The acceptance and success of family based treatment interventions in the world of eating disorders has been one of the major mental health breakthroughs of the past few decades. Empowering parents to be in charge of re-feeding and in charge of helping their child with anorexia nervosa achieve weight restoration has been a resounding success, especially for the child who is still young enough to be dependent on their parents for schooling, food and shelter. This means children roughly between the ages of 6 through 17.
“Parents in charge” makes more sense when you are young, but becomes a very hard sell after the age at which our legal system endows us with “adulthood.” So what are the challenges for those families of eating disordered children who are 18 and older?
One of the enduring fallacies of young adulthood is the belief that our parents are vested in keeping us dependent on them and want to control our every move. We have to go to college to escape their grasp, the sentiment goes. (And what will our parents ever do with all their time, without us to care for?)
The truth, I believe, is that by the time our children are ready for their independent lives, ready to fly the coop, we are pretty much ready for them to go. Far from wanting to continue to care for their every need, we are ready for them to begin their new lives of caring for their own needs.
I sometimes think that mother nature’s way of allowing us to endure separation from our beloved children is to make them so obnoxious in their last teen years that we are good and ready for them to try it on their own.
This “independence disconnect” is one of the main reasons parents of older kids stumble with the family based treatment options. First, the kids are now “adults” and can refuse their help, and second, the parents only very reluctantly agree to resume “treating them as children” because it is so much work, work they had thought they could leave behind them in favor of a more relaxed and less responsible lifestyle. To put a parent back in charge of cooking, shopping and supervising meals, which is almost always as necessary for the 19 year old with anorexia nervosa as for the 12 year old, is a bitter pill for both the child and the parents. It’s damned hard. It’s thankless. But it’s necessary.
Although this is not true everywhere, in the state of Oregon we have been able to work with the courts to get guardianship approved in cases where a very sick young adult refuses care for their eating disorder. But even where guardianship is technically possible, it is a fraught situation. Few parents happily disenfranchise their adult child of their decision making rights. Why not? For the reasons listed above: they are ready for their child to make good decisions on their own.
I did once have an especially insightful young woman tell her mother in front of me that she wanted her mother to get guardianship. Her mother had told me in the hospital “I won’t need guardianship. I know my daughter, and she will comply with what she needs to do.” The daughter then said: “Please do it, Mom, because I know that the minute I start to really gain weight I will panic and refuse treatment.” So Mom got guardianship.
But that was a rare case. Usually, to call obtaining guardianship “thankless” is to greatly understate the pain involved. You do it to save the life of a child. Your child. No matter their age, they will always be your child.
The courage and resolution needed to treat with family based interventions when your child is old enough to say no is essential to their success. To endure the challenges associated with this, I would advise you to seek the help, not only from your treatment team if you have one, but from other parents whom you can lean on. Organizations such as F.E.A.S.T. have many members facing these very issues.
But know this: you are “paying it forward.” By modeling resolution and caring for your own child, you are enabling them to do difficult – even wrenchingly difficult – things for their own children later when life throws them their own challenges (or even the same one). In this area, as in others, clarity of purpose and courage of conviction, leavened with a hefty dose of love, will be able to take us where we need to go. Indeed, it is the only thing that ever has.
