THE PROBLEM >> Anorexia is one of the deadliest psychiatric diseases, with an estimated 10 to 15 percent of patients dying from suicide or complications from starvation. Recovery rates from conventional treatments-psychiatry, group therapy, nutrition education-are extremely poor, and many physicians and therapists are unsure of how best to treat the disease. Too often, the first or last resort is hospitalization, which is costly and has not proved to be an effective treatment over time.
THE BIG IDEA >> For years, the standard approach preserved the anorexic teen’s “autonomy.” Prevailing theory held that the adolescent-usually a girl-needed to “choose” to eat and that parents should refrain from pressuring their daughter. Le Grange takes the opposite approach with his family-based Maudsley method, a treatment he created with other doctors at the Maudsley Hospital in London in the mid-1980s. Relatively unknown in the United States, Maudsley says that parents are part of the solution, not part of the problem. “We empower parents to do the job that they normally do well, which is to take care of their kids,” says Le Grange.
HOW IT WORKS >> The Maudsley approach tells parents to supervise every meal with the adolescent, ensuring that a proper amount of food is consumed, no matter how long it takes. “It’s not a choice, it’s not negotiable; it simply must be done,” says Le Grange. “Yes, it can be a huge challenge to have parents home for every meal. But if their child needed chemotherapy or dialysis, families would make the same kind of arrangements to accommodate that.” Usually parents resort to taking family sick leave or vacation time; after the first two weeks, according to Le Grange, the momentum of the disease often begins to change and arrangements can be made that are slightly
HOW FAMILY DYNAMICS COME INTO PLAY >> At the end of the first meeting, Le Grange books a follow-up family session during lunch or early dinner time. Parents are asked to bring food for all family members. “I always say, ‘You decide what is an appropriate meal for someone who is as starved as your daughter.'” The meal takes place at a table in Le Grange’s office. He sits and watches. “Nine times out of ten, [family members] will display their fixed ideas on how to get the child to eat more, or how they ignore her when she doesn’t eat.” Sometimes, there is gourmet food for everyone but the anorexic daughter, who is given something like low-calorie yogurt because “that’s all she wants to eat.” According to Le Grange, it is always a tough meeting. During the first half he makes small talk while trying to assess the families’ strengths: who does the grocery shopping and cooking; how much flexibility exists in the parents’ working schedules; whether the parents can present a united front. “They must agree that the daughter isn’t eating enough, and that they are willing to be guided in how to apply persistent pressure on the adolescent for every meal.”
WHY HIS RESEARCH MATTERS >> Three studies of the Maudsley approach indicate that 90 percent of the adolescents treated either recovered or made significant gains; five years later, almost 90 percent were considered fully recovered. Currently, Le Grange and Dr. James Lock, a colleague at Stanford University, are overseeing a multi-site study, the largest yet testing the Maudsley approach. “There is a high public awareness of anorexia,” he says. “But often it’s seen as something you have brought down on yourself. You wouldn’t tell a child who has cancer to just snap out of it.”