Understanding Eating Disorders: Conceptual and Ethical Issues in the Treatment of Anorexia and Bulimia Nervosa

Cover......Page 1
Acknowledgements......Page 6
Contents......Page 8
Introduction......Page 18
Paternalism......Page 20
The Value of Autonomy in Psychiatric Health Care......Page 22
Understanding Eating Disorders......Page 25
Introduction......Page 32
‘Anorexia’ and ‘Bulimia’: The Terminology......Page 35
Eating Disorders: Epidemiology and Prevalence......Page 36
The Society of the Eating-Disordered Person......Page 38
Diagnosis and Description......Page 39
Eating Disorders and Perception of Body Image......Page 40
The EVects of Abnormal Eating: Secondary Symptomatology......Page 44
Ethical issues......Page 47
Introduction......Page 50
The Ethics of Paternalism......Page 52
Autonomy......Page 53
Paternalism......Page 55
Freedom of Action and Autonomy: Two DiVerent Types of Paternalism......Page 57
Strong and Weak Paternalism......Page 58
Life and Health......Page 59
Practical Similarities between Respect for Autonomy and Protection of Welfare......Page 60
Welfare or Autonomy?......Page 61
The Value of Autonomy and Weak Paternalism......Page 70
Objections......Page 71
Conclusions......Page 73
Introduction......Page 75
‘That man committed suicide because he was mentally ill’......Page 76
‘I had to wash my hair ten times today because voices commanded me to do so’......Page 78
What do we Mean when we Say that a Person has a Mental Illness?......Page 80
The Fallacy of Psychiatric ‘Explanations’......Page 82
Conclusions......Page 86
Introduction......Page 89
Genetic and Eating Disorders......Page 91
The ‘Addiction’ Model......Page 93
Similarities between Eating Disorders and Substance-Use Disorders......Page 94
Are Eating Disorders a Form of Addiction?......Page 96
Starvation and Addiction......Page 98
Addiction to Sweet Foods: Reactive Hypoglycaemia......Page 99
The Role of Central Nervous System Neurotransmitters......Page 100
Hypothalamic Abnormalities......Page 101
Conclusions......Page 104
Introduction......Page 110
The Central Feature of Anorexia Nervosa: The Pursuit of Lightness......Page 111
The Pursuit of Lightness and Fear of Intrusions......Page 112
The Unbearable Lightness of Being: A Representation of Anorexia Nervosa......Page 114
Lightness as a Defence from the Invasions of Personal Space......Page 117
Is Lightness a Contemporary Obsession?......Page 118
Light Beauties......Page 120
The Ancient Myth of Lightness......Page 122
Slimness and Lightness in Literature and the Arts......Page 123
Lightness as a Positive State......Page 126
‘Dans l’eau de la claire fontaine’......Page 127
The Value of Lightness......Page 128
The Life and Work of Emily Dickinson: Lightness and Spirituality......Page 129
Moral Integrity and Spirituality......Page 132
Moral Integrity and Christian Asceticism: The Value of Lightness......Page 135
The Moral Value of Lightness......Page 138
Food Restriction and the Body/Mind Split......Page 139
of the......Page 143
Moral Integrity and......Page 144
The Contemporary SigniWcance of Ancient Moral Values......Page 145
Conclusions......Page 148
Introduction......Page 154
The Family of the Eating-Disordered Person......Page 156
The Father of the Anorexic Person......Page 158
The Mother of the Eating-Disordered Person......Page 159
The Family Expectations of the Future Eating-Disordered Person......Page 161
Conclusions: The EVects of these Expectations on the Future Eating- Disordered Person and the Struggle for Control......Page 162
Introduction......Page 163
Why Women?......Page 164
Factors that are Thought to be Related to the Spread of Eating Disorders......Page 165
The Role of Women in Modern Western Societies......Page 166
Contradictory Aesthetic Expectations of Women......Page 169
Eating Disorders as a Response to Familial and Societal Expectations......Page 170
Conclusions......Page 172
Victims or Persecutors? The Moral Logic at the Heart of Eating Disorders......Page 174
Why are People Made to SuVer by Others’ Inappropriate Expectations?......Page 175
What Makes People Treat Eating Behaviours as an Instrument of Power?......Page 177
Conclusions......Page 179
Introduction......Page 181
The Need for Neutrality in the Analysis of Mental Phenomena......Page 184
‘Whatever has a Beginning has also a Cause of Existence’: The Logical Fallacy Involved in the Search for the Causes of Eating Disorders......Page 186
Eating Disorders: The Role of the Person......Page 188
The Role of the Individual in the Articulation of External InXuences......Page 189
Conclusions......Page 191
Introduction......Page 196
Hospitalization and Treatment of People with Mental Disorders: Coercive Assessment and Treatment......Page 200
Can People with Mental Illness be Competent to Make Medical Decisions?......Page 202
Competence in English Law......Page 205
The Case of Anorexia Nervosa......Page 208
Eating-Disordered Patients and Competence to Refuse Treatment......Page 210
Treatment for Eating Disorders is Enforceable, Irrespective of Patients’ Competence......Page 211
Force-Feeding can be Enforced under the MHA 1983: The Cases......Page 213
Force-Feeding is Clinically Appropriate and Ethically Uncontroversial......Page 218
Force-Feeding may be Necessary to Render Other Therapies Meaningful......Page 219
Coercive Treatment is Always a Clinical Mistake......Page 220
Why is a Mental Statute Necessary?......Page 222
Conclusions......Page 225
Introduction......Page 228
Autonomy as Self-Control......Page 230
Autonomy and Information in Psychiatry......Page 233
Information and Self-Perception......Page 234
Information Relating to Food......Page 236
Eating Disorders and Beliefs......Page 238
The Cognitive Approach to Eating Disorders......Page 241
The Ethics of Paternalism towards People with Eating Disorders......Page 243
Factors that Limit the Strength of Paternalism towards the Eating-Disorders SuVerer......Page 244
Conclusions......Page 249
Introduction......Page 252
Competence......Page 255
A Paradoxical Distinction between Passive Euthanasia and Refusal of Treatment......Page 259
Refusal of ArtiWcial Feeding is not ‘on a Par’ with Refusal of Treatment in Debilitating Chronic and Terminal Illnesses......Page 262
Why Draper should have Made the Brave Claim......Page 263
Draper has not Made the Brave Claim, although She Should Have......Page 264
Why Draper has not Made the Brave Claim......Page 265
Can we Defend the Brave Claim in the Case of Anorexia Nervosa?......Page 266
Conclusions......Page 267
Conclusions: The Need for Change......Page 271
Clinical Studies......Page 282
Philosophical and Literary Studies......Page 296
Legal Studies and Cases......Page 302
Index......Page 310