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Figured World of Eating Disorders: Occupations of Illness



The biomedical diagnosis of eating disorders signifies a mental illness with complex physical symptomology. The socio-cultural determinants and impact of eating disorders on daily occupations are not adequately addressed in this classification. This paper introduces the concept of a figured world as a framework for how eating disorders exist in daily activity and social discourse. How occupations become ascribed with meaning generated by an eating disorder will be proposed through the voice of a composite character in the figured world. Central elements to contextualizing figured worlds include positional identity, self-authoring, and semiotic mediation. The generation of meaning in illness arises from the integration of these elements into this specific figured world. The competing agendas of the biomedical model and figured world permit a new understanding of the challenges associated with recovery. For occupational therapists, these challenges require the reattribution of meaning of daily occupations.
Canadian Journal of Occupational Therapy February 2012 79(1) 15
Michelle L. Elliot
Figured world of eating disorders: Occupations of illness
Key words
Eating disorders
Figured world
Mots clés
Monde guré
Troubles de l’alimentation
Background. The biomedical diagnosis of eating disorders signies a mental
illness with complex physical symptomology. The socio-cultural determinants and
impact of eating disorders on daily occupations are not adequately addressed in
this classication. Purpose. This paper introduces the concept of a gured world
as a framework for how eating disorders exist in daily activity and social discourse.
How occupations become ascribed with meaning generated by an eating disorder
will be proposed through the voice of a composite character in the gured world.
Key Issues. Central elements to contextualizing gured worlds include positional
identity, self-authoring, and semiotic mediation. The generation of meaning in
illness arises from the integration of these elements into this specic gured world.
Implications. The competing agendas of the biomedical model and gured
world permit a new understanding of the challenges associated with recovery. For
occupational therapists, these challenges require the reattribution of meaning of
daily occupations.
Description. Le diagnostic biomédical d’un trouble de l’alimentation est une
maladie mentale accompagnée d’une symptomologie physique complexe.
Toutefois, les déterminants socioculturels et l’impact des troubles de l’alimentation
sur les occupations quotidiennes ne sont pas abordés adéquatement dans cette
classication. But. Cet article utilise le concept du monde guré comme cadre pour
décrire comment les troubles de l’alimentation se manifestent dans les activités
quotidiennes et le discours social. La façon dont on attribue un sens aux occupations
en raison d’un trouble de l’alimentation sera proposée par l’intermédiaire de la voix
d’un personnage composite dans le monde guré. Questions clés. Les éléments
centraux pour contextualiser les mondes gurés sont : l’identité positionnelle,
l’autocréation et la médiation sémiotique. La création de sens face à une maladie
provient de l’intégration de ces éléments dans ce monde guré spécique.
Conséquences. Les programmes concurrentiels du modèle biomédical et du monde
guré favorisent une nouvelle compréhension des dés associés au rétablissement.
Pour les ergothérapeutes, ces dés exigent la réattribution d’un sens aux occupations
Michelle L. Elliot, MScOT, OT(C),
Doctoral student, University of
Southern California, Division of
Occupational Science and Occupational
Therapy, 1540 Alcazar Street, CHP – 133,
Los Angeles, CA, 90089-9003.
Telephone: +1-626-807-9374.
Citation: Elliot, M. L. (2012). Figured world
of eating disorders: Occupations of illness.
Canadian Journal of Occupational Therapy,
79, 15-22. doi: 10.2182/cjot.2012.79.1.3
Submitted: April 5, 2011;
Final acceptance: November 10, 2011.
The author received no funding for this
This paper extends the boundaries of the traditional biomedical model of eat-
ing disorders through the introduction of a “gured” or “lived” world frame-
work (Holland, Cain, Lachicotte, & Skinner, 1998; Holland & Skinner, 1997).
e terms “gured” and “lived” world will be used interchangeably throughout
this paper because not only do they imply the lived experience, but also that lived
experience gures in a socio-culturally constructed manner (Holland & Skinner,
1997). In this gured world framework, a basic assumption is that eating disorder/
illness behaviours, thoughts, occupations, and resulting identities are appropriated
and supported in a manner not fully captured by the medical model. e paper
will begin with the introduction of the normative biomedical perspective of eating
disorders, and then this perspective will be contrasted with the co-existing, yet com-
peting, discourse from the gured world of eating disorders. is will be followed
16 Revue canadienne d’ergothérapie février 2012 79(1)
by thoughts condemning her weaknesses and failures. Despite
exhaustion, she will put on her shoes and go running into
the night to escape these negative cognitions. She eats noth-
ing but fat-free yogurt and drinks countless cups of coee the
following day as penance for her previous diet transgressions.
Anne will return to the oce prepared for the day’s agenda
and to continue the cycle of her dual realities. When asked if
she is happy with her life, Anne characteristically just smiles.
She speaks to her position and the opportunities it aords her.
en with the grace and charm of one in the communication
business, she seamlessly changes the subject.
Competing Discourse
Within the eating disorder–gured world proposed in this
paper, there is a competing discourse. e more familiar rep-
resentation of the medical perspective of eating disorders as
illness will be introduced rst, followed by the gured world
perspective of eating disorders as a normative aspect of life.
Medical Perspective
e American Psychiatric Associations (APA) Diagnostic and
Statistical Manual of Mental Disorders (2010) denes eating
disorders within the categories of anorexia nervosa, bulimia
nervosa, binge eating disorder, and other specied feeding or
eating disorders. is paper will include references to anorexia
nervosa and bulimia nervosa (herein referred to as anorexia
and bulimia), though all of the classications exist within the
proposed gured world. Hallmark features of anorexia are sig-
nicantly low body weight, a fear of subsequent weight gain,
and endorsement of means to maintain a restrictive intake of
food (APA, 2010). Bulimia is characterized by regular patterns
of binge-eating behaviours followed by compensatory mea-
sures to eliminate the food (purge), without the corresponding
low body weight (Treasure, Claudino, & Zucker, 2010).
Eating disorders result from the complex interplay of
physiological, psychological, and sociological forces produc-
ing cognitive distortions and conicted interpersonal relation-
ships (Cockell, Geller, & Linden, 2003). ey are also strongly
correlated with the creation of a disordered lifestyle (Lock,
2000). e multiplicity of variables aecting and being inu-
enced by the illness and the high rate of relapse complicate the
ability to denitively conclude rates of “successful recovery”
(Wilson, 2005). Living with an eating disorder as opposed to
recovering from it thus becomes a reality.
Many people with eating disorders struggle to fully cope
with daily activities, whether they be grocery shopping, orga-
nizing time, or managing the demands of work or school (Lock,
2000). e chronicity of the illness (Holliday, Wall, Treasure,
& Weinman, 2005; Steinhausen, 2002), particularly anorexia,
infuses the daily occupations through the meanings ascribed
to the activities structuring the day, and it becomes the lens
through which the world is seen. Essentially, the meaning
associated with engagement in everyday occupations becomes
enveloped within eating disorder behaviours and cognitions.
e construction of this meaning is an essential element in the
propagation of the gured world of eating disorders.
by a discussion of the way in which daily occupations become
subsumed into the eating disorder through three theoretical
concepts of gured worlds: positional identities, self-author-
ing, and semiotic mediation. Implications for occupational
therapy practice using the conceptualization of illness-derived
meaning in occupation will be acknowledged. e character
of Anne, a representative member of this gured world, is
introduced as the voice of the paper. She is an amalgamation
of the many stories and personally constructed narratives that
exist and were witnessed by the author in an eating disorder
treatment setting. Using this composite voice aords Anne the
cumulative attributes to fully illustrate the theoretical-gured
world concepts being introduced without adding the complex-
ity of concurrent background stories. Bruner (1990) claimed
that the signicance of the narrative matters not in whether it
is real or imagined. ough the individual character of Anne
may not be real, her narrative is real because of the multiple
truths and voices it represents.
