Guest guest Posted October 2, 2007 Report Share Posted October 2, 2007 Understanding anorexia: A thin excuse Naomi Hooke has delved deep into the causes of the anorexia that nearly killed her. But of one thing she's sure – it had nothing to do with 'size 0' models Published: 18 September 2007 It was two days before Christmas, and for the third time in my 20-year-long existence I found myself having my blood pressure monitored, my blood taken for biochemical analysis and my mental state being assessed for risk of self-harm and suicide. Once again, I'd been admitted to an eating disorder unit, rescued from my own little world of self-destruction. The day before, I had filled my every hour with food (or rather the avoiding of it), exercise, my ongoing obsession with academic work, and fantasies about a future where I wouldn't be there to spoil everything. My parents came to visit, my younger sister excited in anticipation of present-opening. It hurt to sit up, and hurt to lie down, yet I refused to believe that this was due to starvation and muscle wastage. My family brought me a stocking, but I couldn't understand how they would ever think I deserved nice things. I left the presents unopened for over a month. I'd suffered from anorexia to varying degrees since I was 11, hiding food and concealing my body under layer upon layer of clothing, and once again it had caught up with me. As London Fashion Week continues, the controversy surrounding " size zero " models is once again up for discussion. Prompted by the Madrid ban on models with a BMI below 18.5, fashion capitals around the world have undertaken enquiries into the links between eating disorders and the catwalk. Although any measure to protect models at risk of eating disorders is to be applauded, to believe that the fashion industry causes eating disorders is to completely misunderstand this most complex of illnesses. At 11, I was showing early signs of puberty, and the prospect of an adult life ahead terrified me. I was afraid of responsibility, of a time when I would have to face the world without my parents' hands to hold. But most of all I was scared of men and sex. Throughout my illness, even when I was motivated, I was convinced that recovery was impossible. But miracles do happen. I was in the grip of anorexia nervosa for more than eight years, but with a lot of help from family, friends and professionals I was able to turn my life around. Anorexia has often been perceived as a quest for model-like beauty, as a teenage fad or as a diet gone wrong. It has even been described as a lifestyle choice. Seldom is anorexia acknowledged as the life-threatening medical condition that it is. Many anorexics detest their bodies, refusing even to pose for family holiday snaps. I, like many of the eating disorder patients I have met, never sought beauty; instead, I spent years trying to make myself look as ill as possible in order to avoid male attention. As far back as I can remember, my self-esteem was low and I lacked confidence. Children can be cruel, and although they weren't the " cause " of my eating problems, the bullying I endured throughout my schooldays only added to my feelings of self-hatred. It is often assumed that the distress in anorexia revolves solely around food and weight. However, the vast majority of eating disorder patients have numerous other difficulties, including low self-esteem or confidence, lack of self-care, and social difficulties. Sufferers are often presumed to pour over the pages of glossy magazines and starve themselves in their aspiration to become glamorous, thinner-than-thin sex goddesses. From my own experiences and from those of numerous other eating disorder patients I have met, I can say unequivocally that nothing could be further from the truth. Beauty has very little to do with eating disorders, and the desire to be thin is merely one of many symptoms. Rarely can a single " cause " be identified. On the ward, Christmas had been and gone, and it was beginning to dawn on me that I would not be well enough to return to university. I was convinced that, once again, I had failed. During those weeks, I hit rock bottom. After years of pretending, I finally opened up to staff at the hospital, and began speaking about some of my troubling innermost thoughts. I had never felt so ill; the pain was excruciating. My memories of this hellish period are sketchy, but I have since been told that my kidneys were failing and that I was at risk of cardiac arrest. I had many meetings with the doctors, and eventually I agreed to be fed via nasal gastric tube. It was horrible when they passed the tube, though deep down I know it probably saved my life. It was at this point that something flicked inside my head. It was as though I'd " swapped sides " : I stopped fighting everyone who was trying to help me. As the weeks went on, my stomach ached as it was stretched to accommodate food again. It still took me hours to eat a bowl of soup, and I still had a tube up my nose, but nevertheless, things were getting better. I wasn't an easy patient. I cried and screamed and threatened to run away. But in spite of everything, staff at the hospital never gave up on me, and I'll remain eternally grateful for every hug and kind word. Although my first trip home was challenging, it did open my eyes. At last I began to see how much anorexia was holding me back. I was getting stronger, thinking more logically, and perhaps most importantly