Recovery from Eating Disorders: A Guide for Clinicians and Their Clients Sensitive and respectful
Based on interviews with over one hundred males and females in recovery from an eating disorder, Greta Noordenbos offers a sensitive, compassionate and above all respectful approach to supporting individuals facing this perilous condition.
The book with its blend of intimate patient accounts and therapeutic insight will be useful for not only patients, but also for their families and the therapists who are involved in supporting them. Written without promotion of a specific therapeutic stance, Noordenbos details the road to recovery that is often long and frightening offering warmth and optimism to the reader and demonstrating how important it is for clinicians to listen carefully and with respect, in order to try and understand the patient’s perspective.
The patient testimonies illustrate that sustainable recovery involves much more than ensuring enough food intake, weight stabilisation and reducing bingeing and purging. Although these are necessary conditions for recovery, it is also essential that the individual gain insight in to their own feelings, needs and wishes and learn to express their emotions. Noordenbos describes the importance of improving body image, self-esteem and how to empower their identity. Furthermore individuals have to improve their emotion regulation and social relationships. Despite the complexity of the tasks that are involved, Noordenbos gives voice to those that have battled the condition and won, emerging from the depths of despair to lead more comfortable and fulfilling lives.
Evidently this book would be a valuable resource for readers on both sides of the clinical process. The chapters chart the course of the disorder, firstly identifying problems in the period before an eating disorder, including negative self-evaluation, compliance and perfectionism, hiding real thoughts and opinions from others and the beginning stages of extreme dieting. The reader is introduced to the negative consequences of eating disorders, losing control over eating habits, rigid rules and obsessive-compulsive behaviour, indoctrination and brainwashing, the toxic effects of starvation, and the impact of depression and suicidal ideation. There are also a number of helpful questionnaires throughout the book, which can be used for identification and for documenting the change process as well as assignments for patients to complete.
Ambivalence for change and increasing engagement in treatment are core themes in my work as a clinician. When the negative consequences of the eating disorder become very serious, patients may feel completely locked up in the prison of their eating disorder. They may realise that by continuing their eating habits they risk death. At this point, many patients experience a turning point, when they feel that they need to change, perhaps choosing between life and death. Here they can become motivated to change, though this motivation is often very ambivalent. Noordenbos offers thoughtful ways for therapists and family to increase their support at these times and maintain optimism.
Overall, this is a very readable book that will be useful to both early-career and experienced clinical psychologists who want to develop strategies for their clinical work and understand the service-user position whilst benefiting from up-to-date research and developments in the eating disorder field.
Wiley-Blackwell; 2013; Pb £29.99
Reviewed by Dr Louise Langman who is a clinical psychologist with Plymouth Community Healthcare
Fat Lives: A Feminist Psychological Exploration
I came to this book hoping for a critical exploration of the ways in which women experience their own bodies and the impact of wider cultural pressures. This is indeed where the book starts, with an exploration of ‘fatness’ in popular culture, public health messages and within psychology. The author builds a convincing argument that the relationship between weight and health is not as simple as has been claimed, and introduces fat activism and Health At Every Size. She explores the way in which the constant public visibility of one’s physical size enables the stigmatisation of ‘the obese’ (terminology is controversial in this area, and is discussed in the book in some detail); she also looks at the role of gender in ‘fatness’ and in turn how feminists have tried to underplay or emphasise ‘bodiliness’ within their thinking.
The heart of the book is an account of the author’s research, a series of interviews with ‘large’ women and men, subjected to
a poststructuralist discourse analysis. Having a minor phobia of post-anything-ism, I approached this section with some trepidation. The author gives an impressively scholarly explanation of the theoretical and historical underpinnings of her approach, which is obviously aimed at people already literate in critical psychology, although for beginners a thorough introduction is helpfully provided in an appendix. The analysis itself is fascinating and the quotations from interviews compelling, particularly when accompanied by the author’s critical reading of the assumptions hidden inside apparently innocuous remarks. It sometimes felt like the same quotes were reused in too many contexts; although it was interesting to see how much meaning could be contained in such small snippets, it did give a sense of repetition.
