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12.x.95 within the Section of Psychotherapy pages {7kb}
last updated 2.iii.96
Happy New Year everyone and welcome to 1995. This year we have our fourth General meeting to look forward to in Dublin from 21st -22nd September and plans are also being made for a satellite meeting in Austria next year. We've expanded the newsletter somewhat by including book reviews - if you find this a useful service please let us know, we would also still like to have more news to share about members.
One exciting recent development is the European COST programme which is developing with a great deal of collaboration between eating disorders centres in a range of countries. If there are any developments in eating disorders in your area that you would like other ECED members to know about please send us the information for the next newsletter.
21st-22nd September 1995
By now you should have registered with the Dublin Committee for the meeting which is to be held in Dublin Castle. There is still time to send in yours offers and suggestions for the scientific programme and if you want to offer an abstract or suggest a debating topic you should contact the conference committee at the address below. The final date for abstracts is 21st March 1995
Gerard Butcher and Mike Bourke are developing an academic and social programme with something for everyone - an introduction to two essential parts of Irish culture - a literary museum showing works of Irelands most famous writers and tours of local pubs with the (possibly more famous) Guiness Beer. The meeting will be opened by Mrs Mary Robinson - The President of Ireland and Professor Arthur Crisp will mark his retirement with a special presentation and reflection on "The Unchanging Nature of Anorexia Nervosa".
Further information and registration forms can be obtained from
Gerard Butcher, ECED Conference Secretary, St. John of God Hospital, Stillorgan, Co. Dublin, Ireland. Telephone: +353 1 288 1781 Fax: +353 1 288 1034Please send us any news or bulletin items for inclusion in the next ECED Newsletter and we can share your information with 500 eating disorder workers at one time
AUSTRIA
The University of Innsbruck have a job vacancy for a Research Fellow to work on a cross-cultural epidemiological study including eating disorders. Applicants should have a Ph.D., preferably in sociology or have an excellent knowledge of social research methods and epidemiology. Experience of statistical programmes (SPSS/PC+ and/or SAS) is needed and the candidate should come from within the EU or European Economic Area. Some working knowledge of German might be useful, but is not essential.
The salary is between £15,600 - 20,800 depending on experience. For more information contact
Dr. Gunther Rathner on Tel: +43 512 504 3505 fax: +43 512 504 3444 or preferably by Email on Guenther.Rathner@uibk.ac.atUNITED KINGDOM
The Advertising Standards Authority (ASA) - the national body which monitors the standards of advertisements and promotions has issued tough new rules of practice governing the advertisement of slimming products in Britain. The ASA is concerned that advertisements should be legal, decent, truthful and socially responsible and has for the first time addressed the concern that the advertising industry promotes "slimmer's diseases" especially amongst under 18 year olds. The 12 specific rules include that:-
Further details of the advertising code, published in February 1995, can be obtained from:-
ASA Ltd., 2, Torrington Place, London WC1E 7HW. Tel: +44 (0)171 580 5555 Fax: +44 (0)171 631 3051COST is the French acronym for European Co-Operation in the field of Scientific and Technical research. Begun in 1971, it enables co-operation between countries in Europe both within and outside the EU. This allows for a concerted approach with an interchange of research results. The projects are funded by the participating Nation, but resources of the COST programme are used to co-ordinate action through a management committee.
A memorandum of understanding to implement trans-European research action into psychotherapeutic treatment of eating disorders was drafted in Brussels in 1994 and has already been signed by Finland, France, Germany, Hungary, Italy, Spain, Sweden and the United Kingdom. Other countries such as Austria, Belgium, Czech Republic and Denmark are planning to join.
