Anorexia and other eating disorders – Eva Musby Book Interview
Author Eva Musby, joined us for an interview on her book, Anorexia and Other Eating Disorders. What follows are our questions in italics, and her thoughtful answers.
You describe a number of experiences which typify the impact of an eating disorder on the lives of parents and loved ones. You also note what the child with the eating disorder may be experiencing. This seems like a compassionate and intimate beginning. What is the role of compassion for self and other in the recovery process?
Compassion gives us access to a whole lot of internal resources which stress deprives us of, like courage and open-mindedness, rational thought and emotional intelligence. We need these to keep well and to support our children, so I aim to make readers feel understood right from the start of the book. Likewise our youngsters need compassion from us to access to their own strengths. So, the book covers emotional skills just as thoroughly as practical answers – both are needed if we’re to help our children recover.
It can be quite a revelation for a parent to discover how much their child is suffering beneath their hostile faҫade. And when parents get into empathy they can support their child through the toughest of challenges. One father told me that the first few pages made him change how he viewed his daughter and this produced a much-needed breakthrough at the next mealtime.
Can you please share your thoughts on a parental “wait-and-see” attitude?
Too often, non-specialists downplay parents’ instincts, are over-cautious about making a diagnosis, and hesitate to refer a young person for treatment especially if the person isn’t (yet) skin and bones. Specialists and parents alike protest that this ‘wait-and-see’ position is like waiting for a cancer to move from stage 1 to stage 4. Chapter 3 offers tips to help parents get prompt action. And since the first phase of treatment is to help your child eat and interrupt harmful behaviors, parents can do that right away with the help of the book, even if the health service forces them to wait.
You wrote, “The two main elements of treatment for a child are food and love”. Please explain.
Whereas the previous generation of therapists attempted to treat sufferers with talk and insight into potential causes, modern research has clearly shown that food is key. First, we know that rapid weight gain leads to swifter recovery, and that conversely someone will not recover while they are underweight. Next, when your child is avoiding certain foods or behaving in a destructive way around food, they will improve as you help them to normalize their behaviors. As they get desensitized to what they fear and as they experience new ways of feeling OK, their brain gets rewired.
Now if food was all that’s needed, inpatient units would have a better success rate. In fact, it is when youngsters are treated at home, with their family, that they get lasting results. Home is where the heart is. It’s where life beckons, coaxing our children away from their restricted world. They need our love and acceptance to re-engage with their own love of life, their aspirations, and their pleasures. Love, even when we don’t feel it, is also what keeps us parents returning again and again to their side when we would otherwise be running away, screaming at them or giving up.
The temptation to reward or bribe a child to eat probably crosses every parent’s mind. Can you please share your words of caution?
The carrot and stick approach has produced breakthroughs for some families and I’m keen for parents to hold onto what works for them. But incentives and punishments can also get in the way of long-term progress, so I help parents think through their options. I offer approaches that may appeal to them more and that also foster connection.
What could go wrong with rewards? Imagine you tell your child, “If you manage this whole meal I’ll give you ten dollars”. Your child’s brain is firing off danger signals as he sits at the table, but he really wants the ten dollars, so he dominates his panic and picks up his fork. Bravely, he eats, and he eats more than he’s managed in a long time. You’re ecstatic and you’re looking forward to rewarding his courage.
But the eating disorder hasn’t vanished just because you’re dangling ten dollars in front of him. So let’s imagine he has a meltdown close to the finishing line and leaves the last potato. Should you hand out eight dollars instead of ten? What if your child argues that he managed nine dollars-worth? And what if the coveted reward was not money but, say, a pair of trainers? You can’t give a fraction of a pair of trainers. But it gets worse. The deal was your child had to eat “the whole meal” and you want to maintain your credibility for the longer term, so you decide to withhold the reward. Now your child feels punished instead of incentivized. His disappointment and self-hate add to his panic over what he’s eaten. Next meal, what are the chances that he will try as hard?
I guide parents through other ways to tackle meals, which avoid these potential complications and offer more choices.
In Chapter 8, “See the Tools in Action: Mealtime Scenarios”, you provide parental responses to various challenges they may experience during a meal. What have you heard from parents about these suggestions?
