More Reviews

Fourteen reviews follow: From readers, Scholars, and Psychological, Psychiatric, and Social Work Journals

Psychology and Psychotherapy: Theory, Practice and research, Vol. 78 (2005), p. 563

‘Biting The Hand That Starves You’ is an inspiring boook suitable for anybody touched by an eating disorder, whether they are professionals, carers or sufferers. Using techniques grounded in narrative therapy, the authors offer a fresh and empowering way of approaching anorexia/bulimia(a/b) from an anti-anorexic standpoint.

Divided into four sections, the book begins by introducing the ways in which a/b enters and takes over the lives of its victims. Rich descriptions of real-life/insider experiences give a very powerful introduction to the devious nature of the disorder and the unfair and cruel games it plays with its victims’ minds.

The second and third sections introduce the reader to the concept of anti-anorexia and the language and techniques used by anti-anorexic practitioners, carers and insiders. The reader learns how to put these techniques into action to work towards reclaiming control of a/b.

The final section is designed for carers of people trapped in the a/b lair and offers practical advice on hw to work with anti-anorexic professionals and sufferer’s loved ones to fight against a/b and its oppressive regime.

As a professional who works with eating disorders, I was left feeling highly motivated to employ techniques outlined in the text and share the ideas with colleagues. I could not recommend this book more.

Madeline Rolfe(Tavistock and Portman NHS Trust, London, UK)

Journal of the American Academy of Child & Adolescent Psychiatry, Volume 44 (12), December 2005, pp 1318-131

Maisel, Epston, and Borden have written an impressive and useful book based on their work as narrative therapists with patients struggling with anorexia and bulimia. The approach of this book, rooted solidly in the narrative therapy tradition (Freedman and Combs, 1996; Parry and Doan, 1994; Beels, 2001) is revolutionary. It requires of its reader a profound paradigm shift from pathologizing that which is within the patient to villifying a cultural force gone awry-a pathological influence that is distinctly external to the patient. The authors demonstrate how helpful this approach has been with the young women who are often our most challenging and highest risk patients.

Much of the book quotes the words of young women themselves. The writings are lovely, and they are haunting in the uniformity of experience of anorexia. Emily writes:

“It [anorexia] promises to take away your pain. If you are having an identity crisis, it will promise to provide you with an identity. If you are lonely, it will promise to be your friend. If you are feeling powerless, it will promise to make you powerful. It will make you promise after promise, but its promises are lies. It says, “I will make you happy.” As soon as you believe the lie, you have already begun to die”.

“Anorexia’s spoken words are those of self-denial. Anorexia promises to reward you for denying yourself anything and everything you need and desire. Anorexia tells you that denying all your needs and desires will make you strong, happy, and free of pain. If you are tired, anorexia forbids you to sleep. If you are hungry, anorexia forbids you to eat. If you are cold, anorexia forbids you to turn up the heater or put on a sweater. Anorexia forbids you from enjoying your sexuality. The most important of Anorexia’s rules is that you must follow all the rules perfectly at all times.” (p. 30)

In her fighting words to keep anorexia at bay, she writes:

Emily Lives Here

No Vacancy

Sorry Anorexia

Vacancy Filled (p. 54)

In narrative work, the problem is approached as if it were external to the person (Freeman, Epston, Lobovits, 1997; White, 1997). Externalizing anorexia is the first step in waging the anti-anorexic battle: “Anorexia/Bulimia thrives on the objectification of people, for it must cut them off from their own knowing and their own voice in order to impose itself on them.” (p. 80) Externalizing anorexia allows the team of patient, parents, and professionals to make an explicit alliance around the task of outwitting anorexia, in contrast to the traditional model, which encourages parents and professionals to fight against the child and her recalcitrance. One parent is quoted, saying,

“Externalizing anorexia, recognizing it as separate from Diana, gave us the liberty to vent our anger and frustration at the real culprit. It was such a relief to get angry at anorexia and not at Diana[horizontal ellipsis]” (p. 263) Rosemary told her therapist “the most interesting and novel thing about our discussion was the fact that you look at anorexia as an influence, not as a state of being or something you are. And from that point of view, I, who am sometimes under its influence, can be in control of it.” (p. 81)

The authors situate anorexia in a cultural context, asking,

“How is Anorexia/Bulimia able to so utterly persuade even those girls and women generally regarded as among the most thoughtful, considerate, talented and accomplished of their generation that they are worthless and inadequate? How does it turn every opportunity for pride and self appreciation into a cause for self-condemnation?” (p. 35)

Their answer is that girls feel locked into the pursuit of two virtues: “perfection and the ethic of pleasing others.” (p. 35) Biting the Hand that Starves You describes the tactics anorexia uses to come between young women and their pleasures. Anorexia comes as a friend, extending “what appears to be a benevolent hand.” (p. 22) It then stays on as dictator and tormentor, driving young women to their death by “convincing them that they are not good enough and that anorexia is going to make them good enough.” (p. 123) “Anorexia/Bulimia becomes the arbiter of nearly every thought, gesture, and action-a judge, jury, and executioner all rolled up into one.” (p. 30)

The authors are realistic about the difficulties inherent in doing this work, observing that, “we have never met a person who has won an argument with anorexia. It doesn’t yield to logic and has no compassion to which one can appeal. Anorexia cannot be conquered, but it can be foiled.” (p. 144) They describe the reclaiming of lives from anorexia as having two poles: First unmasking and defying anorexia, and then constructing a life apart from anorexia. The latter is the fun part:

“Few things can rival the pleasure of hearing these tales of people rediscovering those things most of us take for granted-smiling, relaxing, feeling carefree, flights of the imagination, the pleasure of another’s company, and the satisfaction of our own desires.” (p. 3)

The only people who are not carefully protected from blame in this book are traditional practitioners. More than one chapter might be subtitled “What’s wrong with the traditional approach?” There is a portrayal of the traditional, hierarchical psychiatrist who separates the patient from the clinician most allied with her against anorexia, replaces anorexia’s directives with those of the inpatient unit, and propels the patient to work hard to be the best anorexic rather than to fight for her freedom from anorexia.

Like all truly useful innovation, the ideas in this book quickly become part of one’s therapeutic arsenal. This is an excellent book for medical students, residents, senior faculty, and, in part or whole, our patients and their families.

Shoshana R. Sokoloff, M.D. Amherst, Massachusetts

Beels C (2001), A different story: The rise of narrative in psychotherapy. Phoenix: Zeig/Tucker

Freedman J, Combs G (1996), Narrative Therapy: The social construction of preferred realities. New York: Norton

Freeman J, Epston D, Lobovits D (1997), Playful Approaches to Serious Problems: Narrative Therapy with Children and Their Families. New York/London: Norton

Parry A, Doan R (1994), Story Re-Visions: Narrative Therapy in the Postmodern World. New York/London: Guilford White M (1997), The externalizing of the problem and re-authoring of lives and relationships in White M, Epston D Retracing the past: Selected papers and collected papers revisited. Adelaide: Dulwich Centre Publications Accession Number: 00004583-200512000-00017

A Reader’s Review of ‘Biting the Hand that Starves You’  (FEB., 2005)

Mr. Epston,

I do not know quite where to begin.  I bet I have drafted over ten letters to you none of which I feel does justice for the amazing gratitude I have for you and your work.  I am a student at Indiana University and was recommended to read your book by Helen Gremillion.

From the dark and lonely places I once was I have travelled miles and I owe a great deal of that to Biting the Hand That Starves You and the Archives of Resistance at www.narrativeapproaches.com.   I have found incredible strength in your words, those of your colleagues and those of the remarkably brave women you have worked with.  I need not explain how my own story so eerily relates to that of the other women or my views on how mainstream practices reinforce the tactics a/buses but I would like you to know that you have planted a seed within me that I cannot resist. 