Looks Can Be Deceiving
Anne is a tall, slim woman with a thoughtfully cultivated sense
of style. She works in a downtown oce as a manager of a per-
sonal relations company, servicing many corporate contracts.
She is single; her small circle of friends joke that she is married
to her work as she rarely dates, though privately, she yearns for
companionship. Long days at the oce mixed with aer-hour
work functions prevent her from establishing her new house
with the warmth and decorative appeal that makes a house a
home. Annes strong and dedicated work ethic, drawn from
the desire to achieve the success she and her parents always
envisioned, has contributed to her securing this managerial
position. Annes life, from an outsiders perspective, appears
successful. is has come at a cost, for she has sacriced per-
sonal relationships and opportunities, developing a lifestyle
not conducive to wellness or balance.
Since her later years of high school, when she felt like
an outsider who belonged everywhere and nowhere, Anne
has struggled. She did not seem to meet the criteria for any
one socially constructed peer group, and consequently she felt
powerless to change her perceived lot in high school life. In
response to the disconnection she felt equally from her class-
mates and her own self-worth, Anne sought means to assert
control. Cultivating her own pursuit of perfection, Anne
excelled academically. She took up running almost as a disci-
pline and became a strict vegetarian, believing it was a means
to live more ethically. She counted calories and weighed her-
self daily. Her parents assumed it was a phase, something that
most girls grew out of. Anne never did, for she still engages in
these behaviours today, many years later. Anne has an eating
She takes pride in her ability to exercise self-control at the
functions she attends, where food and drink are readily avail-
able. Recently, however, Anne has begun keeping chocolates
in her desk drawer, which she consumes prior to these events
or in response to particularly stressful encounters. e oce
bathroom is a single room, which aords her the privacy to
vomit in secret aer eating from this illicit cache of food. Going
home to a dark and empty house, Anne is oen immobilized
Canadian Journal of Occupational Therapy February 2012 79(1) 17
ates a gured world from these other conceived realities are the
symbolism, meanings, interpretations, and identity generation
that emerge from the interaction of members with the associ-
ated occupations, objects, spaces, and fellow members. Cain
(1991) and Holland et al. (1998) provide a detailed account
of Alcoholics Anonymous to exemplify the symbolic dimen-
sion of the gured world construct. e process of attributing
meaning to occupations occurring in the eating disorder–g-
ured world will be introduced in the next section.
“Doing” in the Figured World
Christiansen and Townsend (2010) broadly dened occupa-
tion as the daily and active pursuits from which signicance,
meaning, and purpose are attributed to life. In other words,
meaning is created through the participation and process of
engagement rather than being inherent in the activity itself
(Bruner, 1990; Singlehurst, Corrs, Griths, & Beaulieu, 2007).
is connection between meaning and occupation can be
translated to eating disorder behaviours as understood in the
proposed gured world.
Concluding their studies on the meaning of self-star-
vation, Nordbo, Espeset, Gulliksen, and Skarderud (2006)
determined that the symptomatic behaviours of eating disor-
der illness develop personal meaning and signicance for the
individual with the illness. ese behaviours include restrict-
ing, binging, or purging. Using Christiansen and Townsend’s
(2010) denition of occupation, these diagnostically sig-
nicant behaviours could be dened as occupation; they are
meaningful, purposeful, and structure the daily routines in
the eating disorder–gured world. To make such a statement
challenges the implicit assumption in the denition that mean-
ing in occupation is health promoting and life arming. Kan-
tartzis and Molineux (2011) argue the need for understanding
and situating occupation within “alternate constructions of
daily life” (p. 62), thus further challenging the traditional con-
ceptualization of occupation.
is paper introduces the idea of illness-directed mean-
ing and illness occupation, using gured world as an exem-
plar of the “alternate life construction,” by translating Jacksons
(1998) concept of complementarity poles to occupation. Jack-
son suggested that the broad understanding of a term can
remain consistent across a continuum of representations. For
example, the healthy, engaged experience of an occupation
exists at one pole, contrasted with the other pole, whereby the
same occupation exists in the gured world and is reinforced
with illness-focused meaning. Alternatively, occupations
emergent within the eating disorder experience itself, includ-
ing binging, purging, or restricting, also exist along the contin-
uum. eir positioning in proximity to the poles is dependent
upon which competing discourse is most dominant, as will be
discussed shortly.
Occupations associated with daily living, such as cook-
ing, working, shopping, exercising, and grooming, can become
enveloped within the eating disorder (Lock, 2000). In the
gured world, everyday occupations that previously held a
neutral aliation aord space for eating disorder inuences
to emerge. Consequently, the meaning ascribed to such occu-
Figured World
Anne’s doctor is concerned for he believes, and has shared with
her, that she endorses symptoms of a subtype of anorexia and
encourages her to seek therapeutic support. Anne does not
perceive herself as having an eating disorder, though. To her it
is simply a way of life rather than an illness, granted a life that
possesses many layers of restriction. e rigid eating patterns,
cognitive distortions, and perfectionist determination con-
tribute not to a symptomatically diagnosed problem, but to a
self-identied way of participating in her life. e perspectives
of illness (biomedical) and identity (gured world) co-exist,
although through a competing discourse.
As social and cultural constructions, gured worlds are
conceived to exist through the practices and interactions of
collective groups of people, in variable environments, and with
a range of symbolically derived artifacts (Holland et al., 1998).
A gured world is conceptualized as an “as if ” realm in which
the social interaction or engagement in daily events creates
symbolic, imagined, and culturally determined signicance
(Holland et al., 1998). e “as if ” potential of a gured world
indicates that, while people are participating in their everyday
lives, they may be doing so concurrently engaged in a world
with a specic interpretive dimension. In the gured world of
eating disorders, members live as if the diagnostic symptomol-
ogy were merely one part of their daily existence and, thus, not
entirely outside the realm of “normalcy.” ere is an important
mediational element to the development of gured worlds and,
thus, this interpretive lens by which life is perceived is real-
ized through the interaction of objects, rituals, traditions, and
occupational and interpersonal roles of members (Holland &
Skinner, 1997). Entrance into or exit from a gured world for
an individual may be determined by his or her socially con-
structed position and personally generated narrative, both of
which contribute to the formation of personal identity within
this world. e fundamental elements of social position and
personal identity will be more fully discussed in later sections.
e classroom serves as a representative example of a g-
ured world that many people have experienced. In general, a
classroom is conceived as a space in which knowledge dissemi-
nation and reception occurs. As a gured world, the classroom
is a structured environment where cultural norms and rules
are generated, contributing to the formation of student and
teacher identities. e artifacts signifying a classroom include
blackboards, desks, and books. ese objects are neutral out-
side the classroom; however, in this gured world they assume
the symbolic meaning of tools for learning, which is under-
stood by all members. e social construction of the class-
room ensures that members of this gured world, teachers and
students, actively participate in the creation and maintenance
of social norms, etiquette, and hierarchy. Occupations inher-
ent in the classroom, such as teaching, studying, and playing
become associated with the meaning the classroom-gured
world aords.
e boundaries of a gured world are not conned to
concrete, physical space as implied in the classroom example.
