AUTUMN 1995 NEWSLETTER
Following the Dublin meeting we solicited two conference reports from members who had their first experience of ECED meetings in Dublin:
Melanie Katzman gives her views of her first ECED meeting
Page 2 in the paper version
The fourth biennial meeting of the ECED convened in Dublin in September. Held in a castle the participants were treated like royalty. The Irish tradition prompts a welcome, not with one hello but with "a 1000 greetings", this certainly was the case as Gerard Butcher, Mike Bourke, John Griffin and Noel Walsh made sure the guests enjoyed a balanced diet of intellectual stimulation, fine gestation and plenty of 'craic' (Gaelic for good times).
The meeting was officially opened by the president of Ireland, Mrs Mary Robinson, who presented me a real dilemma. Just as we are trying to help our patients recognise the impossible task of fulfilling multiple and conflicting roles, her knowledge, grace and warmth suggested that it may be possible to be a 'superwoman' after all.!!
Delegates representing 21 countries were in attendance (some reflecting a very liberal definition of Europe) which provided for lively discussion during three plenary debates. This years debates revealed not only academic wizardary, but cinematic prowess as videos, audio tapes and film were used to present material for the discussion.
Bridget Dolan reported the results of the study of the therapists' attitudes towards gender in their work, based on questionnaires completed during the Prague meeting in 1993. Professor Arthur Crisp, on the occasion of his retirement, addressed the audience on the enduring nature of Anorexia Nervosa and the number of delegates demonstrated their multifaceted skills by engaging in native Irish dances during the conference dinner of the Royal Hospital in Kilhainham.
The meetings were officially closed by the Irish Minister for Health, Michael Noonan. After hearing proposals from German and Italian colleagues, Padova, Italy was chosen as the site of the 1997 meeting; the time will be set so that no conflict with the World Congress of Psychosomatic Medicine to be held in Australia that August. For those who attended this ECED meeting, you will take the pleasure knowing that the Sunday immediately after the ECED meeting took place, the cover of the New York Times travel section featured Dublin as one the places to visit this year. Obviously this group is making its mark.
Dr. Melanie Katzman,
A sociologist at a congress of psychotherapists has two main interests: to observe ideas and activities within 'their' profession and to share some of the insights of 'hers'. In this process, both might re-evaluate their positions on the main focus of the conference. In this particular gathering, concerned with the problems of anorexia nervosa and bulimia nervosa, there were further divisions to consider: between psychology and psychiatry; cognitive, individual and family therapies; biological and social approaches; professional help and self-help; and the unacknowledged presence of former sufferers now working as therapists or researchers themselves.
I went to Dublin with some anxiety. Over the years, I had come to understand eating disorders as a profoundly social phenomenon and to see the potential for recovery within social processes, especially social myth-making. I wanted to share with clinicians the ideas I had acquired from my interaction with people who look back on many years of recovery from eating disorders - an interaction for which clinical work does not usually provide the opportunity. How would my presentation be received? The situation I met changed many of my perceptions of clinical treatment and its underlying theory and, of course, the most important benefit of the conference was the influence of personal contact during formal and informal discussions with participants.
The President of Ireland, Mary Robinson, officially opened the proceedings. She was introduced as 'a symbol chosen by the Irish people: mother, wife, lawyer, scholar...' and her speech highlighted the importance she attaches to women's issues: she commented on the even gender balance of our group and the gendered nature of eating disorders. She was passionate in her concern for the problem in her own country and spoke of an award-winning play she had seen about eating disorders, written and performed by secondary students in a small town in the west of Ireland. Her response, for me, highlighted the the 'good' and the 'bad' in current approaches to eating disorders in the media, among the public and to a certain extent in the therapeutic community: This play, she said, was 'stark - with no concession to happy endings'. The problem here, is that eating disorders generally DO have 'happy endings', as presentation after presentation noted: in every country where outcome studies have been conducted, they have found that around two thirds of sufferers recover and go on to lead quite normal lives. It is understandable that the media prefer the sensational endings to the more prosaic (wonderful as they actually are). It is also understandable, therefore, that the public (including the President) should have gained the false impression that happy endings are unlikely. But why don't more therapists speak and write about the process of longterm recovery? Even if the struggle to help people in the throes of anorexia or bulimia absorbs all the therapist's attention, couldn't such stories be the very tools therapists need as examples and sufferers and their families need to give them hope? And isn't hope the beginning of recovery?