my sense of ambition was returning. I started to dream about getting back to university and one day being able to help people with mental illness myself. I spent seven months as an in-patient and two more as a day patient. I regained a healthy body weight, spent numerous hours discussing my underlying fears and was slowly beginning to develop a sense of self-worth. My fall into the dark world of anorexia was never influenced by fashion or waif-like celebrities, though I knew others whose recovery from life-threatening illness was indeed hindered by the Western world's culture of thinness. I believe that the British Fashion Council's guidelines will go some way to protect the models themselves (of whom 40 per cent are said to suffer from eating disorders). However, I see problems both with the approach taken in Madrid of banning models with a BMI under 18.5, and the recent health certification scheme proposed in Britain. Although BMI can offer a crude measure of physical health, it can never quantify psychological distress. Despite popular belief, low weight is not the only danger of eating disorders. There have been times in my life in which my BMI has been in the healthy range and yet my eating behaviours and mental state were far from healthy. I would starve myself for days on end before my body gave in to the pains of hunger and I would binge, after which I would feel so disgusted with myself that I would make myself vomit and/or cut myself with razor blades. As for doctors' certificates, it takes considerable time and skill to assess whether an individual has an eating disorder, not least because sufferers often go to great lengths to hide their illness. I've been there, told the lies and tricked the scales. It is a fact that a higher proportion of models suffer from eating disorders than do the general population. The " grooming " and competitive atmosphere undoubtedly perpetuate eating disorders within the modelling profession, but I am personally of the opinion that young girls with existing eating disorders are selected by modelling agencies because of their tiny figures. But, although the fashion industry may be rife with anorexia, the majority of eating disorder patients have not become ill through catwalk influences. And nor are they models. http://news.independent.co.uk/health/article2974474.ece ------------------------------- Understanding Anorexia -- the Basics What Is Anorexia? It's got a fancy Latin name: anorexia nervosa, " nervous want of appetite. " It's a killer. One in 10 cases ends in death. People with anorexia starve themselves by eating far too little food. Eventually they become dangerously thin -- yet they still see themselves as fat. People with this eating disorder may become so undernourished that they have to be hospitalized. Even then they often deny that anything is wrong with them. Anorexia usually begins around the time of puberty. Nine out of 10 people with anorexia are female; one in 100 U.S. women is anorexic. Technically, anorexia is when a person eats so little that their weight drops at least 15% below normal body weight. There are 2 subtypes of anorexia. One type of anorexia is linked to another eating disorder, bulimia, in which people periodically go on eating binges and then force themselves to vomit the food they have eaten. The other subtype does not binge and vomit, but merely restricts the amount of food and calories taken in. A person with anorexia becomes obsessed about food and weight. Some people develop strange eating rituals and may refuse to eat in front of other people. Many people with anorexia seem to care a lot about food. They may collect cookbooks and prepare sumptuous meals for their friends and families -- but they don't join in. Often the refusal to eat is paired with strict exercise regimens. What Causes It? Nobody knows why a particular person becomes anorexic. It is a psychological problem that has profound physical effects, including death. People with anorexia come to believe that their lives would be better if only they were thinner. These people tend to be perfectionists. The typical anorexic person is a good student involved in school and community activities. Many experts think that anorexia is part of an unconscious attempt to come to terms with unresolved conflicts or painful childhood experiences. WebMD Medical Reference View Article Sources SOURCES: Halmi, K. Eating Disorders: Anorexia, Bulimia, and Obesity.; Yudofsky, Textbook of Clinical Psychiatry ,4th edition American Psychiatric Publishing, pg 1001-21, 2003. Brewerton, T., Clinical Handbook of Eating Disorders: An Integrated Approach - Edition 1, Marcel Dekker, Inc, 2004. Reviewed by Michael H. Aronson, MD on July 01, 2005 © 2002 WebMD, Inc. All rights reserved. http://www.webmd.com/a-to-z-guides/understanding-anorexia-basics --\ -------------------- Understanding Anorexia Nervosa Anorexia nervosa is a complex psychological disorder that literally involves self-starvation. People who suffer from this illness eat next to nothing, refuse to maintain a healthy body weight for their corresponding height, and frequently claim to “feel fat” even though they are obviously emaciated. Because anorexics are severely malnourished, they often experience symptoms of starvation: brittle nails and hair; dry skin; extreme sensitivity to the cold; anemia (low iron); lanugo (fine hair growth on the body surface); loss of bone; swollen joints; and dangerously low blood pressure, heart rates, and potassium levels. If not caught and treated in time, victims of anorexia nervosa can literally “diet themselves to death.” It is estimated that approximately 7 million Americans suffer with anorexia nervosa. 