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Student Health Association Conference Exeter 2015
Fresh Approaches to Eating Disorders Exploring different perspectives
using the arts, personal & clinical perspectives
Fiona HamiltonWriter, arts practitioner, parentOrchard Arts Health Foundationwww.orchardfoundation.co.uk
Dr Clare ShortConsultant Psychiatrist, Southmead CAMHS, Bristol
Lottie Kokum, Medical Student
Let’s have a conversation
to ‘turn together’
from Latin conversationem/conversatio ‘act of living with’verto, vertere ‘to turn’, conversare ‘to turn around and around’
How can anyone describe…?
What are we talking about?
Anorexia
Bulimia
EDNOS (Eating Disorders Not Otherwise Specified)
Binge Eating
Other eating problems
What useful books are there?
B-eat website – Book Reviews page on website www.b-eat.co.uk/about-eating-disorders/book-reviews/page:3
Eva Musby, parent and writer – resources and linkswww.evamusby.co.uk
These sites contain many useful sources of guidance and information including:
Clinicians’ guidance: ‘A Parents’ Guide’ by R. Bryant-Waugh and B. Lask
Parents’ guidance: ‘Anorexia and other eating disorders’ by E. Musby
Mother’s story in poems: ‘Bite Sized’ by Fiona Hamilton
First person story: ‘The Time in Between’ by Nancy Tucker
Research papers: www.pubmed.gov, www.pubmedcentral.gov, www.plosone.org
Videos for carers, online forums eg F.E.A.S.T., blogs, websites
Where can I get factual and clinical information?
B-eat website – the UK eating disorders charitywww.b-eat.co.uk/about-eating-disorders/types-of-eating-disorder
NHS health trusts’ websites eg North Bristol Trustwww.nbt.nhs.uk/cchp/explore-cchp/eating-disorders
Eva Musby, parent and writerwww.evamusby.co.uk
Where can I get information about guidelines for healthcare professionals on best practice?
Royal College of Psychiatrists’ website www.rcpsych.ac.uk
MARSIPAN report – available online onwww.rcpsych.ac.uk/usefulresources/publications/collegereports/cr189.aspxMARSIPAN= Management of Really Sick Patients with Anorexia Nervosa
Carers and confidentiality in mental health atwww.rcpsych.ac.ukhealthadvice/partnersincarecampaign/carersandconfidentiality/aspx
What we know
Illustration:Jitka Palmer
in ‘Bite Sized’
What we know
Clinical definitions – part of the pictureAnorexia – grossly inadequate, irregular or restricted food intake; significant weight loss greater than 15% of body weight; pursuit of thinness with weight loss and BMI less that 17.5; preoccupation with weight and shape; distorted body image
Bulimia – eating larger amount of food than most people would consider normal under similar circumstances and within same time frame; observed lack of control over amount of food or type of food being consumed; recurring efforts to compensate for bingeing episodes eg with vomiting, use of laxatives, restricting calorie intake etc; on average, binge eating and compensatory behviours take place twice weekly and have done so for 3 months; excessive influence of body weight and shape on self-worth
Incidence – part of the pictureAged 13-19 50.8 cases per 100,000 per year; 0.11% prevalence in women; median onset 17 years; 90-95% female; across all social classes;at risk groups – ballet, dancers, models
What we also know
Visible or relatively easily identified events – part of the pictureeg change in body size
Overlaps between conditions – part of the pictureeg Sometimes bulimia follows an episode of anorexia
Feelings/thoughts that person with ED is likely to experience – part of the pictureeg preoccupation with body size, lack of self worth
What else do we need to understand?
Ourselves
What’s like ‘from the inside’
What it’s like for families and carers
That we can’t ‘get it’ all, but we can havea go at the whole picture
Anorexia nervosa –
‘the impossible subject’
?
Juxtapositions that are difficult to understand
being small - feeling huge
dependence on ‘lack’
physical depletion - mental euphoria
physical frailty - pushing to limits with exercise
life threatening illness - social approval for ‘thin’
desire to be ‘best’ - desire to achieve low body weight
Other things that are difficult to understand
EDs are not all about food
Not one cause
‘Triggers’ can come in different forms
May not know what cause is
Media messages are not necessarily helping
Different perspectives
You need to eat
I need to avoid at all costs the unbearable feelings I get when I eat
You are underweight
I feel and believe I am enormous
Questions for the carer or professional
How can I understand what it is really like for the person with the ED?
How can I understand this and take it seriously AND also keep telling them they need to eat, or that they need help?
How can I deal with my own emotions – frustration, sadness, anxiety, anger – if this goes on and on?
What support do I need and where can I get it?
Knowing what we don’t know
Body, mind, brain…it’s complex and we don’t yet have all the answers. Neuroscience research is looking at interconnections
Illustration:Jitka Palmer
in ‘Bite Sized’
Thinking in fresh ways
Connect
Communicate
Bear the unknowns
Build confidence from some simple starting points
Connecting
Use expertise available in your locality
Use expertise of online and other information
Build a network within your staff team
Communicate and talk about the issues
Communicating
Create forums where conversations can be held that are open and safe enough so that a carers/professionals feel empowered and that there are collaborative networks, that they are not isolated
Create a culture where it is possible to discuss eating disordersand where people know where to turn for advice or help
Create an environment where students are given maximum chance to help each other and to seek help themselveswhere stigma and shame are minimised
Use the arts and creativity to allow people to have their own voicesand to think ‘in 3D’
Bearing the unknowns
Accept there are unknowns and uncertainty and choose to think in fresh ways, out of the box
Attend with permission and determination to self care
Building confidence from some simple starting points
Firm and kind Hold hope
Nourish yourself
Bite Sizedpublished by Vala Publishers 2014
why poems?‘poetic documents’ allow us to ‘capture ‘sparkling’ images and metaphors, loiter for longer in the open spaces that have emerged in conversations’Speedy (2005)
use of language as means of generating new ways of thinking – in spaces between ‘binary opposites’, attending to that which is ‘left out, unthinkable and unthought of’
Cixous (1986)
‘in narrative practice there is [an] emphasis on joining together with others and on witnessing and sustaining each other in written and other ways. Groups of people have produced
collections of their words and reflections on each others’ words, not only to sustain themselves but also to communicate to
wider audiences and future clients’
Speedy (2004)
‘poetry can be utilized to elicit here and now reactions while extending both backwards and forwards in time’
Mazza, N. (2003)
Embodying words – ‘3D thinking’
Dancers Laila Diallo and Helka Kaski show moments ofconnection…
…and disconnection
Has this session given you any food for thought?
References
Cixous, H and Clement, C. (1986) The Newly-Born woman, Manchester: Manchester Uni Press Furman, R., Collins, K., Langer, C. L., & Bruce, E. A. (2006). Inside a provider’s perspective: Using practitioner poetry to explore the treatment of persons with mental illness in The Arts in Psychotherapy, 33, 221-342 Mazza, N. (2003) Poetry Therapy: Theory and Practice, New York: Bunner-Routledge Speedy, J. (2005) Using poetic documents: An exploration of poststructuralist ideas and poetic practices in narrative therapy in British Journal of Guidance & Counselling Vol 33 issue 3 2005, 283 298 [Taylor and Francis online]
CopyrightFiona Hamilton [email protected] 2015
Please email [email protected] to let us know you are using this resource – we like to know! Thank you.
