My Daughter Does Not Want to Recover From Her Eating Disorder
One of the strangest, and most dangerous, symptoms of an eating disorder is "not wanting to recover." Parents panic or get understandably angry when their child denies being ill, hides the eating disorder behaviors, and lashes out at anyone trying to help. We see a horrible illness that is sapping the life and personality from a beloved child - yet they seem to embrace it. What can parents do when a son or daughter says "I'm not ill and I don't want to get better?"
First Step: We Have to Change Our Response
The first thing to do is to change how WE think of the illness, and of their resistance. When I hear that a patient with anorexia or bulimia or other eating disorder "doesn't want to recover," I don't hear "denial," I hear "anosognosia." This means "brain-based lack of insight into the seriousness or existence of a medical condition." Anosognosia is also a symptom of other organic or traumatic brain damage, and common in bipolar illness and schizophrenia (Impaired Awareness of Illness (Anosognosia): A Major Problem for Individuals with Bipolar Disorder). The difference with eating disorders is that the anosognosia abates as the patient recovers.
Malnourishment causes damage to the brain and often a temporary blindness to certain sensations and insights. This isn't under the control of the person and no amount of anger or logic on our part helps them "see" what we do if they are in certain stages of the illness. In addition, because some of the symptoms of eating disorders are ones society seems to value - like the pursuit of thinness and self-control - the patient is often encouraged in these symptoms or they are mistaken for healthy impulses.
Seeing Resistance to Eating Disorder Recovery as a "Can't" vs. a "Won't"
I find it very helpful to see these thoughts and this lack of motivation as a "can't" and not a "won't." Instead of being angry or frightened by a loved one's lack of insight we can choose to think of this as a symptom and something that they can't do YET. We can hold the optimism and the seriousness in our thoughts and actions until they can.
Parents usually find that anger doesn't work. Logic and pleading and punishment don't help. Compassion, commitment, and firm response can help a lot, however. We can insist on restoring the brain, keeping the loved one going to treatment appointments, and providing an environment where recovery is the goal and optimism is the mood - even when they cannot.
We can connect on an emotional level, instead of a logical one, by being unconditionally loving regardless of what the ill person does in response. We have to believe in the real person, the well person inside, and not allow ourselves to become embittered or defensive even when our loved one is irritable or combative. This is very, very hard. We are connected to our children and not used to separating them from their thoughts and behaviors - but we must try.
Brave Parenting: Not Needing Their Love
We can do the bravest thing of all for many parents: not need love or friendship or agreement from our children. They don't have to agree with or understand what we are doing in response to their illness. They don't have to like it or like us. Our responsibility is to "do the thinking for both of us" on behalf of the real person inside - until they can.
Motivation to recover is not required for the early stages of eating disorder recovery. In fact, whether a patient is voluntarily or involuntarily brought into care has little impact on the success of treatment and does not mean the patient will permanently resent us .
I speak with former patients all the time who are grateful to those who listened to their needs and not their words, and those who were silently rooting for those who refused to listen to what they said aloud. I speak with parents who are amazed to discover that when they stop arguing and stand firm that their ill loved one becomes compliant instead of more combative. Parents often find their child feels safer and less anxious when the parent is firm and direct.
Eating disorders have been looked at as a form of self-expression for a long time, and so it follows that we have seen motivation to recover as a necessary factor in recovery. I agree: but the motivation is often a sign of recovery and need not be the price of admission.
It is our job as parents to "want recovery" until our dear children can.
Collins, L. (2010, May 12). My Daughter Does Not Want to Recover From Her Eating Disorder, HealthyPlace. Retrieved on 2022, December 7 from https://www.healthyplace.com/blogs/eatingdisorderrecovery/2010/05/my-daughter-does-not-want-to-recover-from-her-eating-disorder
Author: Laura Collins
Firmness and directness is exactly what has caused my step daughters anorexia. This is per her psychologist. She feels she has no say or that no one will let her make her own choices. Her Dad and I have always been the ones to be open and discuss and hear their wants and needs and let them have say in things. But we only had them every other weekend. Their mom used guilt and manipulation and unfulfilled promises and denial as a means to parent with a sold - I hear you, now do what I said, and don't tell anyone this happened it will make me look bad type attitude. We finally got her to move in with us at 15. They don't attend school because it triggers them, and all mom cares about is that they aren't going to graduate. Meantime the psych is telling us to focus on keeping them alive and school can always be caught up on. A diploma is useless if they are dead. So we are picking our battles. It's a slooooooow process to build that trust they were taught doesn't exist...and until we have that ...being firm and giving direction and all that jazz is literally the opposite of what we have been told to do. It's not a one size fits all problem and it's not safe to suggest a one size fits all solution.
It sounds like you are getting the 1980s treatment myth that ED is about control, which has been disproven. Has your child started eating more now that you aren’t directing them to? This sounds like very outdated information that you have been given and I have not seen that approach work in the many years I’ve been doing this. If it is leading to a gain of a kilo a week or more, then you will know it is working for your situation. Parents do not cause neurobiological illnesses, so it can’t be her mom’s fault she got sick. Have you asked your provider how the ANGI study informs their approach? It’s very possible your child will die before her ED trusts you in a way that leads to eating. What I have seen happen when parents step back as you describe is the child seems very happy—and it’s actually the ED that’s very happy, because no one is making them eat.
