Hilde Bruch called. She wants her outdated theories back.

I read this article a while ago, and I'm still scraping gray matter off my computer screen. The only response to this load of tripe is complete and utter evisceration of her points.
First off, the article. Read it here. If you're low on Sanity WatchersTM Points, read no further. If you have MohDoh, get it out now. Oh, and here are some paper towels to clean off your computer if your brain explodes like mine did.

(Hey, it's the Quicker Picker-Upper, right?)

So, onto the evisceration.

Let's start with the first paragraph:

The medicalization of eating disorders -- that is, the push to find the genes that trigger them -- has offered solace to many sufferers. It's got to be easier to consider anorexia and bulimia more like, say, an autoimmune illness linked to an inherited vulnerability than than a reflection of family trauma or your own insecurities.

Unfortunately, at this point, the hunt for the illusive eating-disorder gene is just that. Illusive. Perhaps one day, doctors will be able to tailor treatments to fix genes that prompt self-destructive behavior. For now, without any quick fix, the best solution may in some ways hark back to something a bit old-fashioned: looking at the home environment and exploring your and your child's emotional issues around food, control and power.

A biology lesson for the good doctor (the university who granted her medical degree really should revoke it--this is seriously BASIC biology): Most disorders with a genetic basis don't have a single causative gene. Those disorders that do, like cystic fibrosis or PKU, are the exception to the rule. There's no cancer gene, no diabetes gene, no schizophrenia gene or bipolar gene. There won't ever be. Genes don't cause disease. They basically make proteins, and if the protein isn't made properly, then a disease can result. Often many genes combine with environmental factors increase or decrease the likelihood that you will develop illness.

And just because there's no "quick fix" for eating disorders doesn't mean that there isn't a biological basis. There's no quick fix for HIV, for crap's sake, but that doesn't mean it's not caused by a virus.

The search for genes linked to eating disorders aren't because people are lazy. They're not doing because they just don't want to do the work. Nor are parents looking for a so-called "quick fix" lazy, either. I'm sorry, I don't think that not wanting to put your kid through years of painful treatment with an unknown payoff makes you lazy or a bad parent. In fact, quite the opposite. Wanting your child to return to normal life as soon as possible sounds rather, dunno, healthy to me.

When Food is Family contains anecdotes about parents who are so controlling that children feel the need to restrict food as a way to assert their own independence, about families that are so emotionally starved that children fill an emotional void with food. None of these analyses are brand new, but the coping techniques she outlines offer a framework for families who may be coping with a child who is starving or purging or both.

The plural of anecdote isn't data. I'm sure these families exist, but several studies have shown that emotional starvation or over-controlling parents don't cause eating disorders. Researchers have known this for YEARS (Eisler, 1995; le Grange, 2008). These views show willful ignorance and pure boneheadedness. Yes, people with eating disorders have crappy families, but they don't have them at any higher rate than people without eating disorders.

So...yeah. I just can't figure out how the hell people get these platforms for such trash!

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Angela Elain Gambrel said...

Good for you, Carrie! Why is this doctor buying into such old, outdated theories??? Maybe the exact genetic component(s) haven't been found, but I am sure - although genetics is really not my things - that the genetic component to many disease has not been teased out yet. That doesn't negate the fact that many illnesses have a genetic component.

And the modern twist is CBT? CBT has been around for quite a while. This doctor's theories is just another twist on the old "let's blame the family/parents/patient" idea.


Unknown said...

I'm an average parent. I mess up all the time, but that didn't cause my daughter's clearly delusional and life-threatening eating disorder, nor did I have to fix myself to help her recover. I had to channel every skill I had as a parent and we had as a family to help her, and we did.

Did I learn from the experience? Heck yeah: I learned that all those who empowered my daughter's eating disorder instead of me were doing dangerous harm.

hm said...

Oh. My. Gosh. I literally felt like I couldn’t breathe as I read some parts of this. It is a painfully psycho-babblicious essay in stupidity- utterly ignoring recent scientific advancements and facts while at the same time trampling all over people who appreciate the science of eds- like a giddily happy dog in a flower bed, not realizing it’s destroying someone’s flowers.

She writes casually as if she’s not offering radically offensive accusations towards families who have studied up on the scientific advancements of treatment. She says they want an easy out, a quick fix, like they're too fucking lazy to do the REAL work.

WTF??? “Parents today want a sound bite, a solution that will take no more than, say, four months,” ????? Where the ***** does she get the four months bit??? And maybe she’d like to ask my 76 year old mom if recognizing that my ed isn’t my fault (or hers) and coming to stay with me and fix my meals for me, in spite of her age, is a “quick fix” or an “easy out.” I have never once read ANYTHING to substantiate her views on parents who take on their child’s ed as an illness. If anything, I’ve read the opposite. Parents who take on the ed b/c their child can’t are profoundly strong, courageous, dedicated, and loving. Not lazy assholes on a time crunch looking for a quick fix. ***** this woman. And the author she quotes.