I see my life in a new light now, I have not changed but anorexia’s role in my life has.  Instead of using my skills and determination to feed anorexia’s desires I am feeding my own.

From the days I hid in bookstores ashamed of the self help books I was reading, which ranged from how to overcome an eating disorder to how to align certain types of rocks to create a clean aura, to now when I am actively telling my story and recommending your book to anyone who will listen.  I believe so strongly in the approaches of narrative therapy I want to do anything and everything I can to learn more about it so I can show others.  There is such a need it makes my heart hurt everyday when I see friends, family members, and people on the street with those sad eyes, trapped that torrent cycle of despair, I want to hear their stories and offer them hope.

I have also taken an active role in eating disorder awareness and prevention, right now, through a narrative art piece by a local performer and insider, Amy Fortoul.  Amy tells her own story and recovery through her art which externalizes her struggles with an eating disorder.  One of the great parts of her program, for me, is the question and answer session she has after each show to interact with her audience, which provides a safe environment for open discussion.

Right now I am resisting anorexia’s voice that this letter is not good enough for a man that has heard the same story so many times before.  But I had to write it.   Before I felt like I was in a car on a rainy day with a broken defroster, I couldn’t see where I was going.  Bad analogy but I hope you see what I mean before now I internalised everything, ideals, people, thoughts, emotions, I was a puppet doing what everyone expected of me achieving, perfecting, giving but no matter how hard I tried or how careful I was I still was lost.   You have fixed the defrost.   Every time I reread biting, I am in awe of how clear I see my tormentor and I have new vigour to fight it.

I have never felt such passion about anything in my entire existence..

I know you are retired or at least that is what your forward said but I hope I can continue to learn from you- you have already taught me so much.

The seed is growing.

FROM: Psychiatric Services: A Journal of the American Psychiatric Assocation, vol. 56, spring, 2005

This is the book we have been waiting for.  Anorexia is a pervasive mental health challenge affecting our brightest young women.  Despite our best therapeutic efforts, anorexia still causes years of debility and ten percent of the time, death.  With unfailing respect for those suffering, Maisel, Epston and Borden offer a fresh analysis of the etiology of anorexia and bulimia and give us effective new therapeutic tools. Readable and full of first-person accounts by girls and women dealing with anorexia, Biting the Hand that Starves You gives psychiatrists and clinicians in every therapeutic setting the theoretical framework and practice options needed to treat anorexia and bulimia.

Maisel and his colleagues demonstrate the ways in which anorexia and bulimia (which they consider two halves of the same coin, hence their preferred term anorexia/bulimia, or a/b) is caused and maintained by powerful but hidden pro-anorexia rhetoric.  By carefully listening to hundreds of patients, the authors discovered that after insinuating itself into people’s lives using the weight-obsessed lingo of the media, anorexia/bulimia goes on to generate an endless supply of pro-anorexia rhetoric that mutates into sophisticated new forms whenever it confronts anti-anorexia resistance.  For example, a/b instantly offers myriad convincing reasons why the doctor pointing out the harmfulness of self-starvation is not to be trusted.  The sufferer experiences toxic pro-anorexia thoughts not as alien or unwanted, but as reality.  Anorexic thoughts proliferate and come to dominate a person’s thinking and actions, leading them to lose touch with their own values, identity and relationships.

Understanding the sources of anorexia’s tenacity guided the authors in developing compassionate therapeutic practices against it, which they present with clarity and illustrate with therapy transcripts.  The narrative therapy informing their approach was originated by Epston and White in the 1980’s and has since gained a wide following.  Based on how we experience our lives through stories, narrative therapy is uniquely suited to address a problem whose deadliness stems from persuasive rhetoric.

The first priority of treatment is to distinguish the rhetoric of a/b from the person’s own values, hopes and dreams.  Externalizing anorexia in this way allows clinicians and family members to ally with the person against the anorexia.  Once anorexia is seen as separate from the person, therapy can help the person see its true effects and to turn against it.

The authors demonstrate how a/b is vulnerable despite its metastasizing linguistic strategies.  A/b needs isolation to brainwash its victims; the authors re-connect them with family and friends and link them via anti-anorexia archives with survivors worldwide.  A/b thrives on secrecy; unmasking it and exposing its strategies weakens it.   Revealing a/b’s lies and its role in starving and killing women guts a/b’s claim of moral authority.  More fully articulating the person’s, as opposed to anorexia’s, hopes and dreams feeds the spirit and strengthens anti-anorexia efforts.  Creativity is needed, for a/b is unprecedented in its ability to induce persuasive thoughts that support anorexic ends.

Biting the Hand that Starves You is a welcome paradigm shift in the treatment of anorexia and bulimia.  In my work with dozens of women dealing with anorexia/bulimia, I have found the narrative therapy approach of Maisel, Epston and Borden to be dramatically more effective than any other kind of treatment.  Furthermore, their acknowledgement of anorexia as the confusing horror it is without blaming victims or parents is healing and refreshing.  Patients and their families will find this book invaluable; the last section is specifically addressed to parents. If you are interested in compassionate, respectful and effective treatment of anorexia/bulimia, get this landmark book.

Dr. Hamkins is a psychiatrist at the Carson Center in Westfield, Massachusetts.

FROM: Narrative Network News by Christine Fagan

‘Biting The Hand that Starves You: Inspiring Resistance to Anorexia/Bulimia’ is a long-awaited book that documents practices of resistance to anorexia by those caught in its’ tenacious grip, their therapists, friends and families. The authors of the book are Richard Maisel, David Epston and Ali Borden. They are all practising therapists: Maisel in California US, Epston in Auckland NZ and Ali Borden, who writes as both an insider to anorexia and an outsider in her therapeutic work with other women struggling against anorexia.

This book documents in great detail, therapeutic conversations and approaches collectively named ‘anti anorexia/bulimia’. ‘Biting the Hand that Starves You’ has four parts; the seduction and imprisonment; turning against anorexia/bulimia; reclaiming one’s life from anorexia/bulimia; and becoming an anti-anorexia/bulimic ally.

The privileging of ‘insider knowledge’ is one of the things that makes this book so unique. Almost every important point is illustrated by an example of the thoughts of a actual person struggling with anorexia/bulimia.

The book documents many ‘insider journeys’, recounting each step in the process from anorexia’s entry into the person’s life, its’ increasing control and regimentation of their activities, its’ eclipse of their identity, and then the prizing back of their selfhood from its’ vice-like grip.

The skills of this ‘prizing back’ are clearly described, although a single method would not work for everyone, as ‘anorexia/bulimia is too cunning a problem for any one-size-fits-all approach … It is a moving target, side-stepping your shot and returning fire.’

The voice of anorexia speaks to crush the hopes, intentions, wishes and identities of each of its’ victims in a unique and personal way. Yet when anorexia/bulimia is unmasked and examined in the full light of day, its’ rhetoric, criticisms, denigrations, humiliations, abuses and demands often resonate from one survivor to the other. This is the reason the authors encourage creating one’s own archives and using them in therapy, or sharing from the archives of anti-anorexia bulimia at www.narrativeapproaches.com.

The authors strongly condone a stance of outrage, determination and defiant opposition to anorexia and its’ consequences. This includes refusal to participate is acts of evaluation, judgement, measurement, weighing, ordering, or any type of activity designed to ‘act on’ the body of the young person. These actions favour anorexia, and are exactly the type of activities that anorexia requires for itself. Much of the social/political environment that influences young people in our society supports such anorexia activities.

An anti-anorexia/bulimia stance involves creating a language for highlighting a different type of knowledge, divesting anorexia’s moral authority to speak on the value of a person and encouraging more sustaining voices in the young person’s life. These may be the voices of family and friend’s love and compassion, perhaps inner (barely audible) voices of worth remembered from pre-anorexia days. They may be voices of other survivors. They may be voices of hope about the future. The creation of anti-anorexia/bulimia language is greatly assisted by this book.