Figured worlds are not necessarily represented in every occu-
pational context or associated with dierent roles that people
play in the course of their daily lives. Rather, what dierenti-
18 Revue canadienne d’ergothérapie février 2012 79(1)
a diagnosis and collection of occupations is seen by those with
eating disorders as more socially acceptable, requiring greater
commitment, control and strength than bulimia (Brooks,
LeCouteur, & Hepworth, 1998). e occupations Anne dem-
onstrates as symptomatic of anorexia include overexercising
and restrictive eating. She does occasionally binge eat and
purge; however, she has concealed that aspect of her identity,
fearing it would cast a negative light on her perceived compe-
tency in the workplace. Such occupations would also lower her
esteemed position within the anorexia domain of this gured
world (Brooks et al., 1998; Broussard, 2006; Rich, 2006). In
maintaining this social position, there is a signicant amount
of occupational engagement and time consumed: exercising,
counting calories, comparing herself to others, deception, and
planning how and when she might exercise or eat (Patching &
Lawlor, 2009). Eating disorder–specic occupations thus exist
within the complementarity poles, though their positions are
dependent upon their hierarchical nature.
A caveat to this representation of eating disorder occupa-
tions, specically those regarding exercise and weight manage-
ment, is that outside the gured world these are normalized.
Advertising and media representations (Bishop, 2001), as well
as health literature (Healthy People, 2010), support engage-
ment in healthy eating and exercise for optimal well-being.
How this message is interpreted is where the dierence lies:
in one lived world, these are strongly encouraged methods to
be and stay healthy; in this gured world, they become edicts
and endorsements for furthering the eating disorder. Such a
distinction reects the same occupations as existing in the
complementarity poles of meaning interpretation.
Anne also takes pride in her inuential managerial posi-
tion. Her morning routine entails a meticulous grooming
regime, consistent with the self-care occupations of people
with eating disorders (Gardiner & Brown, 2010). Anne tries
on multiple outts before selecting the one which she believes
makes her look the least fat. She believes that how she looks is
a reection of how she does her job, and so feels tremendous
pressure to appear as though she is worthy of her executive
position. Annes ability to succeed in this managerial role has
required her to battle the defeating thoughts which dominate
her inner world. oughts of being incompetent, useless, stu-
pid, and fat are a daily reminder of the cognitive distortions
associated with the illness (Cockell et al., 2003). In her pro-
fessional circle, Anne assumes an occupational position of
authority; in the gured world, this high social status is gar-
nered by the eating disorder, leaving Anne in an emotionally
subservient position (Patching & Lawlor, 2009; Weaver, Wuest,
& Ciliska, 2005). e tension imbued in the disparate social
positions contributes to the creation of Anne’s sense of herself
in the gured world. Her personal narrative is also the prod-
uct of the interrelational negotiation occurring in the social
Self-authoring is the process of creating one’s own personal
identity through the appropriation of relevant social discourse
(Holland et al., 1998). By navigating through multiple and
pations goes beyond the scope of productivity, self-care, or
leisure (Kantartzis & Molineux, 2011). ey exist at one end
of the complementarity pole, where the meanings of certain
occupations become associated with the negative and punitive
elements of the eating disorder. In this gured world, cook-
ing may become an occupation in which foods are carefully
weighed, fats are excluded, or recipes are modied. e sin-
gle occupation of cooking invokes a multiplicity of meaning,
much of which is guided by eating disorder cognitions. Further
examples of occupations from Anne’s life, specically shop-
ping and running, will be discussed in subsequent sections.
e derivation of illness-infused meaning from occupa-
tions is a dierent way to understand occupational engage-
ment generally and the occupational challenges of people with
eating disorders more specically. Hasselkus (2002) referred
to occupation as “the vehicle by which life is experienced” (p.
69), a representation from which the meaning associated with
illness experiences can overpower those occupations of daily
living. is meaning becomes the frame of reference from
which occupations are undertaken in the creation of an eating
disorder identity in the gured world. In summary, members
in the gured world of eating disorders actively participate in
both diagnostically identied illness behaviours, herein under-
stood as occupations, and the previously neutral occupations
aligned with illness-derived meaning. Figured worlds exist
through active occupational engagement, but such worlds are
also structured on the pertinent social themes of positional
identities, self-authoring, and semiotic mediation (Holland et
al., 1998). Each of these components will be discussed through
the lens of the eating disorder signicance in Anne’s daily
Positional Identity
Identity creation and maintenance in gured worlds is mul-
tifaceted. One aspect is the personal narrative, internally
generated and socially constructed, inherent in the daily
engagement of activity. Another is more nuanced, emerging
from the interrelational domain of social position. Holland et
al. (1998) dened these as positional identities, in which the
expression of self is bounded by the hierarchical and categori-
cal nature of social relations. Positional identities are oen an
implicitly formed outcome of participation in daily activities.
ey emerge as representations of power and privilege, contin-
ually reproduced within the social and cultural construction
of the gured world (Holland et al., 1998). Returning to the
earlier example of the classroom, positional identities develop
from the hierarchy of teacher and student. Neither student nor
teacher may be given explicit instructions as to what role each
plays or the manner in which they play it, and, yet, in class-
rooms this positional identity is regularly reproduced. Reect-
ing on Annes life experience in this eating disorder world, she
participates in social environments that contribute to the cre-
ation of a relational sense of self from diering social positions.
One source of pride for Anne is her ability to demonstrate
restraint when eating in public. She also runs regularly and
thus receives the admiration of her colleagues. Within the g-
ured world, Anne assumes an inuential position. Anorexia as
Canadian Journal of Occupational Therapy February 2012 79(1) 19
ing alongside identity-generating elements. ey are also the
occupations that give shape to her days and which the general
public believes are healthy. Take for example her occupation
of running. In the gured world, Anne runs to purge calories,
to distance herself from the onslaught of negative thoughts, to
relieve her building anxiety, and because the loudest voice she
hears is the one telling her that she “must” (Dignon, Beards-
more, Spain, & Kuan, 2006). It helps her feel special, taking
satisfaction in her ability to do what others cannot (Weaver et
al., 2005), which is to push her body past the point of exhaus-
tion. Outside this gured world, running is a socially accept-
able leisure pursuit oering multiple meanings depending on
personal connection to this occupation (Primeau, 1996). In
both lived worlds, the occupation of running and occupational
identity as a runner appears similar. Yet in self-authoring, the
conventional social discourse (healthy activity) and Anne’s
internal dialogue (punishment and escape) possess diametri-
cally opposed meanings in how she navigates and participates
in this single occupation.
