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Chapter 4 |
Living With Fire |
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Jo Viljoen |
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This is a slightly edited version of Chapter 4 of Jo Vijoen's PhD thesis (2003) - Power Discourses and Afrikaans Women, completed under the academic mentorship of Profs. Christina Landman and Kobus Kruger, Department of Religious Studies, University of South Africa. If you are interested in reading more of the thesis or entering into discussions with the author, you can contact Jo Viljoen at joviljoen@mweb.co.za.
Chapter 4 Living With Fire 1 Introduction As discussed in the previous three chapters, Foucault put considerable effort into tracing the history of the development of modern power. Working from a conditionalist perspective of religious studies, which is characterised by a respect for the given concrete, the integration with widening contexts and universal solidarity, response-ability and compassion, the exploration of modern power and its subjugating effects on the life of the participant is relevant to this research. White (2002) emphasises that although the operations of modern power were derived through the uptake of self- and relationship-forming practices first developed at the local level of culture, Foucault also claimed that the professional disciplines of criminology, medicine/psychiatry, psychology and social work play a key role in the further development of the technology of modern power. In this chapter we look closely at the ways in which psychiatric knowledges created an identity of failed personhood in Grace's life. White (2002) extrapolates this concept as follows: Foucault considered the power relations associated with normalising judgement to be disciplinary in two senses. In the first sense, rather than being a mechanism of repression and oppression, these power relations engage people in the fashioning of their own lives and in the fabrication of their own identities according to norms that have been constructed through the history of the modern "disciplines". In the second sense, rather than being prohibitive and restrictive, these modern power relations engage people in the fashioning of their own lives through the "disciplines" of the self . In Chapter 3 the researcher illustrateChaptd the ways in which religious discourses and technologies of modern power contributed to the constitution of identity of failed personhood in Mara's life, and how a narrative approach to therapy assisted her in manufacturing her preferred identities of hope and moral agency. In this chapter the researcher explores the ways in which the professional discourses of therapy and psychiatry, as technologies of modern power, recruited Grace into accepting an identity of failed personhood. The therapist-as-researcher narrates Grace's experiences with the modernist, internalising discourses of psychiatry and psychology in the treatment of Anorexia Nervosa and self-injury as well as the ways in which the professional disciplines constituted her identity as a mental patient. Grace actively participated in the writing of this chapter by offering her reflections, experiences, comments, poetry and art for inclusion in the final draft . This chapter also illustrates the effects of radical anti-anorexic practices and externalising conversations on her preferred identity as a person during a process of narrative therapy, which spanned the period of three years.
Grace deliberately selected her pseudonym because of its meaning. According to Strong (2001: 2618) Grace means favour; charm; grace is the moral quality of kindness, displaying a favourable disposition; to be in a state of favour. Grace is a thirty four year old Afrikaans woman. She is married to Pieter , and they have two adolescent children. Grace, Pieter and their children live on a smallholding outside the city. Grace and Pieter both grew up in Afrikaans homes attended Afrikaans schools and churches, but decided very early on in their relationship to develop a family culture of their own. Their children attend English-medium private school, and speak both Afrikaans and English in their home.
Grace grew up as the eldest of two children. Her father is a military man with strong ideas about right and wrong. Her mother is a teacher with a post-graduate qualification in languages. Grace says her growing up appeared "perfectly normal" on the surface, but her father was very rigid and prescriptive, a real man's man inclined to abusing alcohol and periodically, her mother. Her father made all the rules in their family and Grace, her brother and mother had to adhere to his rules or else suffer his rage and abuse. These rules included excelling at school, regular attendance to Sunday school and church and living a "decent and respectable" life. Grace became perturbed as an adolescent when she discovered that her father had two sets of rules: one set for adults and another for children. For example, he was allowed to drink alcohol because he was an adult and could physically and verbally abuse her mother, but she was not allowed to misbehave because she was a child. She was expected to do exceptionally well at school and obey her father's rules at home. She grew up fearing her father's drinking and verbal abuse. Grace is highly intelligent and could not make sense of the contradictions that ruled. As an adolescent she started rebelling against her parents. Her rebellion took the form of willful starvation, recognised as anorexia nervosa. Grace has been struggling to free herself from mental illness for seventeen years.
Pieter is a young, successful businessman. He is a free thinker, an adventurous person who loves nature, mountain climbing and traveling. He is a loving life partner for Grace and a caring father for their children, but because he is the primary breadwinner and his job demands so much of his time and energy, the responsibility for the running of their home and the upbringing of their children is largely Grace's responsibility. Pieter turned his back of the Christianity of his youth and formulated a set of spiritual beliefs for himself, borrowing from paganism and the Eastern religions and philosophies. Grace initially chose to accept his brand of spirituality as her own. 2 The gaze of mental illness 2.1 Anorexia Nervosa In Kaplan and Sadock's Synopsis of Psychiatry Anorexia Nervosa is described as follows: In the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV 1994) anorexia nervosa is characterised as a disorder in which people refuse to maintain a minimally normal weight, intensely fear gaining weight, and significantly misinterpret their body and its shape. (Kaplan & Sadock 1998:720)
People with anorexia nervosa have high rates of comorbid major depressive disorders: Major depressive disorder or dysthymic disorder has been reported in up to 50 percent of anorexia nervosa patients (Kaplan & Sadock 1998:723). 2.2 A psychiatric perspective on deliberate self harm Favazza (1989:113) describes deliberate self-harm or self-mutilation, as the deliberate destruction or alteration of the body tissue without conscious suicidal intent, occurring in a variety of psychiatric disorders. According to this researcher, major self-mutilation includes eye enucleation and amputation of limbs and genitals. Minor self-mutilation includes self-cutting and self-biting. Favazza explored patients' explanations for self-mutilation, and found that religious or sexual themes are often provided as reasons for self-injury. He also claims that even though no one approach adequately solves the riddle of such behaviors, that habitual self-mutilation may best be seen as a purposeful if morbid, act of self-help (Favazza 1989:113).
2.2.1 Lay and professional attitudes strengthen self-injury Grace's experiences with medical professionals echo Favazza's claims that despite the prevalence of this problem of self-mutilation, attempts to understand it have been hampered by negative social attitudes: Laymen usually perceive self-mutilation to be repulsive and purposeless, while mental health professionals often focus on their own feelings of helplessness and of being "torn apart" or "emotionally blackmailed" by patients who deliberately harm themselves. Patients in need of medical attention may "confess" to a suicide attempt because they have learned that physicians and nurses confronted with self-mutilation may act in an angry and inappropriate manner. For example, sutures may be applied without an anesthetic. (Favazza 1989:137)
Grace says:
The medical profession repeatedly strengthened my feelings of failed personhood. After one self-destructive episode I was admitted to a hospital in Benoni where while he was suturing my wounds, the doctor kept telling me what a bad person I was to have done this to myself. It felt as if he attacked me violently and aggressively, pulling at my skin when he sutured me. He sentenced me for crimes against humanity and put me on massive doses of anti-convulsants. The side effects were dreadful. When I complained he refused to treat me again. 2.2.2 Religious reasons for self-injury Religion has a comprehensive, integrating role, which helps people to make sense of their lives and the events of their lives and relationships. When religious reasons are given for self-injury, this phenomenon should be critiqued, as religion should offer a sense of meaning in the face of hopelessness and emotional and physical suffering, instead of becoming an accomplice to human acts of deliberate self-destruction.
Favazza (1989:138) mentions some of the religious themes that patients offered as reasons for major and minor self-mutilating behaviours. He says these explanations reflect aspects ranging from Biblical influence, to identification with Christ, to the influence of demons. The advice offered in Mark 9:47-48 and Matthew 5:28-29 directs Christians to tear out an offending eye and to cut off and offending hand since losing part of one's body is better than being cast whole into hell. Adherence to this advice is the most common explanation offered by persons who enucleate their eyes. The prototypical enucleator is a psychotically depressed male prisoner with a Bible in his cell.
Grace understood Favazza as follows:
He is right. I tried to cut off my breasts and the ugly parts of my thighs. I also starved my body to punish me for my sins and to control my sexuality.
Favazza (1989:138) cites a report about deliberate hand amputation. This is rare, but there was a report about a young man diagnosed with schizophrenia who discussed Matthew's advice in a Bible group, following which he tried to saw off his hand. He finally shot off his hand and repeatedly requested surgical amputation. Another portentous passage is Matthew 19:12, which states, "there be eunuchs which have made themselves eunuchs for the kingdom of heaven's sake". A middle-aged man with a history of recurrent major depression treated with electro convulsive treatment brooded for weeks on that Biblical passage before cutting off both testicles. (Favazza 1989:138)
Favazza (1989) cited Identification with Christ and His suffering as a reason given for major deliberate self-injury. Grace agreed. She said she identified with Christ's suffering when she struck two large nails through her feet. She explained that she used acts of self-harm as a way of voicing her feelings of despair and failure, because nobody seemed to hear her pain and suffering when she simply spoke about her feelings. Mental illness was proof to her of her inherent sinfulness and self-injury became a way of atoning for her sins.
Favazza (1989:138) cites the story of a 48-year old widow who accused herself of being a great sinner. Because Christ shed His blood, she believed that she also had to shed her blood in order to become saintly. She removed both her eyes and requested that her physician amputate both her legs.