Other anti-anorexia stances encouraged by the authors are activities in direct opposition to the anorexic lifestyle. For example, welcoming spontaneity, where anorexia demands adherence to a strict regime and punishment for failures; tending to oneself first, where anorexia demands tending to others first; noticing one’s feelings, where anorexia demands ignoring feelings; celebrating imperfections, where anorexia requires perfection in everything; having choices, where anorexia demands its’ own way; noticing small steps, where anorexia discounts small steps as inconsequential; refusing to count and measure, where anorexia is tied up with numbers; and nourishing the spirit, where anorexia is focused on the body.

‘Getting well’ doesn’t mean you stop binging and throwing up, they are only superficial manifestations. ‘Getting well’ means that you are not caught up with food. There is a lot of underneath work that needs to be done. It would be nice if that was instant and overnight but it isn’t … This foundational work involves getting back self-worth and feeling connected to yourself. The binging stuff is superficial. It is really about getting back to finding out who I am, what I want, and how am I going to live my life. And the food stuff, which is symptomatic, will resolve without you trying. Anti-anorexia is living your life from the inside out; anorexia is living your life (if you can call it a life) from the outside in. That’s it in a nutshell. (Amy, p195)

An important section of this book looks at ‘Comebacks and Retreats’, the inevitable intensified fight back that anorexia will wage once it has been defied and opposed. Anorexia/bulimia never concedes a battle or unconditionally surrenders. Some of the rear-guard anorexic attacks identified in this book are claims that the person is ‘back to square one’ and it is not worth fighting for her life, claims that the person is a failure and may as well give up, and claims that anorexia is part of the person’s ‘nature’ or ‘destiny’. Therapeutic responses described in the book include predicting anorexia’s comeback, seeing this comeback as a sign of its’ desperation, maintaining compassionate concern and efforts to help, deconstruction of anorexia/bulimia’s attacks, taking note of progress made, accepting strategic retreats, becoming aware of the rhythm of recovery, and alternatives to open battle such as conscientious objection, entrusting one’s health to others and allowing others to carry one’s anger and outrage. In one of the chapters I found most heartening in ‘Biting the Hand that Starves You’, parents and allies speak of their experience in supporting a loved one with anorexia/bulimia. This brings me to the key technique of externalizing, a bedrock of Narrative practice, particularly with anorexia/bulimia. There is an example of this in a situation where anorexia was preventing Diana from attending therapy, and her mother and father began to learn the language of anti-anorexia.

In our conversations there was respect for myself and for Richard in the very way David spoke to us about ‘anti-anorexia’. He talked about speaking anti-anorexically with each other and with Diana. So now anorexia became something you could actually fight back against. Instead of Diana being this problem, we could see that Diana had this problem and we were trying to fight it and to find out more about it. So there was anorexia almost with its own persona.; You could say ‘This has come in and intercepted Diana and overtaken her. This is not Diana. She is separate from it.’ That was very important. Very important.

Externalising anorexia , recognizing it as separate from Diana gave us the liberty to vent our anger and frustration at the real culprit. Diana hated it at first when we started saying things like : ‘We hate it when anorexia treats you like this and makes you so unhappy,’ ‘It is so sad when anorexia stops you enjoying your food.’ ‘Anorexia is trying to stop you doing the things you really want to do.’ But it was such a relief to get angry at anorexia not Diana. It was really hard work at first. Diana did not even want to hear the work anorexia, and she sure didn’t want us separating her from it. The new language seemed forced and unnatural. We said it but we did not feel it. I wasn’t comfortable when I first tried to speak anti-anorexically. I was uncertain because it sounded so awkward. When I began speaking like this Diana seemed to think: ‘Mum and Dad have really started to go round the bend and they’re losing it.’ But we persisted and eventually we saw breakthroughs in Diana. (Ann and Richard, p263).

The four parts of ‘Biting the Hand That Starves You’ are divided into sections and sub-sections. The advantages of this format is that the reader can quickly get an overview of each chapter, and the sub-sections lead you through the therapeutic techniques. However I found this fragmentation of the chapters interrupted the flow of reading at times.

I thoroughly recommend ‘Biting the Hand that Starves You’ not just to therapists using Narrative approaches, but to people who have struggled with eating disorders and feel that stories from fellow travellers would assist them to maintain their anti-anorexia progress.

It is a book you can dip in and out of, to find a little bit of hope for a difficult day or a fresh perspective to sidestep a seemingly intractable problem!

Chris Fagan is Co-ordinator of CoCare, the Youth Health Team at Moreland Community Health Service in inner Melbourne. She can be contacted at ChristineFa@mchs.org.au.

FROM: Narrative Network News by Marilyn O’Neill, Sydney, NSW

I have just read ‘Biting the Hand that Starves You: Inspiring Resistance to Anorexia/Bulimia’ – and I am excited!

My practice has been informed for some years, courtesy of David Epston, by the therapeutic ideas presented in this book. Impatient enquiries about when the book would be written have given me an appreciation of the dedication and hard work that has gone into its emergence, and I want to thank all those who have persisted to complete it.

Already familiar with anti-anorexia and anti-bulimia practices, I might not have predicted this level of excitement. I will try and describe what it is about this text that has me buzzing.

First, it is a relief as a practitioner and teacher to have documented ideas for those new to this work , and reminders for those familiar with it, of ways that we might effectively respond to the destructive thoughts, suggestions and requirements of anorexia /bulimia.

Then there is the benefit of real and lived experiences. ‘Insiders’ is the description given in the book to women and their families who have had direct encounters with anorexia/bulimia and who have gifted us with their knowledge. This knowledge is of immeasurable worth to all who wish to free lives from anorexia/bulimia and assists a more forceful stand against its’ isolating effects.

Maisel, Epston and Borden have made these direct experiences a base from which to make available new understandings for readers of the intrusion of anorexia/bulimia thinking and its’ potentially deadly nature. These real life stories are responded to in the text in a way that supports resistance to anorexia/bulimia, rather than enticing panic or a run for cover response from the reader.

The stories of ‘insiders’ are also used to demonstrate to the reader clearly articulated and user-friendly therapeutic processes’ that are made more visible by weaving copies of therapeutic documents into the text.

Never before in print have I seen anorexia/bulimia so clearly outed and exposed for its’ unworth, deceit and trickery.

Never before in print have I seen such clear ideas for the taking of an effective anti-anorexia/anti-bulimia position.

‘Biting the Hand that Starves You’ includes a clear and continuous deconstruction of the ideas that contribute to the experience of anorexia/bulimia. It considers the conditions that are misused to establish anorexia/bulimia thinking in the minds of women. It exposes the ways that anorexia/bulimia comes to represent women’s preferences, whilst stealing or covering up their real intentions for living life.

Reading this book has already reinforced my own practice and increased my resistance and resilience when I confront anorexia and bulimia’s influence in the lives of the people I meet. I have also transferred these practices to benefit me in standing against other difficult problems.

This book is very readable and consequently accessible to the people I work alongside and their families. Its’ clear and available style means that many members of the community may benefit from its’ content. The potential of more of the community having access to clearly written anti anorexia /bulimia practices is what really excites.

Review by Maree Burns (PhD). Research Fellow, School of Psychology, University of Exeter.

In a move that is a significant departure from much of the existing literature about eating disorders, Biting the Hand that Starves You begins with and takes seriously, the experiences of those who are intimately familiar with anorexia and bulimia (‘insiders’). Rather than using detached and expert language to describe disordered eating and those whose lives are at risk of being taken over by it, this passionate account invites its readers inside the worlds of those struggling against anorexia/bulimia. This is achieved using first person narratives (letters, poems, therapeutic conversations) that provide vivid and often poignant accounts of the battles that take place between anorexia/bulimia and those fighting to free themselves from its influences.