The author has struck a fine balance between sitting outside the text as a neutral observer, and exploring how her personal beliefs and her physical appearance (gender and size) may have influenced her interviewing and the responses that she received. Although it wasn’t the book I expected, it was a thoroughly interesting introduction both to poststructuralist theories and to the lived experiences of the interviewees.
Routledge; 2013; Pb £26.99
Reviewed by Emma Taylor who is a clinical psychologist in adult eating disorders services
The Universal Addressability of Dumb Things
Nottingham Contemporary Gallery
An unsettling sound piece by Florian Hecker fills the darkened gallery as the glowing outline of the Cerne Abbas man stares for ever up to the stars. In another room, an inflatable Felix the Cat towers to the ceiling. What does it all mean?
Turner Prize-winning artist Mark Leckey has curated this exhibition as ‘a non-realist, anti-realist, magic-realist, speculative, slipstream fiction’, ‘an inflation or amplification’ of the way the world appears to him, ‘a shape of “things” to come’. Drawing on object-oriented ontology, Leckey demands that we rethink our relationship with objects. He believes that the further technology evolves the more
our minds devolve back to the imaginings of our superstitious past. ‘Call it an animistic future or techno-avatism’, he says. ‘We’re back in a world where things are greater than ourselves, and we are no longer central to that narrative.’
In a world beyond tomorrow, ordinary, unthinking objects become imbued with a supernatural potency. The mental gets materialised. So the massive Felix stems from an archival image of a Felix doll sitting on a gramophone, which Leckey discovered was the first televisual broadcast image in North America. ‘I thought that was magical’, he says. ‘I liked that it was a two-dimensional cartoon, that became a three-dimensional doll, that then became this electronic entity that got broadcast out into the ether… I like that transformation of matter, or of states.’
The exhibition is loosely divided into four themes or scenes – the Vegetable World, Animal Kingdom, Mankind and the Technological Domain. Leckey tackles the hybridisation of humans with technology, and of humans with other animals. There’s a cast of poet and artist William Blake’s death mask, fitted with EEG paraphernalia; a Cyberman helmet from Doctor Who; and Nicola Hicks’s Maquette Head for Crouching Minotaur, a bust of the bull-human hybrid. It’s often baffling and irreverent, as Leckey admits to being excited by the idea of treating these things badly. ‘I just want them to do things
to each other and I want to do things to them. So they transform, or transcend their object-hood.’
We take ‘things’ for granted, even though they endow blessings and inflict punishments on us every day. Leckey finds them bewitching, and after wandering around in his mind for half an hour I was reconsidering these not-so-dumb things that all talk, literally or metaphorically, to each other and to us.
Reviewed by Jon Sutton
who is Managing Editor of The Psychologist. The exhibition is at De La Warr Pavilion, Bexhill-on-Sea from 13 July to 20 October.
The Truth about Mental Health
BBC World Service
Exploring the treatment gap
As significant changes are being implemented in the way that mental health services are provided within the NHS, Claudia Hammond presents a thought-provoking series that provides an insight into service provision for mental health problems in less-developed countries. A treatment gap exists with fewer mental health resources available to people diagnosed with a mental health problem in developing countries, and an estimated 95 per cent of them reported not to receive evidence-based care.
The series highlights the importance of reflecting on the culture system within which an individual is located. In one episode, it was highlighted that the evidence base for the effectiveness of treatments provided by traditional healers in Kenya is sparse, yet the question is raised as to whether the considerable demand for such interventions should be considered evidence for their efficacy.
Contrary to this, traditional healers were reported to provide unethical treatments that violate human rights. Psychiatrists working in Kenya make reference to lobotomies being carried out by witch doctors. This reminded me of my undergraduate lectures on historical approaches to mental health treatment and how such treatment had been left behind and more ethical treatments prevailed.
Despite the limited access to psychiatrists in Kenya, psychiatrists report they are working to bridge the gap between mainstream services and traditional healers and create a system where referrals can be made across the two modalities of treatment to support a whole spectrum of mental health problems across the life span.
Recent advances in mental health services in the developed world were described as empowering people to ‘look after their own mental health’, and the suitability of this approach to developing countries was considered. This, along with the notion of an ‘inter-agency’ approach between psychiatrists and traditional healers in Kenya, was identified as a potential beginning to breaking down the barriers between different approaches and hence reducing the treatment gap that currently exists.
