Shaista – Reintegration and Diet Culture

Eating Disorders Awareness Week, 22-28 February 2016

At work I found a copy of the book Naturally Thin on a shelf of what I assumed to be donations. I skimmed through the pages expecting to get a few giggles, but was sorely disappointed. The only thing about the experience that evoked anything reminiscent of enjoyment was the fact that someone decided that this book was trash and kicked it out of their possession. A book like that belongs nowhere better than the bin. What accomplishments can this author boast? Furthering a vitriolic empire that makes its money off of desperate people? Name-branding and endorsing eating disorders as a lifestyle choice? Posing in a bikini three weeks after giving birth? Trash. Books like these are trash. Unfortunately, they are not a rarity either. In fact, they help to compose a billion-pound industry that permeates nearly all of the modern landscape. It’s as simple as turning on the TV, walking outside, standing in line at the supermarket, or sitting in a GP surgery to suddenly become privy to the world’s obsession with dieting.

This particular book claims that a “naturally” skinny girl is hiding inside of every female. What is cleverly veiled behind cheap rhetoric, is that this girl requires unnatural methods to be unleashed. Likewise, a chiseled, virile, strong man with post-Photoshop abs is sulking inside of every male. He too is waiting and growing impatient with his own slovenliness. The diet industry does not discriminate by gender; it merely changes its face. It is our self-contempt that makes us malleable, and our desperation that sharpens its teeth. Failure to attain the ideal is not only expected by the diet industry, it is depended upon. If we do not see our own weakness and fallibility, then we would not need to turn to anyone else for their hallowed advice. Our failure has been preordained.

Difficulty arises when you attempt to disassociate yourself from a culture, an industry which everyone seems to be a part of. I made the false assumption that returning to the Real World (read: outside of hospitals and waiting rooms) would mean severing my connections from that part of my life. Reintegrating into what I thought to be the Real World made me realise my history, my past exists in every single person I meet – albeit in diluted forms. Parities of failing to attain the ideal vs. the expected exist and manifest in so many different ways. Yet still, I begrudgingly eat, remorseful for every morsel as I hear people talking about their diets, their weight loss. Of course, I’m aware not everyone develops a life-threatening eating disorder, but I am mindful. Mindful of how much emphasis and value, often moral value, we place on the very act that sustains us, our being.

I find it hard not to associate abstinence with peace and a twisted type of pleasure. Eating disorders exist because they serve a function, they fill a void, they address a need. I cannot say that this illness did not do anything for me, because that would be a lie. But I can tell you that these are the words of a psyche still under siege. I am however acutely aware relapsing will eventually kill me, so I maintain this functional state of being. Eating enough to survive, not quite enough to live. It is not ideal; it is not where I want to be. I hold out for hope that I will be able to make further progress, and get to a better mental state of being.

I will be happy when we begin to invest less money on the diet industry and more money into mental health. I will be happy when there are more options for psychiatric treatment than there are for weight-loss aids. I will be happy when eating disorder rates stop exponentiating. I will be happy when the guilt stops. I will be happy when our collective death-drive either loses its allure or succeeds. The only thing some people gain from this war is an indent of their broken bodies in a hospital bed. Some day, that is all that will be left.

Not every body is the same but every body is an efficient machine that requires and deserves help and health. A well-intentioned diet can easily become disordered. If you plan on altering your diet, do not take it in your own hands but consult with a qualified dietician or doctor. If you are concerned that you or someone else has an eating disorder, do not hesitate to get help. There is a solution out there, but early intervention and continued stable support is key. As hard as it may be to unconditionally love yourself or your body, understand your inherent worth and learn to protect it.

Shaista

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For more information and sources of support:

 Mind

B-eat

Eating Disorder Support Service

Men Get Eating Disorders Too

Mental Health Foundation

 

 

 

 

 

Hilmar Sigurðsson – ADHD and Medication – What About Exercise?

There is a growing concern among professionals in regards to increased use of ADHD prescription drugs. In this case I will not discuss the recreational use of such stimulants, rather discuss the increase rate of prescription for children and adolescents diagnosed with Attention-deficit hyperactivity disorder (ADHD).

