Friday Reflection: Does 'Refeeding' Change Relationship
I worried refeeding would do lasting damage to our relationship.
I went from instinctually working to make the world a safe and easy place for my daughter to actively creating highly distressing circumstances that she was required to suffer through. It felt horrible. I was able to put it in context and think of the long game but, nothing about it feel right. Our days were fraught and tense. Sitting for meals took up most of our time and I would steel myself and murmur 'another bite...just one more...nope, you can't stop.... keep going" through raging and heartbreaking tears. I struggled mightily to summon up 'compassionate drill sargent' but, more often than not, during meals I veered away from compassion and more towards automaton taskmaster. I didn't talk much. I didn't touch her other than to still a jiggling leg or stop a hand from flicking food off the plate. I wanted to comfort her but that raised her ire and she lashed out physically. I couldn't really look at her and take it all in for fear of busting into tears, so I just sat close prompting through the pain. It felt at times like we were adversaries in battle. I tried to create points of closeness and connection to offset all the rest but nothing made things better. She was closed and gone. She said she hated me. Weird. After 10 years of intense little kid love it was weird. weird. weird.
I wanted her alive more than I wanted her to like me so I did not back down but I spent many a night lying awake thinking: What does it do to a kid when home doesn't feel like a safe place anymore? What does it do to a kid when the people they love and trust most in the world are making them face their biggest fear....6x a day. Does it leave a mark? How can it not?
These two studies, one from the International Journal of Law and Psychiatry and one from the International Journal of Eating Disorders, suggest that that taking control and coaching them through the difficulty of eating will benefit our children and that we should not fear it will damage our relationships.
1. How do parents of adolescent patients with anorexia nervosa interact with their child at mealtimes? A study of parental strategies used in the family meal session of family-based treatment
Findings: Despite associations with negativity from the adolescent, the use of food-related prompts (both verbal and physical) seems to be associated with increased eating. This indicates the potentially important role of parental control of eating.
2. Attitudes of patients with anorexia nervosa to compulsory treatment and coercion
Findings: The perception of coercion was moderated by relationships. A striking result was that what mattered most to participants was not whether they had experienced restriction of freedom or choice, but the nature of their relationship with parents and mental health professionals. Indeed, within a trusting relationship compulsion may be experienced as care.
Our experience bears this out. At then end of the day the bad stuff was left on the field and we ended with the same relationship we had before she became ill (albeit the teenage version which seems to include considerably more eye rolling). She loved me before; she loves me now. She trusted me before; she trusts me now. The world felt safe before; it feels safe now.
Refeeding didn't 'change' our relationship; the 'illness' changed our relationship. If anything it was refeeding that got us on the road back to the start.
Parents, what is your experience? How is your relationship now?
References:
1. White, H. J., Haycraft, E., Madden, S., Rhodes, P., Miskovic-Wheatley, J., Wallis, A., Kohn, M. and Meyer, C. (2014), How do parents of adolescent patients with anorexia nervosa interact with their child at mealtimes? A study of parental strategies used in the family meal session of family-based treatment. Int. J. Eat. Disord.. doi: 10.1002/eat.22328
I went from instinctually working to make the world a safe and easy place for my daughter to actively creating highly distressing circumstances that she was required to suffer through. It felt horrible. I was able to put it in context and think of the long game but, nothing about it feel right. Our days were fraught and tense. Sitting for meals took up most of our time and I would steel myself and murmur 'another bite...just one more...nope, you can't stop.... keep going" through raging and heartbreaking tears. I struggled mightily to summon up 'compassionate drill sargent' but, more often than not, during meals I veered away from compassion and more towards automaton taskmaster. I didn't talk much. I didn't touch her other than to still a jiggling leg or stop a hand from flicking food off the plate. I wanted to comfort her but that raised her ire and she lashed out physically. I couldn't really look at her and take it all in for fear of busting into tears, so I just sat close prompting through the pain. It felt at times like we were adversaries in battle. I tried to create points of closeness and connection to offset all the rest but nothing made things better. She was closed and gone. She said she hated me. Weird. After 10 years of intense little kid love it was weird. weird. weird.