Upon reflection, in the absence of NICE guidelines and evidence-based care in the developing world, this joining of the two ‘systems’ can be useful for individuals with mental health problems. For the developed world, we can learn that a psychological formulation that incorporates religious, spiritual and emotional narratives may be more meaningful for the individual.
An interesting and thought-provoking listen that offers a new insight in to how services are provided around the world at a crucial point of change in mental health services in the NHS.
Reviewed by Jennifer Black who is an assistant psychologist at Psicon Ltd
According to Freud, at least, we should all be bisexual. Though
his theories on sexuality are no longer fashionable, his notion of universal bisexuality has held the public imagination and continues to be most evident in the academic disciplines of queer theory, postmodernism, and social construction. Where Freud famously demanded that the question of heterosexuality needed answering just as much as homosexuality, modern iterations of these theories tend to ask, ‘What would we be if it weren’t for the social construction of our internal lives that tend to enforce binaries – like man and woman (foreclosing intersex and trans) and straight and gay (foreclosing bisexual and queer)?’ So for Freud and his modern contemporaries, it should be a no-brainer that we all are, at the very least, bi-curious.
Channel 4’s Bi-Curious Me doesn’t quite do what it says on the tin. Rather than exploring bi-curiosity across the board, it follows three women’s journeys in relation to their bisexuality which, for the most part, they seem to have already accepted as part of themselves to varying degrees. Hayley and Sophie, in their twenties, are the two younger women featured. They represent somewhat polar positions with regard to (un)confidence and (dis)comfort with their bisexual dispositions while Jill, 57, offers a different perspective in having ‘come out’ to have a relationship with a woman after 25 years of heterosexual marriage. None of these women, however, present as curious about their sexuality; instead they detail what it is like to be bisexual in a heteronormative culture.
Given this, the show essentially sets up the viewer as the curious one thereby creating an exhibitionist/voyeur dynamic that can make for some uncomfortable watching. As the featured characters are all women (with no shortage of titillating material to boot) there is the further invitation to see it as mildly exploitative from the point of view of the male gaze; that is despite it being narrated and produced by women. The fact that this a programme was created (filmed, produced, and directed) by a woman while retaining the sensibility of the heteronormative male gaze satisfies to some degree the social constructivist position that it’s very difficult to step outside this culturally embedded paradigm.
For these reasons, Bi-Curious Me ultimately failed not only to open up the question of bi-curiosity, but also to ask it at all. While some of the stories brought to light the difficulties and delights of life in the margins of heterosexual expectation, it is a narrative in which we are already familiar. The opportunity is lost to speak to those who are really bi-curious – men and women, young and old, who are on the cusp of exploring same-sex desire in the context of heteronormative expectation – instead, the programme takes a more familiar and clichéd path rather than one that truly opens up questions around human sexuality in Britain in the 21st century.
Reviewed by Dr Aaron Balick a psychotherapist working in Clerkenwell, London
Laughology: Improve Your Life with the Science of Laughter
The best medicine
Author Stephanie Davies is Creative Director and founder
of Laughology, a training and consultancy firm that makes use of humour and positive thinking (see ‘Careers, April 2013). This is her ‘workbook for a new model of living’.
A comedian herself, she is studying for an MA linking humour, laughter, health and psychology, while practising the techniques in specialist mental health units. Laughology ‘provides you with a means to use humour and laughter to enhance thinking skills on every level for positive well-being, resilience and communication’.
As Davies admits, the techniques are largely common sense, but she challenges us to be proactive in finding ways to introduce more humour and laughter into our lives. ‘FLIP your mood’ with Focus, Language, Imagination and Pattern Breaking. Find your laughter triggers. SMILE – yes, that’s an acronym too.
There’s a light and cheery feel to this relatively slim tome. It’s a playful and practical guide, and you'd have to be agelastic, or even misogelastic, to keep
a straight face throughout.
Crown House; 2013; Pb £12.99
Reviewed by Jon Sutton Editor of The Psychologist
Steven Pinker on Desert Island Discs
Radio 4 Come back soon
I have always had a love-hate relationship with Steven Pinker’s work. On the one hand, he is a creative and fiercely intelligent cognitive psychologist who rightly promotes the importance of evidence-driven theory. And I heartily applaud him for choosing Elvis Costello’s ‘God’s Comic’ as one of his tracks for Desert Island Discs this week. On the other hand, I vehemently disagree with his ideas on language acquisition. For me, the poverty of the stimulus argument – the central tenet of nativism, which states that the environment is too impoverished to support language acquisition on its own – is simply an argument from the poverty of the imagination. We cannot figure out how children learn language from the input, so we assume that they cannot do it.
