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Tom Wooldridge, "Eating Disorders: A Contemporary Introduction" (Routledge, 2022)
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Welcome to the New Books Network.
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Hello, this is Helena Wiesing, a host on the New Books Network. Today I'm talking with Tom Wooldridge about his book Eating Disorders A Contemporary Introduction, published with Routledge. Welcome to the show, Tom.
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B
Thank you so much for inviting me.
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So I want to open us with our traditional opening question we always ask on this show. So to the extent that we can know our motivations, what motivated you to write this book?
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B
Yeah, I think there are both personal and professional reasons. Personally I, I was an athlete growing up and so was sensitized to issues around body body image fitness from a very young age. And so, you know, there were certainly those dynamics in my own personal life that, that sensitized me to these issues. I think also there's a kind of unfolding of my clinical work over the past, you know, more than a decade now. Some of my earliest patients were young people suffering from eating disorders and so that really sensitized me to the intensity and depth of that struggle. At that time I was exposed to some of the more symptom focused, manualized responses to eating disorders and while I found them helpful certainly for helping restore weight in a short term way, I found again and again that they didn't really get to the deeper dynamics at play. And, you know, I saw some patients relapse, I saw some patients restore weight, but then continue to struggle with the same characterological issues that were implicated in the eating disorder in the first place. And that coincided with my own growing interest in psychodynamic and psychoanalytic treatments and psychoanalytic thinking. And so it just organically unfolded as a kind of intersection of the two. And I've really been trying to sort of build that out since in a series of articles, some of which are in this book.
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Yes. And maybe did you want to mention a bit about how this book is part of a series from Routledge and you were invited to write it?
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B
Yeah. This is part of the New Introductions to Contemporary Psychoanalysis series that's continuing to grow. And they have books, I think, on a range of thinkers and different topics. And they approached me about writing specifically around eating disorders. And so, you know, what I tried to do in the book is bring together some of my writing to illustrate the core idea. And the core idea is that with eating disorders, it's really important to think about what used to be called structural diagnosis, to really think about the kind of underlying way that the person is put together and how that drives the symptomatology, as opposed to a purely descriptive or symptom focused way of formulating the person. And the idea, of course, is that with that structural diagnosis in hand, you can really address the whole complexity of the person in treatment with the hope that their path towards recovery will be more complete or more sustainable.
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Yes. And I was very impressed with how this is like an introduction book. And it's not a very length or big book, but there's so much in it. It's very dense in that way. And you cover so much of. Also sort of general topics like attachment, affect, regulation, and all of these things. You cover so much of that, but then kind of, you tie it in really with the topic of eating disorder, also a topic. You make very clear it's not a monolith. It's a very diverse group of clients. And you just, you really clarify how there are those things that they have in common, but also how they're very different. So I was really impressed with that. I don't know if you wanted to speak a bit about how this is a very heterogeneous. Heterogeneous group of clients.
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Yeah, I think that's exactly right. Certainly, you know, between the different eating disorders, there could be quite pronounced differences. But even within the same group, say the group of people with anorexia, there can be quite different, you could say character structures or personality styles. So just as an example, there's some research done with the Schedler Weston assessment protocol looking at the personality types of people with anorexia. And in some of that research, different configurations have emerged and I think it matches clinical experience pretty closely. Just for example, you might meet a person with anorexia that's very high functioning, perfectionistic, obsessional. You know, the typical, you know, college student that's getting straight A's, has two part time jobs, you know, and is just driven, Very, very driven. That's a, that's a common, I guess you could say, prototype that I've encountered in my clinical practice. But then there's also the anorexic person that is much more under controlled, underregulated, you know, more consistent with maybe what in the DSM would be thought of as borderline personality disorder. You know, struggling to perform at school, you know, struggling to hold down a job, this kind of thing, maybe more overt, explicit history of trauma. So a different kind of prototype emerges, but both would have the same diagnosis of anorexia. And of course the treatment implications of that underlying character structure are quite profound. You know, what's needed for one person is not necessary necessarily what's needed for the other.
