I've never had anorexia, but I know it well. I see it on the street, in the gaunt and sunken face, the bony chest, the spindly arms of an emaciated woman. I've come to recognize the flat look of despair, the hopelessness that follows, inevitably, from years of starvation. I think: That could have been my daughter. It wasn't. It's not. If I have anything to say about it, it won't be.
In Brave Girl Eating, the chronicle of a family’s struggle with anorexia nervosa, journalist, professor, and author Harriet Brown recounts in mesmerizing and horrifying detail her daughter Kitty’s journey from near-starvation to renewed health. Brave Girl Eating is an intimate, shocking, compelling, and ultimately uplifting look at the ravages of a mental illness that affects more than 18 million Americans.
****Update: 25/3/2012: The massive thread that follows just totally reaffirms every point I made in the review. All of this from a writer whose work appears in the New York Times? Nice. Enjoy.****
****Update: 21/3/2012: I need to give credit where credit is due. For an eloquent and informative review (NOT AUTHORED BY ME) of Brave Girl Eating that, unlike my review, places facts over rage, please see http://www.amazon.com/review/R1F9BQBA...
For scathing snark and wrath, my review is below.****
***Sigh. Let's do this. Oh, and Harriet Brown, I hope you read this. I really, really do. Though I doubt it would do you any good.*** (Update: she has read it, contacted me and unleashed her fans on me. I was right: it didn't do any good.)
Brave Girls Eating is Harriet Brown's memoir about her experiences with her daughter's anorexia.
This book gave me nightmares: I literally had dreams that I was in a therapy session with Harriet Brown, screaming at her while she laughed and smiled away. The positive reviews of this book on goodreads have left me absolutely dumbfounded.
Here's the deal.
Decades of psychological studies done on anorexia paint a picture of family dysfunction that brings about the disorder. More or less, the typical story goes like this: one parent -- usually the mother -- is overbearing, controlling, suffocating, lacks boundaries, is the center of the family's attention, and is totally entrenched in denial about any problems existing within herself or her family. (Narcissistic Personality Disorder, anyone?) Right around the time of puberty, when the normal progression is for the child to separate from the parents and form an identity of her own, the child enters into crisis. She wants to become her own person but has no idea who she is because she's never been allowed to be herself: she's been who others (i.e., mom) want her to be. She has NO identity.
Additional family dysfunction only enhances the child's difficulties. The family dysfunction likely never created a problem before because the child was, well, still a child. It's when the kids start to grow up, see that something is wrong in the family, and are unable to articulate it, that anorexia comes about. Hey, some kids do drugs. Some smoke. Some go the other way and excel at sports. Whatever. But most kids in this kind of situation end up with an eating disorder because food is the only thing in their lives that they can control. (For example, mom may make herself the center of attention when her daughter takes first place at a gymnastics meet...but mom can't make her daughter put an apple in her mouth, chew it, and swallow it.) Like a toddler who cries because he can't express himself, the anorexic starves because she can't articulate her feelings.
The problem?
Well, among others things, when parents finally figure out that their kid is sick, it's too late. The child has adopted a coping mechanism that she can't shake despite the fact that it's making her miserable. Why can't she shake it? Well, starving (and the mental torture one must inflict upon oneself to continue starving) make a person half crazy. Even better? The fact that she's never been allowed to have an identity? Well, guess what the anorexia has become? It becomes her identity. Then the sufferer is so mentally screwed up from the starving/anorexia-thinking that she's even more at a loss to understand why she does this to herself, what drove her to do it in the first place, and why she can't stop.
Enter Harriet Brown, whom I suspect is one of those above-mentioned overbearing narcissistic mothers. That's just my guess, given that only an extremely narcissistic and controlling mother would take the one thing that her daughter clings for an identity (the anorexia) and make it her own. And publish a book about it. And make that book all about herself. And see nothing wrong with that fact.
A little reading between the lines in this book tells you a lot about Harriet Brown. You see, from the beginning, she tells us that anorexia "chose" her daughter and not vice versa. Harriet also says that while her family had a little dysfunction, it was nothing out of the ordinary. No. Not her family. She insists they simply don't fit the anorexic family profile. (Translation: Harriet is blameless.) Yet Harriet leaves us so very many clues to the contrary that she renders own her claims laughable.
1) The book's title alone should tell you that mom's got a penchant for drama. If that's not enough to convince you, consider some of the following gems: Every time her daughter eats it's like she's "jumping from thirty-thousand feet. Without a parachute" ; "If I'd had a gun in my hand, I swear I would have pulled the trigger" ; "Every day was fraught now, strewn with mine fields and tears." Yikes. If that's just the drama on the page, imagine what it's like to live in a house with and be the daughter of this woman.
2) Here's a little hint as to what kind of mom we're dealing with. To illustrate the anorexic's typical family dynamic, Harriet gives us an example of a girl who told her mother that she wanted to be a flight attendant when she grew up and mom replied, "that's not good enough." (Shock, the daughter developed anorexia, probably after a lifetime of dealing with such *loving* encouragement.) Instead of noticing the meanness in the mother's statement, Harriet writes, "I wonder if there's a mother anywhere in America who has actively supported every single one of her daughter's choices." (ARGHGHGHGH!!!!)
3) Some other hints that something's up with this mom and her kids? --Her daughter's first anxiety attack/anorexic meltdown happens on Mother's Day. Symbolic much? --The girl is in her teens and still calls Harriet "mommy." --The sick daughter would "rather be with her family than her friends" on Halloween. Huh?? She's a TEENAGER who chooses family over friends? Hello, red flag. --The very pseudonym that Harriet gives her daughter in the book infantilizes the girl even more: "Kitty." Like a pet. Like a baby. --Oh, and Harriet is quick to tell us that when it came to writing the book, her daughter "overcame her own preference for privacy out of a wish to help others." Sure she did. She "overcame" what she valued and wanted so that she could give mama Harriet what she wanted. And the brilliance? Harriet has herself (and probably the kid, too) convinced that it's what the daughter wants. Narcissism at its finest. Fuck me. --On that note, it took me all of 3 minutes to find "Kitty's" true identity with Google. If Harriet really did care about concealing her daughter's identity, wouldn't she have done a little more to hide her than simply changing the name? It almost makes me think Harriet enjoys the attention. Shocking.