90 percent of the sufferers are women and roughly 10 percent are boys and young men. Although any personality can fall victim to this life-threatening illness, most anorexics tend to be perfectionists who keep their feelings bottled up inside, straight-A students, good athletes, and people who always do the right thing. For anorexics, restricting and controlling food becomes a way to cope with just about anything. Here are some of the warning signs of anorexia nervosa: Nutri-Speak Anorexia nervosa means “appetite loss of nervous origins.” Bulimia means “ox-like hunger.” Abnormal loss of 15 percent (or more) of normal body weight with no medical reason for the loss. It can also be a failure to gain an expected amount of weight during a period of growth for younger children and adolescents. An intense fear of becoming fat or gaining weight, along with strict dieting and severe caloric restriction—despite a rail-thin appearance. In females, absence of at least three consecutive menstrual cycles otherwise expected to be normal. Always moving the diet “finish line.” (“Just five more pounds and then I'll stop.”) Constant preoccupation with food. Anorexics will often cook and prepare food for others but refuse to eat anything themselves. Distorted body image. For example, claiming to “have fat hips” even though scales and mirrors show that they are severely emaciated. Strange eating rituals such as cutting food into tiny pieces, taking an unusually long time to eat a meal, and constantly preferring to eat alone. Obsessively over-exercising despite fatigue and weakness. Becoming socially withdrawn, isolated, and depressed. “Weighting to Be Normal” At 13 years of age and 172 pounds, I wasn't very involved in the world around me. Sure, I saw the fried chicken, mashed potatoes, cakes, and cookies, but boys, clothing, and beaches eluded me. Don't get me wrong, I wasn't miserable all the time; I just wasn't particularly happy. In fact, most of the time I was nothing; I was just FAT! Like most perfectionists, I seemed to do everything to extremes. Initially, I ate to the fullest, and later, when my doctor told me I needed to lose weight, I dieted to the skinniest. Three hundred sixty-five days later and 52 pounds lighter, the new Jane emerged. I had exercised and dieted my way to health. Burgers and taxis were out, low-fat foods and biking were in. Not surprisingly, my doctor was ecstatic with my success, and my family was beaming with pride. My friends, on the other hand, were filled with that strange combination of jealousy and admiration, and finally, for the first time in my life, guys noticed me. They whistled when I walked down the street and approached me at school. “Wow,” I thought. “If I can get this much attention at 120 pounds, imagine how great life could be at 110.” At 100 pounds, I thought I had found bliss: I could count my ribs, pull down my pants without unbuttoning them, and most importantly, I could go an entire day on just a small fat-free frozen yogurt. Months flew by, and my weight continued to plummet. Exhausted, freezing, and wearing size-0 clothing, I had propelled myself into a lonely abyss. Summer nights felt like the dead of winter, and the urge to sleep was unstoppable. I knew I was sick—everyone knew I was sick—and I was ultimately diagnosed with anorexia nervosa. Although I rejected the notion of having a disease, I struggled both mentally and physically with solid foods and decreasing my amount of exercise. Gradually over the course of a year, I regained both my body and my life. I admit, low-fat foods and exercising are still entrenched in my life, but this time in a healthy manner, not as a destructive disaster. I must push myself to eat a risky meal (a “scary” meal with fat) every other day and allow myself to indulge in a dessert treat twice a week. Although I still obsess about my weight, it's no longer about losing; instead, it's about maintaining. I have been at my current healthy, thin weight of 112 pounds for the last year, and I guess you can say I have finally found an ideal way to exercise my “control.” I “control” what I eat and how much I exercise, not in a freezing abyss, but in a hot, sweaty gym. —Jane Stern, a 20-year-old recovered anorexic http://life.familyeducation.com/nutrition-and-diet/eating-disorders/48917.html --\ - Understanding Anorexia Nervosa Allan N. Schwartz, LCSW, PhD Sun, Jan 7th 2007 Finally, the fashion and media industries appear to be paying attention to the dangers of anorexia nervosa. For decades, both industries have placed very thin models on center stage. The message conveyed to young women was unmistakable: " if you wish to be beautiful, you must be skinny. " The recent deaths of some top models in Brazil and the greater awareness of the public about the health dangers of being too skinny have convinced some of the top executives in both industries that it is time to be more aware of health rather than just being skinny. Nevertheless, Anorexia Nervosa continues to plague the lives of young women and their families. While a small percentage of men do develop anorexia nervosa, the overwhelming majority of people with this disorder are female. NEDA, the National Eating Disorder Association, estimates