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Yeah, and I think it's exactly these differences where you demonstrate how important it is to draw on psychoanalytic thinking, because this is like exactly where the purely behavioral symptom, focused approaches will not go into the depths and the layers of all of these things where you draw on a range of psychoanalytic theories and also kind of the adjacent things like ethic or regulation theory and things like that. I want to actually jump into one topic here that is really very difficult. And I'm curious to hear your experiences because you write in your introduction that from that psychoanalytic point of view, full recovery of an eating disorder is tantamount to the growth and development of the personality. So of course we understand healing as a developmental process. That's really the gift of the psychoanalytic way of thinking. And as a clinician myself, I often think about what the really difficult challenge with eating disorders and disordered eating is that you're working with the individual often, but you're also working relationally and with the family system. And you have lots of really great vignettes and examples where you describe and demonstrate all the super complex relational dynamics that are like at the center of eating, disordered and disordered eating. So I'm thinking about how to, what's your experience of what working in that realm. Because, you know, there are times when an individual might heal, but the family is not able to heal or willing to. So I'd love to hear kind of your. Your thoughts on that, because a psychoanalytic approach to this is. Will inevitably bring up the family.
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B
Yeah, yeah, yeah. I think there's a lot to say there. The first thought that comes to me is more general, which is to say that in some of my other writing, I've really tried to emphasize the importance of a treatment team approach. And so I'm in. I'm in no way here to say that I think that a psychoanalytic approach is sufficient for most people, especially when they're still kind of actively symptomatic. I really do think that you need a treatment team that includes a physician, a nutritionist, a psychiatrist or family therapist, et cetera, et cetera, depending on the individual case. So, you know, in no way do I think a purely psychodynamic treatment is going to be sufficient for many patients. I agree with what you're saying, which is that I think when you start to work with people psychoanalytically, you very quickly unearth histories of, you know, family dynamics, family trauma histories that are implicated in some way in the symptom that's showing up now. And how to handle that in a given treatment, I think is really complicated. When someone is, for example, a minor and still dependent and interwoven in the family system in a way that they may be less so in five or 10 years, you know, the sensitivity is even more required. In my experience. You know, some people do make a full recovery in the sense. Not only in the sense that, say, they're recovering, um, you know, they. They achieve a healthy body weight and, you know, the symptoms disappear. But that the kind of underlying tendencies that. That drove the eating disorder in the first place are. Are really significantly ameliorated. But you can't always say ahead of time what's possible for any individual. You know, we see this, I think, not just with eating disorders, but across the board. When people have experiences, especially at a very young age, the degree to which they can be fully left behind or largely left behind is unclear until treatment unfolds. I think it's even more complicated, as you were sort of gesturing at when somebody is a minor and still living in a family. And if, say, the parents are not willing to do the work of attunement and reflection, what's possible then? I think there is wisdom in some of these situations. And some of the more symptom focused treatments. So, you know, for example, the prevailing wisdom is that for adolescents with anorexia, the first line treatment is family based therapy to promote weight restoration. And the research does seem to indicate that the sooner you can restore weight, the better the prognosis. And I think there's, there's wisdom in that, but then there's also the reality that, you know, some families are not in a place to do that kind of work. The pathology and the. In the family undermines that kind of work. So it is a very complicated system that requires a lot of thought and reflection.
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Yeah. And from a psychoanalytic way of thinking, we also know that there's so much of this that are happening on the unconscious level. And of course, because if this was all conscious, I mean, the parents would not want their child to suffer in this way. And if they were able to change it, they certainly would. These are really deeply unconscious dynamics. And I just want to make a note, to be fair, that you, in your book, you make it clear that this is not a book that accounts for all the big kind of sociological, historical, cultural aspects that are also relevant to the topic. I mean, you are focusing on the clinical treatment in that way and there's a whole range of scholarship on that out there. But I think about it because I'm also thinking about, I work a lot with parents of like, there's enormous pressure on parents today. I mean, I don't think we've ever had so much pressure on parents to be perfect parents and to produce perfect children without issues. And there's a lot of shame and stigma. So I wonder how you see that come up. And if you've had experiences of kind of like, like working with parents to kind of shift that stigma and, and kind of destigmatize and, and show how that, you know, when there's a, their child is suffering, it's, it's often also because there's the suffering happening for the, for the parents. I mean, we, we also know about intergenerational trauma, which certainly also plays a role.
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Area.
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Right. Of eating disorders.
