I struggled mightily with this letter today. I just don’t have it in me to joke about eating disorders – it hits too close to home on several levels. So, while I apologize for not filling today’s blog with chortle-inducing prose, I will be back at full speed tomorrow. I hope you understand when you read on.
A very good friend of mine (“Maggie”) has always been obsessed with weight. Not just her weight, but everyone else’s. She was very thin all through high school and college and many of us thought she had an eating disorder.
Now she’s in her mid-40s, with a 14 year old daughter (“Jennifer”). Here is my problem or I guess question: I think her daughter is starting to get an eating disorder. She has gone from pretty average to very thin over the past few months and her mom seems really proud of that, not worried like I would be if it were my child.
I know for a fact Maggie has always surrounded Jennifer (an only child) with negative talk about food and fat. I remember several times even when her daughter was very young Maggie saying Jennifer couldn’t eat certain food because it was fattening. I have also heard her call her daughter “chubby” on several occasions, but I didn’t say anything because I didn’t feel it was my place.
While I wouldn’t say Jennifer is anorexic at this time, I am worried she may be going in that direction. She is obsessed with calories and exercise and she recently became a vegetarian because she said people who eat meat end up being fat. I am a nurse, so I tried to explain to her the benefits of eating lean meats, especially at her age. She was adamant that they would make her fat.
What should I do? I don’t think I can sit by and do nothing.
Worried in Chicago
First, I’d like to thank you for writing me in the midst of the hellish weather you are going through right now. Yikes! We Portlanders complain about the rain but I’d take buckets of it every day to avoid the cold you are experiencing. Stay warm.
Before I give you my advice, I have to admit your letter jolted me a bit. I don’t have a daughter, but I do have a 12 year old son. I suppose I always assumed that because I had a boy, rather than a girl, he would be immune to my years of shit-talking about my body.
I spent over 20 years as an active and quite enthusiastic bulimic (I used to joke that I didn’t have the willpower for anorexia), and I remember so clearly how old I was when I began purging. I was 12, same as my son. It’s hard to believe that such a young person can develop so much self-hatred in just a few years.
As kids do, my son has gone through the back and forth of heavier/thinner that accompanies growing into an adult. At one point a few years ago he was pretty bulky, and his jeans were always too long in the leg and too small in the waist. Now it is exactly the opposite, and the same pants he couldn’t button a while back are now hanging off of him, but too short.
I have noticed that like his mom, my son has an inordinate amount of focus on food and his physique. I have tried so hard to assure him that he is fit and healthy and looks great, but I fear I may have done some damage to my little boy. As a result, I am remaining ever-vigilent when it comes to giving him positive feedback on his strength and fitness level and biting my tongue when he reaches for a 12th piece of pizza.
I fucked up, Worried, and your friend has fucked up too. I’d like to point out that I win in the “Less of a Bad Mom” contest, because my fuck-up was inadvertent and more self-directed, while it sounds like your friend has actively encouraged her daughter’s disordered thinking about food and weight.
I kind of hate her, but I’ll help you help. Fasten your seatbelt, because this is going to be a bumpy ride.
If what you say is true, and Jennifer continues to lose weight with her mother’s encouragement during this critical point in her adolescent development, you are witnessing child abuse. As you should know better than I, Worried, you are a mandated reporter under Illinois law. Here, let me refresh your recollection: http://www.state.il.us/dcfs/child/index.shtml
If you click on that link you can confirm that as a nurse, you must report to the Illinois Department of Children and Family Services any suspicions of child abuse. If you don’t, you could be sanctioned by your licensing authority. Worse still, you could watch as Jennifer slowly disintegrates, knowing you did nothing to save her.
When I was young, I had a dear friend who was slowly killing herself through food restriction and excessive exercise. Her father seemed obsessed with her weight, and ridiculed her for being fat when she was just a young perfectly healthy girl.
