Article

Three uses of recognition in Emma Woolf’s anorexia recovery memoir An Apple a Day (2012)

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Abstract

In this article, I employ illness narrative theory to analyze Emma Woolf’s recovery from anorexia through autobiographical writing. This is a novel approach, insomuch as anorexia memoirs focusing on recovery are a rare phe- 10 nomenon, as are their analyses. This essay narrows this gap by exploring Woolf’s articulation of anorexia recovery through a phenomenological perspective, using the concept of “recognition.” I employ this notion in three different ways: to mean (1) that memoir writing 15 provides Woolf with a sense of self-recognition about the difference of her anorexia; (2) that it allows her to achieve a sense of recognition from others about her struggles; and (3) that it enables her to develop a sense of recognition of other sufferers, encouraging the author to incor- 20 porate pro-recovery content in her piece, An Apple a Day. The analysis therefore proposes that this memoir is potentially bibliotherapeutic for readers with anorexia.

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Thesis
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In my thesis, I compare three memoirs written by recovering/recovered anorexics: Wasted (1998) by Marya Hornbacher, How to Disappear Completely (2013) by Kelsey Osgood and An Apple a Day (2012) by Emma Woolf. I read these works within the framework of the illness narrative/autobiography and compare the ways in which they represent the lived illness experience of anorexia nervosa. For this comparison I borrow ideas and concepts developed by theorists working on disability, mental illness/health and anorexia, which enables me to explore the portrayal of illness, diagnosis and recovery in the memoirs while also investigating the underlying notions of health, normalcy, disability and difference that precede the general understandings of these terms. In this way, I can determine to what extent the general explanatory models of anorexia have either been internalised or subverted in these autobiographical narratives, as well as form an understanding of how the practice of diagnosis influences the experience of living with anorexia and the ways in which recovery is conceptualised by these authors. In interpreting the various representations of illness, diagnosis and recovery, I employ concepts from the field of autobiography that can aid me in reading the narratives from a literary perspective, as well as works about the illness narrative as a genre in order to place these three memoirs in a context of other illness life writings.
Article
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Background Narratives of recovery from mental health distress have played a central role in the establishment of the recovery paradigm within mental health policy and practice. As use of recovery narratives increases within services, it is critical to understand how they have been characterised, and what may be missing from their characterisation thus far. The aim of this review was to synthesise published typologies in order to develop a conceptual framework characterising mental health recovery narratives. Method A systematic review was conducted of published literature on the characteristics of mental health recovery narratives. Narrative synthesis involved identifying characteristics and organising them into dimensions and types; and subgroup analysis based on study quality, narrator involvement in analysis, diagnosis of psychosis and experience of trauma. The synthesis was informed by consultation with a Lived Experience Advisory Panel and an academic panel. The review protocol was pre-registered (Prospero CRD42018090188). Results 8951 titles, 366 abstracts and 121 full-text articles published January 2000-July 2018 were screened, of which 45 studies analysing 629 recovery narratives were included. A conceptual framework of mental health recovery narratives was developed, comprising nine dimensions (Genre; Positioning; Emotional Tone; Relationship with Recovery; Trajectory; Use of Turning Points; Narrative Sequence; Protagonists; and Use of Metaphors), each containing between two and six types. Subgroup analysis indicated all dimensions were present across most subgroups, with Turning Points particularly evident in trauma-related studies. Conclusions Recovery narratives are diverse and multidimensional. They may be non-linear and reject coherence. To a greater extent than illness narratives, they incorporate social, political and rights aspects. Approaches to supporting development of recovery narratives should expand rather than reduce available choices. Research into the narratives of more diverse populations is needed. The review supports trauma-informed approaches, and highlights the need to understand and support post-traumatic growth for people experiencing mental health issues.
Article
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Recovery is now widely acknowledged as the dominant approach to the management of mental distress and illness in government, third-sector and some peer-support contexts across the United Kingdom and elsewhere in the Anglophone Global North. Although narrative has long been recognised in practice and in policy as a key “technology of recovery,” there has been little critical investigation of how recovery narratives are constituted and mobilised, and with what consequences. This paper offers an interdisciplinary, critical medical humanities analysis of the politics and possibilities of Recovery Narrative, drawing literary theoretical concepts of genre and philosophical approaches to the narrative self into conversation with the critiques of recovery advanced by survivor-researchers, sociologists and mad studies scholars. Our focus is not on the specific stories of individuals, but on the form, function and effects of Recovery Narrative as a highly circumscribed kind of storytelling. We identify the assumptions, lacunae and areas of tension which compel a more critical approach to the way this genre is operationalised in and beyond mental health services, and conclude by reflecting on the possibilities offered by other communicative formats, spaces and practices.