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Yeah, I really appreciate that question because this is actually what has captured my attention since writing this book is, you know, what are the ways that we can work with parents most effectively? So I think, you know, in the 60s and 70s, when, say, Hilda Brook is writing, you know, her contributions, in my view, are enormous and important. But I also think that this is a place where the field got off track. We really started to emphasize simplistic explanations that had the unfortunate downside. I Think of really stigmatizing and alienating families and parents in particular. And of course, parents are an incredible resource for the treatment of adolescents, a necessary resource for the treatment of adolescents. And so we, we want to be kind of careful. And I think just psychodynamic writing in general has this kind of failure mode in it. Eating disorders are kind of a perfect storm of causes and conditions that come together cultural, as you mentioned, you know, also genetic, biological, you know, factors are absolutely at play. I mean, as my understanding is, for example, with anorexia, some of the twin studies show at least 50% of a vulnerability is genetic. So there's a huge, you know, kind of temperamental component into who goes down that path versus some other path that has to be acknowledged. But I don't think we do anybody any favors in avoiding or bypassing the psychodynamic components. You know, we all come into parenthood with our own histories, our own, you know, complex dynamics, attachment styles, traumas. And those things are transmitted even if unwittingly. You know, it's very rare that you meet a parent who has conscious malice towards their child, but nonetheless, you know, the effect is there. And so parents, I think, really need help developing the capacity for emotional attunement, the capacity to reflect on their own states of mind, their child states of mind. They need help moving through and out of self, blame, through grief, so that they can really be, you know, present for the experience that's happening in the family now. I think that's the really difficult emotional work that's necessary. And it's a hard conversation to have because you don't want to fall into, on the one hand, stigma and blame, and you also don't want to fall into kind of denial. On the other hand, on top of.
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Yeah, this is exactly that balance there that you're talking about that makes this work so complex. But I, and I appreciate how you say that there was a time maybe where it got a bit too simplistic and, and there was a lot of that, like too much blaming or stigma and then, but I wonder if you think that maybe it, then there was a kind of a counter move that, you know, to the other extreme, what, which we see in kind of like behavioral psychiatrics with like the so called agnostic position where it's almost like parents coming in and they're told that their child's eating disorder is like kind of out of nowhere and they have nothing to do with that, as if it was like some kind of virus from outer space coming in. And that also seems a bit extreme to me. So I wonder what your experience has been also with that extreme in your clinical work.
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Yeah, I completely agree with what you're saying there. I think there has been a swing to the other end of the continuum because there's a good intent to not pathologize and stigmatize families. You know, I think that's the, the aim there is to foster treatment engagement. And you know, it is certainly true that at the beginning of a treatment with any particular person or any particular family, one would want to be more or less agnostic about what's going on, but you wouldn't want to foreclose the kind of unfolding of understanding that can occur as you start to, you know, analytically look at what's going on for a person and a family. You wouldn't want to, you know, kind of collude with a lack of reflective function. You know, as, as people start to explore their inner worlds, they start to see things that have to be emotionally reckoned with. And I think we're trying to strike that balance.
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Yeah, and, and I think this also touches on why this work you're, you're doing here about eating disorders, even though they are very Particular situations, they really touch on so much that is very, I was about to say universal, daring to use that word of like, how, what is, what are relationships? And also on a bodily level, there's one quote from one of your chapters, chapter seven, which is a really great chapter on where you connect the, you know, kind of the, our, the foundation of affect regulation theory and body image as it relates to eating disorders. And you say that body image may vary, our self states vary with each cell state bringing to the foreground relational identifications that in turn shape the way that the body is experienced. And I really love this quote because it, it captures something that is very relevant for eating disorders, but is also, also capt about all human relational experience, about how this thing we call body image or our experiences of our bodies cannot be separated from the relational contexts. And I find it interesting that this is something that I think for many is very evident. And we have enormous amount of research from different paradigms to confirm this. And yet there's something sometimes in, in our culture, and certainly if people are, are impacted by, you know, trauma or other forms of like, or maybe denial, dissociation, there's something about this very clear fact of life that there's sometimes this kind of denial, like this denial that, yeah, the way that a child will grow up and develop a sense of their bodily self is directly related to their relationships, their, in their early attachment relationships. And I, I, I wonder how you, how you see that and how you might, maybe you also, some of your work, you've experienced that. There's a lot of psycho education we have to do around this.