Sinfulness is given as a reason for self-mutilation. Favazza (1989) found that patients felt they had to atone for their sins by performing acts of self-sacrifice, and engage in self-injury as means of atonement, purification and punishment for their sinfulness (Favazza 1989:138). Heavenly commands are also cited as reasons for self-injury, and patients self-mutilate in response to a spoken command or vision of God or a godly agent. Other reasons given for self-injury are the influence of demons. Favazza (1989:138) says some patients have explained their self-mutilation as the result of demonic possession or of demon's trickery. He cites the example of an eighteen-year-old man who mutilated himself during an adverse reaction to LSD. The youth stated: "My mind was so weak because of the LSD that the devil possessed me. Now I've got the devil out of my mind since I plucked my right eye out"(Favazza 1989:1328).
Favazza (1989:138) also cited other religious reasons persons gave for self-mutilation, namely a patient who saw self-castration as a mission for God, another person who believed it was a free-will offering to God, and yet another who believed it was a repetition of behaviour from a previous incarnation as a member of a mystical Russian sect of eunuchs. 2.2.3 Sexual themes as reasons for self-injury Other themes were sexual themes, for example the desire to be a female, as a control measure of hyper-sexuality, repudiation of one's sexual organs and an obsession with amputation. Grace also cited self-injury as a way of controlling her normal sexuality.
Van Schalkwyk (2002:135-161) explores the history of Christian patriarchy, misogyny and devaluation of particularly the body and reclaims the female body as sacred. In the ancient goddess traditions the female body was regarded as powerful, sacred and fruitful, in sharp contrast with the ways in which contemporary women feel about their bodies. She says that sexism and misogyny goes back to the patriarchal need to control women's bodies and sexuality. Patriarchal control of the female body is an invisible discourse still alive and well in our society. 2.2.4 Self-injury associated with psychopathology Favazza (1989:138-139) says the explanations patients gave for minor to mild self-mutilation reflect a range of psychopathological beliefs which are associated with a broad variety of conditions such as personality disorders, eating disorders and factitious disorders. In his study patients described tension release, a return to reality, a way of establishing control and a way of ensuring security and uniqueness as reasons for moderate to mild self-injury. Other reasons given were the desire to influence others, possibly in an attempt at punishing a loved one or a family member for a transgression, negative perceptions about themselves, to relieve pressure of multiple personalities and a way of venting anger and relief from alienation. Some patients reported an irresistible urge to self-mutilate. These explanations fit with Grace's reasons for cutting herself. Favazza (1989) also explores biological and psychodynamic theories to explain the behaviour of people who self-mutilate, and a claim that the weakest link in professional understanding of the problem is knowledge of the biological causes of self-mutilation. Favazza (1987:191) acknowledges that "self mutilation is not alien to the human condition; rather it is culturally and psychologically embedded in the profound, elemental experiences of healing, religion and social amity" and that it may share an identical purpose to culturally sanctioned and deviant behaviour, namely "to correct or prevent a pathological, destabilizing condition that threatens the community, the individual, or both" (Favazza 1987:191). He concludes that "self-mutilation can thus be seen as an ancient and widespread, albeit morbid, form of self-help behaviour inherent in the repertoire of human activity" (Favazza 1989:142) and that the "pathological acts of troubled adolescents may thus be primitive, morbid attempts to overcome seemingly unsolvable problems" (Favazza 1989:143).
Grace struggled with self-mutilation in many forms, particularly cutting and starvation. She describes her experience as follows: I used the weight of the psychiatric labels to punish myself because I believed that I was a bad person who had no right to live. Anorexia was the furnace in which I could incinerate myself. . But no matter how hard I tried, I couldn't kill myself. I fed the fire so that I could burn out completely, but every time I arose from the ashes like a phoenix. I became addicted to the magic of recovery and hope, trust and regaining trust. For ten long years it worked in three to four monthly cycles of self-destruction, burnout, resurrection, and recovery before I would burn out again and be hospitalised.
Medical research shows deliberate self-harm to be a serious clinical problem, which can result in suicide in 4% of persons who self-injure (Bennewith, Stocks, Gunnell, Peters, Evans & Sharp 2002:1254). They claim that evidence on how best to manage patients in primary care who have harmed themselves is seriously lacking. These researchers developed guidelines for general practitioners in primary care on the prevention and intervention in patients who deliberately harm themselves, but found that there was a lack of benefit from the intervention evaluated in this trial, leaving the question open of the most effective management of patients with self-harm in general practice. 3 A Radical feminist therapy approach to self-injury Radical feminist Burstow (1992:187) sees self-mutilation in a totally different light. She believes that women have the right to do with their bodies as they wish: to cut, them, destroy them and mutilate them, as long as the decision to do so is their own. Burstow also believes that expertise does not reside in patriarchal psychiatry, but she warns therapists: Because self-danger is used as an excuse to intrude on women in this intrusive society, it is absolutely critical that we do not invent danger where little or none exists. (Burstow 1992: 188)
Burstow (1992:188) continues: "Whether they are in danger or not, and however upsetting the wounds are to us, it is not our place to interfere with their choices. The bottom line is that however much we may want something better for these clients, WOMEN HAVE AN ABSOLUTE RIGHT TO DO WHAT THEY WANT WITH THEIR BODIES. They have a right to nurture and starve that body; and although we may and should invite something else, we need to respect that right. The history of sexism is the history of other people &endash; generally males &endash; taking charge of women's bodies. People have already interfered profoundly with these women's bodies. They do not need interference or pressure from us".
The radical feminist point of view is valid but at times too radical for me as therapist. From the distress the self-destructive behaviour caused Grace and other women, I believe them when they said that they want something else for their lives: a life without the threat of self-injury. However, I do agree with Burstow (1992:191) when she says that women are trained by society to hurt themselves: Even passive acceptance helps. Simply by not being shocked, not bong alarmist, and not pathologizing, we are sending out the message that we are not going to freak out and that she is okay. Further help comes from making these messages more explicit. It is easier for the client to accept herself and trust us if we make it clear that we accept and respect her just as she is. Let her know that many women self-mutilate, that she is not doing anything awful. Point out hat we all hurt ourselves in one way or other, that as women we are trained to hurt ourselves. Make it clear that you understand that self-mutilation is a way of coping that has served her well and that you have no intention of robbing her of it.
Grace believes that suffering for beauty is accepted practice in our society as women are taught to suffer for beauty through beauty practices, like waxing, dieting, extreme exercise, and wearing uncomfortable clothing and unhealthy shoes. Grace also said that the way I dealt with her injuries were very helpful, especially when I explained the cultural discourses that promote self-injury to her family members. Some of Burstow's suggestions were very constructive in therapy, but everything in my heart and mind told me that Grace did not choose to behave in a self-injurious way. Useful knowledge from this perspective was that even when Grace injured herself, I respected her choice to do so. Not acting alarmed or disgusted at the sight of her injuries, seemed to go a long way towards gaining her trust and showing her that I respected her as a person.
This was contrary to her previous therapeutic experiences where the sight of blood sent her family members and health care workers scurrying to save her life and to gain control of her life, whilst punishing and or scolding in the process. Despite the insights gained from a radical feminist approach to the therapy of self-injury, I preferred to use a narrative approach as pioneered by White and Epston (1990) rooted in a religious studies approach as described by Krüger (1995) in our conversations with one another. 4 Illness as narrative surrender White (1995:118) declares that psychiatric diagnosis provides for an exemption that is permissible through illness, instead of assisting people to "find alternative sites in this culture in which they can succeed in breaking form dominant ways of being and thinking, alternative sites that bring with them other options for how they lead their lives, options that do not require exemption through illness". Frank (1997:5) also claims that the modern experience of illness begins when popular experience is overtaken by technical expertise, including complex organisations of treatment. He says that the medical narrative, or story of illness, trumps all other stories in the modern period. According to Frank (1997:5), Parsons made the observation already in 1950 that one of the core social expectations of being sick is surrendering oneself to the care of a medical expert: I understand this obligation of seeing medical care as a narrative surrender and mark it as the central moment in modernist illness experience. The ill person not only agrees to follow physical regimens that are prescribed; she also agrees, tacitly but with no less implication, to tell her story in medical terms. "How are you?" now requires that personal feeling be contextualised within a second hand medical report. The physician now becomes the spokesperson for the disease, and ill person's stories come to depend heavily on the repetition of what the physician has said.
Frank (1997:6) believes that if the modern experience of illness begins when the medical experts assert their authority as scientists by imposing specialised language on their patients, the postmodern divide is crossed when ill people recognise that more is involved in their experiences than the medical story can tell. In my experiences I tried everything in my power to prevent narrative surrender but rather to privilege her voice. In this chapter her voice is amplified and honoured wherever possible. 5 Grace's curriculum vitae of mental illness Foucault (in White & Epston 1990:66) found that Western society has increasingly relied on the practices of objectification of persons and their bodies to improve and extend social control, and that the modern history of the objectification of persons and their bodies coincides with the proliferation of what Foucault (1965) refers to as "dividing practices" and the practices of "scientific classification". These practices are specifying of the identity of persons. These specifications have serious implications for people's lives, as illustrated by Grace's narrative. The dominant expert discourses of psychiatry refused her the right to introspection and reflexive self-awareness. Apart from having her identity socially constructed by the religious and social discourses that are active in the constitution of the lives of most Afrikaans women, Grace carried the added weight of a seventeen-year-long history of mental illness, which co-prescribed her identity as a sick person. Shortly after completing school, despite anorexia and psychosis, Grace met Pieter and fell pregnant: I was very ill before I met Pieter. I overdosed and cut myself repeatedly. He did not realise how ill I was, but I was as mad as a hatter. He just thought I was a really intense person! When I fell pregnant, the doctors told me that I was too mentally ill and could not bring up a child. They insisted that I have a legal abortion based on my history of mental illness. Pieter and I decided to take responsibility for the baby, refused the termination of pregnancy and got married.