that one in every 100 girls develops anorexia. As early as age ten and twelve girls become aware of weight and begin the process of dieting and exercising. If they develop anorexia it can last until age 35 and in some cases becomes a life time problem. In Middle School many girls will not eat their lunches. The reason is that they feel embarrassment about eating in front of boys. In addition, they are reluctant to eat in front of other girls for fear of appearing to be greedy. Losing weight becomes a competitive issue for many of these females who judge themselves by how much thinner they are as compared to other girls in school. What Is Anorexia Nervosa? Anorexia is a disorder characterized by the fact that a female weighs less than 15% of normal body weight for their age and height. These females do not think of themselves as thin. As a matter of fact, no matter how much weight they have lost, they think of themselves as being fat. As a result, they severely restrict their food intake and obsessively exercise for the purpose of losing more weight. Generally speaking, these young women are extremely intelligent and achieve excellent grades in school. They are perfectionist, demanding and expecting the best possible performance from themselves in all areas such as academics, athletics and social interaction. Along with the symptoms of anorexia, most of these young people experience extreme anxiety, depression and self loathing, distorted body images and obsessive-compulsive symptoms. Symptoms of Anorexia: Anorexia is a dangerous disorder resulting in the deaths of almost 6% of victims of this illness each decade. Even as these tragic women are dying of starvation, they insist on the belief that they are fat. Symptoms: 1. Severe restriction of food intake. 2. Complete denial of the fact that they are skinny. 3. A deadly fear of gaining weight. 4. Loss of menstrual cycle. 5. Loss of secondary female characteristics, so that hips become narrow, breasts shrink and hair loss occurs. 6. Nails become brittle. 7. Osteoporosis or thinning of bones occurs increasing the danger of fractures. 8. Compulsive exercising of all types. 9. Blood pressure drops to dangerous levels with the danger of fainting. 10. Body temperature drops so that these people often feel cold. During meals, these young women may fill their plates with food but push the food around and actually take in very few calories. They will then complain of feeling " full " particularly if anyone at the dinner table points out the plate remains full of uneaten food. These girls also wear long over sized clothing that hides their real appearance. If asked why they are wearing " baggy " clothes they will state that they want to hide their fat. Of course, they are really hiding their skinniness but seem unaware of this. The Why of Anorexia: Anorexia Nervosa has existed as long as civilization. There are historical reports of this disorder among the Ancient Egyptians and Romans, through the Middle Ages and up until the present time. The question is what causes this disorder? Many theories have been advanced and research continues to be done on the causes and cure for this eating disorder. Here are a few of the theories on the causes of anorexia: 1. One explanation for anorexia is that limiting caloric intake becomes the one way that many girls believe they can exercise control over their lives. Raised to be nurturing and believing they have no real power, these young people discover that the one area in which they can exert full control is by controlling their food intake and their weight. It is important to understand that these girls feel extremely hungry and think about food all of the time. For them, the achievement is to resist hunger pangs and obsessive thoughts about food by exercising and refusing to eat what they consider to be " unhealthy food. " 2. In addition, this becomes the one certain way that these perfectionist girls can reach goals they set for themselves. The problem is that there is no limit for the goal of weight which is why too many die of malnutrition. 3. Another explanation is related to the value of sexual beauty. Today, in an age where the media and fashion industry puts such a high value on women being skinny, these young people emulate the females they see on television, in the movies and in teenage magazines. Also, they take seriously the constant messages (meant for obese people) that it is healthier to be thin than to be heavy. Attempting to achieve physical beauty as defined by society and to be as healthy as possible, these young women diet and exercise to the point where they become obsessed. 4. There is increasing evidence that there is a genetic basis to anorexia. Obsessional thinking combined with one or another type of eating disorder in the family seems to set the stage for anorexia. If it is true that some forms of anorexia are inherited then a cure could be available in the future. 5. Dysfunctional family life is also seen as a possible cause of anorexia. Fathers who criticize their daughters for being over weight add to the danger that they will become anorectic. In addition, authoritarian homes in which parents are very strict and in which there is a lot of arguing and hostility adds to the likelihood of girls developing this disorder. Families have boundaries and members have role definitions. However, it has been observed that in many of the family systems from which anorectic girls come, boundaries between generations and between individuals are often violated. Therefore, girls who become anorectic suffer from developing a real sense of autonomy and independence because of intrusions on the part of the parents. Without a strong sense of separateness, exerting control over food intake by not eating becomes the only way many of these females can develop any sense of power and control. 