A Nutritional Lobotomy?

That is exactly what I felt I would need to undergo after our son discharged from inpatient treatment.  Our world turned upside down when our son became ill with an eating disorder.  The shock,  the anger, the disorientation, and of course, the guilt.  Did I do something to cause this to happen?  Could I have prevented this?

Our journey through treatment has had its ups and downs.  There have been setbacks, but there has been real growth for our entire family in many areas.  We have tried many different strategies and have received mostly really good advice.  Sometimes, though, things have been said that just didn’t make sense to me.   They seemed to defy the principle of common sense in my mind.  I am not a particularly rigid person.  I do not subscribe to the philosophy of one size fits all in the realm of eating disorder treatment or anything else.  Eating disorders are very complicated and throughout our journey we incorporated aspects of many treatment modalities, used a variety of strategies based on research past and present, and also used a very large dose of common sense.  All of this has been within the framework and guidance of our treatment providers.

There is one particular day that stands out to me.  It was very early in our journey.  My son was getting ready to be discharged from the inpatient unit and I was sitting in a group meeting.  The discussion was about meals and meal planning after discharge.  My son was 21 and an adult.  He would be eating with us, but because of his age it was felt that he should be planning his menu or heavily assisting with the menu choices.  I didn’t necessarily have a problem with that.  He was welcome to help me plan meals if this did not interfere with his ability to eat them.  I made the comment that we needed to work together to plan meals, but also choose healthy foods as part of that plan.  That, apparently, was the wrong thing to say.  I was sternly informed that there was no such thing as healthy food.  Food was food, period.

I initially felt ashamed.  I thought that I had said something that would cause a setback.  My son smiled.  We could see the wheels turning inside each other’s head, but in very different directions.  I asked for clarification.  I asked this person, who was not going to be my son’s outpatient therapist, if she was saying that I should have no regard as to the nutritional content of the food that my son was choosing.  She responded that I should not.  There is no such thing as healthy food, she told me.   There is just food.

I left that meeting quite confused.  I got the concept that we want someone with an eating disorder not to be picky about food.  I got the fact that we want calories in the body of someone that is grossly underweight.  I got the idea of variety in the diet.  I went through many mental gyrations trying to understand where she was coming from and to remind myself that she knew more than I knew and, yet, this just plain offended my common sense.  My son was clearly malnourished when he entered the hospital.  He was very anemic and many of his other labs were grossly out of whack as well.  His inpatient diet stressed the importance of fats and foods that addressed the deficiencies common with malnutrition.  How, then, did we leap from this to the idea that food is food and the nutritional content is unimportant.   I fully understand what Orthorexia is and how dangerous this can be, but there had to be something between Orthorexia and who cares.

What effect was this style of eating going to have on my other children?  I wasn’t as much concerned with lunch and dinner because the standard was generally an entrée, side dish, and a vegetable for dinner and lunch was pretty standard as well, but breakfast would be a real problem.   I generally fixed breakfast, but there were some variations and sometimes breakfast was eaten before school with several choices available which my kids fixed themselves.  I wasn’t a breakfast Nazi and there were treats for breakfast which included sweets at times.  This wasn’t standard fare though.  I didn’t, and still don’t, find breakfast foods that begin with such names as “Chocolate, Cookie, and Marshmallow” nutritionally sound.  There were not enough books in print explaining the meaning of eating disorders to siblings that was going explain or justify why my oldest son could eat anything he wanted while the rest of them had to eat what I served.  I could read those books to his siblings several times and it would still go over a bit like a pregnant pole vaulter. Honestly, I couldn’t blame them and I could see this quickly breaking down into culinary anarchy.

I was never horribly fastidious about food.  I do have a child that is fairly chemically sensitive and I prefer my food to be free of pesticides, but even with that limits existed within my budget and the availability of such foods.  Some of our food had pesticides and I didn’t spend my nights awake obsessing about it.  I did, and do, believe in a healthy diet, but that didn’t mean we cut out sugar or didn’t eat dessert.

Did the fact that my son had anorexia mean that I had to begin believing there was no such thing as healthy and unhealthy food?  This flew in the face of common sense to me.  My children sometimes stayed up very late for special occasions or events, but I still believed in healthy and unhealthy sleep patterns and I insisted on a standard bedtime.  Why did I have to change my opinion of food?  Was I required to have a nutritional lobotomy because my son developed an eating disorder?  My common sense told me that my son needed sound nutrition in order to heal his brain.  That was preached throughout his inpatient stay.  That variety was required and that dessert and sweets could be a part of that variety was, to me, a given.  It was also the way we lived before he became sick.  Why, now, with discharge from inpatient was all of this seemingly unimportant?

With my common sense still offended, I did follow the discharge instructions and agreed to this treatment plan until we met our new outpatient provider.  Fortunately, there was not a long wait time for the outpatient follow-up.  Our outpatient provider was more than wonderful.  She did believe that restoring proper nutrition was important and worked with my son to develop menus which met his individual needs.  She was very quick to point out how my other children could easily feel that there was a secondary gain to be achieved with an eating disorder if my oldest son was able to eat whatever he wanted while they ate what was served.  She was also very understanding of the fact that mom preparing separate meals to meet the needs and desires of everyone in the house wasn’t likely to be very successful.  My oldest son needed certain portion sizes and needed 3 snacks in addition to his meals and even required some supplements in the beginning, but it was decided that we should all be eating the same food and that food was what mom cooked.  The portion sizes would vary from person to person (my husband and I could not eat the portion sizes of my son if we wanted our blood pressure to stay on the charts). This individual approach that was taken with our son and our family was much appreciated and a very good fit for us.   There are standards of treatment within the genre of eating disorders, but every individual is different and every family is different.  One size will likely never fit all.

With my common sense put back in joint my son and I worked very well to develop menus that met the requirements and desires of us all.  The entire family was included in menu planning at the beginning of the week and it was understood that mom had the final say because mom was cooking it.  That said, mom understood individual likes and dislikes, the desire for sweets and dessert, and I tried to balance that within the special needs of our son while he was in recovery.  Common sense told me that we were all going to have to bend and compromise a bit, and we did.  I will say, as I always do, that it was not idyllic or a fairytale, but it worked.





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