Brave Girl Eating by Harriet Brown

This is a memoir of Brown’s experience helping her daughter Kitty recover from anorexia, using an approach called family-based treatment (FBT). It’s also an indictment of traditional attitudes towards anorexia (blame the victim, blame the family) and a call to action to make FBT more widely available to doctors, therapists, and struggling families. A recent randomized controlled trial of FBT shows that FBT offers a success rate greater than 50%, vs. 23% for traditional treatment methods.

Anorexia is a nightmare for children and their parents. Brown chronicles her family’s dawning horror as they realize how sick Kitty has gotten, and the medical maelstrom they encounter as they try to learn about the disease, find the best treatment, and fight for coverage from their insurer. In family-based treatment, parents take responsibility for their child’s weight restoration; this is a huge difference from traditional approaches that isolate the child from her parents and place the responsibility for weight restoration directly on the patient. But FBT is a hard path to take. Brown and her husband had to sit with Kitty during every meal and every snack for the many months it took her to gain weight. It was an emotional rollercoaster as meals would take hours, and be accompanied by rivers of tears as Kitty fought the demons that were preventing her from eating.

Brown takes deeply entrenched theories (both scientific and popular) about anorexia and turns them on their heads. Here is the fundamental question: Is extreme weight loss caused by deviant thinking, or is the deviant thinking caused by the weight loss? According to Brown, (and FBT advocates) it’s the nutritional deficits that result from too much weight loss that lead to the deviant thinking among anorexics, not the other way around. On this issue Brown has become a crusader, and she backs up her conclusions with results of studies performed on starvation victims. Without exactly saying it, she clearly blames the medical establishment for long-held “blame the victim” attitudes and she seeks to rebut that approach in this book.

Okay, but why did I read this book, you are wondering? It’s not my usual fare. It’s because I know Harriet Brown, and I know Kitty (not her real name). For several years their family lived in our neighborhood, and my oldest son was friends with Kitty in the sibling-ish manner of boys and girls who have gone to school together their whole lives. I saw Harriet fairly frequently at school events and other neighborhood activities. Lots of my friends have been skeptical about Harriet’s decision to write this book: is she taking advantage of Kitty’s illness for her own personal gain as a writer? Let me answer a resounding NO to this question; I think she is doing adolescent girls a huge favor by telling their family’s story and by calling attention to FBT. If you know both of these women (Kitty is 19 now), you know they are no shrinking violets. Kitty was always fearless on the playground, and for as long as I’ve known her, Harriet has been pissed off about something or other. It’s like she’s finally found her cause and she brings to it a wealth of wisdom, the energy of a true zealot, and the communication skills of an experienced journalist; quite a formidable combination.

(Book 47, 2010)