Andrea LaMarre

Identifying fundamental criteria for eating disorder recovery: a systematic review and qualitative meta-analysis

BackgroundOutcome studies for eating disorders regularly measure pathology change or remission as the only outcome. Researchers, patients and recovered individuals highlight the importance of using additional criteria for measuring eating disorder recovery. There is no clear consensus on which additional criteria are most fundamental. Studies focusing on the perspectives of recovered patients show criteria which are closely related to dimensions of positive functioning as conceptualized in the complete mental health model. The aim of this study was to identify fundamental criteria for eating disorder recovery according to recovered individuals.MethodsA systematic review and a qualitative meta-analytic approach were used. Eighteen studies with recovered individuals and meeting various quality criteria were included. The result sections of the included papers were searched for themes that were stated as criteria for recovery or ‘being recovered’. All themes were analyzed using a meta-summary technique. Themes were labeled into criteria for recovery and the frequency of the found criteria was examined.ResultsIn addition to the remission of eating disorder pathology, dimensions of psychological well-being and self-adaptability/resilience were found to be fundamental criteria for eating disorder recovery. The most frequently mentioned criteria were: self-acceptance, positive relationships, personal growth, decrease in eating disorder behavior/cognitions, self-adaptability/resilience and autonomy.ConclusionsPeople who have recovered rate psychological well-being as a central criterion for ED recovery in addition to the remission of eating disorder symptoms. Supplementary criteria, besides symptom remission, are needed to measure recovery. We recommend including measurements of psychological well-being and self-adaptability/resilience in future research, such as outcome studies and in routine outcome measurement.

Social Justice Oriented Diagnostic Discussions: A Discursive Perspective

Abstract In the West, the concept of mental illness represents the dominant perspective on emotional distress. Despite their prominence, psychiatric diagnoses have been subject to extensive critiques, including their suitability for increasing therapists’ understanding of distress of socially marginalized clients. Family therapists are among the professionals expected to treat mental disorders. As family therapists are becoming increasingly oriented to social justice issues, the question arises whether they should continue using diagnoses. In this article, we set aside the should question and focus on how a social justice perspective can be infused into diagnostic conversations. We analyzed diagnostic discussions in family therapy to highlight how medical constructions of clients’ experiences are constituted using language in therapy.

Unrecoverable? Prescriptions and Possibilities for Eating Disorder Recovery

Introduction: In Western psychology, post-structural feminist scholarship on eating disorders (EDs) has brought to light three key differences between critical and conventional frameworks: differences in understandings of causation and course, in conceptualizations of the normal/pathological divide, and in attendance to lived experiences as a source of scholarly and clinical knowledge and insight.

Cultivating disability arts in Ontario

This work was supported by the Canadian Institutes for Health Research Grant #106597; the Canadian Foundation for Innovation Project #35254; and the Canada Research Chairs Award #950-231091.

Making spaces: multimedia storytelling as reflexive, creative praxis

ABSTRACT In this article, we explore our experiences as researchers and participants in multimedia storytelling, an arts-informed method wherein we work with artists and aggrieved communities to speak back to dominant representations through film. In positioning ourselves as storytellers, we do research with rather than “on” or “for” participants, allowing us to connect in practical and affective ways as we co-create films. Drawing from dialogues about our workshop experiences, we outline four themes that make the storytelling space unique: reflexivity; structure and creativity; transitional space and reverberations; and fixing versus being/becoming with. We analyze our self-reflexive films on mind-body difference as “biomythographies,” as films that situate stories of ourselves in technological-temporal-spatial relations and that highlight how we make/experience change through creative research. Multimedia storytelling, we argue, allows us to enact reflexive creative praxis in a way that opens to difference rather than trying to fix it, forging an ethic we find all too rare in the neoliberal university.

Cripping the Ethics of Disability Arts Research

The use of multimedia story-making and narrative-based drama in disability research raises conventional ethical issues of informed consent, anonymity, and confidentiality. In this chapter, we explore unique issues that arise when working with non-normatively embodied/enminded participants in a collaborative way, using arts-based mediums that transgress boundaries of anonymity and privacy, and call for difference-tailored consent processes. We identify unique ethical issues/practices arising out of our research with Re•Vision, a research-creation centre that uses the power of the arts to dismantle stereotypical understandings of mind-body difference that create barriers to healthcare. Drawing on Re•Vision’s arts research, we map ethical conditions under which participants/collaborators/artists create their stories, and how curation of multimedia stories and drama gives rise to an ethics of voice and bearing witness.