6. Psychodyamically, it is thought that anorectic girls hate being female and wish to be males. According to this theory, girls want to lose their menstrual cycle and appear more masculine in an effort to deny their femaleness. Treatment: Treatment of anorexia is extremely difficult partly because of the strong denial on the part of the patient. It is hard to convince someone that they need treatment when the patient cannot see that they have a problem. For this reason, the younger the patient when the therapeutic intervention occurs the better the result. In providing treatment for anorexia one of the questions that must be asked and carefully weighed is whether or not hospitalization is necessary. Usually, if the loss of weight is to such a degree that health and survival are in danger then hospitalization is required. The particular type of hospitalizations is specifically for eating disorders where, on an inpatient level, the issues of food intake and weight loss are discussed in psychotherapy and in groups. Medication is administered to reduce the serious depression that accompanies anorexia. If the young woman can be maintained at home then outpatient treatment is what is called for. In the case of anorexia, there is a team of treatment specialists that are needed to help the young person with this illness. The team consists of the following: A. Psychiatrists for anti depressant and anti anxiety medications. B. Psychotherapist for individual and group sessions. The therapist can come from psychology, social work or psychiatry as along as they are trained in eating disorders. Family sessions with the patient are an important and integral part of the treatment. C. Nutritionist who is trained in the treatment of anorexia and bulimia. The nutritionist monitors food intake on a daily basis by requiring the patient to complete a comprehensive log of everything that is eaten each day in addition to moods and feelings in connection with the food intake. Also, education is provided about food categories, calories, value and instructions about what and how much to eat at each meal. D. Medical Doctor to do weekly weigh-ins and health checks. E. It is important for the patient to understand that failure to maintain at least a minimal weight can result in hospitalization. There is a constant consultation among all members of the treatment team so that everyone is fully aware of the status of the patient and what changes in strategy are called for. These regular consultations also help prevent the patient from causing friction among team members by " playing one off against the other. " Note: One of the interesting but disturbing things about the family of anorectic girls is how unaware they are of how little the patient is eating and how much weight is lost. It is often necessary for someone from outside of the family to make the parents aware of what is happening. Whether or not there is a genetic factor in this eating disorder it is clear that much of it is tied to family dynamics so that family therapy is a necessary adjunct to treatment on both an inpatient and outpatient basis. Have an Anorectic Daughter?...Do Not Scold: Once denial on the part of the parents is broken through and they realize they have an anorectic child... For many parents faced with a child who is showing symptoms of anorexia the temptation is to scold, punish and argue. These are the worst possible strategies because they will be met with resistance, either direct or passive. Directly, these very bright young women can argue anyone under the table, using reason and their own form of illogic to defeat anyone who is attempting to convince them that they are thin or do not eat. The result is that parents end up feeling even more frustrated and helpless. Punishment and force do not work because they result not only in more resistance but in a greater resolve to lose weight. What Can Parents Do Once They Are Aware? Rather than using confrontation and conflict in an attempt to force eating, parents need to go with their daughter to the family physician, have her weighed and take referrals from the MD to the nearest eating disorder facility available. Avoiding argument and allowing the professionals to deal with the issue is the best policy. However, this does not mean that parents should say nothing and pretend all is well. Like one psychologist recommends to his parents of anorectic kids, use " hit and run " tactics. This means that a short and brief reference be made either to not having eaten or to looking to thin and, then, retreat and say nothing more. These short sorties are the best policy. Engaging in all out warfare does not succeed. In addition to his contributions to Mental Help Net, Dr. Schwartz maintains a private psychotherapy practice in the Boulder, Colorado area. His areas of specialty include relationship problems, depression, anxiety, eating disorders, and adult attention deficit hyperactivity disorder. He is open to inquiries from prospective clients, and may be contacted via email at aschwartz. http://www.mentalhelp.net/poc/view_doc.php?type=weblog & id=143 & wlid=5 & cn=46 --\ --- Published: Tuesday, September 16, 2003 Conventional anorexia treatments challenged by IUB professor in new book Procedures can reinforce what they try to remedy In her new book Feeding Anorexia: Gender and Power at a Treatment Center, Helen Gremillion, the Peg Zeglin Brand Chair in Gender Studies at Indiana University Bloomington, argues that mainstream treatments for anorexia nervosa can actually exacerbate the problem. Feeding Anorexia challenges prevailing assumptions regarding the notorious difficulty of curing anorexia nervosa, a practice of self-starvation, often coupled with rigorous exercise, occurring primarily among girls and young women. Through a vivid account of treatments at a state-of-the-art hospital program, Gremillion reveals how therapies participate unwittingly in ideals of gender, individualism, physical fitness and family life that have contributed to the dramatic increase in the incidence of anorexia in the United States since the 1970s. She describes how treatment strategies, which include the meticulous measurement of patients' progress in terms of body weight and calories consumed, ultimately feed the problem, not only reinforcing ideas about the regulation of women's bodies, but also fostering in many girls and women greater expertise in the skills anorexia requires. " The patients in the program I studied are required to have an exact calorie count every day. There is also detailed attention to even very small weight gains and losses, " Gremillion said. " Of course, any treatment program must devise ways to encourage eating and weight gain, but I argue that such careful attention to the numbers plays right into anorexia's hands. The focus of the treatment takes on a life of its own to the extent that it ends up reinforcing the problem. " Gremillion argues that anorexia intensifies dominant ideals of femininity in contemporary U.S. society. She adds to existing literature on this topic by showing how treatments for anorexia can perpetuate these ideals as well. " Young women today are expected to carefully monitor their consumption of food, and people who struggle with anorexia are caught up in this ideal with particular intensity. Treatment programs that don't recognize this cultural pressure can contribute to it when they require patients to monitor their body size very carefully, " Gremillion said. " The goal of weight gain vs. weight loss in treatment pales in comparison to practices of self-control and self-surveillance that both anorexia and mainstream treatments for it require. " " It's a controversial claim since I'm not a mental health practitioner, " added Gremillion, a specialist in gender studies, cultural and medical anthropology, and U.S. popular culture. " I'm a disciplinary outsider looking at the treatment of anorexia from a gender studies and anthropological standpoint. This book might appear to be a negative critique, and it does take a critical stance on the standard therapies which I believe feed anorexia. But I don't make the claim that mental health practitioners are consciously trying to feed anorexia. Instead I try to focus on the prevailing assumptions and attitudes that many people have that end up contributing to this very serious problem. " Feeding Anorexia is based on 14 months of ethnographic research in a small inpatient unit located in a major teaching and research hospital in the western part of the United States. Gremillion attended group, family and individual therapy sessions and medical staff meetings; ate meals with patients; and took part in outings and recreational activities. She also conducted over 100 interviews with patients, parents, staff and clinicians. In her book Gremillion describes a typical day at the treatment center, which is heavily structured around eating and the careful measurement of calorie intake and body weight. In this strict environment, the author discovered that many patients developed various " tricks " to avoid eating and weight gain such as water-loading (drinking extra water to engineer the appearance of a higher body weight) or hiding weights on their bodies before stepping onto the scale. The author also learned that the center had developed several practices in response to these patient techniques, such as measuring the density of patients' urine as a way to detect water-loading and conducting random weight checks, which were called for when a patient was suspected of hiding weights. Gremillion argues that these practices, while meant to be deterrents, actually underline these various tricks as resources that patients who are resisting treatment can use to continue anorexic practices. Additionally, Gremillion describes mealtime as a strange and often tense environment in which many patients spend most of their time calculating and recalculating their calories for the day as a way to delay eating. In response to this common occurrence, the hospital instituted a heavy degree of surveillance to ensure the patients would eat the required amount of food. " The problem with this whole environment is that it's all about power and control, " Gremillion said. " On the one hand, you have a hospital that is very meticulous in calculating how many calories these girls are consuming. On the other hand, you have the patients who spend entire meals adding the numbers, as a form of resistance to treatment. Then you have the heavy