4) Apparently, a lot of other people noticed her daughter's anorexia long before Harriet did. One friend tells her as much. Instead of using this moment to do a little reflection and self-evaluation as to why she, as the mother, never saw it happening, Harriet's reaction is, "I feel like slapping her. No, punching her in the mouth. No, garroting her." (Jesus H. Christ.)
5) Harriet is sure her family is not the cause of the anorexia, despite the fact that nurses write "mother in denial" on her daughter's charts. Harriet is sure that it's not the family despite the five plus decades of research on the disease that basically says, "If your kid is anorexic, you fucked up." (Yes, the research, the case studies, the psychologists, and everyone else -- they're wrong, wrong, wrong.) She's sure it's not the family despite the fact that her other daughter screams "It's your fault my sister is anorexic!" before tearing down the street screaming at the top of her lungs that her parents are horrible.
Well. PHEW. Now that Harriet has shown us that the cause of her daughter's illness is not because she's a narcissistic "take-all-the-credit-and-none-of-the-blame" mom, Harriet can adopt the radical new "Family-Based Treatment." In FBT, the parents take complete charge of all of the child's meals ... because that's just what an anorexic needs: more control from mom. What a wonderful way to go against the stacks of research that say "it's not about the food," and, well, make it about the food.
FBT is great for Harriet because, according to developers of the method, there's "no need to know [the cause of anorexia] in order to treat the illness." Oh! Perfect! So her daughter never needs to learn why she's sick, what triggers her anorexia, and what changes to make in her life in order to sustain her recovery! YAY! That pesky "why?" that plagues all anorexics can just be swept under the carpet! It'll all be fine as long as she just eats! HOORAY!
Wow. That sounds a lot like not vaccinating your child, treating the onslaught of illnesses that follow with sugar pills, and all the while wondering why your kid keeps getting sick. Heh. Fixing the surface issue instead of repairing the problem at the source. Gee. Great idea.
Are you surprised to hear that her daughter relapsed again and again?
What kills me, absolutely KILLS me, is that the daughter repeatedly asked to go to inpatient therapy and the parents continuously refused. God forbid they relinquish control and let their daughter develop the skills necessary for recovery. Could it be that they're afraid of what will surface if the daughter were to go and learn for herself just why she's sick?
And why is she sick? That doesn't matter, according to Harriet, but our author gives us a little clue anyway: "I don't think I'm one of those mothers who believes she's close with her child when actually the child loathes her." (PSSSSST. Harriet. Think again. You just nailed it.)
300-some pages of infuriating, self-serving denial. My heart really goes out to Harriet's daughter.
Extremely disappointed in this book... While I am empathic with the writer and know how traumatic it is to experience this disease within a family, I am shocked by Ms Brown's denial and her rejection of all psychological theory. The way she labels her treatment team "Dr Newbie"??? She is disrespectful and uninformed. I have been treating eating disorders for 30 years. Family Oriented Treatment is something I applaud when it works but it still needs to be supervised by a therapist regularly and a nutritionist as well as the physician who should be taking blood and checking vitals regularly. Sometimes Family Based Treatment does NOT work for a family but Ms Brown would have readers believe that it is the only way to go. She states if her daughter does not go back to school she would feel like a "freak?" I am horrified by her use of language and shudder to think that my young patients and their families would read this book. The girls I work with who cannot attend school because of their illnesses are NOT freaks or misfits. The girls I work with who need hospitalization are not "mental cases" and she is extraordinarily wrong to think her daughter is fundamentally different from the other girls. I am not saying she needed to place her in a hospital (although at that weight, I would have immediately done so until she got to normal weight and THEN used FBT) I would not have my child potentially die at home, emaciated with barely a heartbeat. She seems to have no interest in finding out why her daughter may have developed Anorexia and just makes the assumption that it IS totally biologically based because she was so perfect and the family was so perfect prior to her sudden illness. Eating Disorders absolutely are biologically based but exploring other emotional issues is relevant. This idea is completely ignored. She continually refers to her daughter as the most wonderful child ever until the day the illness took hold but even once she knew that Kitty was desperately ill, no treatment was given for weeks! What was that about??? If I didn't have room for a new patient for three weeks, I would have referred her to someone immediately, just to make certain this child was being treated. And if you do not like your treatment provider, you find a new one. FAST...I know how much denial is present with mental illness and with any illness but Ms. Brown's denial takes on new heights. I admire this family's courage and commitment to feeding Kitty and it saved her life (so far). But there is no depth. There is no sense of what Kitty is feeling only that she becomes NON KITTY which I know is Ms Brown's way of referred to the Eating Disorders voice but Kitty's regression emotionally leaves me to believe that her psychological difficulties are greater than just her Anorexia. I have treated 100s of cases and her behaviors are not the norm...To ignore this piece is very concerning to me. I only wish this family well and some of the facts (such as the recovery rate, etc) are accurate but many are false. Just false. There are some cases where EDs can be predictable; others not. But she states that there are no predictors. For a scientific writer to ignore thousands of studies and research is astounding to me. I may sound harsh but it is only in the review of this story. I am troubled that the families who may read this may take this as fact rather than one family's journey. I say that because of Ms. Brown's writing style. She states things as facts when they are opinions. She is entitled to these opinions but she does not help families struggling with their own EDs. I think she meant to rather than to simply write her own memoir but it is unclear if she means to be helpful to others. I have a patient's parent reading this book now, asking me if her child should read this story. This is what prompted me to get the book. I would have to say absolutely not. Her constant put downs of mental illness and her description of the mental facility is unfeeling and unkind. She may not have wanted Kitty there but the children who ARE there are as worthy as her own daughter and do not need to feel like the freaks she makes them out to be. Sorry but I would have liked to hear her story of Family Based Treatment along with accurate facts about Anorexia and some honest insight into her daughter's plight.
I just spent more than half an hour responding to La Petite Americaine's review of this book and somehow it got deleted. I will try to repost it in more detail the next day or so; for now, let me just say that her inexplicably vitriolic review is uninformed, ignorant, and just plain wrong. Her stereotype of anorexics coming from dysfunctional families with overbearing mothers has been discredited for years; family based therapy (of the kind that Harriet Brown recommends) is the ONLY evidence-based therapy used to treat eating disorders, and its success rate is well over 70%, while other programs have dismal rates in the single digits and tremendous recidivism.
