Refrigerator moms and the evolution of parent-bashing
A few weeks ago I had the pleasure of attending a two-day training in Palo Alto (um, who can beat the location? really…) on Family-Based Treatment (FBT) for eating disorders, sometimes called the Maudsley Approach. The experience was incredibly rich and this will hopefully be only the first of many posts based on what I took away from it.
When I left California, I took with me a deeper understanding of how parents and caregivers can be helpful, or rather, vital, in the process of recovery.
You may be thinking, “Wow, that’s not rocket science. You don’t have to do an intensive training to figure that out.” But in fact for many of us, clinicians included, this is a new concept.
This is not to say that in my own practice I don’t incorporate family support and even do family therapy. But do I rely on the parents of the individual with the eating disorder to do the therapy? In a word, no.
Proponents of FBT would suggest that parents are, in fact, the best possible people to do the intense work of treatment. In short, this means that FBT teaches caregivers the skills they need to implement re-nourishment at home. Parents initially take control of restoring the individual’s weight, gradually turning over appropriate control to their child after a period of time.
If this seems foreign to you, you are not alone. The radical-ness of this idea is radical in part because our society has readily adopted the notion that parents are the root of all of our problems and thus cannot be the source of our solutions.
Putting aside the question of whether that’s a valid argument for a moment, here’s another question: How did we start blaming parents for, well, everything?
Looking back at nearly every public tragedy in history, we find questions about the parentage of the individual responsible. We want to know the background of Adolf Hitler, and from where his brutality might have stemmed. We wonder, who exactly did raise Bernie Madoff? An article in the Philadelphia Daily News recently asked about the shootings in Arizona, “At the risk of sounding harsh, how could the parents of accused shooter Jared Lee Loughner have missed so many signs that their son was a major safety threat?”
And when it comes to individuals with severe mental health or developmental issues, the history of parent blame is perhaps even more striking. And, as Dr. James Lock, one of the major investigators and proponents of FBT said in our recent training, “And let’s be honest, when we say ‘parent blame,’ what we really mean is ‘mom blame’.”
Indeed, the term “refrigerator mother” has plagued the moms of mentally ill and developmental delayed individuals since the mid-20th century. The idea was that the mothers of children with schizophrenia and autism were emotionally cold and distant. In the first paper to describe autism, Leo Kanner described a cause being “genuine lack of maternal warmth,” and parents of these children as “just happening to defrost enough to produce a child.”
Similarly, parents have historically been blamed for eating disorders as well. In the ground-breaking 1978 book, Golden Cage, psychiatrist Hilde Bruch suggested that narcissistic and unloving parents, or hypercritical and over-involved parents, actually caused these illnesses. Now most experts agree that parents do not cause anorexia or other eating disorders. When experts talk about parental contributions today, they are more often talking about the genes that they pass down. Scientists suggest that over 50% of a person’s risk for developing an eating disorder is attributed to genetics.
Does this mean that parents don’t contribute to the development of an eating disorder? I would say no. Parents comments, personalities, own mental health issues, and modeling can in fact influence the development of a disorder. And yes, in many cases those struggling need to better understand the development of their beliefs around food, shape, and weight and, at times, to even redefine what family means.
When things “go wrong” our instinct is to look to the parents; we believe that some answer lies in their egregious errors. Why do we do this? Perhaps it makes us feel safe. We need to know that the man with schizophrenia screaming at the wall couldn’t be our son – we wouldn’t let it get to that. Or that the girl starving herself to an emaciated death – we’re better parents than that. If the cause is genetic or, worse, unknown, then we’re all at risk.
But what we lose in blaming parents is the opportunity to enlist an incredible ally – people who (at least usually) truly know and love the individuals suffering. These are the people who at the end are making the hard sacrifices and praying to whatever entity they believe in for that individual’s safety and protection. When we riddle parents with blame, blame that they often all too easily take upon themselves, we’re might be colluding with the illness.
What role do you think parents might play or not play in mental health issues?