Semiotic Mediation
e previous two constructs pertain to the creation of identity
in gured worlds through social positioning and self-author-
ing. e nal construct discusses the creation of symbolic
meaning for an otherwise neutral object or behaviour, the use
of which is then to aect a dierent subjective experience. is
is referred to as semiotic mediation (Holland et al., 1998). e
acquisition of such symbolic artifacts is through active and
collective engagement in the socially constructed lived world
(Holland et al., 1998). Time and sustained use of these power-
ful objects create symbolic meaning and invite the construction
of a new relationship between self and object. e symbolic
associations to previously neutral artifacts (Rich, 2006) are
strongly present in the gured world of eating disorders.
e weigh scale is generally used to provide basic infor-
mation about a person’s body weight. at same scale in Anne’s
world is the instrument against which her self-worth is mea-
sured. It guides her choice of food and clothing as well as her
occupational decisions for the day—will she join a friend for
lunch or cancel in order to restrict; will she buy that new scarf
she has been eyeing or avoid spending money because she
does not deserve anything new? e scale becomes a symbol
for how eating disorder–driven Anne’s day will be.
Clothing size is also a mediating device incorporated into
the occupation of shopping. It aords a shopper the knowledge
of whether an item is likely to t based on the historical asso-
ciation with that particular item. In the gured world, clothing
size serves a similar role as the scale, though it too has a histor-
ical element. Anne will not buy any item of clothing if it is not
the size she believes is the “right” one for her. When her own
clothing of that same size no longer ts, this symbolizes either
success (too loose) or failure (too tight) in her eating disor-
der occupations, and she must respond accordingly. Ironically,
Anne likes shopping. She enjoys the aesthetic experiences, the
colors, textures, and opportunity for creatively matching items.
She also enjoys the feeling of being able to slip into the smallest
sizes; a reality she recognizes is not aorded to everyone.
competing voices of perspective, the self is internalized and
expressed with personally signicant characterizations (Asaba,
2005). Holland et al. (1998) conceived that we make meaning
of ourselves through the process of self authoring. is occurs
through the dialogic orchestration of distinct “voices” present
in the social world in concert with our own inner voice. In a
gured world, the creation of personal identity is inuenced
not only by active engagement in ordinary occupations and
social positioning, but also by the interpretation of compet-
ing labels, categories, or inferences made through the gured
world’s collective social discourse. In this paper, that compet-
ing discourse exists between the biomedical perspective of
illness and the normative perspective inherent in the gured
Christiansen (1999) asserted that “one of the most
compelling needs that every human being has is to be able
to express his or her unique identity in a manner that gives
meaning to life” (p. 548). In this gured world, identity is in
part expressed through occupations associated with the eating
disorder, giving rise to meaningful association between behav-
iours, thoughts, and self (Garrett, 1997; Holliday et al., 2005;
Nordbo et al., 2006). When identity is formulated by the illness
experience, without recognition of the distinction between “I
have an illness” and “I am my illness,” meaning may be con-
structed in those occupations that rearm illness identity
(Hannam, 1997).
e traditional medical representation of mental illness
disassociates people from their illness insofar as it claims that
the disease is aecting a person rather than becoming the per-
son (Holland et al., 1998). Eating disorders are a psychiatric
illness and, thus, according to the biomedical opinion voiced
in Holland et al. (1998), separate from the construction of self-
identity. Due to the presence of dialogically opposed views,
the eating disorder literature, imbued with the voices of people
living in the gured world alongside Anne, would disagree.
Matusek and Knudsen (2009) wrote about the “master narra-
tive,” the culturally dominant perspective of the appropriate
ways to experience and behave in the world. Shohet (2007)
referred to this master narrative as originating from the medi-
cal etiological discourse of illness. ere is, however, an alter-
nate master narrative emergent in the illness experience that
also guides and directs behaviour. In the gured world, the
diagnostic label of anorexia may be viewed as a label of power
rather than illness (Garrett, 1996). Yet, in the representation
of eating disorders by popular media, those living with the ill-
ness are referred to as “victims” (Bishop, 2001), perpetuating
the stigmatizing nature of eating disorders under the mental
illness banner (Garrett, 1996). ese oppositional viewpoints
represent the competing voices within the gured world; the
voice of the illness, which is both highly regarded and reec-
tive of its seriousness (Rich, 2006), and the cultural discourse,
which problematizes the illness (Saukko, 2000).
Anne navigates the dual realities both within and outside
the gured world, where contradictory messages impede her
own ability to assert the voice of which she is most innately
connected. If you were to ask Anne which voice that was, the
response would likely be dependent upon the day. Her daily
occupations are infused with eating disorder–derived mean-
20 Revue canadienne d’ergothérapie février 2012 79(1)
Semiotic mediation is not conned simply to tangible
artifacts in the gured world. e bathroom at Anne’s place
of work retains eating disorder meaning, for this is where she
secretly engages in purging. Consequently it is a daily reminder
of her inability to control herself around food. Anne’s home
also possesses a duality. Her career success has independently
aorded her the opportunity to purchase a beautiful house, yet
the house’s lack of communal warmth embodies her loneliness..
is paper has introduced gured worlds as the perspective
from which eating disorders co-exist as both identity generat-
ing and symptomatic of illness. Elements of the gured world
pertaining to identity construction, social discourse, and sym-
bolic meaning have been discussed to support this assertion.
Engagement in illness occupations, cognitive distortions, and
ascription of eating disorder meaning to daily occupations is
reected as the norm in this world. How might an individual
begin to recongure this gured world should meaning no
longer assert its dominant inuence through the eating dis-
order? e following metaphorical reference provides insight
into the challenges recovery entails.
In the lm e Shawshank Redemption, one of the central
characters describes life in prison in such a way as to facili-
tate understanding of gured world. e character Red speaks
about the obstacles facing a newly released Brooks, an older
man who had spent the previous 50 years incarcerated. In jail,
Brooks was an important man, an esteemed and educated
man. He knew how the prison, and his life in it, was socially
and institutionally structured. Beyond the security and pro-
tection aorded by those prison walls though, Brooks was a
“nobody.” He did not possess the basic skills from which to
navigate the fast-paced, oen confusing outside world. His
occupational repertoire and knowledge were ineectual in cre-
ating a sense of freedom; thus, Brooks longed to return to his
familiar connement.
While eating disorders are not prisons in the literal sense,
they can imprison individuals in a gured world. ere are par-
allel realities between Brooks’ world and Anne’s world, includ-
ing the transformation of meaning over time. For Brooks, the
prison walls initially signied incarceration and punishment,
though over time they became the familiar walls of security.
Anne’s proverbial walls of security provided by the eating dis-
order have also been shaped through routine, trust, and time.
Physical and social environments both constrain and support
the propagation of gured worlds. Disconnection does exist
between gured worlds and other lived worlds; thus, the way in
which a person exits the gured world becomes a complicated
process. e personal narrative literature on recovery from an
eating disorder cites a transformative process whereby a new
self is authored (Weaver et al., 2005) and created in the tempo-
rally disjunctive space between past and future selves (Shohet,
2007). Exiting the gured world necessitates the cessation of
eating disorder occupations and transitioning previously held
illness-ascribed meaning toward wellness in daily occupations.
If Anne were to exit the gured world, however, she would
likely not require a vastly dierent occupational prole. She
would need to connect with her current occupations in a new
way, creating a dierent understanding of what those activi-
ties personally represent (Broussard, 2005; Garrett, 1997). In
so doing, she would begin the process of positioning herself
outside the gured world of eating disorders and authoring a
new sense of self as part of the recovery journey.