Eating Disorder Prevention as Biopedagogy

ABSTRACT The authors describe eating disorder prevention as biopedagogy: that is, as a set of expectations for how to manage one’s body and self to be a healthy productive citizen. This biopedagogy lands differently on different “bodies of risk”—those of people coded as at risk for eating disorders and those coded as at risk for “obesity” in a social milieu that marks certain bodies, such as those of different sizes, sexualities, ethnicities, socioeconomic statuses, genders, and abilities—as unacceptable. In theorizing eating disorder prevention as biopedagogy, the authors consider not only the content of prevention messages, but also conventional notions of the normative self that underpin these messages and hence the form that they take, and how this form conflicts with critical perspectives that view subjectivities as dynamic and in flux. The authors argue for a shift to body becoming pedagogies grounded in social justice and intersectional perspectives, suggesting that systemic changes are needed to make diverse bodies welcome.

Recovering Bodies: The Production of the Recoverable Subject in Eating Disorder Treatment Regimes

In this chapter, we critique biopedagogies that inform eating disorder treatment. We employ a body-becoming counter-pedagogy as a theoretical frame in order to explore how youth develop and enact particular subjectivities when treated for eating disorders. Correspondingly, we consider how the failure or the refusal to enact an idealized subjectivity, one shaped by race and class and of particular interest to this chapter, sex and sexual orientation, results in the marking of bodies as unrecovered, even unrecoverable. We provide an account of biopedagogies of eating disorder recovery, against which we develop a body-becoming pedagogy. Using this philosophical framework we demonstrate how eating disorder treatment regimes sex bodies, and by extension how sex is conceptualized within heterosexual matrices.

The Normal, Improving, and Productive Self: Unpacking Neoliberal Governmentality in Therapeutic Interactions

Psychotherapy might be seen as a site of reproduction of neoliberal capitalist ideology. Unpacking therapeutic discourse affords the opportunity to explore neoliberalism in operation. We present a theoretical case for exploring neoliberalism in the therapeutic context. Specifically, we identify and illustrate three neoliberal discourses: the normal self, the improving self, and the productive self. We discuss how therapists might orient to these discourses and identify ways to challenge neoliberal ideology. Doing so will not dismantle power systems that yield oppression; however, it may help clients reclaim and negotiate preferred subjectivities within this system while also working toward broader social justice.

Words with weight: The construction of obesity in eating disorders research:

In current public health discourse, obesity is conceptualized as a disease epidemic, with treatment being weight loss. The pursuit of weight loss as a treatment for the “disease” of obesity is in direct contradiction to the history of research in eating disorders, which has demonstrated the risks for the development of eating disorders. In this study, we critically examined the eating disorder literature to explore this contradiction. We analyzed 30 of the top-cited articles in the eating disorder literature between 1994 and 2011, asking: how is the concept of obesity examined in eating disorder research? We identified tensions related to body mass index and the perceived associated risks of lower or higher body mass index, assumptions of the “causes” of fatness (i.e. overeating and inactivity), and the anti-diet voice challenging the prescription of dieting for those in fat bodies. In our analysis, we highlight the problematics of, for instance, prescribing a body mass index range of 20–24 in eating disorder recovery, how many studies in eating disorders do not problematize the presumption that a higher body mass index is necessarily associated with ill health, and a lack of cultural sensitivity and acknowledgment of intersectional spaces of belonging. We discuss these themes in the context of biomedical discourses of obesity contributing to the cultural thin ideal. We argue that biomedical discourses on obesity contribute to the thin ideal nuanced against discourses of healthism that permeate our society. Rather than an ideal of emaciation, it is an ideal of a healthy, productive person, often constructed as morally superior. The moral panic around obesity is evident throughout the eating disorder literature, which is a concern given that we would hope that the aim of eating disorder treatment would be to promote wellness for all—not only those who are thin.