Biting the Hand that Starves You: Inspiring Resistance to Anorexia/Bulimia

(By Richard Maisel, David Epston, and Ali Borden. New York: Norton, 2004. 314 pp; $35)

Based on perspectives from “narrative therapy,” these three authors, each of whom brings a different personal background and extensive clinical experience to the work, have joined to understand, and ultimately undermine, the stories that sufferers imprisoned in the inner worlds of anorexia nervosa and bulimia nervosa tell themselves. At a deep level, the premises of narrative therapy converge with those of cognitive therapy. That is, we are locked in by faulty assumptions, and freedom from these chains requires getting behind and under these sometimes-invisible binding thoughts in order to bring them to light. But the narrative stance seems less mechanical and more aligned with the unique and the existential experiences of the individual person. As the authors state, they are not proposing a “how-to” therapy manual espousing a “one-size-fits-all” approach (not that good CBT does either).

The methods of narrative therapy are highly inquisitive, conversational and interactive. They encourage journaling. They strive to enable sufferers to uncover and elucidate the strong, intimidating and self-defeating ideas with which they wrestle in their unique existential states of angst. Starting in that space, the sufferer, aided by the narratively oriented therapist, seeks insight, empowerment, and the spiritual energy required to defeat their demons.

The metaphors used in this work, “anti-anorexia” and narrative therapy, are built on substantial intellectual themes cited in abundance for those who wish to delve further. The book moves from accounting for the “seduction and imprisonment” caused by anorexia nervosa and bulimia nervosa, to “turning against” these problems, in the direction of “reclaiming one’s life,” followed by a section for caregivers on how to assist anti-anorexia impulses and abet spiritual nourishment. The metaphors are certainly ones with which many sufferers may identify, even those lacking the willpower necessary to jump-start and pull themselves away from the burdensome gravitational forces of their disorders.

Nice story. It appears to fit well for at least some individual cases, certainly for the ones presented in this interesting, compassionate, and occasionally stirring book. The narrative framework definitely humanizes illness and recovery experiences of eating disorders sufferers. The stories described in this book may serve as guideposts for therapists and sufferers interested in exploring the potential utility of these concepts as a way out. They may even inspire.

But, serious questions remain unanswered. For whom does such an approach work best? Perhaps, as in most psychotherapy outcomes research, it works best for those most intellectually and philosophically inclined to see value in it. How might this approach stack up against others aimed at helping sufferers and clinicians grapple and overcome these disorders? I, for one, see sufficient merit in the conceptualizations of narrative therapy to encourage its proponents to formalize guidebooks (God forbid, a “manual”) to enable sufferers working on their own and/or with assisting therapists to apply these ideas, so that systematic studies might be conducted to explicate how effective, under what circumstances, and for which group of sufferers, these approaches are most likely to be helpful, in what situations they might be more effective than others, and, finally, for whom they are less likely to be of help.

This book may be profitably read by sufferers and therapists, and might best be used when both read it concurrently, discussing its implications and applications for that individual’s particular story.

— J.Y.