Implications for Occupational Therapy
To enable the reconguring of the relationship between occu-
pation and meaning, occupational therapists need to extend
this awareness to the assimilation of meaning and illness in
occupation. Traditionally occupational therapy has worked
within the sphere of the medical model, which in the gured
world operates in direct opposition to the life experience of
eating disorder illness. Anne’s transition from this gured
world, should she ever be motivated to seek recovery and
begin to live life in a dierent way, would require the therapeu-
tic partnership to begin the process of: exploration of meaning
construction; environmental, temporal, and social reorganiza-
tion; lifestyle balance; and occupational analysis.
Anne’s ability to begin taking action toward changing
how she engages in her daily occupations is predicated on
her existing motivation, availability of personal supports and
resources, capacity to challenge distorted thoughts, and trust
in the therapeutic relationship. Acknowledging the tension
between leaving the familiarity of the gured world and the
potentially harmful realities of untreated illness requires a sen-
sitive approach. e bridge between the gured world and the
medical/treatment world is heavily traveled with bidirectional
member movement between recovery and relapse. Occupa-
tion is a means by which meaning, identity, and position are
assumed in both worlds; thus, occupational therapists play a
valuable role in navigating the ow of trac across this meta-
phorical bridge.
is paper introduces the gured world, a unique perspective
from which one can conceptualize the occupational experi-
ences of a person with an eating disorder. It is well documented
that meaning and identity are generated through, and trans-
formed by, engagement in occupation. In the gured world,
behaviours symptomatic of eating disorders are occupations,
and previously neutral daily occupations and artifacts become
subsumed into the illness experience. ey all contribute to
the construction of the occupational identity by which a per-
son meaningfully participates in his or her world.
e theoretical frameworks presented here provide a dif-
ferent lens from which to understand the occupational real-
ity of individuals with eating disorders. ey bring a deeper
dimension to understanding the complementarity poles of
meaning in occupation, replete with both illness and wellness
meaning. e gured world also highlights the signicant chal-
lenge that recovery poses, requiring the transformation of the
meaning and foundation on which life has been constructed.
For a therapist working with Anne, understanding her as a
member of a gured world creates a perspective on how illness
has become the meaningful construction for her occupational
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Key Messages
• A gured world is an “as if ” realm in which social
interaction in daily activities creates symbolic, imag-
ined, and culturally determined signicance. is
alternate representation of eating disorders reects the
dynamic aspects of identity construction in illness.
• Meaningiscreatedintheoccupations,thoughts,and
behaviours of an eating disorder illness existing in a
gured world.
• e concept of occupation can be understood as
having complementarity poles; the health-arming
potential of occupation existing opposite the illness-
derived meaning in occupation.
e author wishes to thank former clients and colleagues.
Sincere thanks are also extended to reviewers of earlier dras
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... Yet, OTs are not standard multidisciplinary treatment team members for these illnesses [11]. EDs are serious mental illnesses that lead to pervasive functional deficits in everyday activities, which can be addressed through occupational therapy intervention [11][12][13]. Through this narrative review, authors describe the role and benefit of including occupational therapy within ED treatment while offering personal insight from an individual with lived experience. ...
... An ED at minimum will affect the way that an individual interacts with food, engages in social situations involving food (e.g., parties; holidays), manages their roles (e.g., family member, employee), and perceives themselves (i.e., identity, self-esteem) [11-13, 19, 20, 22, 26]. The literature documents that additional areas impacted include but are not limited to: hygiene; school/work involvement; ability to care for others; physical health; mental/emotional health (e.g., mood, anxiety); finances; socialization (i.e., isolation); relationships; communication via increased secrecy; ability to cope positively; emotional regulation; and ability to contribute to society [2,11,12,[19][20][21][22][23][24][25][26]. All of the aforementioned aspects are areas an OT is skilled in addressing, ultimately supporting the individual in living their life to the fullest. ...
... Participating in daily activities that an individual derives personal meaning from fosters the belief that one's life is valuable, aids in the formation of identity, and promotes feelings of satisfaction, competence, and belonging [27,28]. With EDs, these typical daily activities-such as eating, cooking, shopping, exercising, socializing, and working-evolve around the disordered cognitions and are executed in a manner that sustains the ED and hinders one's physical and mental health [12]. For example, participation in exercise is often driven by an intense urge to burn calories to promote feelings of control over one's body shape and size, even when an individual is already medically compromised due to malnourishment and/or being at a low body weight [11]. ...
Full-text available
The literature demonstrates the importance of utilizing a multidisciplinary approach in the treatment of eating disorders, however there is limited literature identifying the optimal team of professionals for providing comprehensive and effective care. It is widely accepted that the multidisciplinary treatment team should include a physician, a mental health professional, and a dietitian, but there is minimal literature explaining what other professionals should be involved in the medical assessment and management of eating disorders. Additional team members might include a psychiatrist, therapist, social worker, activity therapist, or occupational therapist. Occupational therapists are healthcare professionals who help their clients participate in the daily activities, referred to as occupations, that they have to do, want to do, and enjoy doing. Many factors (e.g., medical, psychological, cognitive, physical) can impact a person’s ability to actively engage in their occupations. When a person has an eating disorder, it is likely that all four of the aforementioned factors will be affected, thus individuals undergoing treatment for an eating disorder benefit from the incorporation of occupational therapy in supporting their recovery journey. This narrative review strives to provide education on the role of the occupational therapist in treating eating disorders and the need for increased inclusion of this profession on the multidisciplinary team. Additionally, this narrative review offers insight into an individual’s personal experience with occupational therapy (i.e., lived experience) during her battle for eating disorder recovery and the unique value that occupational therapy offered her as she learned to manage her eating disorder. Research suggests that occupational therapy should be included in multidisciplinary teams focused on managing eating disorders as it empowers individuals to return to activities that bring personal meaning and identity.
... De même, l'émergence d'un TCA peut entraver la réalisation du parcours scolaire chez les adolescents et ainsi compromettre leurs perspectives d'emploi (Gardiner et Brown, 2012). Également, les activités productives ne nécessitant pas d'exposition corporelle à l'autre semblent être investies au détriment des activités sociales (Elliot, 2012). Enfin, l'investissement d'occupations reliées à l'éducation, à l'emploi ou au bénévolat peut exprimer une compensation de performance chez certaines personnes présentant un TCA ; même si cela nécessite d'être en relation avec d'autres (Pettersen et coll, 2013). ...
... Ils abordent l'étiologie multifactorielle des TCA selon trois catégories de facteurs contributifs aux troubles psychopathologiques, tirées du modèle des 3 P de Garner (Garner et al., 1983), soit : Prédisposants, Précipitants et Perpétuants (Lock et Pépin, 2019 La majorité des auteurs recensés expliquent le dysfonctionnement occupationnel en exposant les problèmes psychologiques et relationnels de la personne issus de ses préoccupations corporelles et alimentaires, tels que la faible estime de soi, la gestion émotive déficitaire et les habiletés sociales dysfonctionnelles. Ces caractéristiques personnelles influencent le niveau d'investissement de certaines occupations, qui se structurent fréquemment en routine autour de la problématique du TCA (Crouch et Alers, 2014 ;Elliot, 2012). Par exemple, les personnes présentant une anorexie mentale qui vivent de l'instabilité émotionnelle à la fois positive et négative sont plus sujettes à une variété d'occupations liées à la perte de poids et à l'évaluation corporelle telles que se peser et vérifier les graisses du corps (Selby et al., 2015). ...