This woman doesn’t sound like she's being purposely aggressive, but man, is she dumb. And if any of her patients have come clean of an ed after dealing with her, it has been in spite of her thinking, not because of it.


Sensory Overload said...

I don't even know how to comment but want to.

Simply to essentially say, ARCHAIC THINKING!!!! Or; what in the hell world foolery?

-Thank you for the Bounty paper towels. Brain explosions, to all out me spilling my own disbelief to wondering if I actually am reading what Hilde Bruch is saying. is she "okay"?

Thank you for bringing this to light Carrie. I wish I could arrange my thoughts to translate to a proper response, but this has simply stymied me.


Anonymous said...

Thank God I live in New York, or the passersby on the sidewalk below my apartment window would find it strange that I'm yelling profanity at no one.

"looking at the home environment and exploring your and your child's emotional issues around food, control and power"--I didn't read the title of your post, and the moment I read this line, the first thing I thought was "Well, this has already been looked at...in The Golden Cage."

They can censor forums for ED'd people not currently in recovery (and I'm not talking pro-ana, either), but they can't censor this? Misinformation passed off as accurate and current by someone touting letters after her name is downright dangerous and irresponsible.

Anonymous said...

Just read the Huff Post article by Randi Doodah. The book by Judy Scheel sounds utterly dreadful and terribly outdated.

I actually do agree with the idea that a gene or specific genetic trigger for anorexia nervosa (AN) alone will probably never be found, and that it seems unlikely that AN is purely an inherited condition. We know that AN, anxiety disorders, major depression and autism run in families, so it would seem more likely that the inherited factors are cognitive processing styles and personality traits.

Nevertheless, the idea that family dynamics somehow cause the self-destructive behaviours of AN is nonsense. This book is taking the treatment of AN back to the dark ages; as you say, to Hild Bruch, whop did so much damage to families, including my own, in the 1980s.

I actually HAVE had psychoanalysis to attempt to uncover the 'root cause' of my AN - and this strategy was useful in that it uncovered absolutely NOTHING in my family dynamics, or attachment that could plausibly have caused my AN.

Katie said...

I don't know whether to explode at the idiocy or laugh at your title Carrie! Possibly both, which will make me sound a little hysterical. The other one which drove me crazy this week was the "economic analysis" of anorexia...I'm sure you saw it.

I've seen psychodynamic therapists too, two for eighteen months each. I got sicker and sicker during those three years. Conversely, one year with a humanistic therapist who taught CBT and DBT strategies on the side did more to help me than the entire rest of the therapy I'd ever had. And my poor mum - I didn't say this at the symposium, but I was actually diagnosed with an attachment disorder at the age of 16. I didn't have a bloody attachment disorder, I had a bad combination of a basically anxious personality reacting badly to the hormonal chaos of puberty and some bad experiences with bullying at school. The whole reason my relationship with my mum was so difficult throughout my illness was that she was blamed at the very start. I'm still pissed off about that over a decade later - it would have saved everyone a great deal of time, effort and pain if she had been told that it wasn't her fault, it wasn't ANYONE'S fault, and she was given lots of support to help me.


Katie said...

I said bad three times in one sentence there. My writing goes to hell when I'm worked up!

Rod McClymont said...

Go Carrie !!!!! I have nothing to add, you have said it all clearly and eloquently and I'm just cheering from the side line.

Anonymous said...

I disagree.

I think that there may be some use looking into the biology, but if it hadn't been for my home environment and childhood trauma, I don't believe I would have developed an eating disorder.

My feelings about my body being repulsive and contaminated have a source that I do not think is rooted in genetics.

HikerRD said...

Ok, in fairness while I totally understand your frustration, let's put her writing in context: didn't she write The Golden Cage or whatever it was called back in 1979 or 1980? At least she was among the few to explore eating disorders when no one else, to my knowledge cared. And she was, I believe, the one who identified a connection between a low percent body fat in dancers and others, and ammenorhea. She probably did a lot to raise awareness. I remember reading her books way back before anyone was talking about genomes and the like, and neurobiology was at best a sci fi idea.
Just saying...

Ann said...

My daughter has anorexia, and I blame myself every day. I know that this is illogical of me; I know that there are so many factors that come into play. But as a parent, it's hard not to place all the blame upon yourself. Just wanted to write to say that I really enjoyed this post. And for any parents out there http://onlineceucredit.com/edu/social-work-ceus-eda is a great site to learn more about how EDs affect those who have it. Thanks again for the honest post.

Ari J. Brattkus said...

Carrie, as always you rock. And here's another link to a wonderful resource for parents:

mlks said...