ADHD is a neurodevelopmental disorder, characterized by deficits in attention, hyperactivity and/or impulsiveness that is not age appropriate. In May 2011 a journal article was published in Acta Psychiatrica Scandinavica entitled: The use of ADHD drugs in the Nordic countries: a population-based comparison study. In this specific article the authors demonstrated that Iceland (my home country) had five-fold higher prevalence rate of medication prescription for ADHD per 1000 inhabitants compared to Sweden, for example. These results were consistent with recent news reports from Iceland, notifying the public of a substantial increase in medication prescription for children diagnosed with the disorder. For such a small nation, the rate of prescription is too high. Another similar study from Iceland demonstrated that approximately 8% of children between the ages of 9-12 were treated with ADHD medication. To put into perspective, a class of 25 students would include at least 2 who are prescribed ADHD medication. The stimulant treatment is also detrimental to their academic performance, in comparison with their peers. Interestingly, BBC news reported in August 2013 a similar situation in the UK. According to the Care Quality Commission between 2011 and 2012 an 11% rise had been observed in the prescription of ADHD medication. This rise is considered too steep and should be reviewed carefully by physicians. Thus, the question must be, aren’t there any other remedies?

The NHS lists, on its website, other possible forms of treatment to control ADHD symptoms. These remedies include psychoeducation, cognitive behavioural therapy and a change in diet. With all of these alternatives being more favourable than medication, the website does not recommend exercise as a possible therapy. A myriad of evidence suggests that exercise is quite powerful in controlling ADHD symptoms. Several scientists propose that physical exercise could be an effective treatment for the paediatric ADHD population. In particular, two recent studies showed that a moderate-to-vigorous exercise programs resulted in improvements in motor performance, social and behavioural functioning, information processing and response inhibition (Smith, et al. 2011; Verret, et al. 2012).

Moreover, the studies reported improvement in behaviours of interruption and unintentional aggression, results that can be traced back to improvement in response inhibition. Physical exercise has also been shown to reduce stress, negative affect, anxiety and depression, as well as self-destructive behaviour (Archer and Kostrzewa, 2012). Despite few study limitations such as small sample sizes and short study duration, these results should be of interest since most participants had been treated with high doses of stimulants from a young age. Similar results have also been reported in other neurodevelopmental disorders where a high aerobic exercise resulted in a significant decrease in reaction times on cognitive tasks.

Lastly, looking at the most decorated Olympian of all time the effect of exercise minimizing symptoms of ADHD can be seen. Michael Phelps was diagnosed with ADHD at the age of 9. According to his mother, Michael suffered from a lack of concentration that affected his performance in school severely. Being physically active helped Michael to overcome his symptoms and quit taking medication.

Despite further research needed on the effect of exercise, it would be interesting to see exercise being recommended by physicians as a form of treatment of children and adolescents with ADHD.

Hilmar Sigurðsson (lpxhps@nottingham.ac.uk)
PhD Student, School of Psychology

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References

Archer,
T.
 & Kostrzewa, 
R.
M.
(2012).
Physical
 exercise
 alleviates
 ADHD 
symptoms:
 Regional
 deficits
 and
 developmental 
trajectory.
 Neurotoxicity 
research,
 21, 
195‐ 209.

Smith, A. L., Hoza, B., Linnea, K., Mcquade, J. D., Tomb, M., Vaughn, A. J., et al. (2011). Pilot physical activity intervention reduces severity of ADHD symptoms in young children. Journal of attention disorders, 1-13.

Verret, C., Guay, M-C., Berthiaume, C., Gardiner, P., & Beliveau, L. (2012). A physical activity program improves behavior and cognitive functions in children with ADHD: An exploratory study. Journal of attention disorders, 16, 71-80.

 

 

 

 

Anne Goodwin -From Clinical and Academic Writing to Fiction

In March 2003 I attended an event on novelists in conversation with psychologists for trainees and supervisors from the Leicester University DClinPSy training course in which the writers AS Byatt, Nick Hornby and Pat Barker were interviewed by psychologists Steven Frosch, Simon Thomas and Caroline Garland about their work. I was keen to attend, not only as a reader, but because I had just reduced my working hours as a clinical psychologist to four days a week in order to make time for the writing that had been an interest since childhood. With four degree theses/dissertations under my belt, and a clutch of papers in academic journals, I knew how to write for publication and thought it wouldn’t be long before I too could call myself a novelist. As it turned out, although I did manage to publish several short stories in the meantime, it was another twelve years or so before the launch of my first novel.

So what went wrong? Well, nothing really, except that it takes an exceedingly long time to learn to write fiction, even for those experienced in other types of writing. I’d like to share my reflections on the similarities and differences between clinical/academic writing and fiction, some of which will also apply to creative non-fiction.