I decided to "pull myself together" and become a wife for Pieter and a mother for Anne. Marriage and motherhood constituted my identity. There was no sign of anorexia. I bought into the social expectations of the identity of a wife and mother.
It was like putting a lid on a volcano.
Trying to fit into society and living a normal life, being a wife and mother legitimised my right to exist in society, from which mental illness deprived me. I subconsciously sculpted my identity to legitimise my participation in life as a normal person. I put myself under pressure to prove that I was not crazy. I was scared that I would somehow be exposed as a lunatic, as a crazy, evil, sick person.
I even baked my own bread.
I looked around me and saw what other happily married women were doing and I copied them. I did whatever I thought Pieter expected of me as a wife, mother, partner and lover. I managed to be the perfect person for seven years. I had to drive so many ideas and emotions that I became physically ill with chronic fatigue syndrome, hepatitis and glandular fever.
As can be seen from the above, societal discourses competed with psychiatric discourses for Grace's identity. Grace was determined to make a success of motherhood, wife-hood and personhood. She succeeded in living a so-called normal life for seven years, but the colonising effects of psychiatric discourses and the stigma of mental illness never ceased to torment her. She was constantly aware of the pervasive "gaze" of mental illness, which pressed her to relentlessly evaluate her thoughts and actions. 5.1 Identity and practices of self and relationship For seventeen years, Grace spent the better part of every year as an inpatient in a mental hospital. Countless psychiatrists and psychologists treated her, and each psychiatrist and psychologist added another diagnosis to her growing curriculum vitae of mental illness. A neurologist diagnosed Temporal Lobe Epilepsy as the cause of her problems, and prescribed large dosages of anti-convulsant medication, in combination with the other psychotropic drugs she was taking. The psychotropic medication had unpleasant side effects, resulting in her repeated refusal to comply with the doctors' prescriptions. Feelings of hopelessness frequently overwhelmed her, resulting in episodes of acute self-injury and consequent re-admission to hospital.
Grace said that in her career as a mental patient, she deliberately constituted her identity according to the multi-axial classification scheme of the DSM-IV (1994) : When they told me I was a manic-depressive, I assumed the identity of a crazy artist; I call it my Van Gogh project. That meant that my mental illness was all in the name of good art. At this time, I was able to write and paint with abandon; psychosis was my ticket to ride, to be an individual. It was dramatic, exciting, but the catch was that I had to deliver brilliant art all the time. You see if I could prove that I was highly talented and gifted, people did not judge me as crazy. That was a time when I was convinced of the tragic script of my life. I had to create efficient proof of my brilliance so that when I wipe out, everybody would be very sad.
Psychiatrists labeled me with probably every personality disorder in the book. When you have a personality disorder it means you are un-fixable. I have been diagnosed as being a person with dependent, histrionic, narcissistic and borderline personality disorders. I have also been treated for bipolar disorder, schizoaffective disorder, various psychotic and mood disorders; you name it. My latest diagnosis is "psychotic mood disorder not otherwise specified".
I believe that although they saved my life many times, the psychiatric system supported and aggravated my condition. I have had sleep therapy and electro-convulsive therapy. I remember it was winter. The shock therapy did not help me; in fact I totally lost it. When I woke up after the anesthetic I remember cutting the ECG stickers off my chest and breasts. I saw the medical interventions as proof of my suffering and as punishment for my evil nature. It confirmed how bad I was. Let's face it: they had to shock me to try and make me a better person! They had to incinerate my brain because I was such a failure as a person!
A patient is pretty helpless. I always had a feeling of despair. They told me I was unfixable, irreparably damaged. They told me I would never be able to escape from this hell of incapability, dysfunctionality; that I was a lost case. I had no say; they "had it under control". What was important was that I "behave" myself and drink my medication. I am blacklisted at the private psychiatric clinics; they refuse to treat me again. Their failure to cure me was proof to me that I was evil and irreparably damaged. 5.2 An identity of failed personhood In the years of psychiatric treatment Grace described above, the nature of the psychiatric discourses privileged a particular process of naming, rendering irrelevant and disqualifying Grace's knowledges in the process. Every psychiatrist tried to help her, but because their expert scientific knowledge left no room for her own knowledges and alternative ways of being, the effects of their diagnostic and treatment practices marginalised Grace and strengthened her identity as a failure. She resisted their treatment and marginalising practices with unbridled devotion, resulting in certification and expulsion from hospital care:
Their control over me fuelled my committed and devoted mission to expose the sick power games they play in psychiatry. I devoted my career as a psychiatric patient to proving to the doctors and nurses that they were really not as sane as they pretended to be, but that they were, like everybody else, on a continuum between illness and health. I searched for their Achilles heels and purposely pushed those buttons. That made them angry. When they were angry they'd certify me and send me to Weskoppies. They all gave up on me in the end.
Mental illness deprives you of the right to make your own decisions. They have a hierarchical power system in which they can certify you, lock you up in isolation or put you in a chemical strait jacket. Their power goes nowhere and their power is everywhere. It makes you start watching your step and watching yourself.
White and Epston (1990:24) assert that when conditions are established for a person to experience ongoing evaluation according to particular institutionalised "norms", when these conditions cannot be escaped, and when persons can be isolated in their experience of such conditions, they will become their own guardians. In these circumstances, persons will perpetually evaluate their own behaviour and engage in operations to forge themselves as "docile bodies". Anorexia nervosa and bulimia may well reflect the pinnacle of achievement of this form of power (White & Epston 1990:24). The following pen sketch by Grace illustrates her experience of an identity of failure: Pen-sketch of an identity of failed personhood
6 A social constructionist view of Anorexia Postmodernism, feminism and social constructionism have lead to a reconsideration of structuralist and functionalist traditions. In a postmodern telos, the client is the expert of her life. The client lives in relationships with other people, has her own local knowledges that provide her with the expertise over her own life, and can participate as equal partner in her healing.
Gremillion (1992) suggests that the traditional psychiatric approach and many family therapies replicate the conditions of anorexia for women. In effect, further self-domination is not only encouraged, it is insisted upon through acts of power used to control the person. These acts of power, Gremillion (www.narrativeapproaches.com) suggests, are justified by the person's "underlying weakness". Dependency and marginalisation can occur through practices of pathological classification, long-term hospitalisation, medication, funding shortages and messages of hopelessness, dysfunction and blame (Epston 1998:139). MacSween (1993 in Epston 1998:91) says dominant psychological and psychiatric conceptualisations of anorexia nervosa often define it as a personal and internal maladjustment, rendering the sufferers passive recipients of care. Kraner and Ingram (1998:91) feel that this view focuses on food and weight gain as primary goals for intervention. The researcher found the latter to be true. In a case study cited in Kaplan and Sadock (1998:723) they describe a woman's treatment program as follows: When Peggy was first evaluated for admission to an inpatient eating disorder program, she was a 20-year-old woman who had difficulty in supporting her 5-foot 3-inch frame with a weight of only 67 pounds. … She was admitted to a medial unit, treated for peptic ulcer disease, and discharged, only to be readmitted 3 months thereafter to a psychiatric unit of a general hospital. During that 8-week hospitalisation, she went form 84 pounds to 100 pounds.
Psychiatric discourse recognises the biological, social, psychological and psychodynamic factors in the etiology of anorexia nervosa and acknowledges the fact that patients with anorexia nervosa find support for their practices in society's emphasis on thinness and exercise (Kaplan & Sadock 1998:721). On the other hand, therapists who work from a social constructionist point of view, are less concerned with issues of etiology and describe the experience of anorexia as more relevantly located in the social domain of interaction, where food and weight are imbued with meanings about control, personal agency and tension Kraner and Ingram (1998:91): "It is our view that anorexia sits at the intersection between the physical body and how that body is perceived and experienced".
McLean and Bridget in Chorus of voices (2000: 275) cite Bordo (1993:67) who says that in the medical model, the danger is that the individual becomes a passive object who is subjected to having the "cause" of their disorder discovered and their symptoms interpreted by a professional who has gathered expertise in "unlocking the secrets of the disordered body". The medical establishment minimise the social construction of eating disorders. McLean and Bridget (2000:276) follow Bordo (1993) by saying that the social constructionist view of eating disorders casts doubts on anorexia as psychopathology, and rather attends to the role culture, gender and social factors play. From a social construction point of view these are not individual factors but dominant cultural discourses.
Gremillion (2001:135) used an anthropological feminist approach in her studies of anorexia nervosa and found that this approach encourages questions about why eating disorders occur only in particular places, particularly in developed countries where there is an abundance of food. She says that the refusal of food needs to be seen against a historical and cultural context: … it does seem likely that anorexia, whomever it affects, articulates certain culturally dominant ideals of "success". My sense is that people struggling with anorexia have adopted and ethic of hard work and perseverance in their lives, and are really trying to build very powerful, good strong lives within certain parameters of contemporary Western culture. People struggling with anorexia have been caught up in ideas that are not of their own making, ideas that tend to be relatively individualistic, and that involve constantly comparing oneself to other people.