Anorexia is a serious mental illness (and the one with the highest mortality rate) so uneducated people with their own agendas like LPA should defer to those with more experience. Brown spends chapter after chapter in Brave Girl Eating detailing the latest science and studies about anorexia (they have recently found a genetic link between people with autism and people with anorexia), so how the reviewer can make the unwarranted claims that she does is unfathomable to me.
Her ad hominen attack on the courageous Harriet Brown ( she claims Brown is out "whoring" her daughter to make a buck) is disgusting, as is the entire tenor of her review. Far from sounding compassionate about people who suffer from eating disorders, LPA comes across as an angry, hate-filled, paranoid person. When, in the comments, a medical doctor refutes her claims, she challenges him to produce his credentials- why would he bother to lie? Another reader who defended FBT and Brown is dismissed by LPA as not credible, simply because she had never posted on Goodreads before. The lady doth protest too much, methinks.
I, too, am new to Goodreads. I am also a medical researcher, having collaborated with a team of Cleveland Clinic doctors on a recently published book about the heart. I am a high school teacher who has taught and mentored- and cared about- scores of girls with anorexia who have spent years in and out of the inpatient facilities that LPA lauds. Finally, I have personally spent agonizing months doing Maudsley with a family member who might not be alive were it not for the treatment described in Brave Girl Eating.
I wish that I could have written this book, but Harriet Brown did a much better job than I could have dreamed of doing. So my job will be to crusade to see that this important book makes it into every school library and onto the shelves of every parent whose child is being stolen away by this awful disease. And while talk of "karma" clearly upsets our esteemed reviewer, she had better pray that no parent decides not to buy this book which could save her child's life based on this vitriolic review.
One final note: my son is 25 years old, married, has 2 gorgeous daughters, and lives on the other side of the country from me. And he still calls me "Mommy." Can't imagine why that's a crime or evidence of serious dysfunction; La Petite Americaine must be carrying around some serious baggage.
Overall, I thought the book was very insightful about the suffering a family endures when a relative has an eating disorder. You rarely hear about eating disorders from this perspective, so I thought it was very unique. I also was ultimately glad I read it because I was very unfamiliar with the approach.
The points that bothered me were her stance with psychology and her writing style. Perhaps I'm defensive both because I'm a psychology major at school, and I go to therapy, but it really bothered me how easily she dismissed the whole psychological approach because of one bad doctor. She even stooped so low as to call them "experts" with the quotations around the word, as if their education and training meant nothing. Psychologists are just like her, they base their beliefs and thoughts off of what they know and what they've experienced. It's difficult to know the exact right thing to do in every case, though I don't disagree with her that the approach to eating disorders needs to be changed drastically.
I also hated how she repeated a lot of the same words. I can't tell you how many times I saw the phrase "I wish I could cry, and howl, and pull out my hair" in some form throughout the book. Nor could I tell you how annoyed I became with the phrase "rabbit hole" which was repeatedly used. Ultimately, she used and re-used the same "hot" words in her writing and had little to no variation. Whether this was for readability or lack of expertise, I couldn't tell you, but it was disheartening. And as soon as I saw the word "shrink" being used, I was done.
This was a very interesting book. My imagination doesn't come close to how this parent described dealing with her daughter's eating disorder. How it affected them as a family unit. How it affected their younger daughter. Everyone in this family is brave and strong. And I appreciate them sharing their story.
I didn't mind this book in the beginning, but the more I read it the more I got irritated with the author. It's all poor me. boo hoo. I wanted to read more about the daughter and her struggles. REAL struggles and day to day life. Not the crap vomited about by a mother who wants attention. That is what it feels like while reading this.
I wish this book was written by Kitty's point of view. I think it would have been more interesting and much more real. But, I'm sure she is just as irritating as her mother. From her mothers descriptions she sure sounds like it.
I'm pretty sure I read the same information regurgitated multiple times through out this book. Just with a different combination of big words she used to try and sound smart. I could really care less about doctors studies from the 60's. Tell me about now. Things change.
Why would you deny your daughter treatment? Especially when she asked for it!? And what the hell kind of name is Kitty. Seriously. You're just asking for her to be a stripper.
oh. And why the hell do you refer to your daughter as a demon?! Who does that?? A crazy person does! She is not a demon, she is your goddamn child. Treat her like one. Teenagers are moody. Get over it. Don't treat her like she's a piece of shit you smeared with your shoe. She is a person. A living, breathing person with feelings. Not a freakin demon. Get over yourself.
There is so much about this book that just frustrates the crap out of me. I can't stand it.
I wouldn't recommend this book. Not unless you want to be pissed off by the end of it.
Edit 2021- I have every right to hate a book. I’m not an idiot, I’m not “out of touch”. This is a badly written book and SIX YEARS LATER I still stand by it. Get over yourself and bother someone else. I’m not changing my review.