Utilising narrative approaches to the problem of eating disorders the authors powerfully outline the innovative ways (in both dialogue and practice) in which anorexia/bulimia can be understood and approached as separate from the person &endash; as an unwelcome intruder or captor &endash; rather than as a part of the person or as evidence of internal individual deficit or psychopathology. This understanding is a radical departure from mainstream constructions of disordered eating and it opens up a space between the person and the problem thereby allowing the tactics and effects of anorexia/bulimia to be uncovered and explored. Alongside these investigations, descriptions and knowledges of the insider’s identity and preferred ways of being can be developed and strengthened in order to reinforce her (and sometimes his) resistance to anorexia/bulimia. This is perhaps one of the most compelling and hopeful messages of the book, which is convincingly illustrated using powerful examples from interviews, conversations and other writings. This unique approach to anorexia and bulimia allows those whose lives are immediately affected and their loved ones, health professionals and therapists to unite in resistance by focussing frustrations, anger and intolerance where they belong &endash; at the problem &endash; rather than at the person who is engaging in what otherwise appear to be inexplicable acts of self destruction.

In delivering this powerful message, the book is well structured and clearly written. The first part of the book is devoted to outlining the ways in which anorexia/bulimia initially seduces and then traps the women and men whose lives it takes over. The second section details how anti anorexic/bulimic allies can help insiders to see anorexia/bulimia for what it really is thereby indicating possibilities for ways in which it can be resisted. Detailing this radically different approach to overcoming eating disorders and outlining the ways in which insiders are invited and supported to reclaim their lives is the main focus of the third section. Strategies include exposing anorexia/bulimia through critique of its tactics and effects and then engaging in a process of acknowledging and strengthening an insider’s identity, goals and values for the purposes of taking one’s life back from disordered eating. Finally the last section is concerned with the process of generating collaborative resistance by outlining ways in which family members and other loved ones can join with insiders in this battle to defy anorexia/bulimia.

Biting the Hand offers an innovative way to understand and approach eating disorders &endash; problems that often strike fear into the hearts of those affected and those charged with treating or helping. Using narrative approaches enables the authors to get around the immobilising discourses of anorexia/bulimia as impossible to overcome, of the women who struggle with it as difficult and hostile and of the families of those women, as somehow deficient. Another major strength of the book is that it goes well beyond the simple nod towards socio-cultural ‘factors’ in disordered eating by conceptualising anorexia/bulimia (and their practices) as constituted within particular contexts that value for example dieting, self restraint, perfection etc. As such, the book effectively demonstrates overlaps between so-called ‘normal’ body management that is encouraged in most westernised cultures (especially for women) and ‘disordered’ body management thereby resisting the pathologisation that goes hand in hand with these problems. Furthermore, by treating ‘insider’ knowledges as central the authors outline an approach to disordered eating that does not universalise women’s experiences by seeking to provide uniform explanations and ‘treatments’, but that rather works respectfully with individual women’s own knowledges and histories of living with these problems.

Biting the Hand is also a potentially political text inasmuch as it forces us to rethink the ways in which mainstream approaches understand, represent and construct eating disorders as real, individualised, clinical entities. It forces readers to consider radically different ways in which power might be operating in the life of somebody struggling with an eating disorder. As such Biting the Hand implicitly problematises many of the existing treatment orthodoxies for eating disorders and poses challenging questions regarding current approaches in psychology and psychiatry (and elsewhere) to recovery from disordered eating. Indeed, for those who are committed to finding out the ‘truths’ about eating disorders this will potentially be a challenging text. Although there is some very clear explanation at the beginning of the book regarding the theoretical underpinnings of this novel approach, those who are unfamiliar with narrative ways of understanding the world will need to suspend any desire to establish underlying ‘facts’ about anorexia/bulimia and the person whose life is in its grip. Instead it is necessary to accept these innovative ways of thinking and speaking about anorexia/bulimia as a strategy &endash; as a way to proceed that utilises ‘local’ and context-specific knowledge for the purposes of opening up possibilities for novel ways of approaching the problem and supporting people in their battles to reclaim their lives.

Although this is hardly a criticism of the book, there is one issue that I hold some concern about. The authors highlight as potentially problematic, the possible effects on insiders of some of the vivid accounts of anorexia/bulimia’s entrapment in part one. I was also concerned about this as I read this section. In this part of the book the voice of anorexia/bulimia is present at its most seductive and in a way that will be intimately familiar to those who have struggled against it. Although it would be hard to see how one could write about this in ways that do not paradoxically offer space/life to pro-anorexic ideas, I wondered about the possibilities of inserting critiques or ‘other voices’ in layers (or as footnotes or in a different font) throughout the seduction chapter to counter these potentially deadly promises. Of course the authors are careful to suggest that those who feel vulnerable to anorexia/bulimia’s voice seek support and/or read the latter chapters first where pro anorexic ideas are exposed and critiqued. This is an important suggestion.

Finally, in terms of its usefulness to therapists who are interested in working in different ways with eating disorders, the narrative framework and practices that are outlined in Biting the Hand seems to me to operationalise many of the values of feminist and postmodern approaches within the social sciences that are concerned with issues of subjectivity, ‘mental illness’, and therapy. That said, it is offering something that is less about therapy in the traditional sense and more a call to action or a catalyst for mobilising power/resistance against anorexia/bulimia. In this way the book offers a means of working that hands back power to families and insiders and empowers them in collaboration with their therapists and health care providers to take a stance against disordered eating in their everyday lives, conversations and practices. Indeed, it is the first book of this kind that provides a model of united resistance and of practical ways of fighting the problem. As such it is a very hopeful and inspiring text that will be of interest and value to all those whose lives and work are affected by anorexia/bulimia.

FROM: THE HUMAN GIVENS JOURNAL, 2005

This is a powerful book, written in extremely strong language that reflects the strong feelings of its authors. They take an unrelenting stand (reflected in the meaningful title) against the eating disorders of anorexia nervosa and bulimia, which they refer to, for convenience, as,

a/b: “Our intention is not to understand a/b as much as to undermine and subvert it. This, then, is a book about fitting words, terrifying anti a/b deeds and thrilling anti-a/b possibilities for the lives of therapists, individuals struggling with a/b, and the communities in which they reside. A/b is our sworn antagonist in these life-or-death duels.”

Their aim is to enable those “whose lives have been captured by a/b” (referred to as insiders, not victims) to be able to identify a/b as their enemy, not their friend.

They recognise that anorexia nervosa is such an insidious opponent that it even stymies them in the way they structure the book. They have meticulously removed any reference in the weights of the young women whose stories they tell – knowing that readers suffering from anorexia will seize on these to make comparison with themselves. They would have liked the organisation of the book to be less orderly but, constrained by publishing conventions, are obliged to divide the first section of the book into two – the tactics of a/b and strategies to resist it – albeit concerned that, in the first part,

“the reader is exposed to the voices of anorexia without anything immediately present in the text to oppose it. Insiders have informed us that this makes it far easier for a/b to twist the meaning of the text to its own advantage.”

A/b, they assert, uses two principal methods of seduction: promoting self-blame and guilt, and exploiting and appropriating hopes and dreams. It masquerades as the voice of reason – “If you were only more loveable, he wouldn’t have treated you that way” – and, by promoting despair, makes it more likely that girls will turn to a/b for hope and redemption. It appears to dashed hopes and dreams: most of the young women with whom the authors have worked had once nurtured visions of a just, caring world, which were crushed by negative experiences ranging from abuse to over-control, being required to meet too high standards and objectification by others. A/b promises to end the pain and realise the old dreams – “If you are thin, you will feel successful, in control, more loveable, more invulnerable.”