Article
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This article explores the relationship between eating disorders and reading behaviors, arguing that there is a meaningful difference in a minority of readers' approach to and understanding of anorexia life-writing, and of literary texts more broadly. To illuminate this distinction, this article begins by considering the reported deleterious influence of Marya Hornbacher’s anorexia memoir, Wasted, elaborating the ways Hornbacher offers a positive presentation of anorexia nervosa that may, intentionally or not, induce certain readers to “try it” themselves. This is followed by an exploration of how Hornbacher’s own reading praxis is implicated in a discursive feedback loop around anorexia narratives. It concludes with a discussion of disordered reading attitudes in relation to the emergence of the “pro-anorexia” phenomenon.
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Over the past ten years the promotion of recovery has become a stated aim of mental health policies within a number of English speaking countries, including Scotland. Implementation of a recovery approach involves a significant reorientation of mental health services and practices, which often poses significant challenges for reformers. This article examines how four key technologies of recovery have assisted in the move towards the creation of a recovery-oriented mental health system in Scotland. Drawing on documentary analysis and a series of interviews we examine the construction and implementation of four key recovery 'technologies' as they have been put to use in Scotland: recovery narratives, the Scottish Recovery Indicator (SRI), Wellness Recovery Action Planning (WRAP) and peer support. Our findings illuminate how each of these technologies works to instantiate, exemplify and disseminate a 'recovery orientation' at different sites within the mental health system in order to bring about a 'recovery oriented' mental health system. They also enable us to identify some of the factors that facilitate or hinder the effectiveness of those technologies in bringing about a change in how mental health services are delivered in Scotland. These finding provide a basis for some general reflections on the utility of 'recovery technologies' to implement a shift towards recovery in mental health services in Scotland and elsewhere. Our analysis of this process within the Scottish context will be valuable for policy makers and service coordinators wishing to implement recovery values within their own national mental health systems.
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Book
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The persistence and recurrence of anorexia nervosa poses a clinical challenge, and provides support for critiques of oppressive and injurious facets of society inscribed on women’s bodies. This essay illustrates how a phenomenological, linguistic anthropological approach fruitfully traverses clinical and cultural perspectives by directing attention beyond the embodied experience of patients diagnosed with anorexia nervosa to those who are not clinically diagnosed. Extending a model of illness and recovery as entailing sufferers’ emplotting of past, present, and imagined future selves, I argue that women’s accounts of their experiences do not simply reflect lived reality, but actually propel health-relevant states of being by enlivening and creating these realities in the process of their telling. In indexical interaction with public and clinical discourses, narratives’ grammar, lexicon, and plot structures modify subjects’ experiences and interpretations of the events and feelings recounted. This article builds on the insight that linear narratives of “full recovery” that adopt a clinical and feminist voice can help tellers stay recovered, whereas for those “struggling to recover,” a genre of contingent, uncertain, sideshadowing narratives alternatively renders recovery an elusive and ambivalently desired object. This essay then identifies a third narrative genre, eluding a diagnosis, which combines elements of the first two genres to paradoxically keep its teller simultaneously sheltered from, and invisible to the well-meaning clutches of medical care, leaving her suffering, yet free, to starve. This focus on narrative genres illustrates the utility of linguistic analyses for discerning and interpreting distress in subclinical populations.
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This study aimed to explore the construct of recovery from anorexia nervosa through the medium of weblogs, focusing on the benefits and barriers to the recovery process. Data were extracted from female (n = 7) and male (n = 1) participants’ textual pro-recovery weblogs, all of which were posted between 2013 and 2015 in the public domain. Data were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (1) barriers to recovery, (2) factors increasing the likelihood of recovery and (3) support. Results suggest supportive relationships, regaining control and recognising the consequences of the eating disorder benefit recovery, whereas public perceptions, the anorexia nervosa voice and time act as barriers to recovery. Out of eight participants, four described seeking professional help as part of their recovery, of which three believed their professional therapy experience helped aid recovery. Implications for anorexia nervosa treatment are discussed in detail.
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ABOUT THIS BOOK In At the Will of the Body, Arthur Frank told the story of his own illnesses, heart attack and cancer. That book ended by describing the existence of a "remission society," whose members all live with some form of illness or disability. The Wounded Storyteller is their collective portrait. Ill people are more than victims of disease or patients of medicine; they are wounded storytellers. People tell stories to make sense of their suffering; when they turn their diseases into stories, they find healing. Drawing on the work of authors such as Oliver Sacks, Anatole Broyard, Norman Cousins, and Audre Lorde, as well as from people he met during the years he spent among different illness groups, Frank recounts a stirring collection of illness stories, ranging from the well-known—Gilda Radner's battle with ovarian cancer—to the private testimonials of people with cancer, chronic fatigue syndrome, and disabilties. Their stories are more than accounts of personal suffering: they abound with moral choices and point to a social ethic. Frank identifies three basic narratives of illness in restitution, chaos, and quest. Restitution narratives anticipate getting well again and give prominence to the technology of cure. In chaos narratives, illness seems to stretch on forever, with no respite or redeeming insights. Quest narratives are about finding that insight as illness is transformed into a means for the ill person to become someone new.