I really, really wanted to like this book more than I did. Some perspective: I was diagnosed with anorexia 5 years ago and currently relapsing, which makes my case similar to Kitty's. Although me and my medical team never followed Maudsley's approach (the one described in this book, in which the family wholly takes care of the refeeding process), I was offered the choice to have my mother very involved in my recovery and refeeding, something which my therapist thought important as I was raised by a single mother and he thought it would be beneficial for us as we had no one else at home to turn to. I accepted and I think that the experience not only improved my relationship with food but also with my mother, who I know regard as one of my best friends. I'm not opposed to Maudsley's approach, as I think that in certain cases having the family in charge can help the recovery process. My issues with this book lie in the author herself and how she views and describes anorexia. •Firstly, she cites dated studies when she criticizes therapists for doing the same. She can't pick and choose which studies are 'true' and which aren't based on her feelings or whether they make her feel guilty or not. If she thinks only newer studies should be taken in consideration (which I personally believe), she should do that no matter what those studies say and how they relate to their case. •In her attempt to prove their family is not guilty of Kitty's anorexia, Harriet ends up never wanting to know the reason for why her daughter developed an eating disorder in the first place. I understand knowing the cause could be hurtful for parents, but it's cruel to not let Kitty explore that. Knowing just why you developed an eating disorder (or any mental illness for that matter) is crucial to your understanding of your brain and your illness and therefore crucial for your recovery. •She always sees anorexia as separate from her daughter, something Kitty criticizes her for in some point of the novel but something Harriet chooses to ignore. Harriet fails to understand anorexia as an illness within the patient, much like cancer or cystic fibrosis. She's obsessed with getting her former, ED free child back, and in doing so she reiterates that the 'real' Kitty has been taken hostage by 'the anorexia', as if a mental illness were a physical entity outside the body. •She describes Kitty when she's showing anorexia symptoms as Not-Kitty and the demon, which I just find disgusting and offensive, and which shows how in denial she is. •In her quest to defend Maudsley's approach she feels free to call other approaches cruel and inhuman. Yes, forced feeding is cruel and may slow down the process of developing a healthy relationship with food, but it is necessary in medical urgencies (extremely underweight patients, patients whose heart shows dangerous arrhythmia or patients who have relapsed many times and proved that other therapies don't work for them). What's more, although Maudsley's approach can make the patient develop a healthy relationship with food quicker, it's not a 'one size fits all' therapy. Some patients benefit more from a more traditional approach, and then there are also cases of patients who don't have a good support system so Maudsley's is impossible for them. Both approaches have pros and cons. Maudsley's may make your relationship with food better quicker, but the weight restoration is slower, which is something some patients simply can't risk. In fact, many professionals advise to start Maudsley's approach when the patient hits a certain BMI. •Harriet is fixated in proving her family is not at fault for Kitty's illness, which makes her appear holier than thou and judgemental, criticizing parents of other patients as 'dysfunctional' and horrible whereas the Browns are without blame, completely supportive and never harmful to Kitty. To cut the long story short, I enjoyed reading the point of view of the parent of a child with anorexia, but Harriet's attempts to outdo therapists (her insight is to be taken into account, but it can hardly make her an specialist), her obsession with defending her family and her inability to see anorexia as a part of her daughter made this book a huge disappointment.
I always have a difficult time discussing my experience with anorexia. It's not that I'm ashamed of it. It's just that it was a very long time ago now (my second bout ended about 12 years ago). Do I say that I'm an anorexic? That implies an active, ongoing issue, which isn't true. But I can't say that I'm not one anymore, because I know for a fact that it never totally goes away. The thoughts are there - they come back at odd moments. I'm particularly susceptible during times of high stress, although the older I get, the quieter the anorexic voice is. Do I say that I'm in remission? That implies a level of illness that I've never been comfortable admitting to.
So how to discuss such an amorphous topic, especially when most people aren't comfortable talking about it at all? Perhaps that's one of the problems with eating disorders. People don't want to discuss them - really discuss them.
I think that's one of the best things about this memoir of anorexia. It's absolutely unflinching, and yet surprisingly lacking in self-blame and guilt (a good thing, I think). Written by the mother of an anorexic - and thank god, for that, I say, this is a voice that's seldom heard - it is deeply moving. I occasionally like to read these books about anorexia to remind myself of that dark place I never want to go back to. The daughter's story really resonated with me; I could remember so much of my experience in this story, right down to the fact that it happened the summer that this girl turned 15 (also when I had my first bout). I often found myself in tears because it all seemed so familiar, and after a while you begin to forget how truly awful the experience was.
If you really, honestly want to understand what the eating disorder experience is like for an anorexic - oh god, the terrible, terrifying irrationality of it - this is a good book for it. Brown has amazing insight into what her daughter was feeling, better than a lot of books I've read that were written by anorexics themselves. Be forewarned that it seems repetitive after a while, which is why I'm not giving it more stars.
Over the last few years, many of my psychotherapy colleagues (like some of the reviewers on this page) have been bullied and harassed on several occasions by an online group of mothers who subscribe to the Family Based Therapy or Maudsley Approach for Eating Disorders.
As an eating disorder specialist with nearly 20 years of ‘practice based evidence’ and ‘evidence based practice’, as well as my own recovery from bulimia via 1-1 depth-psychotherapy, I am always looking to expand my knowledge and integrate new theories and techniques into my practice.
So – when this book popped up on my audio library list – I definitely wanted to give it a go to learn more about FBT.
This book contains some very useful information about Family-Based Treatment – which I would certainly recommend to a client if I felt it was the right approach for that client.
However, the author completely negates and attacks any kind of psychological treatment. This is extremely dangerous, particularly for parents seeking well-balanced treatment for their child.
At the 2017 Eating Disorder Conference in Sydney, Australia - the Eating Disorder Unit at Westmead Hospital for Children stated, ‘The eating disorder field has been dominated by ACRONYM based therapies – we should not have thrown the baby out with the bathwater – we are returning to include our psychoanalytic roots’.
As a Carolyn Costin Coach, trained and supervised by her, Carolyn Costin (Founder of Monte Nido and who has successfully treated 1000s of women with eating disorders), it was reiterated to us time and again that yes, genes play a role but environment pulls the trigger. At a recent neuroscience conference with Norman Doidge (Author of The Brain That Changes Itself), he also spoke several times how, ‘genes play a role but environment pulls the trigger’. The Childhood Trauma Conference 2014, with leaders in the field Dan Siegel, Van Der Kolk, Ogden et al. all refer to attunement as a protective factor to addiction and Eds. To completely discount the environment, including the dynamics within the family system, is problematic for the child suffering with the eating disorder and who is often pathologised as the ‘sick one’.
I personally feel that FBT would be more accessible and recommended by more therapists if they could get a more balanced view by its cheer squad.
Harriet Brown's "Brave Girl Eating" is the story of her daughter Kitty's descent into anorexia and the long road of recovery for the entire family.
When Kitty decides she needs to lose a little weight at age 14 after a nutrition class, she eventually slides into the body dysmorphism and deliberate eating restrictions that lead to so many cases of anorexia in teen girls today.
Brown talks not only about Kitty's anger about being made to eat again, but also about the effects of Kitty's recovery on her entire family dynamic. She also presents scholarly and scientific information about eating disorders along the way (the bibliography is extensive).
While our current culture of "thin is better" does not cause anorexia, it can most assuredly be a triggering factor for young people who develop disordered eating. Brown presents a very real perspective on an illness that she believed would never touch her family.
