This hard hitting book rages with fierce polemic, horrifies and informs in equal measure with its rich use of raw material by ‘insiders’ and its uncompromising stance, and finally convinces me that it offers a sound method for dealing with anorexia and bulimia — although I am not convinced that it is the only one.
Biting The Hand That Starves You: Inspiring Resistance to Anorexia/Bulimia
By Richard Maisel, David Epstein, Ali Borden, 2004. ISBN 0393703371. W.W. Norton. 314 pages.
This hard hitting book rages with fierce polemic, horrifies and informs in equal measure with its rich use of raw material by ‘insiders’ and its uncompromising stance, and finally convinces me that it offers a sound method for dealing with anorexia and bulimia — although I am not convinced that it is the only one. It is organised and written so effectively, with insider narratives and therapy transcripts as driving forces, that the structure is almost invisible, and the reader is pretty much swept along by the content — which is well worth engaging with.
The book comes from a narrative therapy perspective. Narrative therapy begins with the post-modern idea that the world is composed of a multiplicity of stories, while not denying the reality of any of them, and paying due attention to social, historical, and political contexts. It sees people as experts on themselves and their lives, and, most importantly, problems as external to people. Therapy consists of a collaborative effort to differentiate the client from the problem, dialogue with it, and ultimately retell the client’s story, emphasising and drawing on all the resources they have.
A useful section for parents and other allies, including an in depth account of one family’s experience of various therapies, including narrative therapy, in their own words, leaves the reader in no doubt that this approach is not one that pathologises the family any more than it does the individual. This makes the approach a positive one for families to take, freeing up the energy of guilt for creative solutions.
Dealing with the world as a bundle of narratives, however, leads to a degree of personification of problems which made me initially uncomfortable. I felt it empowered the problems and removed them somehow from their causes; it made therapy seem like a fight and challenged my experience of it as in essence a process of acceptance which leads, sometimes somewhat mysteriously, to change. It also seemed, to be frank, a little crazy.
But I decided to suspend my judgement and read on. The problem was introduced — known as a/b in order to prevent any unnecessary competition between anorexia and bulimia, and to accord them the least respect possible. a/b is the owner of a voice, intentions, and an effective plan for carrying them out. The plan is to seduce a victim, imprison, torture and kill them.
The authors declare war on a/b in unambiguous terms. They are “anti-a/b”; their strategy is to inspire resistance to its totalitarian regime and to fight with all the weapons at their disposal. They pay close attention to the ways in which a/b can twist stories to its own ends, e.g. when giving case studies, weights are not included, so the voice of a/b in readers cannot start to compare.
The accounts of a/b from the inside, as collected together in the extensive archives of resistance at http://www.narrativeapproaches.com, make up the most vivid and coherent storyline of how a/b takes hold that I have encountered. The process of seduction is described, by the new best friend who treats you as if you are really special and takes all the pain away. As ‘Emily’ writes in her journal:
“Okay, it’s like this. You’re walking down the street and for no reason at all somebody shoots you in the back. Anorexia immediately numbs the pain, and you continue to walk down the street not knowing you’ve been shot in the back because you can’t see or feel the pain. Yes, you may be happy, but you are going to bleed to death very quickly if you don’t do something about that bullet hole in your back […] you will bleed to death with a smile on your face. The […] wound won’t kill you if you go to the emergency room […] But there is a problem with this whole scenario. The gunshot wound would be excruciatingly painful and you wouldn’t be able to walk at all, much less walk down the street with a goddam smile on your face. So Anorexia comes and takes away the pain. You don’t ask it to. It just does. It tells you that the pain is too great and it takes it away. Numb. Not feeling. Takes you from your body. In a sense, it rescues you. It doesn’t want you to be hurt. Anorexia cares about you in the beginning. It saves your life. Then it kills you. (pp. 47-48)
a/b promises the victim wonderful things, to provide safety, invulnerability, freedom, happiness beyond their wildest dreams. Then the conditions begin. If you just follow the rules, the promise will be fulfilled. The problem is that the rules keep changing, getting stricter. If you aren’t feeling better yet, it is your fault because you have not followed the rules well enough. At this point the victim becomes isolated from others around her and other parts of herself, the classic abuser’s tactic. The voice of a/b gradually becomes the only voice there is. It is easy enough to mistake it for your own voice.
This is where the externalising tactic of narrative therapy comes in handy. The therapist separates the voice of a/b out from the person, and establishes a collaborative relationship with them, an alliance against the a/b enemy. While this seems to me to be a sensible approach it is one-size-fits-all, and I can imagine it is very hard to apply in the typically long period in which someone with a/b denies that they have a problem. Those early stages of work are under-represented in the book, which is irritating for me as a practitioner.
The therapists enter into combat in a somewhat aggressive manner, which runs the risk of being alienating and dismissive of the clients’ experience, although this is clearly in no way an aim. The transcripts in the book can seem repetitive and in full volume rhetorical mode, in order to counter a/b, who also works this way. I wondered if there was not a gentler way of supporting the anti-a/b parts of the person, and whether it was not possible to take a slightly different, no less firm, approach to the voice of a/b itself, more individualised to the client, rather than entering its own territory. But maybe occupying the territory is the whole point. Once a/b is separated out its tactics and strategies can be exposed, the way in which it pretends to be for the clients’ own good, ultimately relying on shame and self-hatred to keep control.
Where does such shame and self-hatred come from? “Any form of social discourse that establishes a hierarchy of moral worth is inherently empowering of a/b” (p. 215). The social discourse is of course full of hierarchies and categories for judgement. a/b loves conforming to the rules of dominant groups: the rich, the successful, the white, the heterosexual, the thin, preferably all of these at once. An anti-a/b lifestyle, while unique to each survivor, is usually rich in the following elements: embracing risk, embracing choice, living according to feelings and preferences, welcoming spontaneity and venerating imperfection (p. 167-172). Spirituality also plays an often crucial role in winning the battle to get yourself back.
By this point I was starting to understand where the war was — not between the client and the ‘disorder’ but between the client and the order, the order that can be found in so many dominant stories of Western culture, that compares, judges your worth according to external criteria; demands that you compete, conform, obey, submit; demands perfect performance, yet that you never be satisfied; and will not listen to the great messiness and imperfection of real desires, creativities, pleasures, failures, miseries and mystical experiences that make up real individual lives. I was seeing that a/b was the most concentrated form of this order, taken inside the body itself.
All in all, the book is a fresh and inspiring start for this new approach. Full of different voices and creativities, in practice as well as in theory, it gives hope.
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