into the air like dirty laundry. I was made to feel that I caused my daughter's terrible problems and that it would take years of therapy to undo my influence on her. I didn't really understand what was going on with the eating disorder but then I learned that somehow I had caused it and I was therefore not competent to help my own child!
A darkness settled over my soul and it was hard to move out of that place. And yet, with all these bad feelings, I still didn't understand exactly what I did to cause my daughter's anorexia when she was just an energetic girl laughing and playing like other girls the year before?
One therapist told me that my daughter had anorexia and delusional & suicidal depression because I gave her "time outs" when she was little! In my sorry state, I carried that guilt for quite awhile until I realized that this idea was an absurd personal speculation of this therapist and it served no purpose but to beat my mothering instincts and confidence further down into the ground.
So how could I help my daughter if I didn't even know what I did wrong??? I thought we needed professional help and I asked everyone what to do and expected professionals to help my child. And when they couldn't help, they pointed a finger at me and told me that she needed to go to residential!
No way! This galvanized me. I love my girl and wouldn't send her away! She might think I gave up on her or that I didn't want her around! That would be horrible! I was scared not to follow a professional recommendation, but this was so unacceptable that I sought a second opinion with a FBT team.
It was an amazing difference right away! My daughter was ill with anorexia. It wasn't my fault, it was an illness. She needed her parents to help her get better. We knew her best and were authorized to help. Seven admissions to the hospital in 7 months before this point along with countless partial hospitalizations and IOP treatments. After starting FBT, there were no admissions in 2 years and she went right back to high school where she belonged. It wasn't easy but our family had the power all along.
You just can't beat those ruby slippers! Parents have them, yes, but if this illness has cost them their parenting confidence, they may not know they can use those slippers. This blog post was good but if the psychiatrist is wondering why parents are acting so helpless, perhaps one of his/her partners taught the parents that they were......
Anon,
You have a good point. But I think most parents feel helpless when their children are sick. And even with FBT, even with empowered parents, it can be a sickening feeling to know that you don't have a magic wand that will make all of this go away.
So the feeling helpless isn't solely from blame from the medical profession. Some of the helplessness stems from the nature of the disease.
I think the other part of the helplessness has to do with a misunderstanding of what depression/ED/whatever is. Most people think that people with mental illness can be somehow rationalized into behaving better. Whether that means we can logic ourselves into making the illness go away or suddenly being content with treatment, I don't know. But when you realize it's an illness, you stop asking for the impossible. You stop waiting for your kid to start wanting to take her meds and start trying to figure out ways to get her to take them anyway. When you frame resistance to treatment as a symptom of the disease, it gets a lot easier to understand and act.
It's hard to realize that there's a limit to what you can do.
You know what's sad though- In the depths of my ed, I am the one who takes my parents' power away. Not medical or psychiatric professionals- ME. They express concern and I tell them they are making me feel guilty, and that makes me not eat. They tell me I need to eat, and I tell them they're pressuring me, and that makes me not eat. No matter how they try to help me out, I turn it on them and I make them afraid to reach out to me. Then when they retreat, out of fear that they are hurting me and making things worse, my ed gleefully takes hold of me ten times tighter and runs away with me. "See??? They don't give a shit. They were just appeasing their guilt. You've made them free. And all you have is ME." There is a me inside my head that cries and wishes they'd stick with it. But the ed me sabotages them every time they try.
My parents didn't put any faith in the medical profession at all. In fact, they couldn't understand why I wanted/needed to see a psychiatrist or therapist, when OBVIOUSLY all I needed to do was suck it up and stop attention seeking/being selfish/trying to punish them/being pathetic/whatever other theory of the day they had for my ED, self harm and depression. My parents fell into a totally different camp - they were so terrified that I was seriously mentally ill that they refused to believe it and instead placed all the blame on me. I don't feel angry or bitter about that (now, anyway!) because people can react strangely to fear, and their being pissed with me was just a way of pretending there was nothing really wrong. Not that I need it now because my relationship with my parents is much better, but it would be good to know what the magical psychiatrist would say to parents who fall into this camp too.
I understand the point here, but in some situations with EDs don't doctors actually have the last word in terms of coercion? When I went inpatient the team got me to eat - by giving an ultimatum that they would physically hold me down and force feed me if I didn't. Could my parents have done that? Nope, cause it's called child abuse and I was old enough and stubborn enough to KNOW they couldn't follow through so threats didn't work. Doesn't it depend on family dynamics to some extent with adult patients? Also, I always found obeying orders to eat from doctors easier than anyone in 'real' life, parents included, cause it was better 'justification' that I needed it for my ED.
just my 0.02 although I know it won't be popular ;)
Sorry but I disagree with this doctor. I developed raging anorexia at 22 in college and when I came home to live with my parents- nothing they did could help me. Finally, they threw their hands up in the air and said we love you, but you need professional help that can guide you through this. I went into IOP and was very distant with my parents throughout my treatment. Mainly because a lot of my issues causing my ED stemmed from them. They were always there for me during this time (I lived at home), but my therapy would have never worked if they would have done things that the author is suggesting. My hostile household due to my ED would have become even worse. I needed my pdoc, my therapist, and my dietician to be my ED team and they did a great job (I still see my Pdoc today at 26).
i also feel like "just please do it" isn't always the solution. i have a very supportive boyfriend who wanted me to make a schedule and keep it but i was too depressed and preoccupied with death to care about anything. even talking to a therapist couldn't help me. i KNEW i should "just do it," but i just couldn't bring myself to. sometimes i would burst into tears or have an anxiety attack just leaving my room. once i was prescribed wellbutrin (an anti-depressant) however, everything was different, i no longer could dwell on death, and every little piece of encouragement helped.
so yes encouragement is always more helpful than the opposite but sometimes just support isn't enough. in my case there were literally things wrong with my brain (neurotransmitters not working like they used to.) medicine is not always the answer but sometimes the road to recovery is a lot more complicated than just one piece of advice.
i love my friends and doctors and boyfriend who supported me. but nothing they said could help when dying was all i could think about, even if i didn't want to think about it.
anyway i'm really glad you're getting healthier :) i am too, and that's what's important!
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