In her research Gremillion (2001:143) also found that anorexia depends upon very particular ideas about the self and the body, which are tied up with culturally and historically specific discourses of gender and individualism. That is why it does not surprise her to find that anorexia does not occur as often in communities where there is a more collective consciousness and where bodily experiences are not objectified and reduced to "things".
Foucault (1977) suggested that through a technology of normalising judgement, power plays a significant role in the control of people's lives and bodies. Gremillion (2001:149) says that if we regard anorexia and eating disorders from an individualistic standpoint, if we invite young women's lives to be pathologised, then anorexia will continue to be seen as just another individual disorder. However, if we consider anorexia and eating issues to be "warning signals about the hazards of consumer culture, of the hazards of individualism, and of the hazards of a global economy in which certain groups enjoy abundance and other groups are marginalised, the hazards of the resourcing logic that we are applying to our bodies and our lives on the planet, then perhaps there will be the potential for dramatic social change…" (Gremillion 2001:149). The researcher agrees with her that questioning the consumer culture and its effects on women's bodies would be beneficial to everybody. 6.1 Narrative reflections on Anorexia and Self-injury 6.1.1 Deconstructing discourses of pathology Grace was diagnosed with Anorexia Nervosa when she was an adolescent. She was admitted to a State mental hospital for treatment, which included behavior therapy, psychotherapy and nutritional therapy. Although these treatment regimens saved her life, she believed that they contributed to her perception of herself as a "faulty person" and gave birth to seventeen years in which she was both a victim and perpetrator of self-destructive behaviour. She said the ways the doctors and nurses treated her in the psychiatric system confirmed that she was an "evil person who deserved to suffer". Grace explains how she experienced "being mentally ill": This admission was a nightmare experience. It formed my identity as a sick person. They put me in this place with these really crazy people. Being with those people told me that I belonged there, that I was as mad as a hatter, a lost case. It was the shock of my life. I identified with the patients and I started believing that I was just like them. I started believing that I will be as crazy as they were when I turn forty, that there was no hope for me. I started developing fears for my future. The dark story of my hopelessness and evil started here. I blamed myself for the anorexia; despite the fact that anorexia was an act of resistance against the chaos I was experiencing at home. My parents blamed me and accused me of upsetting a perfectly wonderful family life, and I took the blame.
Her experiences are in line with Favazza's (1989) research and findings on medical attitudes towards self-injury, because mental illness and the use of psychiatric diagnoses prescribed the way in which Grace saw herself as a person. White (1995:112-113) says that due to the extraordinary investment in the development of discourses of pathology, therapists have at their disposal a vast array of ways of speaking with and interacting with people that reproduce the subject/object dualism that is so pervasive in structuring of relations in Western culture. He also says that the success of these discourses of pathology is beyond question, and that the hegemony of pathologising professional discourses represents one of the truly great marginalisations of contemporary culture: These ways of speaking and interacting with people puts them on the other side of knowledge, on the outside. These ways of speaking and acting make it possible for mental health professionals to construct people as objects of psychiatric knowledge, to contribute to a sense of identity which has "otherness" as it central feature. (White 1995:112-113)
In Grace's story, the pathologising discourses of psychiatry and psychology not only convinced her of her otherness, but also of her failure as a person. The illness labels undermined her self-accusations and attributions of personal inadequacy to a certain extent, so she continued to consult with psychiatrists and psychologists in an ever-increasing desperation to find healing. The diagnoses and medication provided her with some relief from the stress of societal expectations she would have been subjected to if she were well. However, White (1995:118) believes that although he can appreciate arguments for the use of psychiatric labels, he has no doubt that the outcomes of the use of these diagnoses reflect what is accepted as being a "real" person in our culture: … in order for people to break from these self-accusations and attributions of personal inadequacy, from the stress that is informed by the expectations about what it means to be a real person in our culture, and from the experiences of guilt that we have discussed, they must step into a site of "illness". Illness is a site of culture, one that is structured, one that brings with it particular modes of life and thought. (White 1995:118)
I researched all the diagnoses they gave me, because if something was wrong, I wanted to know how to fix it. I felt like a horrible, hysterical, over-the-top hopeless case. Nobody believed me that I wanted to be well. The doctors used to tell me to take my medication and live with it. That meant there was nothing they could do for me. I also always felt that they were not giving me all the information, as if they kept some coveted information for themselves. It felt as if they did not offer me any way to change; they were not prepared to partner with me to change; it felt unsolvable. It felt as if that was who I was and that I had to accept it as such. (Grace) Grace identified fully with mental illness and mental illness constituted her identity as a person. 6.1.2 Separating the person from the problem Grace and I agreed to use a narrative approach based on the framework of therapy designed in collaboration between David Epston and Michael White (Epston 1989, Epston et al 1992; Epston & White 1992, White 1989, White & Epston 1990). David Epston explains his commitment to this approach as follows: Since 1986, I have become passionately committed to better understand and assist those persons oppressed by so-called anorexia/bulimia. What prompted me, amongst other concerns, was my dawning realization of the ways in which the objectifying practices of weighing, assessing, and measuring of women associated with the discourse of psychology and psychiatry could very well co-produce what is referred to as anorexia/bulimia in those very persons oppressed by anorexia/bulimia. (Epston, Morris & Maisel 1998:149-150)
These authors described some steps therapists could take in the process of getting people free of Anorexia/Bulimia (1998:150-161). The steps they suggested were to engage in externalising conversations about anorexia/bulimia as something separate from and external to a person, so that "a linguistic space can be opened for persons to engage in their own assessment and evaluation of anorexia's "rules of the concentration camp", its "voice" and the practices of self and relationship it requires, for example, exile and isolation, self-surveillance, self-hatred, self-punishment/torture/execution etc." (Epston et al 1998:151). Grace externalised her main problem as "SS", or Self-Starvation and Self-sacrifice. Externalising the problem as "SS" undermined the guilt she felt and made it possible for her to put the blame on "SS", challenging totalising descriptions of her as having the identity of a "self-mutilator" and an "anorexic". It also provided us with a context in which Grace could recall current and historical resistance to "SS's" dictatorship in her life. These resistances were recalled, explored in detail and celebrated as victories over the totalising effects of Self-starvation and its ally, Self-harm. 6.1.3 Exposing "SS" Grace and I agreed never again refer to her in psychiatric terms, for example, as an anorexic, or as a depressive or as a self-mutilator. I suggested that we separate the problem from her as a person in order to join against the problem as a team. At the start of the therapy Grace externalised Self-Destruction as the main problem in her life. Self-Destruction referred to practices of cutting, overdosing, over-working as well as to practices of starvation and bingeing.
In the linguistic space created by externalising the problem, Grace and I were able to explore the invisible cultural discourses that strengthened and maintained Self-Destruction. It was in this space that we dared to say Anorexia's name and to expose a list of its tricks and lies in Grace's life. In this document Grace started calling Anorexia "SS", which is short for Self-Starvation and for Self-Sacrifice:
Listing Anorexia's Tricks and Lies
"SS" rubs my nose in the past. "SS" maintains a running cycle of despair, depression and anxiety set in motion by the trauma of Self Destructive behaviour.
"SS" tells me: "See, you cannot trust yourself to take part. Life is too much, too overwhelming. You are too fragile, too weak". It also says: "You have to control the outcome and have guarantees. If you cut yourself you will bleed, and people will pay attention."
Destructive behaviour promises a sure way to control the outcome of my actions and have guaranteed tragic results. "SS" tells me: "You have to control the outcomes" but I have chosen to live with uncertainty even if it tells me "You cannot live with the uncertainty of calculated risks", "You cannot trust yourself and your decisions even if they look right, they could just be part of the reconstruction phase of building up ---- to be followed by destruction. You are rigged to be destroyed"
"You have to fear your tendency to Self Destruct, it is part of who you are and you can't let go of it". You have lost so much already; too much. You are an invalid, a loser, incapable of participation".
"Disempowerment, immobilisation by means of panic and anxiety and loss of self confidence is your lot." "SS" convinces me to believe that "I cannot bear the anxiety I have to Self Destruct. I cannot bear the despair. I have to express it physically through physical harm by showing blood or emaciation".
"Life is meaningless, its too late, I've had too much loss. There is so much suffering in the world and I cannot help anyone". "You are a bad, evil person. You do not deserve to participate because of your horrible choices and behaviour".
"Temporal Lobe Epilepsy disables you - you will never take part ok". My biggest victory was that I was able to do two reflexology treatments while I had symptoms of Temporal Lobe Epilepsy and proved to myself that I am able to participate; I can work and contribute to their budget and help other people despite the symptoms.
"SS" convinced me to believe that: "I'm feeling out of control, I feel as if I'm intruding into other people's space if I'm not very thin."
Grace's List of Anorexia's Tricks and Lies formed the subject of many therapeutic conversations. This document made it possible for us to explore some of the invisible normative messages she was brought up on and with which she disagreed. Many of these discourses corresponded with Neuger's (2001) research on the contradictory messages of patriarchy (See Chapter 3.3).