In signing the memorandum workers have agreed to:
The programme will last for six years and is expected to provide a solid empirical base for high quality yet affordable psychotherapy. Its main research aims are to :-
In Germany and Sweden multi-centre studies have begun which aim to recruit 1000 subjects each. For further details contact the scientific representative for your own country. Details can be obtained from the secretary for the COST programme is:
Dr Zoltan Somogyi, Rue de la Loi 200, B-1049 Brussels. Fax +32 2 296 42 89.Dr Janet Treasure (COST Vice Chairperson)
BULGARIA
Congratulations go to Dr. Svetlana Boyadjieva who has successfully completed the first doctoral dissertation on eating disorders from Bulgaria. The work is entitled "Adolescent anorexia nervosa - clinical characteristics, follow-up and treatment approaches" and she would be pleased to correspond with any members who are interested in her thesis report. You can contact Dr Boyadjieva at:
Adolescent Psychiatric Clinic, 33, Prohlada Str., 1619 Sofia, Bulgaria.The ECED has recently received these books listed for review in our newsletter. Rather than send out review copies to people who may not have the time or specific interest to do this we are asking for reviewers to volunteer. In exchange for a short review (between 300-600 words) you can get a free copy of any of the books below. Reviews can be written in the language of the book.
If there is a new book you would like to review which is not on the list write to Bridget Dolan at the ECED in London with the publication details and she will request a free review copy for you from the publishers. We are particularly keen to include non-English texts which may not have been noticed by the London steering group.
"The eating disorders" is a handsome, dark blue hardbound book that would look good on any bookshelf. It is prefaced by quotations from William Blake and Francis Bacon on the subject of food, and each chapter starts with a tasteful monochrome reproduction of a famous painting somehow related to eating or (more commonly) the female form. One has the impression that this book will approach eating disorders in a thoughtful and imaginative way which will transcend the usual sterile medical approach to illness. This impression is reinforced when one sees that the first three chapters are devoted to the history of anorexia nervosa, bulimia and obesity respectively, and the last, entitled Literary Resources, is devoted to novels and plays that shed light on eating disorders. At last, a handbook on eating disorders that gives cultural considerations their due priority, as a central theme.
I was soon disappointed. This book has all the expected shortcomings of a multiauthor volume, and this is apparent in the three introductory chapters: each competently addresses the history and cultural context of its own eating disorder but without any unifying understanding of the meaning of weight and shape or of social role of women. Furthermore, the editors miss the opportunity to integrate the three eating disorders, which are addressed as if they were selfevidently completely independent medical conditions. This problem recurs throughout the book as a variety of authors address topics as diverse as the biological basis of bulimia and the occupational therapy treatment of anorexia nervosa. Each author starts from first principles, repetitively giving an account of the definition, presentation and prevalence of the eating disorder in question. The early suggestion that the editors would organise the book around a cultural theme does not stand up to narrow papers on, for example, the neuropsychiatric approach to the eating disorder patient. The quality of the individual papers are highly variable and some are painfully trite, but credit should be given when it is due, and I did encounter a few readable and informative chapters. Among these is an account of the treatment of obesity that explained the principles clearly and intelligently, and would be of use to a newcomer to this condition; also a description of a creative selfhelp program for eating disorder sufferers, the "B.A.S.H. Approach".
I think that books on specialised subjects are always problematic, because the authors are appealing to a specialised and discerning audience. I imagine they must choose between on the one hand writing an authoritative textbook which summarises all current knowledge on the subject (knowing that it will be dated by the time it is published), and on the other, writing an impressionistic but thoughtful work which offers ideas for generations to come (Bruch and Crisp come to mind). This book does neither. It offers an idiosyncratic collection of essays of variable quality, and I cannot recommend its purchase for a private library. It may have some limited use in a medical school library but the money might be better spent elsewhere.
David Hartman
Lecturer, Psychosomatic Psychiatry,This book is principally intended for people with bulimia nervosa and variations of this disorder. The main aim of the book is to give sufferers a self-help means towards recovery. It emphasises how having a realistic notion of recovery which accepts that difficulties with eating will occasionally recur is an important aspect which may guard against unreal expectations of treatment and future disappointments.