Therapies
The first of three plenary debates addressed the question 'Which Therapies Work?' The team from the Department of Psychiatry, University College, Dublin used a video presentation to introduce a case. Three speakers then put forward the management strategy each would adopt, from the perspectives of family/systems therapy (Ivan Eisler, England); cognitive-behavioural psychotherapy (Martina de Zwaan, Austria) and psychoanalytic psychotherapy (Mary Darby, Ireland). These speakers were full of compassion, open to whatever would help them improve their therapy; and to my delight, particularly concerned with the need to focus on the recovery process. Dr Eisler asked: 'Since she has no awareness of herself execept as an invalid, how would others see her as she recovered? Which people within the family may be crucial resources in bringing about change?' Dr de Zwaan emphasized that because of the self-perpetuating nature of anorexia, 'symptoms won't disappear naturally when underlying causes are addressed' - the recovery period, she seemed to suggest, must include re-education about eating, self-image and relations with others. In recognition of the place of language and creativity in recovery, Dr Darby began with the words of a Dublin poet. Like many other therapists during the conference she spoke of the clinician's 'despairing attempt to help someone we don't understand and whom we fear'. 'Anorexic patients objectify themselves and so we objectity them...but they are also more than our objectifications and we need to go to that "more"; to the subject who stands before the mirror'. Since the position of the anorectic is mainly one of refusal, the object of therapy, she stressed, was to assist the patient to know what she really desires and the best way to do this is through a multidiscplinary team of helpers.
Highlights
For me, the other highlights of the meeting included some of the smaller special interest sessions and each of the remaining plenaries. In the first category, was a series of presentations on aspects of self-help in recovery and treatment. Often these presenters agreed, self-help could act as a form of first-stop therapy, forestalling the common experience of a succession of 'failed therapies' and assisting sufferers to find the most suitable therapy. These speakers attributed the success of their programs to their collaboration with health professionals, through whom they have been able to recruit group members and gain media publicity for their work.
Bridget Dolan's report on her survey of ECED members at the Prague Meeting in 1993 revealed that although most respondents believed that having a woman therapist was an advantage, there was no evidence that the sex of the therapist made a difference to the outcome of therapy. In the discussion which followed, the consensus seemed to be that it was important to address the gender issues in eating disorders (what does it mean to be a woman? a man? and how is our development towards gendered identity shaped by social forces?). Therapy was more likely to be successful when these issues were addressed, regardless of the therapist's gender.
A plenary debate on compulsory treatment concluded with a 'yes' vote, but the 'yes' did not necessarily refer to forced tube feeding. The real question, speakers agreed, was about what form compulsory treatment should take; patients must be given choice, but the choice is in how, not whether, they are to recover. The final debate pitted two deliberately overstated positions against each other: whether studying brain function will tell us more about eating disorders than studying society. My sociological hopes were raised by the concluding vote to this session which was in favour of the social and preventive approach. Nevertheless, it struck me that for this approach to be truly furitful, all who work in the area of eating disorders would benefit from a deeper understanding of the discipline which, since the early nineteenth century, has focused on the meaning of 'social' and how an understanding of the social can contribute to social change.
Some conclusions
So what did I learn from my participation at this conference and how will it change my own work?
I have become more aware:
1. of the importance of personal contact in understanding the similarities, instead of the differences, between the disciplines and approaches which are concerned with eating disorders, and the importance of such contacts in fostering intellectual and practical developments in this field.
2. that such contacts can be facilitated by attracting sponsors (though which sponsors might be most appropriate remains an open question).
3. that although the issue of recovery is, of course, important to therapists, a shift of focus is still necessary before the knowledge of recovered patients is recognized as a source of scientific knowledge and therapeutic inspiration.
4. that outcome studies need to be studies, not only of 'treatment' (the clinician's perspective), but also of 'recovery' (the view of the recovered).
5. that co-operation between self-help groups (including former sufferers) and health professionals work and needs to be fostered wherever possible.
6. that there is a great willingness among therapists to collaborate in multidisciplinary teams and that such teams (psychologists, psychiatrists, nutritionists and social workers) would benefit from the inclusion of sociologists, philosophers and educators who have also made this their area of study.
7. of the need for collaboration between all who 'know' about eating disorders and the mass media, especially to counteract the impression often given by the latter, that an eating disorder is a death sentence instead of a prelude to greater self-knowledge and a richer life.
I have returned from Dublin with a new confidence: The confidence that the European clinicians and educators whose work I had only had the opportunity to read are, for the most part, people who share the same hopes as I do about recovery from eating disorders and with the knowledge that our mutual recognition heralds a greater collaboration between their disciplines and mine.
Dr Catherine J. GarrettThis is an abridged version of the full report which is currently under review for publication