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Yeah, yeah, yeah. I mean, I think that with regard to body image, I think a lot of the prevailing explanations of body image attribute negative body image to cultural factors which for sure play a role. I mean, a huge role. I think there's no question about that. There's lots of research that looks at Western and non Western cultures and the introduction of media to non Western cultures and the impact of that on body image. And I think that really is unquestionable. I think it's harder to look at the way that, you know, familial relationships affect body image because again, this specter of blame and stigma, you know, shows up. But clinically, you know, I think we, we see it all the time. Not just that, you know, parents affect the body images of their children or whatever, but, but even in the room with us in a session, a person can come in and can feel really good about their body and then they can come back the next day and have an experience that's the polar opposite. You know, what changed? Well, what changed is something about their emotional state. You know, maybe that they gained a pound or two and they saw that on the scale. But then what internally did that activate for them? What kind of, you know, kind of internal punitive objects started to attack them or, you know, how are they imagining, you know, my gaze casting them, you know, these, these kinds of things also have a profound impact of how patients experience their bodies and also how we as therapists experience our bodies in relation to patients. It's very fluid and can, you know, change quite a bit from moment to moment.
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Yeah, and I'm thinking of what you're saying there, of when there are things there that might be. There's a lot. If there are family systems where there's a lot of like, denial around it. I'm also thinking about the whole topic of like, with, with abuse and, and trauma, where, you know, betrayal, trauma is, is part of that. Where it's like it becomes the, the. The biggest crime is to speak to that which must not be spoken about in the family, where the, the. The child or the minor kind of carries. Carries that. And then the symptom is. Becomes dangerous because the symptom is kind of pointing to something that is a deeper kind of trauma history of the whole family also on that intergenerational level.
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Yeah, I think that's a really important framing. I think what you're pointing to, I don't write about this so explicitly in my book, but I do think it's very important is the dynamics of power in families and how those dynamics can foreclose certain ways of thinking and feeling and understanding. And I think that is very, very important. You know, you think about so many patients come to treatment with some glimmer of knowledge of what happened that led them to this point. But there can be huge resistances to looking at it because of, you know, feelings of loyalty or attachment to, you know, caretakers. Completely understandably. So, you know, very. Yeah, go ahead.
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Yeah. And you also describe how, like, you really demonstrate how we need to understand the symptomology as survival, as adaptation, as coping, and even if it seems so counterintuitive and one of the concepts you have, like several concepts to describe all these different varied manifestations of eating disorders. One of them is that the concept of the entropy body. I wonder if you could speak a bit to that concept. I thought it was a very powerful concept to explain some of this very, very difficult symptomology that we see. For example, in, in anorexia, but also other eating disorders.
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Yeah, yeah, yeah. So the overarching idea there is the idea of body states, which is an idea that was developed by Jean Petrocelli in New York. And it's, you know, we have this idea in relational psychoanalysis of self states. And so she took that idea and extended it to the idea of, of body states. We can have these different states that our bodies can be in, and those states come to serve certain emotional or psychological functions. So, you know, two examples would be the state of physiological starvation and anorexia. Or you know, you could look at something like say, muscle dysmorphia, which used to be called reverse anorexia, where a person becomes increasingly kind of lean and muscular. That's a very different kind of bodily state. So the entropic body was a way of thinking about that state of starvation. And what, what psychological functions does it come to serve for a person? You know, there, there are several. The most kind of concrete is anxiety reduction. So in the paper that I wrote on the entropic body, I have a whole kind of exploration of one particular case and the kinds of anxieties that this woman suffered. I don't necessarily think that that developmental pathway would have to happen for every person with anorexia, but it's one example. But it left her contending with just incredible annihilating experiences of anxiety. And you know, for her, starvation was a way of achieving a state of calm. It could mute the intensity of affect for her. And, and the important piece is that it, it came to be a kind of stand in for a reliable, attuned other who could help her through co regulation. Right? So instead of allowing herself to depend on another person, she found a kind of omnipotent way of regulating herself through starvation. And so then of course, you know, in an analysis or an analytic treatment, that plays out in the transference, you know, what is the meaning of being with you, the therapist, and contending with the possibility of dependence versus this starvation that also can provide a kind of relief and that I have complete control over.