Highly recommended for those who enjoy learning from memoirs, or for families coping with eating disorders.
I rarely read non-fiction, but I found this one to be excellent. The author is a science journalist who writes about her family's experience with a teenage daughter's anorexia. I liked how proactive the author was dealing with the disease. Her writing style was clean and there is a lot of reference to past research studies, which was very informative. As the mother of a teenager, (albeit a 14 yo boy, whom I can in no way ever visualize restricting food, but I could certainly relate to the parenting and feeling of helpless frustration in a given situation) I could understand her drive to help her daughter. The disease is devastating to the entire family. The family opts for a Family Based Therapy approach and embarks on a "refeeding" schedule. Well written and informative, I truly enjoyed reading this book, although my heart went out to this family, who is still dealing with the daughter's eating disorder. Minor quibble about the book cover--why does it look so much like the cover of the first Twilight book?
An excellent book for parents of kids with anorexia. It’s written by a journalist whose daughter spiralled into anorexia at age 14. It’s a flowing and gripping read, and a moving one too.
This family followed the route of Family Based Treatment, caring for their daughter at home and helping her to eat. They received advice from Daniel le Grange but had to make do without a certified Family Based Treatment therapist.
If your child is suffering from anorexia, this is what you’ll find in this book:
. A source of support as you discover that the stresses and challenges are similar for all parents whose child has anorexia. For this reason this is also a good book to ask your parents and relatives to read, so that they understand what you’re all going through.
. At the same time, this book doesn’t dwell on despair, so unless you’re extremely vulnerable right now, you should find that reading it doesn’t turn you into mush, but helps you move forward.
. It gives you an insight into what’s going in the child’s mind, when they wish to eat but need their parent to make the decision for them.
. The author did considerable research and gives you just enough science to help you understand the nature, effects, and possible causes of the illness. Get a copy for each friend who needs to understand this illness beyond chat show level pop-psychology.
What this book might not do for you The book is a memoir, so it is not specifically designed to answer your questions on how to actually get your child to eat, or what to do about school, therapists etc etc, or how to cope with various curve balls this illness will throw at you.
If you're looking for "How to"s, check out the book and videos on my www.evamusby.co.uk, and I also highly recommend the wealth of resources on FEAST: www.feast-ed.org
So calm!!
The only thing that’s not 100% spot on with this book is … the cover of my UK edition. That elegant young woman languidly musing over a little dish of scones has nothing to do with the violent, devastating and passionate world of anorexia. And knowing the world of publishing, I bet it has nothing to do with the author’s view of the topic either.
I received this as an Advanced Reader Copy at ALA Annual 2010.
There is a lot of good information in this book, particularly about Family Based Therapy and this family's experience with it.
Unfortunately, Brown is so wrapped up in her own issues and emotions involving anorexia that her work because repetitive. She is overly defensive and I would like to see this reduced by about 25-50 pages, because I think that's how much could be cut out and still make sense. I wanted to the moments she had with her daughter to stand out by themselves rather than having Brown tell us her feelings and how helpless, guilty, scared, etc. etc. she felt. It's that whole Show versus Tell thing, and we get way more telling, and the little showing Brown does is ruined by even more telling.
I understand that the author digests by writing, but in order for this to be more readable there needs to be a little less digesting by the author so the reader can do their own chewing. The place for the commentary is in the research that Brown inserts into the narrative, which honestly I think would have been more useful and less jarring if she had separated it from the narrative of Kitty and her family.
This is probably a good read for people interested in using Family Based Therapy with their children, but I'm not sure it has much use for entertainment or pure research value (the bibliography might be a good starting place for research though).
The reviewer is a 2009 graduate of Kent State University's Master of Library and Information Sciences program, an alumna of Antioch College, and the author of the blog A Librarian's Life in Books.
Although this book is entitled _Brave Girl Eating_, the title of _Brave Mother Writing_ would be equally fitting. Courageously chronicling her family's struggle with her daughter's anorexia, Harriet puts into words the devastation, pain, raw emotions, obstacles, frustrations, confusion, and exhaustion that too often overwhelm families haunted by the demons of eating disorders. The book reads like a gripping novel, but it is packed with valuable information on family-based eating disorder treatment as well as insight and hope for families in similar situations. Equally important, Harriet identifies and explores the self- and society-induced guilt and blame parents of children with eating disorders shoulder during the already-excruciating-enough struggle. But, instead of being defensive, Harriet learns to create and take an offensive approach that allows her family to actively fight her daughter's anorexia one small spoonful at a time. In contrast to other treatment approaches that involve the parents backing off, Harriet's approach is quite hands (and hearts) on, and she literally, figuratively, and bravely feeds her daughter back to life. I highly recommend this book for families struggling with eating disorders as well as for anyone else who wants to understand the courage, bravery, and tenacity required to fight the demons of disordered eating.
My favorite genre is memoirs, and I understand that an author writes this type of story from his or her own perspective. In this case however, as the author recounted her daughter's illness with anorexia, I was put-off by her constant reiteration that her daughter was a "good girl" and not like those crazy, neurotic, mentally-ill anorexics out there. At one point, after she bemoans the fact that today's society still needs to change it's outlook with regards to mental illnesses, she then makes a committment to refuse to think of her daughter as having a mental illness. In another example, she and her daughter visit an in-patient hospital and they are "appalled" by mentally ill patients they see in the hallways. She's not going to let her daughter be classified with those crazies. Her perspective - we're not like them - they're crazy and/or dysfunctional, we're not.
Meh....not great. While I'm completely empathetic for this woman and her family, her writing style and opinionated approach towards science and health care could be dangerous for readers who might look to this book for actual information and guidance. I think she needed to write this book on some level in order to heal, but the way she writes about different psychological theories that she doesn't agree with is both disrespectful and uninformed. I'm happy that refeeding worked in this case, but in other cases, it can be dangerous and even fatal. Rather than giving readers all the information or even providing a brief disclaimer, the author refers to the "experts" with quotations and discredits anything she doesn't like. I really didn't like this book at all, but if it gives anyone a glimmer of hope, then it wasn't completely worthless.