... De plus, la présence d'un perfectionnisme (négatif et positif) peut accentuer l'investissement occupationnel productif, mais aussi avoir l'effet inverse, ce qui peut accroître l'évitement de certaines activités (Pettersen et al., 2013). Dans ce contexte, le fait de devoir composer avec des pensées envahissantes au point de nuire à l'efficacité personnelle et de parasiter l'emploi du temps affecte l'identité occupationnelle (Elliot, 2012). Chaque occasion de se nourrir rappelle le rapport au corps (Quiles-Cestari et Ribeiro, 2012). ...
Full-text available
Les troubles du comportement alimentaire (TCA) constituent des problématiques multifactorielles complexes qui s’expriment dans le fonctionnement quotidien d’une personne en interaction avec divers environnements. Une personne présentant un TCA peut choisir d’investir certaines occupations sur la base de ses préoccupations corporelles et alimentaires et du contexte écosystémique dans lequel elle évolue.
... Kiepek and Magalhães' (2011) interpretative literature synthesis illustrated how experiences of individuals whereby occupations become problematic, for example, those with addiction and impulse-control disorders including ED and compulsive exercise, meet Townsend and Polatajko's (2007) criteria as occupation. Elliot's (2012) scholarly commentary explains how ED, particularly anorexia nervosa, exists in the tension between "illness occupations" and health-affirming occupations (p. 20). ...
... Occupation is also therapeutic in the context of ED. Occupation-focused intervention for individuals with ED appears beneficial; for example, renegotiating how to prepare a meal, eat or exercise, and increasing tolerance for interpersonal occupational experiences (Clark and Nayar, 2012;Dark and Carter, 2019;Elliot, 2012;Martin, 1991). Two intervention studies demonstrated the value of occupationfocused interventions, that is, practical, meal-related groups, to enable those with ED to develop adaptive strategies associated with fear foods and adopt healthier ways of eating (Biddiscombe, et al., 2018;Lock et al., 2012). ...
... The findings also highlighted valuing an affirming social, that is, human, environment for occupation and wellbeing, which is aligned with evidence in occupational therapy (Dark and Carter, 2019;Dickie et al., 2006;Rebeiro, 2001). In general, recovery from BN requires a recalibration of doing what harms to what constitutes health (Clark and Nayar, 2012;Dark and Carter, 2019;Elliot, 2012). ...
Introduction Recovering from bulimia nervosa challenges a person to learn, revise, and do occupations that contribute to rather than detract from health. This study utilized Interpretative Phenomenological Analysis to (a) explore the recovery experiences of six adult women with histories of bulimia nervosa and (b) interpret how their accounts reflected the assumptions and characteristics of occupation. Methods Data were collected via audio-recorded, semi-structured interviews. Data analysis within and between cases identified six superordinate themes, which included interpretation in terms of criteria of occupation. Findings Superordinate themes reflect (1) occupation emerged in recovering from bulimia nervosa through committed action, not doing what fueled bulimia nervosa, adopting new ways of living, prioritizing self-care, connecting with others, and creating supportive environments and (2) recovery from bulimia nervosa can be construed as an occupation. Conclusion This study provides insight into nuances of recovery from bulimia nervosa. Results offer novel implications distinct to an occupational therapy lens, for example, consideration of self-care beyond eating and meal preparation; modification of the home, work, and social environment; and setting goals associated with not doing versus doing. Further, the interpretative finding of recovery as occupation holds implications for the evolving philosophical considerations within occupational science and therapy.
... She acknowledges that "to make such a statement challenges the implicit assumption in the definition that meaning in occupation is health promoting and life-affirming" (Elliot, 2012, p. 17). Elliot (2012) suggests that occupations exist on a continuum, with a "healthy, engaged experience of an occupation" (p. 17) on one end, and on the other, an occupational experience where previously neutral occupations have become "reinforced with illnessfocused meaning" (p. ...
... Second Draft, for Twinley (2021) Illuminating The Dark Side of Occupation: International Perspectives from Occupational Therapy and Occupational Science It was clear from our discussions that routines are mapped onto spaces and objects in the environment (Pierce, 2003), and that this is no different when it comes to the dark side of occupation. Elliot (2012) describes how otherwise neutral objects or behaviour can take on symbolic meaning through repeated use. For example, Elliot (2012) gives examples of a weighing scale becoming "the instrument against which...self-worth is measured" (p. ...
... Elliot (2012) describes how otherwise neutral objects or behaviour can take on symbolic meaning through repeated use. For example, Elliot (2012) gives examples of a weighing scale becoming "the instrument against which...self-worth is measured" (p. 19) and a bathroom at work becoming associated with purging. ...
... Studies have found that people with eating disorders experience a wide variety of difficulties in performing occupations such as grocery shopping, grooming, meal preparation, and eating (Clark & Nayar, 2012;Costa, 2009;Elliot, 2012;Lock & Pepin, 2011). Preoccupation with food can lead to a narrowing of occupations, ultimately resulting in an occupational imbalance or occupational deprivation at the expense of social, leisure, and work related activities (Lock & Pepin, 2011;Singlehurst, Corr, Griffiths, & Beaulieu, 2007;Tchanturia et al., 2012Tchanturia et al., , 2013. ...
... Framing behaviors such as over-exercise, bingeing, or smoking as 'occupations' provides a space for the individual to see and discuss the needs that the occupations met and how that impacted the rest of their day. Elliot (2012) introduced the concepts of "illness occupation" and "illness-directed meaning" (p. 17) to capture how individuals' occupational lives can be affected by eating disorders. ...
... It is therefore possible that exploration of the dark side of occupation has the potential to not only uncover important clinical information, but to also communicate to the individual a sense of being understood by their therapist. Elliot (2012) highlights the complexity of recovery from an eating disorder, explaining that the process requires a transition from illness occupations and illness-directed meaning to engagement in occupations that promotes wellbeing. She highlights a trusting relationship and the ability to "challenge distorted thoughts" (p. ...
Full-text available
This paper examines the utility of an occupation-focused assessment, Daily Experiences of Pleasure, Productivity, and Restoration Profile (PPR Profile), when providing services for people diagnosed with eating disorders. A descriptive case study methodology was used to analyze the experiences of seven participants at an intensive treatment day program. Participants completed the PPR Profile and reflected on its value. The findings include four themes: (1) honest completion requires assistance; (2) enhanced awareness is informative but poignant; (3) modifications are required to improve the use of the PPR Profile; (4) the use of the term “occupation” to refer to eating disorder behaviors.
... The participants' statements of how they would like to spend more time on friluftsliv could be viewed according to Hitch et al.'s (2014ab) suggestion that a person's self-understanding is connected to their hopes and aspirations for the future, in processes of becoming. This applies to what Elliot (2012) forwards as 'self-authoring'; the creation of harmony between one's personal identity and a valued socio-cultural discourse. In keeping with this, (re)storying one's narrative has been argued as supportive in regaining control over one's recovery, one's life and one's body (Grant, Leigh-Phippard, & Short, 2015), where images of 'possible selves' can provide for a sense of coherence, identity, meaning and wellbeing (Christiansen, 1999). ...