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A
And what can be really hard is that in the kind of the clinical presentation, this can seem so harsh. And so there's a lot of like you describe the dissociation and how hard it is with those states where there's so much dissociation. And I wonder if you could speak a bit to what you've discovered in this work, because this is something that when you read it, it's like this is also intense work for the clinician. Like the transferential field becomes really intense to navigate. And I wonder how's that been for you and what you discovered in that work?
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Yeah, yeah. I think it is extremely difficult work, you know, for somebody like in the entropic body paper, the, the composite patient, I called her Sarah. You know, for, for a patient like Sarah, the thing that you usually encounter first is a kind of seeming indifference to connection. So, you know, the person is kind of behind a wall, unreachable. There's not much of a feeling of them needing you or wanting to rely on you or even looking for much help some of the time. And it's not always possible in my experience, you know, at least in any individual dyad, to move past that point. You know, not all treatments do, but, but at times it is, at times it is, I think, possible to locate the part of the patient that does feel, you know, need and dependency and a kind of longing to rely on another person. And if you're able to make it to that territory, then I think, you know, it can become quite intense because human relationships are not, you know, completely under the patient's omnipotent control. You know, the therapist gets sick or takes vacations or, you know, is misattuned at times. And with Sarah, at least, you know, those moments of misattunement could be, you know, quite, quite impactful. You know, she could be left feeling, you know, wounded or hurt or scared. She could then, you know, retreat back into this omnipotent system of the entropic body. And so, you know, there can be such a feeling of, of having so much on the line, you know, in those moments. I mean, it is a kind of reliving, I think, of an earlier, you know, kind of childhood experience for that patient.
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Yeah. And as I read it, I could also sense that. I don't know if you said it directly, but like there, there is, it seems like there's such a need for the clinician to be willing to get very vulnerable and to be willing to be impacted by the client in a deep way, to really feel into just how intense these states of dissociation are. What are some of the things, like some of the key factors like that you remind yourself, or do you rely on there, is that the concepts or is it other kinds of practices? What are some things that you rely on there as a clinician? I asked this because I think this is what all of us as clinicians are always wanting to hear about those experienced clinicians. What do you rely on when things get really difficult in the room?
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B
Yeah, well, it's an, it's an interesting question. And I don't want to in any way hold myself out as somebody that, you know, can, can do this successfully all the time or, you know, we, we write these papers and at least this paper was a, you know, it was a kind of success story. But not all stories that I could tell are success stories. Right. Sometimes you can reach another person, sometimes you can't. The hope is that maybe somebody else could, or at another time that person would be reachable. I mean, some of the people that come in with say, severe anorexia are very, very walled off. But, you know, I think for me, consultation has certainly been huge. You know, that you need another person. Especially, especially with something like anorexia, where it can really feel that, you know, the other person's physical well being is on the line. And that can be just, you know, just terrifying. Consultation can be really, really important. Somebody to help shore up the containing function of the therap, you know, really, really valuable. And then I think you have to find ways to stay in touch with your own vulnerability. Not in an indulgent way, certainly not in a way that makes the treatment about you or involves any kind of disclosure necessarily, but much more about staying kind of soft and receptive in yourself and knowing that inevitably you're going to lose touch with that, you know, your own, you know, defenses, however subtle, are going to come online. And how do you refine to that, you know, again and again and again? I think that, you know, enactment is of. Of one kind or another is almost inevitable. Susan Sands has a lovely paper on enactment and the treatment of eating disorders, and she talks about the therapist's kind of oscillation between worry and neglect. So, you know, sometimes you're so preoccupied with, you know, is. Is. Is the patient, okay, you know, what about their vitals? Where's their weight? You know, when can I talk to the doctor again? You know, oh, my God, I'm so worried they're going to end up in the hospital. And then at other times, you know, you find yourself getting kind of lost for days or even weeks in the kind of moment to moment exploration and analysis. And then you kind of wake up and remember, oh, they have a body. And so you can move back and forth between these two states. And, you know, the idea is, of course, that it reflects an underlying division within the patient as well. That kind of enactment, I think, is almost. At least in my experience, it's almost inevitable.