I am still in two minds about this book. There are so many aspects which I actively applaud, but there were also so many parts of this book which frustrated and frightened me. Overall, I had to give this book a high rating because there is still so little literature about eating disorders. There is even less written from a parent's point of view - a perspective which is so often neglected. As Harriet Brown points out, an eating disorder will not only affect the victim of the disease, it will affect everyone close to them - it will 'change [their] family forever'.
To summarise how I feel about this book, I will split it into parts I thought were covered well and parts which lacked.
The parts which were done well:
1) The science - eating disorders ('EDs') are still some of the most misunderstood mental health illnesses and there is still so little scientific attention and research invested in understanding them. I appreciated how much time Harriet spends on trying to advocate for better research. She also unpicks the little data that there is to try and dispel the prolific myths and stigma that surrounds EDs. Some poignant and important quotes on the science include:
- "1/3 of all anorexics stay sick forever. 1/3 will truly recover. The rest stay on the brink of illness, living diminished lives… they spend years on the outside looking in, unable to live fully or wholly. - " The numbers are against [anyone who suffers from Anorexia]. Statistics say she’ll relapse again and again, her body getting weaker and more adapted to starvation until it comes to feel natural and right to her, until her cells learn the patterns, shape and feeling of constant gnawing hunger" - "Average length of recovery from anorexia is 5 to 7 years but after 5 years of anorexia, recovery is far less likely. - "Close to 20% of anorexics die, about half from starvation and the other half from suicide" - "Nearly 1/5 of all anorexics try suicide; many succeed" - "People with anorexia are disconnected from the physiological sensation of hunger, but they are deeply, profoundly hungry. That’s why they draw out their meager meals for hours, savoring every scrap they allow themselves. It’s why they douse their food with salt, mustard, condiments to sharpen the taste of what they eat. It’s why they read cookbooks like other people read pornography, why they plan elaborate menus they know they will not eat, why they stand longingly in front of bakery windows but never go inside." - "Anorexia symptoms like distorted body image are related to glitches in the body’s interoceptive system" - "Anorexia is 1 of medicine’s biggest mysteries. From the outside, it seems inexplicable. More than that - it’s a perversion and a denial of the force that animates every living creature. We’ve come to understand suicide as the urge of a moment with permanent consequences. But anorexia plays out over weeks, months, years. It is not a single moment of despair, an impulsive turn of the wheel that sends you headfirst into traffic. You need to be determined and stoic to suffer the slow whittling of flesh into bone, the painful alchemics of the starving body." - "The physical process of starvation also causes psychological symptoms, which can include depression, anxiety, and obsessiveness around food and eating - all are hallmarks of anorexia" - "Anorexics have a relatively large section of chromosome 1p in common" - "Certain personality traits are strongly associated with anorexia: perfectionism, obsessionality, negative emotionality, neuroticism and harm avoidance. These traits often manifest in childhood, long before the eating disorder, run in families, and persist after recovery" - "Some people are born with a biological predisposition, a genotype that produces personality traits like perfectionism and obsessionality" - "A higher percentage of people with anorexia die than people with depression, bipolar disorder, schizophrenia or any other mental illness" - "About 30% of people with anorexia cross over into bulimia, and that purging complicates recovery" - "Dramatic calorie restriction can result in… megalomaniac and persecutory delusions, auditory hallucinations, somatisation, dissociation, suicidality, and confusion"
2) Harriet avoided writing this as a ‘pure’ memoir - so many books about eating disorders are written as memoirs by the sufferer themselves. These are largely unhelpful because they often act as encouragement for those still in the depths of the illness and provide 'tips' on how to be a 'better anorexic'. Such memoirs focus on the details of the sufferer's illness including numbers, figures, what they ate, how much they exercised, how 'ill' they were, how much weight they loss, the lowest BMI they reached. For anyone suffering from an eating disorder, these memoirs fuel the competitive nature of the illness. Harriet tries to move away from specifying numbers. However, this being said, annoyingly, she does seems to forget this and when describing the 'refeeding' process, she does set out the target weights of her daughter, the amount of calories she is required to consume, and the methods her daughter uses to avoid engaging with the refeeding process. I read this book first when I was undergoing treatment myself and although I was so consumed by the illness and was admittedly only reading it for pro-anorexia 'inspiration' (like other memoirs offered), I do remember vividly baulking at the numbers and refusing treatment for days in fear of the 'refeeding' process.
3) A parent's perspective and an advocate for family therapy - I thought it was great to hear a parent speak out about how it affects the whole family. I also agree that family therapy can be an effective and useful method of treatment which is often overlooked as it is relatively new and non-traditional. However, EDs are so personal and unique to the individual sufferer that there will never be a universal therapy which suits everyone who experiences an ED. It is important to recognise that the author lives in America where the medical options differ to those offered in the UK.
Parts I thought were not done well:
1) Harriet appears to be in denial for much of the book. She is defensive and critical of the experts and therapists who try to help her daughter. At times, it seems like she is suggesting that she is the best and only person to provide treatment to her daughter.
2) The author speaks for her daughter (Kitty) on occasion. She assumes what Kitty is thinking when it is unrealistic to ever know what is going on in the mind of someone suffering any MH disorder. There is little coverage of Kitty's own voice.
3) Harriet appears to be desperate to rush through treatment and 'get her daughter back'. This is an unhelpful rhetoric. Her daughter will never be the same 'as she was before the illness' and the illness is part of her, part of her history, part of her character and will remain so for the rest of her life. It is unrealistic to think that there is a quick fix for what is so often a life-long battle which will need to be managed by Kitty every day. Even when a victim of ED appears to be at a healthy weight and eating regularly, the illness will not have necessarily left them, they are not 'recovered'. It will be a daily battle, like someone with IBS would have to manage their symptoms each day, someone with a mental illness will need to constantly monitor their mental health and it requires constant consideration to keep in check.