The authors describe how a/b induces emotional anaesthesia against frightening and difficult emotions, such as intense fear, pain, grief and anger, and extend its perverted moral view to include ever larger domains of the insider’s life. While our culture morally condemns women for ‘being fat’, a/b morally condemns for ‘having fat’. As one woman compellingly describes the experience of a/b,

“Anorexia sucks everything out. And it puts a gloss over you . . . By having you focus on food, it stops you from getting into the inside stuff. It’s really the inside stuff that’s got to be looked at. Anti-anorexia is about feeling connected to yourself.”

If you have ever wondered how women can keep starving themselves even to the point of death, the account of a/b’s powerful tactics for keeping insiders in thrall will help explain it. If someone feels faint (because of malnutrition), a/b redefines this as lack of effort or laziness and urges them to do even more strenuous exercise. When hunger pains or cramps are experienced, a/b reminds the sufferer that it isn’t wise to eat on an upset stomach or transforms serious physical symptoms into ‘signs’ of moral reformation, and so forth.

By the time that a/b’s horrific tactics have all been exposed, it is obvious why straightforward appeals to reason or emotion can’t help insiders conquer a/b. Those desiring to help insiders resist must develop anti-a/b language, and this is done by what Epston has terms ‘co-research’ – the process of externalising a/b from the individual and speculating together about its purposes, intentions, strategies and tactics. There is detailed description of how to go about it, but, we are warned, it is not always easy to distinguish the voice of a/b from the insider’s voice. For instance, if a girl showers for a long time immediately after a meal; is it to hide the sounds of her vomiting as her parents believe, or because, as she claims, taking a long shower helps her deal with the fact that eating makes her feel ‘dirty’ and helps combat her desire to vomit? Is this surrender to a/b;s view of eating as directly, or an act of anti-a/b, or a combination of both? How the therapist responds in such a situation will have significant consequences, the authors says.

A potent means of fighting a/b is to enlist as allies, through the medium of their written experiences, others who have fought back. Because these personal accounts (see archives at www.narrativeapproaches.com) cover so many aspects of the a/b and anti-a/b experience, different ones can be brought into play at different stages of fighting back against a/b.

Anticipating the arguments or rhetoric of a/b’s also an effective weapon. When asked what a/b has promised and what it has delivered, insiders in its grip may insist that, although it hasn’t delivered yet, it certainly will at some point. Rather than let a/b have the last word, it is wise to get in first: “Is anorexia telling you that the only reason it hasn’t yet delivered on its promises is because you have not been obedient or disciplined enough? Is it telling you that, if you keep on listening to it, your rewards will be just around the corner? Is anorexia telling you anything about me and my intentions? Is it telling you I don’t really care about you the way it does – that I am only trying to trick you?” In this way, credibility as someone who ‘understands’ may be increased and the insider may start to waiver in their mistaken beliefs. As a/b is constantly working to twist and pervert, it can also be effective to ask, at times, “What was anorexic’s take on what I just said?”

Temporary relapse can be reframed, before the event, as an anti-a/b choice. One woman describes how,

“I kind of resisted it (bulimia) for a while and then I decided to give in and said to it, ‘You can have me for a while’. I had given Bulimia permission . . . the next morning I feel strong enough to take my life back and got on with it.”

The final part of this book shows parents how they can become effective partners in the struggle to save their daughters’ lives and, as elsewhere, is packed with practical, insightful information. For instance, parents are advised not to focus on weight gain as the indicator that their daughter is on the mend.

“In our experience, weight gain seldom precedes the development of an anti-a/b vision and perspective. Often girls and women will tentatively try out anti-a/b acts in arenas of their lives other than the ‘big game’ of body weight. These initiatives often include attempts to define their values and preferences, to accept and honour their own experience, or to stand up for themselves and their rights.”

Maisel, Epston and Borden are clearly on a mission and sometimes their zeal may be a little too strong for comfort. But this book isn’t about comfort. It is an absolute must-have for anyone working to help suffers from these killing disorders.

Review by Denise Winn.

FROM: www.narrativeapproaches.com/ Archives of Resistance: Anti-anorexia/anti-bulimia

I learned about ‘Biting the hand that Starves You’ from an article in a magazine. It took quite a bit to get hold of the book, but now after over 20 yrs of battling with anorexia/bulimia, I have found something that speaks my language.

I have been hospitalised on several occasions and even though the people were very caring and all their help was for my best interests, it just reinforced the a/b by concentrating on my weight, meals etc etc. My first admission years ago was very frightening. In later admissions I always knew I could go straight back to what I was doing before I entered hospital.

When the book finally arrived, I only read bits here and there and I cried because it was hitting core things that had always been missed in previous treatments. No-one’s fault, it was just how things were done. Now I have a brilliant team around me who have read the book and are right there behind it all. At first I freaked because it felt like I had cornered myself (we laugh now because I nearly threw the book in my nurses lap and ran), but it was pointed out that we as a team, are just beginning to corner the a/b. It’s early days, but I can see it now. I have always imagined the a/b sitting over my left shoulder, but also very entwined and in control of all aspects of my life, Now I can see it in that corner more often.

I have been asked over the years (and have often asked myself) what is it going to take to get out of this torture. I never really attempted answering this question until we finally got the book. I thank you.

From personal correspondence(July, 2005)

Dear David,

Even though, l’ve seen you ‘in action’ at the recent workshop in Sydney and l read you book with such a hunger that l couldn’t really put it down, l haven’t actually met you. So it’s a pretty strange space to be writing this letter to you.

I’m not sure exactly where to start so l will start with you book, which my therapist had given me to read. The book blew me away, and tonight while l’m in a space where l can ‘see it’, it blew away my anorexic (A) thinking too. I remember the anger and complete outrage l felt (or rather she, the voice of anorexia, felt) after l’d read about 3 pages of “Biting The Hand That Starves You”. I felt angry and literally outraged, l felt naked, trapped. Why? Because my therapist finally knew about me. She had let ‘herself’ into my world, she knew the power l felt and the secrets and l hated that. This was supposed to be ‘my thing’ not for her or any of ‘you’ people to know about.

Yet sitting here even typing this, l can see in some ways that-that response surely is Anorexia’s voice and not my own. They are so intertwined it is very hard to distinguish one from another and separate them sometimes.

Reading those first few pages of your book was like a slap in the face, a real shake up. It was like as if someone has opened Pandora’s box, which had been slowly opened with the help of seeing my therapist on & off for 2 years . But this time, I found inside that box was another and another and another. I had thought that this ‘disordered eating’ box had been pretty much dealt with only to discover in the last few days the power that still lurks and the work that still has to be done. There is a lot more thinking to do.

Anorexia’s voice is a catch 22; it promises me so much as you said in your book, yet it also lies and takes so much away. There were some spots in the book that made the voice of anorexia ripple in my brain, as if she was an old machine, who’d been turned off and now was refuelled to go back and ‘do it all again’, and this time to ‘do it properly’. It says ‘just starve yourself and everything will be ok’.

My eating issues started l guess after l was sexually abused by an older female when l was 9 years old. By 14, l was throwing my lunch out at school and by 16 l was a complete mess-l literally can’t recall anything from that whole year. I spent that whole year consumed with thoughts of food l wish l could eat, foods l wouldn’t eat, calories, hours of exercise. It’s funny the little things you remember, for example, eating a piece of bread and lettuce and then crying afterwards thinking l would now become huge; eating 1 cheese sandwich a day for 3 weeks, because that seemed like a safe food…….and the whole time the feelings inside were so completely overwhelming. I felt as if l was pure evil, that l had bad blood running through my veins; l wanted to die and thought about it all the time. Now it is astounding to look back now on the tricks and behaviour that ‘came into my life’. Yet l remember thinking at one point that I ‘felt different inside…., it was as if a devil caterpillar crawled into my brain and just took complete control over it”.