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Abstract. "References cited": leaves 62-65. Advisory committee chaired by Mallory Young, English and Languages Dept. Thesis (M.A.)--Tarleton State University, August 2001.
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Attempts to explain "eating disorders" in contemporary western society have concentrated on aetiology at the expense of resolution. Most "recovered" anorectics, however, question medical definitions of "anorexia nervosa" and clinical criteria for recovery. This article refers to a study of 32 people at different stages of the recovery process, to reconceptualize the problem in sociological terms. Durkheim's account of asceticism offers a fresh interpretive framework in which anorexia and recovery are understood as the negative and positive phases respectively of a ritual of self-transformation. In western culture, where appropriate myths and rituals of re-incorporation are not readily available following a period of symbolic fasting, it is not surprising that recovery from anorexia is not automatic. Participants in this study referred to anorexia as a spiritual quest and for them recovery involved a re-discovery (or creation) of a threefold connection: inner, with others and with "nature". These connections are, for them, the defining features of spirituality. The negative phase of the ritualistic quest (anorexia) involves a confrontation with the inevitability of death as a condition of the positive phase (recovery) in which people actively choose life. This new theoretical approach provides a non-medicalized understanding of anorexia and simultaneously enables a re-interpretation of the fasting of medieval women saints. Recent scholarship in this area is re-evaluated to demonstrate that the continuity between asceticism and anorexia lies in the use of food as a metaphorical attempt to confront the universal problem of one's own mortality. In certain historical situations, asceticism served a socially valuable symbolic purpose. In contemporary society, however, this meaning is no longer available. Instead, it is recovery which constitutes the active and metaphorical "rebellion" against forces of social control. Finally, the work of Van Gennep is used to explore some of the specific ritual processes through which people effect the self-transformation from suffering to recovery, providing further insights into how recovery takes place from a wide range of other sufferings as well.
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This paper applies the technique of dimensional analysis to recovery narratives in order to examine the uniqueness of the recovery process. It finds that there are four central dimensions involved in recovery: self, others, the system, and the problem. The recovery process is made up of component processes that correspond to these dimensions: recognizing the problem, transforming the self, reconciling the system, and reaching out to others. The paper concludes by suggesting how understanding these dimensions and processes may aid practice and policy.
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More than 50 individuals have published eating disorder (ED) memoirs. The current study was the first to test whether memoirs affect readers' eating attitudes and behaviors, and whether they normalize and/or glamorize EDs. Fifty female undergraduates read an ED or control memoir. Before and afterward, participants completed the 26-item Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI) Drive for Thinness subscale, a measure of perceived ED symptom prevalence, and an Implicit Association Test (IAT) measuring associations between anorexia and glamour/danger. Participants in the ED condition did not demonstrate significant changes in the EAT-26, the EDI Drive for Thinness subscale, perceived symptom prevalence, or IAT associations compared with controls. Before reading, the EAT-26 and EDI Drive for Thinness subscale correlated positively with perceived symptom prevalence and strength of the IAT association between anorexia and glamour. ED memoirs appear to have little effect on undergraduates' eating attitudes and behaviors. Future research should investigate whether memoirs affect individuals with preexisting eating pathology, who may normalize and glamorize ED symptoms.
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The outcome in eating disorders remains poor and commonly used methods of treatment have little, if any effect. It is suggested that this situation has emerged because of the failure to realize that the symptoms of eating disorder patients are epiphenomena to starvation and the associated disordered eating. Humans have evolved to cope with the challenge of starvation and the neuroendocrine mechanisms that have been under this evolutionary pressure are anatomically versatile and show synaptic plasticity to allow for flexibility. Many of the neuroendocrine changes in starvation are responses to the externally imposed shortage of food and the associated neuroendocrine secretions facilitate behavioral adaptation as needed rather than make an individual merely eat more or less food. A parsimonious, neurobiologically realistic explanation why eating disorders develop and why they are maintained is offered. It is suggested that the brain mechanisms of reward are activated when food intake is reduced and that disordered eating behavior is subsequently maintained by conditioning to the situations in which the disordered eating behavior developed via the neural system for attention. In a method based on this framework, patients are taught how to eat normally, their physical activity is controlled and they are provided with external heat. The method has been proven effective in a randomized controlled trial.
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The Anorexic Self. A Personal, Political Analysis of A Diagnostic Discourse
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Running on Empty: A Diary of Anorexia and Recovery. Livonia: Nelson
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Ink in Water: An Illustrated Memoir or How I Kicked Anorexia’s Ass and Embraced Body Positivity. Oakland: New Harbinger
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Stick Figure: A Personal Journey through Anorexia and Bulimia. Melbourne: Hill of Content
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