However, the nativism Pinker presented on Desert Island Discs this week was relatively uncontroversial. We all agree with him that the human brain must have built-in ‘wiring’ that allows us – but not ‘our house pets’– to learn language. Where we disagree is in how we characterise what is built in.
I did wonder how listeners would react if Pinker repeated one of his more controversial claims – that children are born with innate knowledge of syntactic roles such as subject, semantic roles such as agent, and rules telling them how to link the two.
But of course, debate is at the heart of science, and psychology itself would be impoverished without Pinker. So I enjoyed learning a little more about him. Kirsty Young’s gentle, perceptive questioning revealed a thoughtful, philosophical workaholic, who attributes his academic talent to his ‘articulate’ and ‘intellectually voracious’ parents. He was allowed the space to explain his ideas on language in detail to touch on his work on morality and violence and to reveal an eclectic music taste (the Andy Statman Klezmer Orchestra, Jimi Hendrix, Leonard Cohen, Eric Clapton, Sarah Vaughan and the Neville Brothers will all accompany him to the desert island). Like Pinker himself, the programme did not shy away from controversy, challenging him to respond to the accusation of ‘biological determinism’.
His great strength as a communicator was also apparent; his incredible way with words. As he told Kirsty, the greatest obstacle for the science communicator is ‘overcoming the curse of knowledge’. It was wonderful to hear his evocative descriptions: complex ideas effortlessly described in language that inspires and enthuses without over-simplifying. I hope they don’t leave him on that desert island for too long. We would miss him.
Reviewed by Caroline Rowland who is Professor of Developmental Psychology at the University of Liverpool
Channel 4 …something beginning with ?
Using clips from Eye Spy when teaching social psychology or research methods could do everyone a favour.One of psychology’s most important contributions arguably comes from demonstrating that people do not always behave as they or others expect. This truth is stark when we witness people like us behaving in ways we find shocking or inspiring. Confronted with dramatic evidence, open-minded viewers can come to challenge their complacent self-certainties and ask themselves, ‘Really, what would I have done?’ They can start to challenge their convictions that they would be champions of truth and justice and wonder whether they too could be manoeuvred into denying reality, torturing innocents, or being passive bystanders to others’ evil. In becoming less cocksure, people can also become more understanding of others – or at least less aggressively judgemental and condemnatory.
Eye Spy seeks to encourage such processes. It is most captivating in its hidden-camera segments. It sets up scenarios, and viewers observe how members of the Great British public react. A waiter is increasingly racist to an interracial couple. When and how will other diners intervene? A boy in a wheelchair asks to be carried up several flights of stairs and becomes increasingly annoying while being carried aloft. To what extent will helpers’ growing exasperation undermine their altruism? The actors and the lines they deliver are brilliant. The waiter: ‘In the wild, you wouldn’t get a grizzly bear going out with a polar bear.’ The boy: ‘You’re not that fit, are you?’
In another segment, people picking up a ringing public telephone hear a gruff voice say, ‘Your money’s in the bag on the floor. Thirty grand, as agreed.’ And there’s the bag at their feet, visibly stuffed with thick bundles of £20 notes.
In other segments, wallets containing money and a return address are ‘lost’ around the country; bikes are left at night apparently unchained on various city streets; and toddlers are told that if they resist eating a marshmallow for five minutes they can have two. Someone on the Eye Spy team clearly knows their psychology.
Lots of topics are addressed or illustrated. The first episode alone could be used when teaching altruism, racism, non-verbal communication, group and intergroup processes, cultural differences, self and identity, social cognition and, of course, media effects. The methods used in the programme are far from scientifically adequate and the conclusions reached are sometimes invalid, contradictory, or just plain wrong. Instructors and students would have ample opportunities to explore such issues as confirmation bias, sampling inadequacies, confounding variables, unreported data and research ethics.