Grace found that apart from being isolated by the patriarchal discourses that put a premium on independence and individuality, her history of mental illness incited her to police herself and to make sure that her behaviour was 100 percent "normal" all the time. Compounding the effects of her yearning for normality, were the discourses that women are weak and dependent on male protection. These beliefs prescribed her identities as wife and mother, and pressed her to perform at her optimum at all times. However, she also knew that as a woman she has the power to destroy the lives of her husband and children and Self-Destruction used her womanly power as a very potent weapon against her. 6.1.4 Deconstructing patriarchal religious power discourses Within the Christian discourse, words carry enormous power and can entrap and control those who become entangled in them. Words are used within a cultural system to legitimise power and normalise relations of inequality (Bowie 1988:56-58). Patriarchal religious power discourses limited Grace's preferred ways of expressing her spirituality. For example, Grace wanted to join a church of her choice when she was a young girl. Her father forbade it. He insisted that as long as she lives under his roof, she would attend the Dutch Reformed Church. His prescriptions confused her because she never saw her father as a particularly religious or God-fearing man. Furthermore, although the church holds up the principles of justice, it insists that women remain silent and submissive, whilst frequently disbelieving women who report abuse. She said the church did nothing to protect her mother from her father's drunken rages and abuse, so she could not understand why she could not develop a spirituality of her own choice.
When Grace married Pieter, although he is very different to her father she felt sh had to subscribe to his belief system because she was afraid that he might reject her: Pieter is a naturalist and a pagan scientist who loves mountains. I suppressed my own spirituality to make sure that he did not reject me. To be honest, I was so confused I did not know what my own belief system was. (Grace)
The scientific psychiatric perspective on mental illness which regards many supernatural events as pathology, combined with her need to please Pieter by adhering to his spiritual beliefs, affected Grace's spirituality adversely. Whenever Grace had visions or heard voices, whether they were hostile or friendly, her doctors and her husband immediately assumed that she was out of touch with reality and therefore psychotic. Grace did not find all the voices and visions troubling but the psychiatric and scientific discourses were dominant and immediately marginalised all her spiritual experiences as pathology.
On the other hand, in African traditional healing visions and voices are forms of connectedness with the divine are sought after and embraced: Traditional healers believe in their ancestral spirits who function in this world much like guardian angels (Campbell 1998:38). Campbell (1998:78) describes "sangoma sickness" as it was told to her by a sangoma : Early in 1978, out of the blue, I became very, very ill. I was experiencing the "sangoma sickness". My ancestors were trying to get me to accept this calling to traditional medicine. I refused. I consulted a variety of medical specialists but found no relief. Finally a visit to an old man in the town of Hershel in the former Transkei homeland brought me relief. I had seen this exact man in a vision and was told he would be my teacher. I trained under this man, this healer. I became his thwasa (in Zulu) or mokoma (in Setswana). To qualify as a traditional healer under this master healer, the old man required me to experience and understand visions. Visions were already coming fast and steadily to me, especially in the first five months. While in training, the visions accelerated my learning and within two years, I was an inyanga, a sangoma.
The African traditional approach to voices and visions made sense to Grace. She chose to be guided by traditional African knowledges and to combine it with the teachings of Reiki and reflexology to embody her spirituality. The literature regarding on the "Companions on a Journey " project in Dulwich Newsletter (1997) also contributed to her ability to learn to differentiate between negative, harmful and hostile voices, and the gentle caring and loving voices she believed were from angels. She found it affirming to "keep" the gentle voices as guides and spiritual companions without being considered "totally psychotic". Although this is an uncommon alternative spiritual site for a White Afrikaans woman, it is a site in which she found spiritual strength to fight against the problem of Anorexia and "SS" for her health. Because I was studying the phenomenon of failed personhood from a conditionalist approach, it is impossible to separate religious discourses from the wider socio-cultural contexts of Grace's life. The dominant religious discourses of her home of origin and the alternative religious discourses that strengthened her husband's spirituality were not helpful for her. Grace had to develop her own spiritual site in which she could be safe and secure. She developed her spiritual breathing space in the spaces between religion and culture: 6.1.5 Grace's Core Credo Grace focused on clarifying her different individual spiritual truths and even though she found it a scary exercise, she compiled a logical, analytical "Current Credo under Construction:" Determine which ideas, emotions and feelings are no longer of value, so they can be filtered out to make way for the new. &emdash; Chris Stormer in "Reflexology: A Definitive Guide." I have filtered 1000s of pages I have read and written, 1000s of observations and conversations and experiences… to pour clear water into the following vessel of words:
I believe There is only one God: the God of Love, God of All that Is and Is Not. All Beings remain equally Loved parts of God. On earth we experience Oneness in Love through also experiencing the opposite: fear, darkness, and division. We can Trust the Voice of Love… in the teachings of Jesus and other Love teachers; in Ourselves; in Others; and in the Flow of the All. When I stand my ground to go beyond fear, I swallow the above words. They become part of my whole body. So when I open my mouth, I voice more clearly. (Grace)"
Grace found hope and moral agency in her ability to co-construct her preferred spirituality and belief system. The following drawing by Grace depicts her strength as a woman who has an identity of moral agency and hope:
6.1.5 Fighting Perfectionism Some socio-religious discourses convince women that they embody moral and spiritual purity in their endurance, steadfastness, and lack of self-interest as woman and mother (Neuger 2001). This belief led Grace to strive for perfection in the running of her home, the upbringing of her children, her partnership with Pieter; in fact, it ruled her whole life. She understood that she needed to be an available, patient and supportive nurturer of her family at all times. She could not allow herself to slip or ever lose her temper, for example. If she did anything of perfect she felt worthless and saw imperfection as proof of her essentially evil nature, resulting in serious self-harm. In the following letter I purposely did not correct any spelling mistakes or typing errors, because the errors represent her resistance to Perfectionism. This letter was written during her training as a Reki practitioner and reflexologist. Her course required of her to write a thesis as part of the qualification as traditional healer.
Subject: we have won this round Date: Tue, 15 May 2001 13:03:50 +0200 From: Grace To: Jo Viljoen
PLEASE RESPOND BECAUSE I NEED THE CONFIRMATION!!!!!!!
WAR DOES NOT DETERMINE WHO IS RIGHT BUT WHO IS LEFT --- CONFUCIUS
Dear David, Jo, Pieter & everybody else who wants to read about this victory
Perfection had been using my thesis to TRY AND LURE me back into anorexia/bulimia/threatening self-harm. It turned my thesis into a monster, a nightmare of demands to do it perfectly and brilliantly despite being unwell and burnt out. I was temporarily driven back into the "SS" concentration camp. I have chosen to turn around the thesis into an act of protest against Perfectionism. An act of living the waterway and being in the present moment. I allow myself to lie down when I am having a bad seizure. To quote from the introduction to my thesis under construction: "I am indeed using the regular practice of Rei-flexology to turn the writing of this thesis into a very courageous act of INPURFECTION (VERY VERY DIFFICULT FOR ME AS TECHNICAL AS TECHICAL AND CREATIVE WRITER AND AS MEMBER OF THIS SOCIETY). Rei-flexology is an act and manifestation of imperfection. I am choosing not to fine-tune/distil/perfect/trim the contents and just to let it flow. Please celebrate every imperfection of this piece of work with me".
My list of victories
Last night I had a whole plate full of food In the last week I attended two socials with highbrow socialites and not once felt inferior. Last night I did not force myself to exercise and am choosing to restart exercising as soon as blackouts stop. I allowed myself some energy therapy for the first time in three months; had music therapy with Chris Tokalon yesterday. Amazing results. I silenced "SS" to contact my doctor and adjust my medication appropriately. I am so excited because I have secured a work contract at Dr L where I will be treating her staff on site with Rei-flexology during June. Lekker ne! (Roughly translated as "Cool bananas!" Good, eh?). I can choose to eat and not to starve my body of nutrition. I have the right to eat. I have the right to forget about self-harm and focus impurfectly on self-care. So there "SS"!!!!!!!!! Another one bites the dust!!!!! And just to keep me focused, with my impurfect thesis: "The less effort and the more powerful you will be (Bruce Lee)"
(Co-constructed during therapy session with Jo)
Grace speaks as follows of her experiences with Perfectionism:
I was driven by perfectionism. I had to be the perfect wife and mother and constantly worked at being perfect. On the surface I looked perfect, but under the surface I was struggling and angry. Eventually the demands became too much for me and the volcano erupted. That was exactly ten years ago.
One day somebody made a comment about my weight at work. I was furious. I stopped eating. I worked 24 hours a day. I stopped sleeping. All I did was work. You see, I believed that the only telltale outward sign that I was not perfect was that I was over weight. I believed that if I lost weight everything would be fine.
To complicate matters, during that period of my life I had a brief affair with a woman. This transgression convinced me that I was a bad person and that I needed to annihilate my femininity. This committed me totally to self-destruction and devoted my time to protecting my husband and children from my inherent evil. I wanted to die. It was a systematically planned process to destroy myself; to kill the fire in my body and my mind and my spirit.
I became a phoenix; a person who tragically but heroically struggles but miraculously recovers from mental illness. Over the years I learnt how to make miraculous recoveries after burning out, by putting together the "perfect personality ". For example, I'd come home from mental hospital and be the perfect mother, wife and employee.