Structure

The classical structure of the experimental report works extremely well for all kinds of academic writing, but is of little help when it comes to writing a novel. While quest novels follow the eight-point arc familiar to us from fairy tales, the writer of literary fiction as to create a fresh structure for each project. This was the area I found most difficult in writing my novel, partly because the story has a secret at its heart. I eventually found my structure for Sugar and Snails, by starting at a crisis point and moving and forth in time with the secret revealed around midway.

Subjectivity

Although, with the increasing recognition of qualitative research methods, this is changing, academic writing has traditionally favoured an objective stance. Clinical report writing is a little more subjective, yet still concealing the individual behind the professional stance. With creative writing mostly about character, subjectivity is of prime importance. Yet, as with structure, the writer needs to play around with different possibilities . Which character is best placed to tell the story? Do we need one or several points of view? How close to zoom in on how that character thinks and feels?

Readers are often curious about how much of the writer’s own personality and experience has gone into their characters. I’m also fascinated by the question of what makes some writers turn to fiction and others to memoir. But I don’t think clinicians and academics are immune from putting themselves into their work. The motivation may be unconscious, but I think we’re drawn to fields that reflect something about our inner worlds.

Research

Whenever anyone asks me about the research I undertook for my novel, my mind flips first to the randomised controlled trial to which I was first introduced as an undergraduate. But, of course, that’s not what they mean. What passes for research in the creative writing world is the fact-finding that would constitute the literature review for the scientist, although novelists can be just as scrupulous as academics in reading around their subject.

Sometimes, that subject is the research endeavour itself, exploring the experience and ethics of the academic life. Although it wasn’t my original intention, the narrator of my novel is an academic psychologist who revisits her PhD research twenty years on.

Evidence

While clinicians are guided by both evidence and professional standards, novelists are free to make things up as they go along. Yet, although unlikely to construe it as evidence, fiction writers need nevertheless to demonstrate the events and emotions that constitute their story. It’s not sufficient to write “this happened and then that happened” or “she felt this and then she felt that”, but the skilled writer must show these events and emotions through dialogue, description, metaphor etc that enables readers to experience the story as if it were unfolding before their eyes.

Economy and precision

I once submitted a 7000 word paper to a journal that had a 5000 word limit on articles, and was a little put out that they asked me to cut and resubmit! Now I write 99-stories and was delighted that, in conjunction with my editor, I was able to cut 10,000 words from my novel before sending it out into the world.

Similarly, although I used to pride myself on the standard of my writing, my knowledge of grammar and punctuation has definitely improved since I turned to fiction. When writing is your main job, there’s an extra expectation to do it well. We are the people who obsess about the placement of commas and are offended by the aisles in the supermarket for “ten items or less”. (Of course, I’ve left myself wide open to criticism if you come across errors in this post.)

Publication and peer review

To be published in an academic journal, a paper is subjected to peer review. The parallel within creative writing occurs at different points in the process, with the actual editing undertaken in-house by a small number of editors. Long before this stage, most writers will have received feedback on previous drafts from a small group of trusted readers. Post-publication reviews are crucial, with book bloggers becoming increasingly influential in spreading the word.

Emotional depth

Like mental health workers, writers of literary fiction need to be highly emotionally literate as it’s through this depth of emotion that the story unfolds. Alongside my background in clinical psychology, I’ve found my psychoanalytic studies extremely useful preparation for drawing my own emotional experience on my writing. A degree of vulnerability, that can be awkward at times as a mental health practitioner, can be a source of strength when it comes to composing engage in fiction.

Standing on each other’s shoulders

Like academics, fiction writers do not develop their ideas in a vacuum, but draw on the work of others. Because this occurs in a diffuse manner, it can be more difficult to map this debt in creative writing than in academia, although the acknowledgements page is one way in which novelists attempt to do so. However, plagiarism is frowned upon as much in the world of fiction as it is in academia.

What similarities and differences have you observed between clinical/academic and creative writing?

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Anne Goodwin is a former clinical psychologist at Nottinghamshire Healthcare NHS Trust. She will be discussing and reading from her debut novel, Sugar and Snails, which explores issues of mental health and self-esteem, at Five Leaves Bookshop on 17 February 2016.

Connect with Anne via on her website: annethology or on Twitter @Annecdotist.