I wanted her alive more than I wanted her to like me so I did not back down but I spent many a night lying awake thinking: What does it do to a kid when home doesn't feel like a safe place anymore? What does it do to a kid when the people they love and trust most in the world are making them face their biggest fear....6x a day. Does it leave a mark? How can it not?
These two studies, one from the International Journal of Law and Psychiatry and one from the International Journal of Eating Disorders, suggest that that taking control and coaching them through the difficulty of eating will benefit our children and that we should not fear it will damage our relationships.
1. How do parents of adolescent patients with anorexia nervosa interact with their child at mealtimes? A study of parental strategies used in the family meal session of family-based treatment
Findings: Despite associations with negativity from the adolescent, the use of food-related prompts (both verbal and physical) seems to be associated with increased eating. This indicates the potentially important role of parental control of eating.
2. Attitudes of patients with anorexia nervosa to compulsory treatment and coercion
Findings: The perception of coercion was moderated by relationships. A striking result was that what mattered most to participants was not whether they had experienced restriction of freedom or choice, but the nature of their relationship with parents and mental health professionals. Indeed, within a trusting relationship compulsion may be experienced as care.
Our experience bears this out. At then end of the day the bad stuff was left on the field and we ended with the same relationship we had before she became ill (albeit the teenage version which seems to include considerably more eye rolling). She loved me before; she loves me now. She trusted me before; she trusts me now. The world felt safe before; it feels safe now.
Refeeding didn't 'change' our relationship; the 'illness' changed our relationship. If anything it was refeeding that got us on the road back to the start.
Parents, what is your experience? How is your relationship now?
References:
1. White, H. J., Haycraft, E., Madden, S., Rhodes, P., Miskovic-Wheatley, J., Wallis, A., Kohn, M. and Meyer, C. (2014), How do parents of adolescent patients with anorexia nervosa interact with their child at mealtimes? A study of parental strategies used in the family meal session of family-based treatment. Int. J. Eat. Disord.. doi: 10.1002/eat.22328
2. Jacita O.A. Tan, Anne Stewart, Raymond Fitzpatrick, Tony Hope, Int J Law Psychiatry. 2010 January; 33(1): 13-19. doi: 10.1016/j.ijlp.2009.10.003
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We walked through hell, she is in recovery and we are closer than ever. "I wanted her alive more than I wanted her to like me so I did not back down . . ." TRUTH!
ReplyDeleteWow this is a very powerful blog. I can completely and absolutely relate to this experience. I would only add that in mine we had verbal and physical assaults by ED and a few breakdowns (by me, mostly in solitude but a few in public). I also had a situation of extreme personal anguish in which I was fighting for custody of my child and where ED was one of the platforms. But more, I was fighting for her life and that was the ONE battle I kept near to my heart and practice. We are now on phase 2 with full weight restoration and life returning to a new normal. It's difficult to let go of the fear of Ed, hard to trust that we are getting the girl back little by little. Hard also to know if this (whatever behavior) is Ed it just 'normal' teenage stuff. Actually when we had a conflict a few weeks ago my D said 'I know you think this is my ED!, and my happy reply was 'no I think that this was just bad normal teenage behavior!'. We both had to smile a bit at that. Has this changed our relationship? Of course. Has ED caused damage? Yes and no. Luckily we caught it within 6 months of inception so the health effects will hopefully be nil. But it's been 18 months now and we are rebuilding a new relationship that doesn't revolve around that every little bite which is a whole new reality. I'm nervous but very thankful. I do think it is possible to come out of this with a new and positive relationship. Will it ever be the same? Of course not - but we stood by them in the absolute worst. And we are still and always will be here. As Marilyn Monroe so pithily said "...if you can't handle me at my worst then you sure as hell don't deserve me at my best.". For me the best is just being here and content. Thanks again for this piece. I also want to add that I think Ed can cause significant damage to families - I think my x was very afraid and some of his fear turned into what he believed was right action. He's also come a long way and was fully engaged in her refeeding and therapy by Skype. It's my hope we can continue to support her even though not living near each other. Truly the whole family needs to be involved!