The book is divided into two parts. Part one provides a brief account of the nature of bulimia nervosa: what bulimia is and how it affects people's lives, the physical complications, the causes and how it can be treated. This information will be of use to sufferers and to their families and friends who want to know more about the disorder and its effects on one's life. Part two consist of a self-help manual which forms the major part of the book. It is based on the application of cognitive behaviour therapy to bulimia nervosa first described by Chris Fairburn in 1981. It sets out detailed guidelines on the steps needed to restore control to eating. In contrast to many self-help books, the guidelines are backed up not only by clinical experience but also extensive research.
The highly structured programme is delivered in six steps: (1) monitoring your eating; (2) instituting a meal plan; (3) learning to intervene and prevent bingeing; (4) problem solving; (5) eliminating dieting and (6) changing your mind. At the end of each step comes a 'Review Box' consisting of questions to ask to monitor your own progress. Only when the positive answers are given are you advised to proceed to the next step.
This is not simply a self-help programme to do alone. Much advice is given along with the steps - particularly recruiting a 'Helper' to talk to when things are not going well, go over what has happened and what you might do about it. You are advised to recruit a helper who is not too closely involved - although a relative or friend will suffice. At the end of the manual there is a special section with information for these helpers.
We are told that the manual has already helped a great number of sufferers and that most people work through the manual in six months. Of course there are people with bulimia for whom this book will not be appropriate and the author describes categories of people who are advised to seek special treatment.
The manual provides a great deal of usefuland practical information in a clear and compact way. This will not only be of use to those sufferers and their helpers but also to therapists.
This multi-author book is based on the proceedings of the 1991 American Psychopathological Association meting. It gives a comprehensive overview of all aspects of eating disorders. There are sections on epidemiology; diagnosis; classification; outcome; biochemistry; family studies and treatment studies. The book is well written, elegantly presented and is both interesting and enjoyable to read. It is wide in perspective and refreshingly, does justice to psychological, biological, psychodynamic, behavioural and social aspects of eating disorders.
The chapters on sociocultural aspects and family treatment studies are very good and comprehensive. It needs a more detailed review of outcome studies, the two chapters devoted to this seem rather narrow in their coverage - one reporting on outcome of the treatment programme at a single institution, whilst the other deals with methodological aspects of outcome studies. The four chapters on biological aspects have important gaps, and to some extent overlap in their coverage. There is little mention of the literature on neurotransmitters, and no mention of functional imaging studies.
The book serves as a first class introduction to the subject and as such is suitable for professionals in training and students. However it is also useful for established professionals who wish to update themselves in the field. There are comprehensive lists of references at the end of each chapter and thus it also provides a good resource for those embarking on eating disorders research.
This impressive book is about the different social meanings of self-starvation throughout European history. The central thesis is that self-starvation can only be understood in a sociocultural, historical perspective. Even in one era, there are usually diverse views about it, which frequently lead to great debate and controversy. Social change is associated with the acquisition of new meanings, and gradual shedding of the old. For example in the medieval period explanation was largely in a religious idiom, with self-starvation being understood as a miracle, or reflection of religious conviction. By the nineteenth century, with the decline of religion, it was regarded as a spectacle, a form of entertainment, or increasingly, as an illness.
The authors are sensibly critical of Bell's approach in 'Holy Anorexia', in which retrospective diagnoses of anorexia nervosa re made for saints who starve themselves. The book is also different to Bynum's feminist account of anorexia nervosa in 'Fasting Girls', in eschewing any overarching of theoretical approaches. The authors have a remarkable familiarity with the relevant literature in many languages. The attention to detail is never used to obfuscate, and the overall argument is always clear. I would highly recommend this book.
Personal Construct Psychology was born in 1955 with the publication of The Psychology of Personal Constructs by George Kelly. Kelly was an American engineer turned psychologist. PCP has always been rooted in the individual person, as the first "P" in PCP marks, and Button declares the personal roots of this book: he has worked with people with eating problems for over twenty years since he finished clinical psychology training and started a Ph.D. with Fay Fransella in the eating disorders unit of the Royal Free Hospital in London. His arrival there coincided with his discovery of PCP and with conversion from someone who got by on the minimum necessary intellectual effort to someone seeking more than that. Button puts these details in the book, taking a refreshingly locatable position as an author.