OK. You saved my head from exploding with "The plural of anecdote isn't data." If you don't mind, I think I'm going to be borrowing this in the future. Love it.

And...so stupid frustrating that there's such an attachment to these types of theories. Gah.


Great blog, Carrie. Just great. Your comment on the HuffPo was also wonderful.

lisa said...

Oh Carrie, thank you! Your words are mine with great intelligence and humor. I love you!

psychai said...

I found the part talking about how mothers need to confront food issues kind of funny. While I've met plenty of people who have had moms with eating issues (which, duh, is not surprising in our culture), I went through something much different.

My mother suffers from a GI disease called Chrone's. When she was sick, she would lose a bunch of weight involuntarily and her goal would be to weigh more again. I never encountered restrictive rules. I never encountered "gaining weight is bad." And yet, still, I developed anorexia and later bulimia in my mid-teens. I'd actually point more towards my best friend having had both eating disorders when we were pre-teens as where I got the idea, and a move cross-country plus my parent's divorce as the sort of trigger.

In any case, I relate the anecdote because it's important not to lose the individual within the theory or statistics. While the symptoms/behaviors of an eating disorder may be at surface level similar, it's possible the reasons for the eating disorder and it's maintenance are highly individualized and in some cases complex.

Thanks for posting.

Anonymous said...

Full recoveries are the best answer of all to psychodynamic theories that undermine sufferers and the families who love them!

When a suffering person presents to a professional for help with what can be a terrifying illness, it seems all kinds of wrong that instead of getting effective scientifically based treatment, they get labelled and blamed along for being sick in the first place.

Sally said...

My parents are the exact opposite of controlling; they let me make my own decisions and eat (or not) what I'd like--from existing off of pb&j and macaroni to eating salad and green beans. My mom never had an eating disorder, and I don't have siblings, yet I have ended up with both anorexia and bulimia. I have had body image issues since the first grade. I am still digging around to find the roots of my ED, but I know it wasn't from over-restricting, demanding parents or parents who don't care.
For some, their family dynamics may be what pulled the trigger, but I don't believe that is the case for everyone. The article is one doctor's opinion. Let her voice it. Just because it is published doesn't make it true, or the only cure.

And Carrie, I LOVE your humor and sarcasm. Makes my day!

Anonymous said...

I also disagree.

While there may be people with eating disorders who have functional, healthy families and no childhood trauma, those seem to be the exception- at least from people I've met in treatment.

This isn't to say your family and childhood weren't perfect- I don't know. I do know that both my family and childhood trauma played a part in my eating disorder. Are my personality, temperament, and co-morbid disorders part of the cause of my eating disorder? They definitely are! But I think it's remiss to overlook psychosocial factors too.

Anonymous said...

"illusion". Intentional pun?

Anonymous said...

How could anyone ever know what caused their eating disorder?

Colleen said...

I've read the book and the review. To her credit, Judy Scheel has a warm tone and genuinely believes she is helping people. She wears a velvet glove as she punches you in the face. Not true of Randi Epstein, who pretty much bare knuckles you.

I almost don't think we read the same book. JS's book is all about very subtle failures as parents: you once said something the wrong way, you told your child to 'get over it' at some point, etc. It's your fault, for sure, but you didn't mean to do it. When JS says a 'no-blame approach', she is talking about the sufferer, not the parents.

Randi, on the other hand, seems to use the book as ammunition for her own (outdated, unsubstantiated) theories about ED etiology. She blames both the parents AND the sufferer! She takes it much farther than the book.

Or does she? Is Judy holding back in the book, only to let it out in an interview with a like-minded colleague?

I'm sure they are both very nice people with very good intentions. But I am everlastingly grateful that we didn't have this kind of support while our d was ill.

ZZMike said...

She's mentioned in Gary Taube's books. The thing that struck me is the fact that she found obesity in New York children in the early 1900s - long before fast-food, long before high-fructose corn syrup.

Anonymous said...

I am so happy to find this article. I was a patient of Judy Scheel's. She emotionally abused me, turned me against my parents (where there was no blame to be had) and as a result, I slipped further into my anorexia. She did not hospitalize me when it was medically necessary but continued to isolate me from those I loved (and who loved ME) most. She once told me "I wish I was your mother. I would care for you."

When I eventually was hospitalized, I was so emotionally (not to mention physically) ravaged that my hospital charts indicate that Scheel is among the worst and most damaging therapists they have ever seen (this came from a leading ED hospital). It's been 8 years and I am STILL working through some of the damage Judy Scheel did. She is an awful human being.

Sadly, she is at work on a documentary at the moment, so this is not the last of her garbage.

petersmith said...

i read your blog, it was too interesting.
Pawn Jewellery

Anonymous said...

I am so sorry to hear this. I, too, had a traumatic experience with Judy Scheel

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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