If I was not perfect, it was a sign to me that I was really evil, and needed to be removed from society. My art therapist was a psychoanalyst. She was convinced that I was a danger to my children and had to be removed from them. She said Pieter and I were "co-dependent", that I played the victim and that he played the role of the rescuer. Those beliefs made me feel like an even bigger failure.
"SS" SPECIALISES IN HALF TRUTHS TO CONFUSE ME. I then ask myself what is the real, full truth based on self-love? Then I choose to replace the false notion/trick/lie and I choose to let go of it and embrace the loving truth."
I had a huge victory over "SS". People do not act before they see blood or emaciation. The blood usually has to flow first before anyone listens. They think I have cried wolf for too many years. This happened to my uncle Jan as well, and he eventually wiped out. I had symptoms for two days. I was overwhelmed and felt l disintegrated. It was severe, acute, but I did not give in to "SS". I did nothing Self Destructive. I did this with self-care. I phoned you, Jo, and you came around. I verbalised despair instead of forcing them to take care of me. My loved ones showed their concern and took my cries for help seriously.
Our efforts gradually revealed that our society's allegiance to an anorexic lifestyle lay behind every act of self-destruction Grace had ever committed. The first step in getting free from anorexia or bulimia begins when a person becomes more fully aware of the physical, emotional, spiritual and relationship cost of an allegiance to an anorexic/bulimic lifestyle (Epston 1998:150). 6.1.6 Understanding the Anti-Anorexia/Bulimia league The Anti-Anorexia/Bulimia League, archived by David Epston, is an extremely important resource on Grace's journey. David Epston (2001) explains how the League came about:
Bob Dylan sang something to the effect - "If you are going to live outside the law, you had better know what the law is!" The philosopher, Michel Foucault, advised the documentation, authentication and circulation of "alternative knowledges" if they were to do what he proposed was their work - that of critique. I have always kept this in mind. Anti-anorexic documentation has taken many forms and the "itineraries" of their circulation have become international, now being carried by fax and e-mail. Perhaps the five boxes currently stored in my garage will soon move to some hypertext or electronic home. To be sure, I'll still keep my boxes of archives as back-up. (Epston 2001 www.narrativeapproaches.com)
David Epston chose the term "archives" as an archive, according to the Concise Oxford Dictionary, "is a place where public records are held". In the early days, the archive operated in a very crude way - he would Xerox copies of archival material and post them on request. These archives have been both a resource to and exemplary tales of a "counter-practice" commonly known as anti-anorexia/ anti-bulimia. Many of the first generation of League membership bitterly complained that the various professional literatures concerning anorexia/bulimia either dismayed them or made them actively ill. The more auto-biographical genre of the "I am an anorexic" type seemed to offer readers little chance for escape. More than anything else, it remains a literature of despair.
From 1992 on, many League members had been urging me to compile the archives and make them available by way of a book. As such, this would have required the format of an encyclopaedia and I doubt if any publisher would have considered that a viable proposal. I could not imagine my way out of this until I hit upon the idea of a conventional book (well, not really that conventional) that could be read for itself at the same time as serving as an orientation for a more complete archives, lodged on a web-site. Hypertext space is far more generous and less costly that textual (book) space. Otherwise, I should have been required to reduce say 5,000 pages down to 200 pages and no matter how hard I tried, it was an utter impossibility. The integrity of the archives had to be maintained at all costs rather than an "anti-anorexic" book of greatest hits.
I envision such an archives of resistance to be both a resource and a platform for anti-anorexic developments that are as yet currently unimaginable to me. I hope too that it will be the means to a movement that will operate both underground and above ground conscientiously object to, resist and finally repudiate anorexia and bulimia. (Epston 2001 www.narrativeapproaches.com)
All the contributors to the Archives of the Anti-Anorexia/Anti-bulimia league are bound together by this website in a "community of concern" of archival knowledge that provided a place to speak from and retreat to.
Such records of resistance tell too of the horrors and inhumanity of anorexia/bulimia, and lifts those up who have suffered and are suffering so that we can witness their testimonies, keep their legacies alive and most importantly pay them our respects. (Epston 2001 www.narrativeapproaches.com)
Once provided with the means to speak against anorexia/bulimia, almost to a person, aged 12 years of age and over, everyone has railed against many of the "psychological" and "psychiatric" constructions of them as "anorexics" or "bulimics". The "stories" from the insiders are incomparable to the stories written about them by outsiders. Why is it that insiders regularly refer to anorexia as either a grotesque manifestation of evil or the devil when such terms have otherwise been consigned to the dictionaries of the histories of words?
These documents can take many forms as you will see but what is common to them all is their manner of speaking - anti-anorexia - an anti-language, a radical form of an externalizing conversation. (Epston 2001 www.narrativeapproaches.com)
I turned to the League in desperation at the end of 2000 when I started to fear for Grace's life. The purpose of the league is to traverse the questionable ideological and fiscal gaps that lie within the traditional treatment terrain of mental health. The league promotes the idea of interdependence and a collective consciousness. Its playing field is two-fold: firstly preventive education through a call for professional and community responsibility and secondly an alternative and unconventional support system for those women caught between hospitals and community psychiatry (Epston 1998:138).
Anti-anorexia differs from most modernist treatments of anorexia. Zimmerman and Dickerson (1995) suggest that most modern treatments of anorexia seem to play into anorexia's hands. Any treatment based on the notion of individual or family pathology supports the construct that the person in the problem. Zimmerman et al (1995) further claim that many therapists inadvertently recreate the conditions that support anorexia, by using the tactics that anorexia itself employs. These tactics include hospitalisation, resulting in the isolation of person, ongoing evaluations (of the person and of weight), the removal of the person's entitlement to her own experiencing (e.g. by suggesting she no longer knows what is going on). According to Epston (2001) Anti-anorexia is strengthened by "community", which, of itself, contradicts anorexia's solitary confinements. Furthermore, anti-Anorexia is a site of resistance to the oppression of the force, which is anorexia. Anti-anorexia's counter-force comes from a moral vantage point, resisting the so-called "truths", "norms" and "reason" of anorexia: Anti-anorexia can be contacted merely by attempting to break free of the "concentration camp" of Anorexia. Immediately you know that it is no summer camp. When you hit the barbed wire, you then know that anorexia is not your "nature" but your imprisonment, with your execution as your only departure. Anorexia tries to camouflage this with the same slogan that derided the inmates of Auschwitz (ARBEIT MACHT FREI= Work/Perfection Will Set You Free!) (Epston 2001) www.narrativeapproachces.com
6.2The virtual response team Towards the end of 2000 Self-Destruction took possession of Grace. Her family and I were all afraid that she might kill herself. In a desperate attempt at learning more about anti-Anorexia and new ways in which I could support Grace's determination to live a life of her own choosing, Grace gave me permission to contact the Anti-Anorexia league by e-mail. David Epston replied to my letter, and we engaged in a three-way therapeutic exchange that continued for a year. He referred Grace and I to an article by Lane, Epston and Winter (2001). This paper tells the story of a therapist, Lane, who was "stuck, overwhelmed and isolated by a problem that seemed to defy therapeutic techniques and skills and personal commitment and determination". Instead of giving up, she reached out to her support network and because no alternative seemed available at the time, this reaching out took place by fax. However, what started out as a choice of last resort revealed a range of therapeutic possibilities that Grace, David and I were able to extend via electronic mail.
It was a tremendous privilege and a great relief for both Grace and myself to be in contact with David Epston, who along with Michael White founded the narrative approach to therapy. Although the bulk of the responsibility for the therapy lay with me, David Epston proved to be a wonderful mentor as he reflected on our therapeutic process via electronic mail. His "electronic" voice became an integral part of our therapy-talk and often times he guided us out of desperate waters. The following letter from David Epston spells out the risks and ways of working that we embarked upon as Grace's virtual response team. Grace and I corresponded with one another between therapy sessions using our e-mail facilities, and we usually wrote in either Afrikaans or English, as we are both comfortable in either one of these languages. During our electronic conversations with David Epston, we only wrote in English to accommodate his understanding of our communications:
Date: Dec 15th 2000
Dear Jo:
Jo, I want you to know that we are all in this together and I am including Grace, Pieter, etc. I know you wouldn't have contacted me if it wasn't possibly Grace's "final fight for her life"; I am really happy to join you and admittedly there are "risks" but those "risks" are nothing by comparison to not doing everything possible at this time. I would ask that you discuss a "there is no such thing as a mistake" policy with Grace and Pieter- let's replace that with "a golden opportunity to know each other so much better" policy. I would ask that you send Grace and Pieter copies of letters on the understanding that they are complex and will take some time in conversation to "see" them through to answers, which quite likely will engender more questions.
Can you discuss this with Grace so that she is aware that these "letters" are merely the means to further conversation(s), ones that I can share in? I would not be surprised, as has been the case so, you, Grace and Pieter may have conversations of your own that you might wish me to join in. If so, I can't wait! If there is anyone who made a mistake, it is me! I got into a "rush", thinking I would be away for 5 weeks, thinking that I had to initiate sufficient "conversations" to keep you "busy" in the meantime. As I mentioned, that is no longer the case as I will be back at my computer a week over my holidays and can keep in touch with you and Grace.