But the show is probably only pretending to do science; its goals being rather to entertain, intrigue and inspire. Judging from reactions on Twitter, it achieves these things admirably. Even the most appalling bits are captivating. When a waiter told a white couple, who had not asked, that his Indian restaurant didn’t serve egg and chips, I laughed out loud. Terrible, I know, but what would you have done?
Reviewed by Tom Farsides who is Lecturer in Social Psychology at the University of Sussex
Clinical and Educational Psychology: An Ecological-Transactional Approach to Understanding Child Problems and Interventions
The challenge of integration
Our profession often adopts elaborate descriptors to avoid accusations of simplicity. Take, for example, this book, which promotes a ‘transactional ecological bio-psycho-social model’ of child development. Basically, an ‘everything influences everything’ model which replaces the archaic nature vs. nurture debate with the sensible approach that children develop through a complex interplay of environmental and genetic factors.
I greatly enjoyed the first section of the book, which makes
the most of its broad approach by clearly summarising a host of theories and research on child development. The second part of the book on ‘diagnosable disorders’ proved less enjoyable. While the idea of bringing together educational and clinical psychology under an integrated model makes sense, this part of the book suffers from a shallowness by trying to be all things to all people. Frustratingly, despite assuming a holistic approach, the very first – and often the predominant – treatment approach discussed is medication. There are thin descriptions of therapies beyond behaviour therapy and treatment guidelines beyond US ones are rarely mentioned.
This book is an excellent summary of child development and
a satisfactory introduction to child disorder. If only it carried more
of the ‘ecological-transactional’ approach to where it mattered – understanding child distress.
Wiley-Blackwell; 2013; Pb £29.99.
Reviewed by Dr Angharad Rudkin who is a Chartered Psychologist
World War Z
Marc Forster (Director) Dizzying and destructive
Zombie films have always been case studies that examine the consequences of a human race reduced to its appetites. Stripping away any semblance of social or psychological control from their monsters, they leave a creature that posits answers to the same questions psychoanalysis concerned itself with during its early Freudian focus on drives. The horror resides in the idea of a being that consists solely of appetite; an id without an ego, a hind-brain without a cortex.
World War Z is just the latest incarnation of this trend, an imaginative look at what might happen if one part of the world population was suddenly set against the other, intent on feeding off and infecting it. These basic ingredients have been fleshed out in multiple different ways because there are numerous possible outcomes waiting to be explored. In early zombie flicks the undead stumbled ineffectually after their targets; in more recent renditions they have acquired the distinctly unsettling capacity to run.
World War Z adds yet another terrifying element, a destructive and powerful degree of intent, which leads the creatures to head-butt car windows and climb over one another into enormous, toppling pyramids in their drive to consume flesh. Equipped with this extra impetus, the zombies can scale vast walls and even bring down military helicopters.
The film has been construed as a study of our fear of infection, of the rapid and awesome spread of viruses and our feelings of impotence against a determined and faceless killer. In fact, what all zombie films do, and what World War Z does particularly acutely, is tap into a basic human intuition that the greatest threat we face comes not from outside us, but from an insatiable drive within. This is the drive that pushes not only the ever-accelerating growth of the world economy but also its dizzying and destructive consequences: pollution, climate change, territorial wars.
Human ingenuity is only ever one step ahead of this blind drive to expand, a fact referenced by two intriguing details in WWZ. Israel has installed a policy to overcome the problem of ‘Groupthink’ (coined by social psychologist Irving Janis to describe how important decisions get biased by a tendency to conformity) allowing it to build a huge wall to keep out the zombies when the threat was considered too bizarre to be taken seriously. Meanwhile, in a nod to the human capacity to commit authoritarian atrocities, North Korea has managed to escape destruction by removing the teeth of its entire population in 24 hours.
It is these nods to strategic decision making that make World War Z more engaging than it might have otherwise been. Told through the myopic lens of the perennial rough-and-ready American hero, this remains no more than an interesting film that has been grafted onto a more conventional one. For fans of the ongoing thought experiment of a zombie apocalypse however, it is a must.
Reviewed by Huw Green who is a PhD student and trainee clinical psychologist at the City University of New York
Don’t Call Me Crazy BBC Three sharing a journey
As a student mental health nurse and support worker on an adolescent ward I was interested to see how BBC Three’s d
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