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Yes. Yeah. And as you're describing that, I'm also thinking that, you know, those things that it requires to work with the clients here and to do this work that we are kind of living in a culture that. Where we're being bombarded with messages to not practice any of those things, you know, that, that, that. That's also the cultural context that therapists are operating in, that we are also living in this culture of, like, this idea that, you know, you're supposed to just be all on top of things and that, you know, bodily issues is something you should just, you know, overcome. Whether, you know, whether that's through some kind of, like, magic love yourself or magic quick fix, nervous system regulation, right? You should be able to just fix it, right, like, magically without any of that, like, acknowledgement of, like all the deep work of. Of working through and grief and mourning and all that, to actually get to a place of feeling healed. Right. There's this bypassing. I feel like we are just. There's so many messages, or rather the lack of messages, this assumption that you're supposed to somehow just figure it all out and be good in your body and feel great if you just follow a good kind of regime of whatever, self optimization. So it's just interesting to hear you describe this, that it's almost like these things that you have to practice as a clinician working here. It's things that you are not really being supported in to cultivate from the general culture, except if you can seek it out through consultation. Consultation, yeah, yeah.
- [39:31]
B
I think your, your point about the kind of larger culture is, is an important one. You know, we, you know, eating disorders surely have something to do with dependency and the difficulty of dependency. I mean, you know, I think that's, that's somewhere in the picture, however we conceive it. And they tend to involve a kind of, you know, consolidation of an internal experience of being in control. You know, at least some of the eating disorders do for sure. Something like, you know, disorders that involve purging, you know, can have very much a kind of out of control aspect to them. But there is that kind of dialectic of control and out of control that I think is central to most eating disorders. And we live in a culture that really prioritizes self control, whether it's in relation to the body or dieting or exercising or like you said, you know, nervous system regulation or the new kind of science around longevity. And, you know, how are you going to live as long as possible? You know, control is highly, highly valued in our culture. That is true.
- [40:37]
A
Yeah. And then, you know, your book also there's this through line of the relationality of the body that in a way also really speaks to this because this is also kind of on a very existential level. Our big issues is that we are not in control because we're not isolated entities and we never will be. And our bodily functions are so tied into our dependency and entanglement with others. So it almost seems like when you're treating eating disorders, I mean, you're of course treating the relational, bodily entanglement issues of humans that can get very, very complex. But it also seems like sometimes with eating disorders there's this like enormous focus on the food and the concrete level and the very objective truth. So, for example, body size. You also mentioned that with, in a couple of your vignettes about how there's this enormous work to help the person, the client shift into seeing that it was not about the objective fact about what you look like, it was about the experience you had of your body in that particular context, the relational context. And I imagine that that's a very hard shift to get to. And maybe it's not possible for all clients to get there.
- [42:12]
B
Yeah, yeah. Because that's the space in which you have traction. You're born with a body, it can be modified to some degree. Everybody modifies their body to some degree, even if just through cosmetics and clothes. It's not that modifying the body is wrong, but in, in analytic therapy, the place that we hope to get traction is, you know, a kind of understanding of the dynamic factors that shape our experience of the body and how we relate to it. A lot of what I've looked at is this idea of alexithymia and how so many people come into treatment. People with eating disorders come into treatment, you know, with very concrete thinking, with thinking that, you know, has very little access to the kind of symbolic and the, you know, image based, symbol based kind of registers of experience. You know, my body is, is fat. There's nothing else to say about it. You know, it's fat, period. And part of what we want to help people do is kind of expand that, you know, more and more. What does fat mean to you? How has it come to mean that to you throughout your kind of history and through your development and, you know, as part of the culture in which you're situated? The idea is that, you know, the more and more we can help people express themselves in those symbolic registers, the more they'll be able to kind of reflect on their own states of mind, you know, express their affect in non concrete ways. There's a kind of, you know, growth of the psyche, I guess you could say that is, I think, part of the healing process for most people.
- [43:55]
A
Yes, and I know I said that of course your book is not an attempt to account for all of the bigger cultural factors, but you actually have a chapter that in a way touches on this because you have a chapter on online forums. And I don't know if maybe also this is a way you've seen things change in the course of your career and the time that you've been specializing in this. So I'd love to hear you talk a bit about that. And how have digital spaces impacted this and also shifted the way we think about eating disorders from a psychoanalytic perspective. What are some of the findings that came from your exploration of that?