... The inward versus outward perspectives may pose a risk of seeing something as either healthy (friluftsliv) or illness-driven (ED) behaviour. In contrast, an occupational perspective on health allows for a multiplicity and dynamic potential of meanings involved in one's doings and beings (Elliot, 2012). As expressed by the participants, friluftsliv was not presented as a solution to everything difficult, but highlighted as supportive in recognizing and finding a balance around one's needs, inclusive of experiences related to living and dealing with an ED. ...
Full-text available
The aim of this qualitative study was to explore subjective experiences of how friluftsliv can support processes of recovery for persons living with eating disorders. Eight participants with experiences with bulimia nervosa and/or binge-eating disorders, and with interests in nature and friluftsliv were interviewed twice, using 'going together' and semi-structured interviews as data generation method. The results reveal how friluftsliv, by encompassing relational processes, facilitated opportunities to recognize one's personal needs-for instance, choosing to be social or to be by oneself. Friluftsliv was described as a learning and practice arena for reclaiming control over one's recovery and life. Furthermore, the participants demonstrated how (re)establishing oneself as an outdoor person supported the development of a new sense of self. The article concludes with an emphasis on how friluftsliv was experienced as comprising nurturing occupations and environments that enabled other aspects of one's life than the eating disorder to be prominent.
... It emerges as a representation of power and privilege, continually reproduced within the social and cultural construction of figured world. Neither student nor teacher may be given explicit instructions as to what role each play or the manner in which they play it, and yet in the school environment and home this positional identity is regularly produced (Elliot, 2012). ...
... There is potential that those people who complete, for example, an exercise class because they are aware it is important to be physically active, but would not routinely choose the activity are not experiencing an occupation, but rather, somewhat ambivalently, adopting health-promoting behaviour. While there is little evidence in the field of frailty, discussion elsewhere considered how routine occupations become 'illness infused' and linked to a broader experience of ill health (Elliot, 2012;Stewart et al., 2016). There is potential that participants who were not historically engaged in physical activity only associate it with avoidance of a declining health, rather than a more positive connotation. ...
Background: Frailty is a syndrome associated with poor health outcomes and, with an ageing population, it has become a focus for research and intervention. Pre-frailty, as a distinct stage of emerging age-related changes, is less well considered in the literature. Interventions to prevent progression from pre-frailty to frailty are being introduced, but lack supporting evidence on the needs and outcomes of this group. There is a need for improved understanding of patient outcomes, including experiential accounts of the application of such outcomes to daily lives. Methods: The research used a mixed methods realistic evaluation of the experience and outcomes of people identified as being at risk of developing frailty and engaged in a frailty-prevention course. Pre/post-test data, relating to physical and functional health outcomes generated at three time points, were analysed for 212 participants. A mixed methods exploration, using framework analysis, of experiences and perceptions of participants occurred based on nineteen semi-structured interviews with eight participants. This considered the way physical health, functional status, well-being and activity participation are understood and interact. Results and Findings: Classification of frailty highlighted that 64.7% of the sample were living with frailty and a further 29.4% with pre-frailty. At baseline there were weak, but significant associations, between increased lower frailty classification and more favourable functional outcomes for all measures, except for the Falls Efficacy Scale. Functional and frailty measures showed improvement after the twelve-week intervention, which was maintained for functional measures only at six-month follow-up. The mixed methods analysis developed knowledge from these outcomes, highlighting that the experience of participants did not closely align with measured outcomes. Participants rejected the term frailty, yet engaged with the need to mitigate for, and adapt to, age-related deterioration that threatened independence and well-being. This was achieved through occupational adaptation to preserve function and well-being. Conclusion: Considering frailty in terms of physical and functional status, mental well-being and occupational performance aligns with the experiences of those living with pre-frailty and frailty. The frailty-prevention intervention was highly acceptable to participants as it adopted a function and assets-based approach to health, which aligned with their conceptualisation of health and self-management. Additionally, improvement, or at least maintenance, of function, was of greatest importance to participants.
... To some extent, risky (Haines et al., 2010;Illman et al., 2013) and non-sanctioned occupations such as problematic drug and food consumption (Cloete & Ramugondo, 2015;Elliot, 2012;Kiepek & Magalhães, 2011;Luck & Beagan, 2015), tagging (a type of graffiti) (Russell, 2008), crossdressing (wearing clothes commonly associated with the opposite sex) (Curtis & Morris, 2015), binge drinking (Jennings & Cronin-Davis, 2016) and resistive occupations (Pyatak & Muccitelli, 2011) have been explored. However, Kiepek et al. (2019) identified that there is still a need for further research in relation to non-sanctioned occupations. ...
Introduction The aim of this study was to investigate how female sex workers perceive and describe meaning when engaging in the non-sanctioned occupation of sex work. Method: In-depth semi-structured interviews were carried out with six sex workers aged 26 to 56 years who were working either part-time or full-time at a brothel or worked “privately & discreetly.” Interpretative phenomenological analysis was applied to develop themes representing the subjective perspectives of the participants. Findings: Mostly, the participants perceived and described their engagement in sex work as holding positive meanings and contributing to their well-being and quality of life. Participants perceived and described the society’s view on sex work as the most challenging part of their engagement in sex work. Six themes emerged from the data: 1) sexual beings, 2) personal development, 3) interpersonal relationships, 4) proud professionals, 5) the public view on sex work and 6) well-being and quality of life. Conclusion: Engagement in sex work was found to be meaningful to the participants as their doing was intrinsically motivated by their being, making them become more knowledgeable, skilled, confident, and empowered and contributed to a sense of belonging. Engagement in sex work was also found to hold negative meaning, as a limited sense of belonging to society was described. Despite this negative aspect, engagement in sex work was deemed to be meaningful and engaging and contributed to their well-being and quality of life. Further research is required to develop knowledge about other sex workers.
The presence of a physical or mental health issue, such as an eating disorder (ED), impacts daily activities, also known as occupations. For example, an overinvestment in body shape and weight undoubtedly can lead to an underinvestment in other, more meaningful occupations. To address ED-related perceptual disturbances, a detailed log of daily time use can pinpoint food-related occupational imbalances. This study aims to characterize the daily occupations associated with EDs. The first specific objective (SO.1) is to categorize and quantify the temporal organization of a typical day's occupations as self-reported by individuals with an ED. The second specific objective (SO.2) is to compare daily occupational time use among people with different ED types. This retrospective study based on time-use research principles was conducted by analyzing data from an anonymized secondary dataset (LoriCorps's Databank). Data were collected between 2016 and 2020, from 106 participants, with descriptive analysis completed to determine the average daily time use for each occupation. A series of one-way analyses of variance (ANOVAs) were performed to compare perceived time use in each occupation for participants with different types of EDs. The outcomes show a marked underinvestment in leisure categories compared to the general population. In addition, personal care and productivity can represent the blind dysfunctional occupations (SO.1). Moreover, compared to those with binge eating disorder (BED), individuals with anorexia nervosa (AN) are significantly more invested in occupations that focus explicitly on perceptual disturbances, such as personal care (SO.2). The highlight of this study is the distinction between marked versus blind dysfunctional occupation, which offers specific avenues for clinical intervention.
