Anorexia nervosa and bulimia Book

	Acknowledgements
	Introduction	1
1	Beginning to unravel the problem	9
	Mysteriousness	10
	The illness as a category problem	12
	The physical illness category	14
	The deliberate action category	16
	Recognizing the condition that is anorexia nervosa	17
	Distinguishing the food/body control that is characteristically anorexic	19
	The similarities between anorexia nervosa and bulimia	22
	Some medical and other objections to taking the two conditions as one problem	23
2	A path through the theories	26
	Two types of theory	26
	Theories and how they relate to what is seen as needing explanation	27
	The practical significance of the theoretical divide	29
	The psychological effects of starvation	29
	Theories that build on the psychological effects of starvation	33
	The starvation whirlpool	35
	Positive ideas about food and body regulation	38
	Professional objections to the idea of starvation effects	42
	The idea of illness	43
3	Control by any other name	45
	The dangers of authoritarian intervention	47
	The anorexia nervosa/bulimia board game	50
	Progression around the board	53
	'Advantages' of a bulimic pattern of control	54
	Completing the board game	56
	The helper's dilemma	60
4	Bad medicine	62
	False leads: appetite and mood	62
	Treatment objectives	64
	Additional medical interventions and their limitations	65
	Taking control of the anorexic patient	67
	Behaviourism: a theoretical rationale for taking control	69
	When black-and-white thinkers meet head on	71
	The use of legal powers to detain and treat the anorexic	73
	The anorexic's alienation from the medical profession	74
	The doctor's point of view	75
	How much weight gain?	76
	The tyranny of assumptions	78
5	The picture at low weight and foundations for help	85
	The move to low weight	86
	Different approaches and how weight gain is implicated	87
	Different meanings of the same words	89
	Low weight and non-medical help	91
	A stepladder for recovery	93
	Mapping low weight	95
	The sufferer's response to the experience of starvation	102
6	Viable weight and the picture that is hidden	105
	... but ever more came out by the same door as in I went	106
	Being invisible	107
	The key to the self-starvation whirlpool	108
	Morality	108
	Worthlessness	111
	Sensitivity	114
	External control	116
	Hidden feelings	117
7	The culture of control	119
	The female role: only part of the explanation	120
	The Protestant or 'work' ethic	120
	The 'therapy culture' in conflict with the sufferer's culture	123
	Social standing	124
	Circumstances that intensify commitment to the work ethic	124
	The transmission of values	126
	Creating the symptoms	128
	Moving the spotlight away from women	131
8	On becoming a person: through food control	134
	Being ...	134
	... and nothingness	135
	How is an existential problem to be recognized?	136
	Food/body control: a solution to confusion	141
	The difficulty there is in expressing nothingness	142
	The significance of indecisiveness	144
	Sources of confusion	145
	The danger in resolving sufferers' conflict for them	147
9	Perspectives that maintain the ability to help	151
	Food/body control and the use of alcohol compared ...	151
	... and contrasted	152
	Symptoms of excessive virtue	153
	The preference for physical explanation	154
	Seeing what is there	155
	Admiring the anorexic	157
	Becoming drawn in and ineffective as help	159
	Intervention: problems and strategies	160
	Self-interpretation and virtue	163
10	Getting through	166
	Acknowledging the sufferer's style of thinking	167
	Returning to the stepladder	169
	Adjusting for the centrality of food control	170
	Adjusting for altered thinking	174
	Adjusting for low self-esteem	176
	Adjusting for different physical experiences	178
	Adjusting for different implicit values	179
	Nurturing a sense of self	180
11	Good medicine	181
	50-65 per cent AEBW: emaciation and medical help	182
	50-65 per cent AEBW: communication	184
	Refeeding the anorexic in hospital	185
	Moderate aims for weight increase	187
	Helping the sufferer feel safe	188
	Refeeding and the need for predictability	191
	Making hospital staff comfortable	195
	The use of sedatives in hospital	196
	Help: dividing the task: providing continuity	198
12	Turning around	200
	How to begin working together?	201
	Discovering anorexia nervosa is in control	203
	The inescapability of choice	204
	Allowing the necessary time to choose	206
	Choosing to change	209
	Learning points	213
13	Transition	216
	Catching the sufferer on the way down	218
	Holding the sufferer on the way up	219
	Getting better feels like getting worse	221
	Giving sufferers the appreciation they need	222
	The constructive use of crisis	223
	Further learning points	225
	Withdrawing from therapy too soon	225
	Acting out the chaos	227
	Help and care at viable weight	228
	Practical responses to the consequences of chaos	229
14	Moving towards a real sense of self	236
	Choice, decision and selfhood	238
	Learning to live in the present	239
	Discovering personal rules and core beliefs	240
	Allowing feelings and emotions	244
	Relating to the world	246
	Integrating the experience of self	248
	Signs and sounds of recovery	251
	Further experiment, self-discovery and real development	253
	Appendix	259
	Index	265