As her anorexia worsened, nobody knew what to do. Efforts by her friends to involve her parents were rebuffed, and as she grew thinner and thinner we feared she would not make it through high school alive. My stepmother finally made the phone call that spurred the parents into action: she told them in no uncertain terms that if the child was not treated for this life-threatening problem, she would have no choice but to alert the authorities.
Two days later she was in the hospital, where she would remain for months trying to conquer this hideous and insidious disease.
Yeah yeah yeah, get to the point, Robin. If it’s not all about ME, it’s all about SOMETHING THAT HAPPENED IN MY LIFE. Sorry, that’s the deal.
Your conundrum is this: you should be able to talk to Maggie about her daughter and encourage her to get help for Jennifer before you make a report to the authorities. But herein lies an ethical dilemma, because you may already be in a situation that requires you to report in order to remain in good standing with the state.
Fuck, I don’t envy you. And I hesitate to get too specific here, lest I be deemed giving you legal advice.
I’ll tell you what: rather than me dictating action to you, I’ll just tell you what I would do. I too am a mandatory reporter, so I can empathize with your problem: you want to give your friend a chance to address the issue, but you don’t want to violate the law by keeping your mouth shut.
If it were me, I would give Maggie and Jennifer the benefit of th
e doubt and assume that at this point, Jennifer is not actually in danger.
“What the fuck?” some of you are saying, “what if she continues losing weight?” Now hold on, you haven’t let me finish. I’m in a real rush today so I’m going to break it down in the AskDesCamp Advice By Numbers method, but please remember this is what I would do, not what I am telling you to do (CYA Advice Goddess is my secondary title):
1. Invite my friend over to talk.
2. You know what’s next: I’d serve drinks. Difficult conversations often require a lubricant, and in this situation I’d choose white wine for my weight-obsessed friend because it’s low in calories. Or is it? My ass would say otherwise. Whoops, tangent!
3. To begin this tough talk, I’d ease into the subject of self-esteem as it relates to body image. During this portion of the conversation, I would relate how my own negative feelings about myself have rubbed off onto my son. I’d then carefully illustrate for my friend how some of the things she says around and to her daughter could have the same effect.
4. Next, I would be specific about my concerns about the child, her obsession with weight, food and exercise, and the recent dramatic weight loss. I would be prepared with written material to share regarding eating disorders and treatment plans. I would also be very keen to monitor my friend’s reaction. More on that in a moment.
5. I would then explain the concept of mandatory reporting to my friend, and show them the law. A lot of people have no idea that certain professionals carry this responsibility.
6. My next action would depend upon my friend’s reaction to this conversation.
(a) If she shared my worries, I’d work with her to find a treatment program for her daughter. I wouldn’t be satisfied until I saw her make the call and demonstrate a genuine concern about her child’s health. I would also strongly suggest joint counseling between the mother and daughter, along with counseling for the mom to help her see how destructive her attitude about weight and food is for herself and her child.
If I saw Mom taking action to solve the problem, I would be satisfied that I was not required to report at that time. If the situation did not improve and I felt my friend was doing nothing to help her daughter, that would change.
(b) If she were defensive and totally denied any problem, I would then inform her that I have a moral and legal obligation to alert the state to my concerns about the health of her child. It could be that the authorities would investigate and find that my fears were overblown, but the state could also mandate treatment. Either way, I’d make the call and pray for the best. Well, I don’t pray, but you get what I’m saying.
(a lot of good that did)
Be prepared to lose a friendship, Worried. At least for a while. Martin Luther King, Jr. once said:
Our lives begin to end the day we become silent about things that matter.
THIS matters. You have a very difficult path in front of you, but I don’t see a choice. You must act, because if you do nothing and Jennifer gets worse you will have to live knowing you stood by and observed undue suffering simply to avoid an uncomfortable conversation with a friend and/or taking action that is required under law to help another. Here, take a look at what Jennifer may end up resembling:
I daresay that if you do nothing, you don’t deserve to carry a nursing license. But I think you will, and I hope you remain in contact with me and let me know how things are going.
Thank you so much for your letter.