The voice of anorexia often tells me what a fake and liar l am, what a wanna be anorexic. How pathetic I was that l felt in so much turmoil and was so often suicidal, yet l was never ‘physically strong’ enough to make myself a lower weight. It often tells me my life will not be complete ‘until’ l go back and make ‘right’ what l have not yet achieved-that of being ‘diagnosed’ as anorexic, looking that sick, being known in that way.

Yet to see myself type out these words makes me think what a ‘nutter’ l am. How could anyone want that for themselves? Yet there is still part of me that does want that and l don’t want to ‘give it up’. The fear of not having that ‘option’ to go ‘Anorexic’ again, is too stressful. l need options and self harm, anorexia and bulimia all feel like safe and good options to have up my sleeve.

You book also made a huge crack into such thinking. It made me think for the first time in a long eight month battle with depression that maybe it was time to more forward from this. Maybe enough was enough!

Never before have l read some incredibly accurate information from a non insider-it was all so spot on it was shocking. What outrages me the most is my frustration in trying to explain anorexia to them, to my friends even, to my family who still just don’t get it. When l read your book l thought-yeah all the answers are here for anyone to read. The only problem is getting them to read it. How can you express to someone not familiar with the strength, the power and the seductiveness of the voice of anorexia. -It would all sound too ‘nutty’ to most.

There was a lot that came up for me in your workshop. Although l could only be there for the briefest hour, it is etched in my mind. The video of your interviewing, your openness was really remarkable and the changing feeling in that therapy room shook me. . At the same time, l felt really uncomfortable, like a fraud, like l didn’t belong there. You can imagine anorexia had a field day inside my head. I felt like a fraud, because those women were ‘so bad, so classic, so sick’ and l never was.

Some things stuck out for me in your workshop and have really puzzled me. I am overwhelmed that you are a man and you ‘get this’. You ‘get it’ and understand anorexia in ways l cant even begin to explain. It’s almost as if you can hear the voices of all those whales that beach themselves and all those people who have anorexia in their lives are the helpless whales stranded on the beach dying. They’re the opposite of whales but their slow and agonizing death seems the same to me.

I cannot fathom how anyone can be able to do this kind of work, again and again and again. How can you keep going? How are you not depressed as the pain and the problem must seem too great and so confusing?

l forget that many of those attending don’t have ‘insider’ knowledge and although l doubt my realness of it at times, to look around the room and see people ‘starting to get it’. It was indescribable! l felt torn inside between anorexia and the me part.

You taking a stand and having those therapists/ people know that “if you can’t separate A from the person, then you shouldn’t be doing this kind of work” was mind-blowing to say the least.

Can you begin to imagine what its like for someone like me to only very recently think that it wasn’t all my fault in the first place. To think that l may not be responsible for all my eating dramas, to just start to see that l am not anorexia, l am not depression, l am not bulimic, l am not a self harmer. To have exactly half my life hating and blaming myself for a whole lot of things and for you and my therapist to show me that perhaps l’m missing something is an absolute mind fuck. I literally feel as if l’ve been walking around the world for fourteen years with dark glasses on and, someone’s just told me l can take them off. l have and now l look at my whole life in a different way. It is truly a shocking discovery, a hard time of transition which requires me to reassess every little thing. There are also times when l feel as if more rocks are falling away off my shoulders and that is a good feeling.

The set up of the anti-anorexia league was an amazing idea, l would have in a sense easily done something for someone else but never for myself. l couldn’t have cared less what happened to me, but have the deepest feeling of love for others. Oversensitivity is what others call it.

I do want to thank you thought, because something changed between my therapist and me. l’ve been fighting her and the therapy on and off for the past few months and been completely consumed with depression. The self harming thoughts were just there resting in my brain. But when l met with my therapist last Monday, l had a different feeling. And then yesterday, l had that distinct feeling that maybe it was time for me to make some firmer choices and commitments in life and do more to get myself back into society and move on with life. l’m scared to say it but perhaps l have just got to the top of a very long hill. I know there are still some more ahead but nothing compared to what I have crossed over. lt might be hope after all.

My biggest outrage of it all though is where to now? How do you get this message out there, that anti-anorexia is the way to go in helping people with Anorexia and other problems.

All l can think David is this. My background is in documentary film-making. lm slowly working my way up that huge ladder of paid employment ( meanwhile studying towards a Masters). It is my hope that one day together with others, we can make a documentary about ‘anti-anorexia’ so that the ‘general public’ GET IT. l’ve always thought these shitty things in life have happened to me for some greater purpose. Well maybe this is part of it. The time is not now but l feel it will be sometime in the not too distant future.

Warmest wishes

Bella

From ‘Women and Psychology’, 2005

Biting The Hand That Starves You is an extremely interesting and thought-provoking exploration of ‘anorexia’ and ‘bulimia’. It is written particularly for therapists, those engaged in ‘eating disorder’ type practices and carers such as parents, partners and friends. It is written with the explicit and passionately articulated intention of providing a text which undermines the seemingly seductive appeals of ‘eating disordered’ practices, experiences and subjectivities and which facilitates a resistance to the “Nazification of everyday life” (p.3) entailed in ‘anorexic’ and ‘bulimic’ practices. Yet, whilst the purpose of the book is “to help those whose lives have been captured by a/b” (anorexia/bulimia) (p.2), it is, also in many (welcome) ways a very radical departure from the vast majority of clinical guides, ‘how to’ manuals and self-help texts written for therapists, insiders or carers both in its theorisation of ‘anorexia’ and ‘bulimia’ and in its approach to strategies for ‘recovery’ from or resistance to ‘a/b’. And it is, in my view, the critical and creative perspective of the book together with the prominence of “insider” accounts which make Biting The Hand That Starves You essential reading for anyone interested in this field.

Biting The Hand That Starves You begins with an introduction which includes a brief and very useful outline of the narrative therapy perspective taken by the authors in exploring (and providing a resource for resisting) ‘anorexia’ and ‘bulimia’. Whilst there are some clear differences between this approach and more academic (rather than therapeutically-oriented) discourse-oriented and social constructionist work there are equally clearly considerable resonances between the two perspectives. Maisel et al. theorise ‘anorexia’ and ‘bulimia’ within framework which emphasises how culturally dominant, normative values and practices are entrenched in the production and practice of ‘anorexia’ and ‘bulimia’ such that they are understood as socio-political problems (manifested in ‘individual’ experience) which therefore require an “active challenge [to] cultural discourses, including the culture of psychotherapy” (p.9) and an approach to intervention (at the level of ‘the individual’) which differs markedly from mainstream approaches which are &endash; by now – notoriously problematic.

The terms ‘anorexia’ and ‘bulimia’ – and more frequently ‘a/b’ to signify the frequent interchangeability and merging of the two terms in lived experience &endash; are thus used in their ‘loose’ sense to refer to problems rather than to reify the problem(s) as if these diagnostic categories really were distinct clinical individual psychopathologies. Biting The Hand That Starves You is thus written from a non-individualising and non-psychologising perspective in which ‘a/b’ is culturally contextualised. Hence, the aim of anti-a/b narrative therapy, as it is explained here, is not to normalise what is often alleged in mainstream texts to be psychology dysfunctional individuals but to “assist people in recognizing and resisting their own subjugation through an exposé of the linkages between a/b power and wider cultural norms, values and practices” (p.7) As someone who has been doing critical feminist research in this field for several years I have often been asked what the ‘clinical implications’ of my work are. I take this to most often mean – what kind of therapeutic intervention am I suggesting as a better alternative to current psychotherapeutic approaches to treatment? And I find this a very difficult question to even begin to answer beyond a claim that disrupting dominant cultural understandings and practices that individualise and de-politicise problematic experiences of embodiment and body-management is worthwhile in and of itself even in the absence of deriving specific recommendations for ‘therapeutic intervention’ from that. The claim is, I think, ‘true’ but nevertheless still seems somehow unsatisfactory. From my own perspective then, in taking a broadly critical perspective to inform a ‘therapeutically-oriented’ approach to ‘a/b’, Biting The Hand That Starves You makes absorbing reading in that it provides a very interesting and much-needed answer to a question which I have frequently felt thoroughly frustrated by. The book provides both “an archive of insider knowledge and an explication of the manner of speaking that brought it into being” (p.12). It is developed out of what the authors refer to as “a thousand and one anti-anorexia conversations” and offers a fascinating &endash; though I think, from a post-structuralist perspective, sometimes rather challenging &endash; perspective on becoming, living with and resisting ‘a/b’.