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This article presents a view of occupation as the principal means through which people develop and express their personal identities. Based on a review of theory and research, it proposes that identity is instrumental to social life because it provides a context for deriving meaning from daily experiences and interpreting lives over time. The article proposes that identity also provides a framework for goal-setting and motivation. It is asserted that competence in the performance of tasks and occupations contributes to identity-shaping and that the realization of an acceptable identity contributes to coherence and well-being. Within this framework, it is postulated that performance limitations and disfigurement that sometimes result from illness or injury have identity implications that should be recognized by occupational therapy practitioners. By virtue of their expertise in daily living skills, occupational therapy practitioners are well positioned to help address the identity challenges of those whom they serve. In so doing, they make an important contribution to meaning and well-being.
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This article asks, “How can we be true to and respect the inner experiences of people and at the same time critically assess the cultural discourses that form the very stuff from which our experiences are made?” To answer this question, the article proposes a quilting mode of doing and writing research that aims to be sensitive to the texture and nuance of personal stories or patches and, by stitching them together, points to discursive resonances between them. The quilting approach is used to make sense of interviews conducted with five anorexic women, listening closely to the voices of these women who are often silenced as disordered, and to illustrate how they complicate and are complicated by notions of anorexics as being too dependent and/or too good.
This important volume deals with the issue of how to make comparisons in the field of human development. In their comparisons of various social groups, social scientists generally focus on what the differences are, rather than elucidating how and why the groups differ. Comparisons in Human Development examines ways in which different disciplines have treated comparisons and development and provides empirical examples that take a comparative, developmental approach to human activity and thought. Contributors share the view that the study of development must be concerned with processes that operate over time and are regulated by their physical, biological, social and cultural contexts. Development is understood in systemic terms, with multidirectional influences that cross levels of analysis, including the cellular, the individual, the family, and the cultural and historical.
The objective world is given meaning through activity and language. The process of creating meaning takes place throughout life and is shaped by our social and cultural environment. Yet little is known about the role of everyday activity in the construction and maintenance of meaning. The paper describes a small scale, qualitative study designed to increase knowledge about meaning construction in one such occupation: tea‐drinking. There were two aims: firstly to identify the elements of making and drinking tea which elicited meaning and secondly, to discover whether elicited meaning and secondly, to discover whether these meanings were shared or unique to each individual. Drinking tea during semi‐structured interviews with five women provided a’ here and now’ focus which linked language and activity. Six shared categories of meaning emerged. These were meaning through reasons for tea‐drinking, the senses, objects used, the social context, and changes in lifestyle. Further study of other everyday activities, and amongst other social and cultural groups is recommended.
Narrative analysis was used to explore the dominant themes in the 47 feature articles on eating disorders that have appeared in women's magazines since 1980, when eating disorders found a regular spot on the public's agenda. The "metastory" that emerges from these articles can be characterized thusly: Victims suffer alone, trapped by their selfishness and perfectionism, while stunned family members and peers stand by, watching as the disease suddenly takes hold. In later stages of the narrative, writers blame the media for the increase in the number of cases of eating disorders. The narrative presents a distorted picture of what life is like for the victim of an eating disorder. It also offers a distorted picture of what goes on outside the discourse of dieting—outside the symbiotic relationship between food companies and diet product makers carried out in the pages of women's magazines. Treating eating disorders as aberration allows the editor to deal with a serious problem while at the same time sustaining a discourse that contributes to the problem. Women's magazines acknowledge the severity of the problem, but make it seem like it takes place outside the realm of consumerism.
In Northern Ireland, only two occupational therapists work within the specialist field of child and adolescent mental health (CAMH). This is despite recommendations made by the Bamford Review of Mental Health and Learning Disability (Northern Ireland) that occupational therapy should be a core element of CAMH provision. The College of Occupational Therapists has urged practitioners to challenge inequalities in health and social care provision and to use occupational language to reinforce the relationship between occupation, recovery and wellbeing. This opinion piece highlights occupational therapy core skills and occupational therapy frames of reference or modalities, underlining the application of both to eating disorders. The treatment models discussed are the Model of Human Occupation, the Canadian Model of Occupational Performance and sensory integration. Evidence reinforces that the models discussed are applicable, appropriate and valuable when treating children and adolescents with an eating disorder. It is argued that the valuable and unique role of occupational therapy must be recognised by health and social care commissioners and CAMH providers and be vocalised by occupational therapists. CAMH teams are advised to embrace the unique skills that occupational therapists have to offer children and adolescents with eating disorders in order to ensure that clients receive truly multidisciplinary and client-centred evidence-based services.
This article proposes that the current conceptualisation of occupation within the dominant Anglophone literature reflects central elements of Western society's construction of a ‘healthy’ daily life, the ‘ideal’ and expected way to live. Contemporary theories of social action are used to describe the structuring influence of social institutions on daily activity. Four of the commonly identified characteristics of occupation, that it is active, purposeful, temporal and meaningful, are discussed in relation to Western institutions and related aspects of daily life. It is not intended to provide a comprehensive account of the socio-historical construction of the concept of occupation, but rather to illustrate the coherence of characteristics of occupation with those of Western daily life. The implications of this for understandings of occupation amongst groups and communities with alternative constructions of daily life are discussed. Some examples are offered, particularly from Greece, as a Christian Orthodox, non-industrialised, largely collectivistic society.
Exploring narrative processes through which women treated for anorexia reframe their illness and recovery experiences, I identify features of two distinct genres, "full recovery" (FR) and "struggling to recover" (SR) that differently shape, while also being shaped by, women's lived senses of self. Analysis suggests that full recovery may entail a temporal disjuncture between past and present selves, and the construction of a coherent empowerment narrative with clear beginnings, turning points, and felicitous, institutionally condoned endings. Alternatively, the habitual telling of equivocal struggling to recover narratives, in which protagonists question received wisdom, ponder past and hypothetical life paths, and envision self-starvation as both good and bad, may perpetuate a cyclical life course in which anorexia recurs and permanent recovery eludes narrators. Illuminating why complete recovery may remain ephemeral and, perhaps, not desirable, for some women, this article contributes to scholarship on the possible role (and limits) of narrative as a therapeutic medium and resource for confronting illness.
Objective The current study examined and compared perceptions of illness in individuals with anorexia nervosa (AN) and lay men and women.Method Participants with AN (n = 95) completed the Revised Illness Perception Questionnaire (IPQ-R). Lay participants (n = 80) completed a modified IPQ-R to elicit perceptions of AN.ResultsParticipants with AN viewed their illness as chronic and highly distressing, with strong negative consequences. They had fairly negative perceptions of illness controllability and curability, which contrasted with the more optimistic beliefs held by lay participants. Both groups implicated emotional and psychological causes.DiscussionThe profile of illness perceptions expressed by the AN sample is associated with poor mental health and functioning and may inform the treatment approach. Lay perceptions of AN differed in the conceptualization of AN as a “slimming disease” amenable to change. This discrepancy may contribute to the stigmatization of AN. © 2004 by Wiley Periodicals, Inc.