Other quotes which I thought were important and some of my own comments in italics:
- "Intelligence is no protection" - no matter how rational, bright, or switched on a person may be, it will not provide any kind of defence from the infiltration of anorexia
- "Fear is greater than your hunger" - even if someone with an ED feels hunger, the feat and turmoil of trying to allow yourself to eat is so palpable, raw, painful, that it stamps out any appetite you may have
- "How ironic - she’s being eaten alive, literally, by the fear of eating" - the irony of anorexia is something that always perplexes me. The inherent paradoxes of the illness are undeniable - I would try to be the perfect daughter by making my parents watch their daughter starve herself to death, I wanted to lose weight to be slim and fit but not to be skeletal, I thought models were too thin and painful to look at but I had no flesh on my bones, and anorexia is not about the food but it’s also all about the food i.e. the only initial treatment for anorexia is to refeed the patient
- "Anorexic behaviour is the very essence of self-destructiveness. Humans have to eat; I couldn’t see how Kitty couldn’t see that"
- "Every trip to the grocery store with [an anorexic] becomes an agonising series of negotiations" - bargaining began to characterise many of my relationships - with family and friends
- "Anorexia, like alcoholism or drug addiction, is a disease with no real cure, a disease you have to “manage”, one day at a time, for the rest of your life"
- "We treat people with mental illnesses like lepers; we shun them when they turn out to be people we know. A few psychiatric disorders have lost a little of that stigma - for example, people talk more openly now about depression and bipolar disorder. But with few exceptions we still don’t want to hear about the most severe cases of depression, or about the inner lives of people with schizophrenia or personality disorders"
- "It paints someone [with a mental illness] all one colour - the colour of mental illness; where I see Kitty as a complex person whose thinking and behaviours are distorted in certain crucial areas, but whose mental processes are working fine in others " - this was, and is still, very pertinent. E.g. I was able to get 11 A*s in my GCSEs, but my brain wasn’t able to comprehend that I needed to eat. My brain could function at an impressive level in some areas but when it came to the ED, I was unable to process what was going on and see what the problem was
- "If you do intensive psychotherapy with someone with anorexia, you wind up with an insightful corpse, but without enough glucose the brain can’t process or think properly"
- "I thought eating disorders happened to other people’s children - [my daughter] would never have an eating disorder. She was too smart for that"
- "Don’t you get it? You need to eat or you’ll die. I’m only just starting to understand that she really doesn’t get it. That her perceptions are genuinely out of whack… [therapists] describe anorexia as a kind of “encapsulated psychosis”: someone with anorexia suffers under a set of delusions just as powerful as the delusions of a schizophrenic - but only when it comes to food, eating and body image”
- "Despite all the trauma and drama, I sometimes have a hard time remembering that Kitty’s ill. When she smiles or makes a joke, it’s as if I suddenly mistrust the events of the last few months"
- "Kitty is the prisoner of compulsions she doesn’t understand - that no one understands - and that she can’t control"
- “You look great!” I say, and instantly wish I’d kept my mouth shut. Kitty’s illness has sensitised me to how many comments we all make about other people’s appearance. In Kitty’s case, even the most well-intentioned compliment can trigger an anorexic reaction.
- “She’s doing so well!” our friends say, and I want to say yes, but she still wrestles with anorexia every single day.
- "If malnutrition has broken the connections between body and mind, will they ever be healed? I wonder if Kitty will ever feel hunger again, ever feel comfortable with her own appetite, or if eating will forever remain a necessary but unpleasant chore."
- "She is unspeakably brave; she has done the most terrifying thing imaginable to her, over and over and over again."
-"It’s like having an angel sitting on one shoulder and a devil on the other.. And they are fighting all day long… It's like I’m watching a movie, only I’m in the movie too.”
- "I’ve grown used to the idea that Kitty fears and hates food, that she doesn’t like to eat. I have, without meaning to, changed the way I think about her and eating"
- "I think of everything [Kitty] is missing now: friends, sports, sleepovers, parties - the ordinary pleasures of a teenage girl. I think of everything she will miss if she does not recover: Love. Friendship. Meaningful work. Her whole life, really."
- "Her functioning confused me; how bad could things be, really, if she was able to manage all that?"
- "When teenagers leave residential care, they nearly always lose weight.. It is not to say that residential care is never helpful; sometimes it can literally save a person’s life. But it is usually a stopgap, a kick start to recovery, rather than recovery itself. Real recovery takes months, often years… [it takes a lot] to alter the neurobiology that perpetuates the disease, to retrain the brain"
-“No long sleeves are allowed at the table. Sometimes they hide food there… you open your mouth after every bite to make sure you are not stuffing food there. No bathroom for an hour after each meal. Oh, and you get thirty minutes to eat. If you don’t finish, you’ll drink Ensures to make up the calories.”
- "No matter how kind the nurses and doctors were, being hospitalised was traumatic for both teenagers and their families. [It is] still inevitably telling the parents the message, “You’ve failed at something that most parents succeed at, which is to feed your kids.”"
- "[Parents are told] that they’ll eat when they’re ready. They’ll eat when the underlying issues that caused the anorexia in the first place have been resolved. Except a lot of them die before that happens. If it ever does."
This entire review has been hidden because of spoilers.
Honestly, this book is a bit horrifying. Brown seems to be in denial about her own daughter’s illness and even uses terms that are unsupportive to anyone with an eating disorder, such as “freak.” She also feels very strongly that people should not judge her family or her daughter for their situation, but feels entitled to judge other teenagers who have mental illnesses. It just seems that Brown has set a double standard for herself and society and I would definitely not recommend this book.
I felt the therapist/clinician bashing was over the top. As a therapist working with eating disorders, we aren't all as ignorant as the author implies. I support FBT in many cases, but it can be dangerous for parents to try to heal their child alone without the support of a medical team.
I appreciated the scientific journalism (although it could have used more footnotes, A LOT more). However, it was absolutely appalling to read her opinions or feelings about doctors— she names one of them “Dr. Newbie,” who is LITERALLY JUST TRYING TO HELP HER DAUGHTER???? Brown assumes that any doctor outside of her daughter’s pediatrician and therapist knows nothing about eating disorders and hates parents. She also is an overly zealous advocate of FBT and refuses to let her daughter go inpatient even when her daughter asks multiple times because the daughter thinks it would be beneficial to her emotional well-being to, I don’t know, get the help of some experts?? Brown further wrongly attributes the manifestation of anorexia to solely biology and neurobiology of starvation, whereas it is widely felt to be a combination of said biology and environmental and psychological factors, such as home life and stressors. Furthermore, some of the theories she cherry-picks and applies to her situation sound really questionable, like the “adapted to flee famine” hypothesis. Ultimately, I don’t want to judge too harshly, as I am not a parent and it was an engaging read, but the writer’s conclusions were sometimes very questionable and emotionally reasoned.