Following the introduction, the book is divided into four parts, the first focusing on the seductive appeals of a/b and the ways in which it can become insinuated into ones life; the second exploring accounts of living with and turning against or “breaking the spell” of a/b. Part three focuses on “reclaiming one’s life from anorexia/bulimia” and part four on “becoming an anti-anorexic/bulimic ally”. The book thus provides a detailed exploration not only of being or doing ‘a/b’ but also of ways in which ‘anorexic/bulimic’ values and practices might be countered and resisted. Each part, of four to six chapters each, combines insiders’ accounts and excerpts of “anti-anorexia conversations” between therapists and insiders with commentary from the authors so that unlike many therapy-oriented texts in this and other fields the ‘voices’ of insiders/clients/sufferers is given some prominence. In Part 1, for example, chapter 1 begins with a two-page piece of writing from ‘Elizabeth’ entitled ‘my new friend’ which serves as an illustration of much of the following discussion of the ways in which a/b can appear as an appealing solution to life’s problems. Subsequent chapters are similarly &endash; though to varying degrees – woven around insider accounts, using reflections, letters and poetry as well as conversations with therapists (and, in part 4, accounts from parents) to illustrate the discussion. The accounts themselves are often very harrowing and sometimes, I think, in the awfulness of the experiences they articulate, could be read as suggesting a world of experiences and practices beyond the pail of mainstream cultural norms. To me the use of the terms ‘insider’ and ‘outsiders’ to refer to those who are and are not engaged in ‘a/b’ type practices problematically underlines this possible reading of ‘a/b’ as a deviation from rather than a part of contemporary cultural norms. However, the authors’ discussions of these ‘insider’ accounts and of ‘a/b’ values and practices more generally do also often explicitly emphasise how western cultural norms and ideals are implicated in the production and maintenance of ‘a/b’ experiences and practices. And the discussion of issues which are not directly concerned with food, eating and body weight as a/b issues similarly adds to the effect of disrupting mainstream and ‘commonplace’ views of ‘anorexia’ and ‘bulimia’ as discrete individual pathologies that could be understood as categorically different from ‘the norm’.

One aspect of the book which I found particularly challenging &endash; that is, perturbing but also very interesting – was the particular, highly novel way in which ‘a/b’ is conceptualised in reifying and personifying terms. Throughout the book ‘a/b’ is presented as “an external force” (p.239) separate from the person engaged in a/b practices and as (if it were) ‘something’ or ‘someone’. For example, a/b is given ‘a voice’ and “might say something like, “You will never be noticed if you are just one of the pack. You must be the best if you are going to get attention and respect …”” (p.25). It has a kind of personality: “Anorexia has the gall to blame Kirsten for the abuse she has suffered … Anorexia spun its deceitful threats and promises…” (p.70-71). It is agentic: “In order to convince Jennifer that her only hope for a good life was to take the path it set out for her, a/b surreptitiously sought to undermine her confidence in herself and her possibilities. It began to denigrate her talents and abilities…” (p.62). And it is purposeful: “A/b’s strategies provoke fear of living without it …” (p.135) and “A/b’s attempts to number a person’s days, both literally and figuratively” (p.170). Given the authors’ emphasis on a culturally and politically contextualised understanding of a/b, this might be viewed as an unexpected and certainly unorthodox move on their part. However, as they explain in the introduction “this perspective should not be seen as a literal “truth” about a/b. Rather, this particular construction allows a/b to be “seen” in particular ways, ways that enable us to decipher possible lines of resistance and support for this resistance” (p.12). As a post-structuralist I found this reifying and personifying way of figuring ‘anorexia’ and ‘bulimia’ uncomfortable at times but also very thought-provoking: on the one hand this way of writing about a/b seemed at first to be meta-theoretically incompatible with the culturally- and discursively-contextualising theoretical framework set out by the authors. Yet on the other hand the construction was given an explicitly metaphorical status and was used to open up and explore different ways of reflecting on and talking about a/b and of developing ‘anti-a/b’ practices. Whilst the earlier chapters of Biting The Hand That Starves You powerfully elucidate how ‘a/b’ functions as a seductive and compelling yet self-punative trap, the later chapters in particular illustrate some of the striking possibilities which “this [metaphorical] manner of speaking” about a/b might open up for challenging and resisting the discourses and discursive practices in which a/b’ subjectivities, desires and forms of body-management are constituted. The examples and discussions of how “this manner of speaking” about ‘a/b’ works to produce the possibility of ‘anti-a/b’ subjectivities, desires and practices illustrate convincingly the potentials of this strategically-adopted construction in the context of anti-a/b narrative therapy. Whilst I sometimes struggled with this construction, Biting The Hand That Starves You certainly repaid my persistence in attempting to understand this approach to theorising and resisting ‘anorexia’ and ‘bulimia’. In a field where mainstream approaches to intervention are notoriously ineffective the approach presented in Biting The Hand That Starves You is undoubtedly compelling food for thought and, in my view, absolutely essential reading for academic researchers as well as therapists, ‘insiders’ and carers.

Reviewed by Helen Malson

Review: New Zealand Association of Counsellors, June, 2005, pps. 40-41

I loved this book! This might seem a strange thing to say about a book that is written about anorexia, but it left me feeling uplifted, and I am sure that anorexia would not be pleased about that.

There are many things about this book that made my heart sing. Firstly, it is a labour of love that comes through very strongly. The authors are passionate about their anti-anorexic stance. Secondly, it is a book that is very firmly anchored in narrative ideas and practices. That in itself is a very difficult outcome to achieve in a world where there are so many ‘truths’ about how books ‘should’ be written. Thirdly, the book is full of wonderful stories of resistance and knowledge that comes first hand from ‘insiders'(those whose lives have been captured by anorexia/bulimia). In many ways this is a tribute to more than fifteen years of co-research that has been carried out by David Epston and the Anti-anorexia League. Both Richard Maisel and Ali Borden acknowledge that their beginnings in this work stems in large part from the ground breaking work done by David and the League, and David’s generosity in sharing this knowledge and mentoring others. And lastly, this book is a treasure trove. Every time I pick it up I find yet another inspirational thought-provoking idea. The following review cannot do justice to the wealth of knowledge contained in this book, but hopefully it will whet your appetite!

On picking up this book, the reader will instantly be struck by its difference. Those of us familiar with narrative ideas and practices will recognize and feel comfortable with the idea of anorexia as an ‘external intruder’ rather than viewing it as a ‘disease’ or a feature of a person’s ‘self’, ‘character’ or ‘make up’. For those who are not familiar with this practice of externalization, it is central to narrative therapy. Narrative therapy centres people as experts in their own lives and views problems as separate from people. Narrative therapy assumes that people have many skills, competencies, beliefs, values, commitments and abilities that will assist them to reduce the influence of problems in their lives.

In keeping with narrative ideas and practices, Richard, David and Ali quite clearly position themselves as co-researchers alongside the insiders who generously gave of their insider knowledge(Alis also acknowledges her insider knowledge). They take a moral stand against anorexia/.bulimia(a/b) very early when they say:

“We did not want to believe what we have come to know and we would have preferred to have remained innocent. But have stumbled upon (or in Ali’s case into) the concentration camp of a/b, it would be morally reprehensible to turn our backs on it. We cannot blind ourselves to what we have witnessed and experienced- death sneaking its way into the lives of young women and young men”(p. 3)

This is not a therapy book nor is it a self help book, rather it is a compilation of insider knowledge that brings about a vision and practice that is hoped will help prevent a/b from turning young women and men against themselves, their families and their communities.