Jo, I have no doubt you will no more than justice to these "questions". As for "methodology", I would like to think you and Grace will work out something that suits you both. But here are some suggestions- you could send the letter to Grace for her to "just go over it out of interest" and when you meet you could agree to either work through them systematically or alternatively just attend to whatever catches Grace's fancy (or indeed yours) e.g. "Grace, I found this question extremely thought-provoking.... read it...that it ring a bell for you? What is critical is that you provide me with "verbatim" responses, indicating as much as possible, what question Grace is replying to? e.g. "Both Grace and I found this question- ...- very provocative. My reason for that was....; Grace was surprised when I told her told as she....... But what she had to say- ...... I wouldn't have been able to predict. We went on in our conversation from there and this is our joint summary of that............
Jo, as we go along, feel free to ask any questions, knowing that there aren't any real answers but only inventions.
I invite you to share in these inventions. Remember, we are in "terra incognita", the land beyond the known. I suspect you and Grace will find your own ways through "terra incognita" and I would ask that you keep me informed of any of your ways, as your ways will most likely be the most opportune, the most salient and the most apposite.
Jo, the best way to approach this approach is with daring.
Best wishes,
David .
In order to share with the reader the spirit of collaboration and the practice of radical externalising conversations between David Epston, Grace and myself, I am including an excerpt from one of the e-mail conversations between us. Grace wrote the letter and sent it to me, I forwarded it to David Epston, and he replied to me. Grace and I then re-read his reflections and discussed his thoughts and comments in the safety of our therapeutic relationship. The speed and accessibility of electronic mail matched the urgency of some of our communications, connecting the three of us instantly. (Grace wrote in normal print, and David Epston's reply to her is in capital letters for easier reading): Subject: Re: [Fwd: Response please: struggling] Date: Fri, 20 Apr 2001 19:01:03 -0700 From: David Epston To: Jo Viljoen
Grace: Dear Jo, David, Pieter, and myself (= my formidable response team) Let me now once again stand on the truths and my right to self-construct with you as witnesses.
David: GRACE, I GET GREAT SATISFACTION WITNESSING YOUR TESTIMONIES.
Grace: As I have said before: no amount of "resistance-writing" (!!) that I did in my diaries in the past ever had as much power as the writings we have been sharing.
David: SOMETIME, I WOULD LIKE TO UNDERSTAND WHY THESE WRITINGS SHOULD BE SO EMPOWERING TO YOU RIGHT NOW!
Grace: "SS" cannot convince me that these Resistance Documents are "just my self-centered little scribblings".
David: GRACE, DOES THAT HAVE ANYTHING TO DO WITH THE FACT THAT THE DOCUMENTS ARE BEING REVIEWING AND CONSIDERED BY US AS WELL AS "SS"?
Grace: I go back to our communications and stand on them when under attack from "SS". I thank all 3 of you for your ongoing response and guidance and confirmation of the truth.
David: YOU ARE MORE THAN WELCOME!
Grace: David and Jo, thanks especially for your ongoing prompt, thorough responses and [never ending :)] health-provoking questions and "homework". Pieter, thanks especially for your unwavering belief in me and the sweet little vase of flowers and gourmet meal yesterday evening when you saw that I was struggling. To my children: Thanks for giving me hugs when you can see that I'm struggling. Thanks for insisting that I spend fun, relaxed time with you. David: DOES "SS" WILT IN THE FACE OF YOUR CHILDRENS' LOVE, AFFECTION AND APPRECIATION OF YOU? DOES THAT HAVE ANYTHING TO DO WITH THE INNOCENCE OF THE YOUNG AND THE UNAFFECTED WAY IN WHICH THEY SEEK PLEASURE AND ENGAGE THE WORLD WITH SUCH UNABASHED JOY AND MAKE NO APOLOGIES FOR THAT?
Grace: Thanks ahead for bearing with this long letter and sharing with me the long slow miracle of recovery from Anorexia and Self-Destruction.
David: I KEEP REMEMBERING MY LATIN TEACHER, MISS MCGREGOR, QUOTING JULIUS CAESAR- "MAKE HASTE SLOWLY", WHICH AT THE TIME SEEMED LIKE AN UNSOLVABLE CONUNDRUM BUT NO LONGER HAVING SEEN HOW "SS" HURRY PEOPLE AND OVERSUBSCRIBE THEIR TIME SO THEY RACE AGAINST THE CLOCK AS IF THEIR LIFE IS RUNNING AHEAD OF THEM, ALWAYS OUT OF THEIR GRASP LIKE THEIR "FORWARD" SHADOW.
Grace: I am struggling. My eating behaviour is slightly buggered: I now have this repeating pattern of bingeing at night about once a week, only after taking Stilnox (sleeping tablet) and no vomiting. This seems to be the only time I do not have full command of my choices and "SS" seizes the opportunity.
David: HAVE YOU EVER KNOWN "SS" TO NOT KICK YOU WHEN YOU ARE DOWN?
Grace: Initially I did not get too upset about this and decided that it was no good to be perfectionistic about eating perfectly right. But now it is clear that "SS" is using this to erode my strength. It upsets and seems to scare Pieter, which alienates me even more from him. Panic and lies: "you are already self-destructing…bad person…can just as well give up totally to self destruction and eating disorder...bad person… deserve to suffer, etc."
David: USUAL, WELL-KNOWN ANOREXIC TRASH TALK!!!! THE SAME ALL OVER THE GLOBE!
Grace: So, I am choosing …
David: GRACE, I NOTICE THAT YOU ARE DOING A LOT MORE CHOOSING NOW THAN YOU USED TO. BEFORE DID "SS" TRY TO CONVINCE YOU THAT YOU WERE THE CHOSEN ONE IN ORDER TO CONCEAL THE FACT THAT IT WAS DICTATING YOUR LIFE? Grace: … now to take a lot of time out from work and other responsibilities for a few days, to rest and relax and recover.
David: WHAT WONDERFUL WORDS!!!!
Grace: And to identify "the problems" and find solutions; to identify the "SS" lies (that tell me "you are the problem") &endash; and replace them with the truth. To take stock of how things are going, which changes I can make to facilitate healing and keep my strength up. But a foul combination of "SS" and my low resources is making it near impossible for me to do the above. I also want to make sure I implement a more balanced approach in general. I am still working too hard. Giving too much importance to work, my responsibilities, and heavy issues. I'm always either busy or thinking/worrying about what i should be busy with even in my dreams at night.
David: LET ME KNOW WHEN YOU HAVE YOUR FIRST RELAXATION DREAM! I AM SURE THAT WILL BE A RED LETTER DAY, MUCH LIKE THE EXPERIENCE OF LANGUAGE-LEARNER DREAMING HER SECOND LANGUAGE FOR THE FIRST TIME AND THEN KNOWING THAT SHE NOW IS A "SPEAKER", NOT A TRANSLATOR.
Grace: I am not having enough fun/relaxation/family time. Becoming alienated/introverted. Becoming more and more exhausted, anxious, depressed, starting to despair. This is an old "workaholic" pattern of attaching too much value to active participation. "SS" has always thrived on this pattern.
David: GRACE, I AM HOPING THAT NOTHING WILL DELIGHT YOU, AND THOSE WHO LOVE YOU AND CARE ABOUT YOU, MORE THAN WATCHING YOU AS YOU LEARN SUCH REFRESHING WAYS OF BEING, NOT ONLY IN YOUR LIFE BUT IN THE LIVES OF OTHERS. CAN YOU REPORT ON ANY SMALL, SEEMINGLY TRIVIAL JOYS OR DELIGHTS YOU ARE NOW EXPERIENCING, EVEN IF NOT ON A REGULAR BASIS YET?
6.3 Mapping and tracking the successes of her life story Language is a very central part of those activities that define and construct persons. White and Epston (1990:188) recognised that modern documents have an elevated status as is reflected in the increasing need to rely upon documents for a variety of decisions about the worth of a person. Documentation plays an important role in the professional disciplines. White and Epston (1990:188) note that she subject of most professional documents is a person who submits to, or has been submitted for, evaluation, while the "author of the document is a person skilled in the rhetoric pertaining to a specific domain of expert knowledge". The author as expert has a myriad of terms and definitions at his or her disposal, which are regarded as the property of his/her domain of expertise.
