Abstract
Treating Eating Disorders: Ethical, Legal and Personal Issues is the first in a series of studies in eating disorders (see following review). It addresses issues that go to the ‘heart’ of the reasons why there is so much controversy in eating disorders care, and why some practitioners may overtly or covertly avoid patients with these problems. Most of the book necessarily is concerned with anorexia nervosa, although some issues (e.g. therapist gender) are relevant to other patient groups. The first chapter by the editors is succinct, comprehensive and covers several major areas in some detail, including active euthanasia, relationships between families and therapists, accessibility of care for anorexia nervosa and the emotional health of therapists. They end with a thought that ‘perhaps the essential precondition for being a good therapist for these seriously ill, difficult but fascinating patients is humility’. If you were to read just one chapter of the book, this would be the one.
In Zerbe's chapter on counter-transference and transference, a particularly psychoanalytic understanding of the more treatment-resistant eating disorder patients is presented. The reader need not ascribe to the thesis presented, however, in order to benefit from the helpful advice given. It would have added to this, I think, to have included some discussion of the ‘rejection’ of anorexia nervosa patients by other clinicians, who often perceive the illness to be wilful and self-imposed. In the chapter on the therapist gender, Katzman and Waller include a dialogue between the authors and point to the importance of the patient's preference and choice rather than dogma. McVoy gives an interesting account of the growth and personal development of a therapist. There is a chapter discussing family therapists and family therapy by Lackstrom and Woodside, followed by Griffiths and Russell's chapter on compulsory treatment of anorexia nervosa that returns to the more central issues of the book. It is an excellent summary of the position, that many would concur with, that the clinician has a duty of care to patients and that compulsory treatment need not, and should not, be punitive or degrading to the patient.
Dolan's account of hunger striking in UK prisons by suffragettes early this century, and more latterly IRA detainees, is interesting. The relevance to the care of patients suffering from anorexia nervosa is, however, limited in contrast to other chapters. Rathner summarises the position against compulsory care and one could not but agree with the citation from a United States Supreme Court judgement (p.206) that ‘Our legal system cannot replace a more intimate struggle that must be borne by the patient, those caring for the patient, and those who care about the patient’. Touyz develops Griffiths and Russell's themes by describing the development of less coercive and more humane inpatient programs. The pressing need (both ethical and clinical) for more empirical research evaluating hospital treatment is highlighted.
The book closes with two chapters relating to the ethical issues around access to treatment and health care provision, from a UK (Robinson and colleague), and a US (Andersen) perspective. They both point to the decline in professionalism by the impact of ‘market forces’, or as sometimes described ‘for profit’ motivated health care. Both also evoke Hippocrates, reflecting his profound and enduring contribution to medical ethics. This is a generally well written book that, as expected, raises more issues that can be resolved. An Australasian perspective in several areas would have added relevance to Antipodean readers. Many of the issues are not, of course, specific to eating disorders, and the book would find a readership broadly in those with medicolegal, ethical or medicopolitical interests, as well those with a specialist interest in the area.