- [44:42]
B
Yeah, so that chapter was based on a paper that was written back in, gosh, 2011, 2012. So, you know, quite a, quite a while ago. And it was looking at this phenomenon of pro anorexia web forums and websites. And so these, these are sites that, you know, at least at that time, brought people together who were either agnostic about or even supportive of the anorexic identity. So it was really meant to be a space that was, you know, free from stigma and, or even encouraged people in how to better pursue their anorexia. So there's a kind of continuum of sites. They're not a kind of monolithic thing. And so it was a, it was an actual qualitative analysis of people's participation in those sites. So, you know, an analysis of actual text drawn from many of those different sites to look for recurring themes. And, you know, a lot of what we saw was what you'd expect. People, you know, giving tips around dieting, you know, ways to kind of hide anorexia from people in your life. The interesting finding was that we also found moments of seeming real connection and support, even support for recovery. So, you know, there were moments where, you know, people made connections that even led to them, you know, pursuing treatment. So, you know, part of, part of what I guess I'd say, looking back at that article, is that those sites are not one thing. You know, there are many, many different kinds of pro anorexia sites. Some are more toxic than others. They're highly utilized by, you know, teenagers that come into treatment. Since writing it, I've heard from a number of people outside the field who read the article and, you know, it really resonated with them. I've even heard from a few who went on to get treatment because of the support they received in a forum like that, which is, you know, really meaningful. I do think, like you said, this is a space that has really evolved and changed. And looking back, I wonder if that article strikes too optimistic of a tone. I think that there is a way that social media has become more image based and less textual and so there's even less of an opportunity for some kind of connection to happen. And I really question, you know, what I mean. I haven't gone back and done an in depth analysis, but I really question to what degree those benefits are derived for any particular person. These days. The prevailing treatment wisdom is if somebody comes in for treatment and they're using those forums, especially if they're an adolescent, they should be taken away. And I'm not taking a position about that or not, but the reality in my clinical practice has been sometimes there's, you don't have that power. You know, sometimes people come in and they are using them, you know, secretively. Their, you know, parents aren't going to set that boundary or even if they are, the child will subvert it. So what I was trying to do was to take a, you know, a psychoanalytic perspective. What is this phenomena? How do we understand it independent of the question of how do we intervene in clinical practice around it?
- [47:56]
A
Yeah, I can imagine. Also, it's been. It's become extra complicated in the post Covid era where it's not so much the. The online presence of. Of young, young people today, but it's that it. It has taken a lot of place of inst. Of the in person interactions.
- [48:17]
B
That's right.
- [48:18]
A
That has made all of this very complex and also hard to. To research. But it was also a really, really fascinating chapter where you bring this up as a very important thing to reflect on for clinicians. So, Tom, I don't want to take much more of your time. It's been a pleasure. But I'd love to end it by asking you about any other projects you're working on, whether in this realm of eating disorder treatment or other areas, any other writing projects or projects that you want to share about.
- [48:56]
B
Sure, yeah. Thank you for asking. I have a couple of things in the pipeline. One is a paper that's on the dynamics of control in eating disorders. So the feeling of being in control, the experience of the need to be in control and really trying to look at and sort of theorize that idea. Hopefully that'll be coming out sometime next year. And then I've also written a book which is unlike anything I've ever done before. It's a book for parents of people with eating disorders. And it really takes a very different approach than any other book I've seen out there. So it's not a book about, you know, how do you find the right treatment for your child? What are the different treatments, you know, how do you manage meal times? It's not that kind of book because those books already exist. You know, there are several excellent books out there that really take that up. This is a book that's about the emotional work that parents need to do. So how do you reflect on your experience, your own states of mind as you engage with your child? How do you address your own grief and try to move through it? What are some of the practices that you can do psychological, somatic, to try to ground yourself in your interactions with your child? So it's really about the parent as a emotional resource for the child, as the child goes through treatment and as the family goes through treatment. So I'm really, I'm really excited about it. I've written it in a way that's very different than anything that I've written before. It's really meant to be, you know, accessible and useful, a useful experience to read in itself, a therapeutic experience to read for parents. And that should be coming out sometime next year in 2026, too.
- [50:38]
A
That sounds amazing. I look very much forward to that. That sounds like a really valuable resource. So we. We look forward to that. Thank you so much, Tom. I appreciate your time.
- [50:49]
B
Thank you.