ReplyDeleteIt took some time (years) to return to an easy, pre-dx relationship state. It got better for sure as time went on but 'back to (pre) beginning' came in fits and starts. You are right, it is not really 'the same'....it's like the same concentrated. There is a level of trust (and, dare I say, respect) on both sides that came from suffering through. We would have gotten to that point naturally eventually.......like in her early adult hood (you know...when kids hit mid-20's and have their own trials and tribulations and realize their parents are humans who are struggling through the best they can....ed got us to that point of recognition sooner.
DeleteWe weren't fortunate enough to see our daughter to recovery as she turned 18 and became in societies eyes an "adult". The day my soul faught back and said no more, all meals would be prepared by me and eaten by her, full around the clock monitoring was back in business was the day my very ill daughter stormed out of the house screaming she hated me....my parting words to her were "I'd rather you lived hating me than died loving me". She doesn't hate me anymore, she is still however very ill. She knows that to come home again, she will need to start hating me again and I welcome that. If they are young enough, go ahead and let them hate you, it will save their life.
ReplyDeleteLisa, I love your strength. Your daughter will get there, I know xo
DeleteWise words Lisa G.
DeleteOur experience was very similar, in that my daughter and I had a close relationship prior to illness, and have an even closer one now, 3 years following recovery. It was a nightmare though....a previously cuddly, loveable kid screaming "I hate you" and "You're the worst mother in the world". It shook me to the core. But ultimately, as you said, I wanted my kid alive and healthy even if she hated me. The only time my daughter would allow me to touch her during refeeding was following the evening meal, when she was required to drink a smoothie as an evening snack. We would sit on the sofa watching a light comedy, Modern Family I think, and then she would allow herself to lean into me. That went on for a long while...and then bit by bit, more and more of my sweet girl reemerged. Three years on, we are very close....it was the illness that affected the relationship, not the parenting we needed to do in order to help her get well.
ReplyDelete"bit by bit"....so true Daryl. That is an important piece for us to remember. It is not a straight line and it can take what seems like forever.
DeleteThis is a wonderful piece. Thank you! When my daughter was first diagnosed, and for the following three years, I trusted the teams (I'm in the UK). Boy ... what a mistake that was. Re-feeding was hell, but when you get a CAMHS woman turn up at your house at dinnertime to help, who ends up telling your daughter that she's being ungrateful for the food I'm cooking her, and to shout at her (needless to say I threw the woman out), you do what you can on your own as a single mum. Clearly, I wasn't strong enough and she is now entrenched. BUT she is now, as a young adult (22, diagnosed at 14), living with us and we are beginning to see signs of recovery. They're only glimmers as yet, but since finding FEAST and MAED I feel better armed to deal with this! I now know that it I'd rather my daughter hate me and die (she almost did, twice) than live in a living purgatory. We're desperately trying to find a middle-ground here now, as being the age she is she could easily just walk away from me. So I can't be quite as regimental as mothers of adolescents are. It's a hard tight-rope to walk, I can tell you.
ReplyDeleteBut walking it you are Jen, I also believe that one day, you will get there xxx
DeleteIt is not about 'not being strong enough' Jen- It is about not having proper support. None of us are prepared for this....none of us are 'strong enough' on our own. Some of us are simply lucky enough to have access to good teams who can really and truly back us up and guide us through refeeding as we guide our kids.
DeleteMy D was highly resistant. Smashing forks, bolting out of the home/car, leaving notes " I hate you mommy and daddy", hated the FBT too, spitting food out, cheeking it, dropping etc etc. We did not have an easy reefed. But to answer your question NO it did not change our relationship. We were close before ED, we are close now. Both of us to her. And the therapists who practice FBT will be heartenend to know the bolting, screaming, hoodie firmly on all the time girl who they first treated, by discharge 11 months later had become so close that on her discharge she let two purple balloons go up in the sky with them. To symbolize her and them, and her recovery the sky is the limit. Do not be afraid of FBT and the difficulties you will likely face during refeeding. Expect resistanc and expect emotional dysregulation. It is a symptom of acuity and just like other symptoms of a severe illness have gone gone gone. Excellent post....
ReplyDeleteI like how you all describe it - so true.
ReplyDeleteI want to add that we know from what our kids say later that often, they were wishing we would make it OK for them to eat, that we would carry them on our shoulders.
That we did so when they were in such distress surely accounts for the stronger bond many of get to enjoy later on.