Having a daughter who is in recovery for anorexia is what prompted me to read this book. I am always interested in other families experiences. This was a mixed bag for me! I give the author 5 stars for depicting her daughter's struggles with her eating and her anxiety. I give her 5 stars for how she so accurately describes how anorexia can wreak havoc on a family. But I can only give her 1 star for her depiction of other treatment options. YES FBT is a great option. FOR SOME SITUATIONS! In our situation we tried it and it was not right for us. Not because we failed. In our situation Residential treatment (shoutout to ERC Denver) literally saved our daughter's life. And in the midst of saving her life it gave us the tools to bring her home and continue the oh so difficult road of recovery with her. WIth the help ERC gave us we knew the importance of a nutritionist, a Pyschologist and how to help her to eat. So read this book with discernment. She isn't an expert. Just a mom with an opinion!
I couldn't get through this book ... I listened to the audiobook version narrated by the author and the condescending attitude is clear. I'm a pediatric nurse who works in a leading children's hospital and listening to someone guess at what they think the doctors/interns/residents are thinking/saying about them was absurd. I started this book to get a mother's perspective on family centered care but this book is a good example of a mother who is truly all the things she claims she isn't. Hearing a story about a battle of anorexia told from the mother's point of view, full of so many assumptions is really what makes this book terrible. The author/mother's simple inability to let her daughter be examined alone with the psychiatrist and her in depth description of how the family changed their eating habits just for "Kitty" to take two bites of food had me screaming "No wonder your daughter is anorexic!".
How I wish we had this resource 25 years ago when our family began our journey with the monster that is anorexia. Instead we had years of mediocre advice, bad advice and so-called experts who had no idea what to do or what approach to take. The Family Based Thereapy method Harriet Brown advocates seems (at this point in time at least) one that offers a more genuine hope of recovery for families dealing with an adolescent in the early stages of an eating disorder. In addition, the exhaustive research Brown has conducted on anorexia makes for a very thorough understanding of what is now known about the disease.
Amazing book -- a very different perspective on causes and treatment of eating disorders. As someone with two siblings with eating disorders and a child in therapy for mental health issues, I was awed and inspired by this mother's dedication to family-based therapy.
This book provided such a personal look into the realities of an eating disorder and how it affects the entire family- very informative and heartbreaking
This book of how one family coped with their daughter's anorexia is quite simply riveting. I read it all in one sitting, all 269 pages. I have not experienced an eating disorder in our home, but I have seen it in the home of a family member. I'm appalled now by my simplistic way of thinking about the disorder. "Why can't she just eat?" asks the distraught father in this book. Why, indeed.
Harriet Brown chronicles her daughter Kitty's struggle honestly and graphically. Of course, the story itself is compelling but on top of that, Ms. Brown's just a great writer, a journalist who has had the privilege of retreats to elite writing colonies like Yaddo.
What sets this family's journey apart from many others is that they chose to treat the disorder with "family-based therapy." This means that instead of being sent away to an institution of some sort -- the way most anorexic sufferers are -- FBT assumes that staying within the family provides the most effective means of recovery. Only one in three patients ultimately beats anorexia in an institutionalized setting, Ms. Brown finds out, while 80 percent do so within a family setting. She went with the numbers.
So begins the family's days of counting every calorie Kitty takes in, forcing her every bite, watching her every move to ensure she doesn't vomit up her food, hide it in a napkin or in her cheeks or any of the many other tricks anorexic people perfect. They endure months and months of her anger, despair and what seems like total madness. Even when Kitty's doctor finally says the family can lighten up, that all is safe now, it really isn't, and they end up stuggling to regain 25 pounds of lost ground. While everyone around her says food is not the issue, that her daughter needs more control over her life, Ms. Brown is convinced it IS about the food, it's about the calories. It's about taking more control of her daughter's life, because anorexia has robbed her of her ability to make good decisions.
Ms. Brown's visual picture of a "demon" taking over her daughter is an effective way to understand why Kitty thinks and acts the way she does. She discovers that even her daughter's voice changes when she expresses the obsessive and self-condemning thoughts of an anorexic. Yet, Ms. Brown learns, the problem isn't all in her daughter's head -- there are physiological reasons an anorexic person struggles to take food in and to gain weight even on a 4,000-calorie-a-day diet.
Because many anorexic people struggle to remain well throughout their lives, you wonder when Kitty goes off to college at the end of the book whether she will make it or whether, like many anorexics, she will descend into the despair that leads to suicide or whether she will return to her "restricting" habits until her body withers away and her heart stops beating. It's to Ms. Brown's credit as a writer that readers are anxious to hear about Kitty's fate, to know that she is well. I sure would like to know that.
Always on the search for another book on eating disorders I jumped at the chance to read Brave Girl Eating when a colleague recommended it. It particularly interested me because it presents a mother’s viewpoint on what it’s like to live with an ED.
I think the book has value; most books on eating disorders offer some type of consolation and information to the reader. We’re often desperate for it. But I warn you that the author is fully embedded in the Maudsley Approach to eating disorders and at times (I actually felt most of the time) came down really hard on those who chose/choose inpatient programs for their daughters and sons. Not everyone has the opportunity to stay at home almost full time to actively feed their child 24/7, not everyone has such an understanding school system that allows a student to go to school halftime, and I wonder if any studies have been done on how the program works across gender lines. Or with individuals who have eating disorders coupled with issues of substance abuse, bipolar disorder, depression, etc.?
Something that did resonate with me is the author’s realization and conclusion that everyone suffers “from” an eating disorder; it affects an entire family. Also that the entire population is vulnerable is some way to some type of mental illness…an aunt, a spouse, a cousin, a close friend may suffer from an anxiety disorder, depression, bipolar disorder. No one is exempt. This is something most people don’t grasp until it personally affects them and until then, they judge and tend to think, “This would never happen in our family.” I learned… never judge, never assume.
Harriet Brown has done her scientific research which goes a long way in helping the reader understand how the brain affects those with an eating disorder. If you’re a parent of someone who suffers from this illness, you reach for every bit of information offered and I found the section on the brain interesting and helpful and it made me anxious to pursue more on the topic.
Read the book. Pick and choose what you need to hear. It helps even if you don’t agree with everything you read.