Parents get very frustrated when they don’t get help with practical questions. They keep hearing they should feed their child, but hardly get any help on the ‘how’. Chapter 8 is very popular because parents can be like flies on the wall as realistic scenarios unfold. Our children can put up tremendous resistance and parents want answers to all their ‘What-ifs’. I highlight choices all along and readers take away what is useful to their situation.
Sometimes a parent is glad they’ve tried something that feels alien. Recently I was coaching a mother who wanted to know what to say when her daughter shouted at her. She was not keen on words of compassion as she was certain her teenager would meet them with extreme cynicism. But things were really bad and she had nothing to lose, so she picked one form of words to try out. Her courage paid off. Her daughter dropped her defenses and they had their first heart-to-heart in a long time.
You have inserted sections in your book entitled “Pause for Self-Connection”. Can you please address the importance of these sections?
Our children’s behaviors can push us to the limits of what we can bear, so we parents need powerful techniques to process our emotions. When readers delve into practical scenarios, this may bring back the feelings they experienced at a difficult mealtime. It’s a perfect opportunity to try out the self-compassion tools I expand on elsewhere in the book, and to prove to themselves that emotions are not dangerous.
Besides, inviting readers to pause is another way of putting ‘Empathy before Education’ into practice – it’s a principle which, as I show in the book, makes all the difference to how we communicate with our children.
You discuss ‘Chatterbox thoughts’ and how to deal with them. Can you provide some examples?
An example of a Chatterbox thought is “My child will never get well.” Your child may well have Chatterbox thoughts like “My parents are control freaks!” Thoughts like these go round and round in your head and make you anxious or angry or low. Some of the older therapies teach you to dispute the thought (such as “We are getting excellent treatment” or “My parents mean well”). They are logical but if you have strong emotions, that may not help. I give readers more recent approaches that welcome in thoughts and feelings while preventing them from looping round. You can then use them as a way in to your strengths and values.
Once parents experience this for themselves, they can help their children cope with the waves of fear or grief, hostility or self-hate that the illness brings.
You’ve included a section dealing with aggression. Thank you for bringing this subject to light. Can you speak about de-escalation?
If your child is behaving wildly, she (or he) is not in a logical frame of mind. You can make a quick, firm request for her to stop kicking you or destroying the furniture, but after that the focus is to help her move out of her state of fight-or-flight and back to her own self. You’re probably in fight-or-flight too by now so it’s not going to be a neat, linear process. I show how to make use of compassion for your child so that she gradually feels understood and cared for, and self-compassion so that you can be kind to yourself and hold on for the time it takes. Compassion, people are surprised to learn, isn’t necessarily about being calm and softly spoken. You may need to make your body language and tone of voice match hers, to show you really get how awful she feels. Then gradually you model calming. These episodes take up a lot of a parent’s courage and grit, and we are wise to get kindness and understanding from others later on in order to reset our own level of wellbeing.
Many parents of children with eating disorders feel like they are walking on eggshells. How can parents get their feet back on the ground?
One ingredient is knowledge. We get heart-broken and scared by how changed our children are, and it helps to know that their new behaviors are in fact normal and that they will pass without harm. The book is informed not only by my experience but that of many other parents, so the reader can gain a wider perspective of their own situation.
Another ingredient is the nitty-gritty of what we say. There are words that usually help and words that usually trigger a reaction. The book guides readers through principles of compassionate communication so that parents can make best use of their natural way of speaking. And for those who have temporarily lost their self-confidence, they can try out phrases from the examples I provide.
There are also skills that help us break fewer eggs or – I’m dragging out the metaphor – put them back together. We get more resilient when we appreciate that our children’s outbursts are about their own distress, not about us. I offer skills for communication, for kindness, courage and self-soothing, that turn a potential drama into one of many small blips. And on a good day, a blip can reveal itself as a wonderful opportunity to strengthen our connection and for our children to blossom.
About the author –
Eva Musby’s daughter was struck by anorexia when she was ten years old. She was hospitalised for a year, and on her return home Eva Musby pieced together a wealth of practical and emotional tools to effectively support her recovery. This approach is in line with family-based treatment, one of the very few evidence-based approaches for the treatment of eating disorders.
Eva Musby’s work for the parents of children with an eating disorder rests on years of personal experience, is informed by research, and supported by a network of parents and professionals across the world.
To learn more, please visit Eva’s website.