surveillance, which contributes to a feeling the girls already have that everyone is looking at them. Again, it's a case of the current treatment feeding the problem. In essence, the treatment is recreating the struggles that patients are already dealing with. " Gremillion said that the treatment program she observed was designed to serve as a substitute family for patients and that parents were expected to distance themselves from their daughters' struggles with their bodies by encouraging " separation and individuation. " In the current setting, parents are given very little information about their daughters' progress in treatment, so that staff and clinicians can work to " break " destructive patterns of behavior in families. The author argues that the treatment team's attempts at corrective parenting and creating a " therapeutic family " can actually perpetuate the problems in families that clinicians diagnose. In particular, she argues that cultural assumptions about ideal motherhood that are deeply embedded in our society form part of the context for both illness and treatment. The message to mothers is to " back off " and stay out of their daughters' lives. Yet mothers are also expected to know how to love and care for their daughters. Mothers are caught in a Catch-22 about caretaking that, Gremillion argues, is part and parcel of the problem. Interestingly, fathers manage to escape the harsh criticisms frequently leveled at mothers, who are often cited as the cause of their daughters' problems. " One mother was actually told to love her daughter and leave her alone. How do you perform this type of minimal mothering when you are culturally mandated to be a nurturer and the primary caregiver of your family? " she asked. " I argue that assumptions about motherhood have shifted (since the 1950s and '60s), but have not radically changed. " As for fathers, Gremillion said they are expected to be a part of their daughters' lives, but are often let off the hook if they choose to be distant from them. The choice to be involved is " extracurricular, " Gremillion said, " and some people are inadvertently pleased if the dads are distant and removed because it's thought that they'll be able to help the mom find a necessary distance. " In the book, Gremillion addresses several other issues pertaining to the mainstream treatment of anorexia and her time spent within the hospital, including: -- The challenges she faced as an observer of the hospital program and how clinicians, patients and their families responded to her presence. She also discusses her reaction to being labeled by some doctors as a " soft scientist. " -- Why most patients diagnosed with anorexia are white and middle-class. -- The characteristics that, according to clinicians, distinguish those patients who are diagnosed with borderline personality disorders from more " normal " patients. -- Her caution about the classification of anorexia as a disease. -- The relationship between anorexia and femininity and how current treatments account for this relationship. -- The relationship between anorexia, its treatment and ideals of physical and mental " fitness " in contemporary consumer culture. -- The " revolving door " phenomenon of multiple repeat admissions. -- A movement toward more outpatient and partial hospitalization services to treat anorexia. -- The ways in which relationships among doctors, nurses and psychologists can recreate the problems diagnosed in so-called " anorexic families. " While Gremillion admits she doesn't have a quick and easy solution to curing anorexia, she supports alternative treatments such as narrative therapy, which she writes about in her book. She believes narrative therapy has the potential to dismantle some of the problematic assumptions underlying more mainstream treatments. " Narrative therapy de-pathologizes problems like anorexia and depression, " she said. " It gets away from absolute distinctions between normal and abnormal by locating problems in their political and social context. The idea is to 'narrate' an illness experience or a stressful experience in such a way that problems are separated from clients' identities, so that clients can begin to imagine a sense of self that is not taken over by a given problem. " For example, a narrative therapist might ask a client who struggles with anorexia, " Who formed the idea that women and girls should be a certain size? " and " How do you think anorexia gets people to go to their death beds smiling? " Gremillion said that " these kinds of questions allow people to gain a critical perspective on anorexia without having to indict themselves for participating in anorexic behaviors. Self-scrutiny and self-regulation often just make the problem worse. But narrative therapy is not about removing responsibility from individuals. Rather, it opens up new possibilities for action against problems like anorexia, which many acknowledge is very complex and is culturally and historically specific. " Feeding Anorexia: Gender and Power at a Treatment Center, published by Duke University Press, will arrive in bookstores this month. To schedule an interview with Gremillion, contact Ryan Piurek, IU Media Relations, at 812-855-5393 or rpiurek. http://newsinfo.iu.edu/news/page/normal/1123.html ----------------------------- Moody friends. Drama queens. Your life? Nope! - their life, your story. Play Sims Stories at Games. 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