If your daughter is getting tinier and tinier and her husband is
getting bigger and bigger (body builder) ...
but husband thinks she looks just fine ...
we are the parents and cannot interfere. This is the saddest
thing to watch.
You are the parents and there are options besides interfering. The first is making sure you and your husband are on the same page: he needs to know that weight loss can be a very serious symptom of a life-threatening mental illness. If the two of you can come together on this, then you can come up with a plan on how to intervene in whatever way you can.
I think it helps to see an eating disorder as much of a threat as cancer, or heroin use. It is THAT important. It is also treatable. Parents may not have rights after 18 but that doesn't mean we don' t have responsibilities and investment. We can speak up, we can withdraw support for symptoms, we can act with urgency.
Ms. Murray, and Lynn,
The things people think when they are actively mentally ill are not their choice. They are not being illogical or unintelligent or stubborn: they truly can't think in other ways at that time. It helps so much to stop arguing and stop expecting different responses.
We have to do what we CAN do without anger and frustration and with compassion and unconditional love. If someone believes they see little green men in the bathtub - or that they are having seizures - or that their medicine is poison - we can accept that. Our job is to figure out what we CAN do: take over giving out the pills, take away the car keys, even have them committed for their safety. We can stop expecting them to "get it" and start just listening and caring about their distress.
Patients with schizophrenia and bipolar can get better. Maybe not cured, yet, but function better and in safety. The calm support of family and friends can be a big part of that.
Eating disorders, thank goodness, are more treatable to full remission, but only if we do some really tough things. We can do a great deal, and we can stop doing a lot of things too, as parents we have an important role to play.
My heart goes out to you. Your son's Schizonphrenia is the hardest of all mental illnesses to deal with. My own son has bi-polar and is handling his
illness well now, taking meds and making informed and healthy lifestyle
choices, I believe. You are showing great courage and faith in supporting
your son as much as you do. Whatever you can do to help him get the medications and counselling he needs has to be done. I also believe that you need to find a way to care for yourself, too. Please take time to nurture yourself. Blessings to you.
You know I'm your hugest fan and have to agree, wholeheartedly, that we need a paradigm shift away from viewing the sufferer's resistance to treatment and getting well as a "won't" and toward a (temporary!) "can't". It is just the biological truth. We must love our patients and children and sufferers through this and find other outlets to manage the emotions this mobilizes within us. Bless you, Laura. I think of you so often. With love and with you always on the journey....
I strongly agree with the way to interact with your child that has a mental illness. But, what if you have an adult son with Schizophrenia who continues to believe he has seizures even when proved he does not by doctors and E.E.G.s. He does not comply with the meds his psychiatrists prescribes. He lives by himself, is able to do a lot for himself - but still after 5 years lacks the insight into his illness - would rather believe there is some alien force allowing this to happen to him. I am so tired and frustrated - continue to give him support in every way. I welcome comments.
I agree with everything that you wrote. You have to have insight into this illness in order to write so accurately. When the brain isn't getting the right nutrients, it does't work properly. Therefore, someone may have to intercede for the individual who is ill! Do the right thing!
I am so grateful to have found the information I need to help my daughter who is suffering from Dilusional Disorder. She is 38, married, with a 6 year old child. I stayed with her for three months, made sure she kept her phychiatric appointments, took her medication, and also found her a great therapist. Less than a month after I left her I can tell that she is not taking her medication. I told her I would not debate her beliefs any longer, that I would be there to help if she asked. Any other suggestions would be appreciated. Thanks
Thank you, Char. Informed choices is what it is all about, isn't it! Well-informed parents do a better job of finding and supporting good care, and patients deserve families who can step up with optimism and confidence.
I love this part of your post especially:
"I speak with parents who are amazed to discover that when they stop arguing and stand firm that their ill loved one becomes compliant instead of more combative. Parents often find their child feels safer and less anxious when the parent is firm and direct."
This is true of so many illnesses. We need our loved ones to stop arguing with us and our attitude and instead believe in us, our ability to make our own choices, and hold the light for the fact that some day things will be better for us. This is particularly true, not just with anoriexia with children, but with adults suffering from depression.
So many people want them to just "snap out of it, get over it, get on with it" and the depressed person ends up feeling like even more of a loner because they now have the added pressure of their loved ones to get over it.
The true medicine is when others hold the light for us that we can get better - we believe in them (instead of fighting with them) - get the heatlhcare that we need, and in time develop that motivation for ourselves.
This is a very powerful and important article that helped me understand my own personal mission of helping people make informed choices about their healthcare via www.the-first-step.com Thank you for this!
You appear to be offering a decent different view here. Are you going to create further on this subject?...
I'm so happy for you Kendra - and your parents. I look forward to a time when parents are armed with information and clinical support early and well so we can help patients better. And I agree with you Kristine that this is a basic, first issue to help parents understand!
A great post, Laura, and a very important one. In my opinion, this is is the thing people need to learn first.
Thank you Laura for your bold comments and recommendations. It is SO hard for parents. I know my parents felt really lost, and didnt know what to do, and knew they couldnt force me to stop my behaviors, but they NEVER gave up on me, and never thought I was a lost cause. They fought and believed in me and in the end they took matters into their own hands and put me in treatment. And to this day I am grateful for their never ending belief that I COULD AND WOULD get better one day. And now I am. :)