The book was written for three audiences- professionals, insiders and their parents, partners and friends. It is structured as a series of parts which resemble the structure of a narrative conversation. In part one, the problem is described and externalized. We learn how ‘a/b insinuates itself into the lives of women”(p. 15). Part two focuses on ‘how therapists and other helpers can help young women imprisoned by a/b to recognize their dangerous predicament and co-create possibilities for resistance'(p. 15). Part three ‘maps the back and forth process of freeing oneself from anorexia’ s prison” and part four “is written for caretakers(parents and professionals) who wish to know how they might aid those who are struggling with a/b'(p. 15).

At the outset, a/b is unmasked and we learn about the meaning of a living a life in a/b’s powerful grip. We learn about the seductive and powerful voice of a/b. Emily, aged 14, (p. 52) tell us:

“It goes about in search for humans in pain and misery. Whenever it finds them, it approaches them and attempts to befriend them. It promises to take away their pain. If you have an identity crisis, it will promise to provide you with an identity. If you are lonely, it will promise to be your friend. If you are feeling powerless, it will promise to make you powerful. It will make promise after promise, but its promises are lies. It says, “I will make you happy.” As soon as you believe this lie, you have already begun to die”.

Later Emily tells of how anorexia tried to ensure her obedience by attempting to “kick my soul out and move in’. She says:

“Anorexia tells you your name is Anorexia and you forget who you are. It goes on. 1. You are not a person; you are an object, a thing, a body to be deprived of pleasure, to be tortured and starved. 2. It says: ‘I will steal your name and replace it with Anorexia. 3 ‘I will steal your soul and replace it with Anorexia. 4. ‘I will steal your voice…”(p. 52)

The book powerfully privileges the voices of insiders who hold intimate knowledge of the workings of a/b. The authors state: “…we have either witnessed or had narrated for us innumerable occasions of breathtaking valour when, despite the risks of a/b reprisals, anti-a/b women and men have fought for their very lives and reclaimed them as their own'(p. 3).

In part two, some of the ways of thinking and speaking about a/b that have provided the means to expose and counter a/b, as well as open it to public scrutiny are described. These ways of thinking and speaking are called anti-anorexia/anti-bulimia(anti-a/b):

“We regard a/b as the ‘Nazification’ of everyday life. Anti-a/b is any number of resistance movements whose members are loosely attached or, at times, unknown to each other but connected by their opposition to a/b. This books offers anti-a/b to you in the spirit of furthering this resistance and inciting fresh resistance”(p. 3).

Insider knowledge shows us that the ways of becoming anti-a/b are many and varied. For example, Chloe described taking risks as the hallmark of her anti-a/b, whereas Victoria emphasized choice as a central feature of her anti-anorexic lifestyle.

Part four is entitled “How to become an anti-anorexic/bulimic ally’. It is written for ‘caretakers(professionals and parents) who wish to know how they might aid those who are struggling with a/b”(p. 15). The suffering of the family has been a neglected areas in much of the literature on anorexia. As the authors point out: ‘A/b can stymie and perplex even the most savvy and skilled of therapists, but the dilemmas therapists confront pale in comparison to those faced by parents looking after their stricken daughter”(p. 238).

Indeed in most of the traditional literature on the subject of anorexia, mothers come in for harsh criticism. David comments in the introduction: “I know of no other problem for which mothers were blamed so zealously and without regard for the consequences…It is my belief that the culture of psychotherapy owes such mothers a blanket apology”(p.5).

In this section of the book, there are some wonderfully clear options for thinking and speaking about a/b to assist in establishing an anti-a/b alliance in collaboration with our daughters. We can read these options and instantly feel like we can take the next step. The anti-a/b alliance can position the daughter in the role of consultant, allowing her to assist her parents in helping her reclaim her life from a/b. I particularly liked the hypothetical anti-bulimic conversation(p. 248) and the list of parenting practices that insiders have found helpful(p.250).

Ann and Richard’s moving account of ‘the story of their daughter’s battle with anorexia and their own evolution as anti-anorexic parents”(p.252) tells us how they did this very thing. It is one of the most moving and thought-provoking accounts of parenting I have ever read. Being a parent is a difficult and sometimes lonely road. I think perfectionism has visited all of us one time or another to convince us that we could be doing(or could have done) a better job at parenting(or anything else for that matter!). We can all learn so much from reading this chapter.

This book has sown the seeds for anti-a/b. As professionals, parents, men and women, we have a moral responsibility not only to read this book, but also to nurture and grow these seeds of resistance. Any anti-a/b step, no matter how small, is a victory.

Glenda Dixon, Dunedin College of Education

From Social Work Review Vol. 25-3, Spring 2005, pps. 47-48

This book provides a narrative practice approach and was written for three audiences – helping professionals, persons with ‘insider knowledge’ of anorexia/bulimia(a/b) and their parents, partners and friends. The authors take great care to caution ‘insider readers’ that the compartmentalising and tidying of the book should not be read as compromising and/or oversimplifying of the spirit of the anti-anorexia/anti-bulimia resistance, which they say at times can be a “messy business” (p.14).

The work is presented in four parts. In the first part of the book the authors address the means by which a/b insinuates itself into the lives of women as it “promotes an adversarial relationship between the person and the body”(p. 39). They describe the susceptibility to the voice of a/b in a refreshing new genre. With great precision, Maisel, Epston and Borden, together with their co-authors who have insider knowledge of the ‘a/b prison’, expose the seductive and brutal voice and tactics of a/b.

The second part explores the predicaments of ‘spell-breaking conversations'(p.101), n which a/b’s deceptions are ‘metaphorically described as spider webs of clever rhetoric. If the person breaks one strand of the web, another adjacent strand binds her'(p. 122). In Chapter 10, Maisel describes the painstaking repositioning from giving an ‘anorexia answer’ and “feeling a bit defensive of anorexia”(p. 124) to an “embryonic distrust of anorexia'(p, 124) and very slowly recognising a/b’s ultimate goal for a person’s life.

Part three goes on from here to speak of the journey towards freedom from the ‘prison of anorexia’. There are examples of the refined practice that makes possible the unmasking a/b and so opportunities for defying a/b. Practice possibilities for therapists are thus opened up. Part four cautions professionals not to step into positions of “transferred dictatorship'(p.274), but to invite reconciling life-saving and spirit-nourishing encounters into their practice, and to become anti-a/b allies.

Biting the Hand is a long-awaited, fascinating, clear and moving book. I find it to be a convincing anti-a/b voice with so many poignant moments, and refined, sophisticated, respectful practices; a book that simultaneously moves the reader and invites professionals to assist in breaking the spell of a/b with many innovative practices. The book is a must for the practitioner working in this field as it calls for reflecting on, and enriching of, practice. It also provides rich resources through what have become known as the anti-a/b leagues and archives of resistance.

The authors honour the words of ‘insiders’ to bring closure to the book. Chloe’s father writes a moving letter to his daughter n which he says the following about hope – let is also speak the last words about the book:

“Hope is something quite different. Hope is not contingent on outcome. That is, hope is relational- it sits between us. It is sustained and nourished by memories, conversations past and present, and faith in who you are in some deep, enduring sense. We never surrendered to despair because our hope sat between us, sustained by all those small, everyday exchanges and little acts of resistance on your part: They act as harbingers of hope for us (p.292).

Book Review by Elmarie Kotze, Senior Lecturer, School of Education, University of Waikato.

Reviewed on Website: Counsellingresourse.com:

http://counsellingresource.com/books/

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 and 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.

By Sarah Luczaj