The book has four sections: an introduction to the eating disorders (ED); an introduction to PCP; accounts of his work with eight women; and a final chapter on issues and future directions. The introduction to ED is clear and sensible and the section on PCP is excellent and introduces Button's repertory grid design: "SELF-GRID"
The case reports are readable with quotes from writing by several of the patients and analyses of SELF-GRIDs including both "before" and "after" grids. Printing the raw grid data would have allowed enthusiasts such as myself to have conducted other analyses. I would also have liked clearer accounts of the duration and spacing of sessions and of the details of the patients' lives; without details the picture of the patients is rather hazy and anodyne. However, there is enough here to be helpful for therapists new to ED.
My main criticism is that Button doesn't fit the language of his descriptions very tightly to Kelly's language. As Button clearly summarises, Kelly had a sparse theory involving thirteen axioms and a further set of redefinitions of words like "threat", "fear", "anxiety" and "hostility". Button makes only occasional use of that system in his descriptions. He emphatically endorses Kelly's philosophy of individual freedom but he doesn't comment on the gap between his language and Kelly's. Button acknowledges that his work may seem similar or identical to other cognitive therapy but says the that he doesn't aim to correct cognitive errors. However, he repeatedly describes offering patients options for greater freedom so the difference may be only semantic. I suspect that Button gets as close to applying unaltered Kelly as we are likely to enjoy reading: the brevity of Kelly's theory may be so philosophical or algebraic that direct application to real people leaves something missing. Reading the book I became interested in that gap: would a more Kellian phrasing have given us just a loss of narrative, or would it have been a loss of the person? If it is just a change of language, then PCP may help us as algebra and calculus have enabled mathematicians. However, if direct use of the theory causes a loss of the person, then either what is personal is inherent in narrative or there is something missing in the theory. Now that PCP is nearly forty years old, it may be time we tried to sort out these options.
In summary, the book is interesting if you, like me, suspect there may be a new continent to be found in the gap between PCP and clinical narratives; more prosaically, this book is good reading for any therapist starting to work eclectically with people with eating problems.
Chris Evans
Senior Lecturer in Psychotherapy,CROSS-CULTURAL ISSUES
We are pleased to announce a forthcoming satellite meeting of the ECED to be held in the last week of February 1996. The meeting will take place in a Tyrolean Ski resort and will be a small meeting to bring together all those with a special interest in cross-cultural issues.
ECED members who are interested in attending should contact:
Dr.Gunther Rathner Univ. of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. Tel: +43 512 504 3505 Fax: +43 512 504 3444 Guenther.Rathner@uibk.ac.atThe ECED have negotiated that all members can have reduced subscriptions on the three main eating disorders Journals. Special order forms for all of these journals are enclosed - if you need more forms either copy them or contact the ECED London.
Eating Disorders: The Journal of Treatment and Prevention is now in its third year and provides a wide range of informative viewpoints for professionals involved in the treatment and prevention of eating disorders. ECED members who wish to publish in the journal are invited to send three copies of the manuscript (prepared according to American Psychological Association's publication guidelines) to: -
The International Editor, Walter Vandereycken, Liefdestraat 10, 3300 Tienen, Belgium.If you are involved in organising meetings or conferences related to Eating Disorders you can send information about the meeting to the ECED for inclusion in the next newsletter. We will include both national and international meetings.
That's all for now, I hope you will find this information useful, any feedback would really be appreciated . Please remember we can only produce these newsletters if we have news to share so PLEASE send any news or requests you have to the ECED for the next one.
(18.ii.98: Bridget has gone on to pastures newer and greener so please don't write to her here anymore) Feedback about the WWW/HTML publication to C.Evans@sghms.ac.uk