Professional documents have a life independent of their authors and subjects (Epston 1990:118). Documents are shaped by rhetoric and this rhetoric serves to establish, in the reader, a certain impression of the character and the moral qualities of the writer in a given situation: Thus, documents are a vehicle for the presentation and display of the author's worth according to moral criteria that have been established in a particular discipline. And so doing, such documents shape the author's life as they do the subject's. (White & Epston 1990:189)
In Grace's long and illustrious career as a mental patient, she has been described and re-described by the professional disciplines of psychiatry and psychology, and these descriptions of her constituted her identity as a person with a deficit, a person who has sites of pathology that could not be fixed. 6.4 Alternative practices of documentation White and Epston (1990:190) contrast alternative practices of documentation with the documentation or foiling system used in the professional disciplines. They suggest that narrative therapists use alternative forms of documentation that encourage a wide readership and are associated with "rituals of inclusion" as opposed to documents that permit only a narrow readership of professional experts. Alternative documents like awards, certificates and letters extend the therapeutic conversations and become useful counter-practices in therapy. One such document was Grace's Bill of Rights: 6.4.1 BILL OF RIGHTS 21/02/2001 o It is my right to cope in real life o It is my right to use my gifts, resources and support system to cope o It is my right to take part in the projects I choose o It is my right to have a certain measure of success o It is my right to feel uncertain/confused/stressed when a lot of things are changing and I am facing a lot of challenges o It is also my right to relax and o It is my right to trust that I will cope with life's challenges - maybe not perfectly, but well enough o It is my right to fail at certain tasks or projects and still be ok with myself and know that I can never fail as a person in this life. o It is my right to become ill sometimes o It is my right to take responsibility for balance when I am ill but not to take the blame o It is my right to resist Self-starvation o It is my right to feel and have and struggle with anxiety/TLE/depression and not pretend it is all-OK o It is my right to make a choice at this age (33) to go in a totally different direction with my life and not to reverse back to self-starvation but to choose to stay on the road of life o It is my right to make mistakes in this fight against Self-starvation o It is my right to have small relapses/slips back to self-starvation but to choose not to punish myself by slipping further. (This work carried me through the night). o It is my right to choose to forgive myself and engage with life and self care. o It is my right to forgive myself o I have the right to let go of and expose perfectionism and self-starvation's lies in all my chosen participation o I have the right to believe that all the challenges are part of my life lessons and that I have the strength to bear all those lessons however difficult and painful and learn from them. I have the right to engage this strength. o I have the right to fight for my life in the real world o I have the right to expose the lies of self-starvation o I have repeatedly recovered and engaged my strength and ability to fight for my life o It is my right to ask God to bless my participation and to believe that it will be so o It is my right to be in the moment and to let go of the past and future o It is my right to be a good mother and a good partner, but imperfekt o It is my right to mourn the sadness and misery of the human existence o It is my right to express this sadness and mourning in healthy ways, i.e. writing, drawing, talking, singing, crying. This is a form of Righting the injustices of anorexia. o It is my right to celebrate and enjoy the wonder of human existence, the love, the Joy, the beauty. o It is my right to use my sense of humor to cope with life. o It is my right to suffer sometimes and to thrive sometimes o It is my right to get regular exercise when I can and want to o It is my right to be a coach potato when I'm dilapidated/tired. o It is my right to feel sick and angry about the discrepancies in society
I encouraged Grace to use her art, poetry and writing as alternatives to self-injury and as counter-voicing strategies of her experiences with Anorexia. I include her written dismissal of Anorexia here as an example of her resistance documentation.
6.4.2. LETTER OF DISMISSAL TO ANOREXIA 14/06/2000 To the no-longer-dear negative sabotaging voices,
I'm ready now to no longer give you airtime. I choose to give the airtime in my mind and spirit and body to the truth about my life, my potential, strength, and wholeness.
I reclaim my freedom to take part in all I choose for my life, without the burden of listening to you and bargaining with you for every positive move I want to make. I choose to dismiss you on the grounds that:
Ever since I was 10 you insidiously attempted to destroy my life by convincing me that your lies were the truth. These are the biggest illusions and lies you sold to me as the truth were the following:
That Life was overwhelming; too much for me, and that the only solutions were illness, self-destructive behaviour, disintegration, and mental illness. You convinced me that if my creative products were not perfect, I had to abort them, that I was unworthy of love from God, others, and myself that I was an outsider. You promised me that Self-destructive behaviour and remaining constantly wounded would keep me immune from getting hurt in life, and that it was dangerous to be healthy, strong and empowered. You lied when you said that to assert my own individuality was disrespectful and hurtful to others.
I carried guilt for making mistakes out of ignorance and unawareness. You made me earn my right to exist and participate in life by performing brilliantly and perfectly in all respects.
You convinced me that illness was my fault and punishable, that self-destructive solutions were good for me and my loved ones, that self-forgiveness was impossible because my sins were too great, too dark, too deep, too horrible and that I was intrinsically a bad person.
I had to prove that I deserved help and support and love by being acutely ill. You forced me to live out the above lies; to actualise them in reality, by incessantly brainwashing me, demanding these results from me, despite the hurtful and painful effects on my life and my world.
This unfair contribution has become totally unacceptable. Seeing as we both know that these ideas are false, it makes you guilty of deceit, abuse, betrayal, and violence and deserving of immediate dismissal from my life. You tried to steal my birthright to be happy and whole.
You have become redundant, seeing as you have no other function or use besides keeping me from taking part in life as a healthy person. You only served to isolate me from my life's tasks, my loved ones and myself.
You trapped me in a network of false accusations and linked unrealistic demands. There is no job left for you to do in my mind, spirit or body.
You enlisted a series of dark allies to carry out your devious, sabotaging plan. These included:
Fear, depression, paralysis of my will, overdrive mode with resulting burn out, various eating disorders, compulsive obsessive behaviour, self-mutilation, offensive and disruptive behaviour, mental illness, disintegration of my self, hallucinations, rages and anger, self-doubt and doubt in God's guidance, distrust of others' love and good intentions, isolation, guilt, anxiety, habitual negative emotions that became addictive, seizures, driven-ness, hypersensitivity, and performance anxiety.
As you know, I have chosen to stop believing you and chosen to use this energy to believe in the truth. Now I am not even interested in hearing you at all, not even in the background. I am not interested in negotiating and bargaining with you any more. I now choose to channel my life energy into listening to and telling the truth of love, light and healing.
I will not allow you to waste the time, and energy I now choose to spend on nurturing and holding my loved ones and myself.
These are the truths about my life and me: I am a strong, brave, empowered woman I empower others by being me I trust myself I have strong trust connection with God I am committed to myself and my loved ones I can accommodate others without self sacrifice I am realistic I forgive others and myself continuously. I take responsibility for my mistakes but I feel OK about my past, present and future mistakes I have fun being human I now tackle problems one hour at a time I can focus on the truth I can let go of what I don't need I can recover quickly from illness; I'm resilient and can negotiate the rapids of life without jumping off the raft. I can create and set safe boundaries. I am committed to change and growth, continuously. I can contain myself during highs and lows and seizures. I am consistent and persistent My commitments are now a motivation for me to stay well I can pace myself, self-care never mind what the conditions I know when to ask for help and support and I do this trustingly I can assert my ideas and needs respectfully&emdash;whether ill or healthy I trust in God's guidance, which liberates me to rest and play
This path of healing and positive break through's has been possible because I refused to listen to you any longer. And I refuse to listen to you now, or in future.
Goodbye. Good riddance.
Grace
Witness: Jo Viljoen Witness: Pieter Muller 6.4.3 Resistance poetry Grace has a remarkable poetic talent. Although Afrikaans is her mother tongue, Grace is fully bilingual and can express herself eloquently in both Afrikaans and English. She wrote the following resistance poems in English : From the carcass of the Beast: SEVEN POEMS (by Grace April 2001) Let our souls soak in the honey of the stories we bring forth from the carcass of the beast as riddles: 1. Prayer 2. To eat or be eaten 3. Resurrection 4. BreakFast 5. Being 6. To hold or let go 7. Declaration Prayer dead flowers just fall fearlessly
will you teach me to just let go knowing of the compost I must be for next time's me To eat or be eaten some days ago this well-known shadow started licking at my skin
soon eating tiny bites to challenge and excite me for the fight: now greedy gashes and delighted horror at the painful mess
my fleshy strength goes lost as it eats more and I eat less and less
just waiting wishing for that moment when my healthy hungriness exceeds the dark one's needs so I can say 'now go away again you've lost the fight!' and I'll be generous again and take brave bites of light Resurrection and now after many days she sees she's strong alone and none of them are looking now but One who nods for her to go
she tears herself loose bleeding freely from the nails they all had hammered in together
then climbs off the cross calling over her shoulder as she strides away for her family to rise BreakFast let me trust my self now as I trust each mouthful of this warm oatmeal to be simply sweet and good Being just the delight in my pen that is scratching as dark ink is drying in writing
To hold or let go When I picked this daisy from the compost heap she was dying crisp and dry as this page on which my fingers start a story holding her hoping for life
I see she has been left a blunt stump in the place of roots
further up the thin stem I feel the pale green she is holding onto in her leaves her head is turned away her petals saturated grey dust where I touch a smell of earthy decay my fingers stiffen at a cobweb deserted
I let her go
she falls face turned up to show the live yellow of many little pointed seeds &emdash; stories just dry enough to fly
Declaration I am the warrior who fought for death to bring in life
I'm well and fired up to tell fierce stories peacefully
I'm strong enough to stand in night
awake enough to bear the child that came from loving darkness:
Light
These poems, authored by Grace shows how she plays a central role in the specification of her own self. In so doing, she becomes conscious of her participation in the constitution of her own life. This leads to a profound sense of personal responsibility, as well as, a sense of possessing the capacity to intervene in the shaping of her life and relationships.
Her work of art, Seeding, and her comments accompany these poems: Seeding
Stories are like seeds. I need to trust to let some parts of my story go, to sow them freely like seeds, so they can settle in the fertile ground of other people's life stories. There the seeds can germinate and grow into healthy plants, feeding on the compost of anorexia. This is self-nourishment, livening up, preparing for life and the next season. New life sprouts forth in the form of new living segments of the universe and myself; we are all one, all part of one another, part of the universe. My seed-stories can fly and plant seeds in the life stories of others. (Grace) 6.4.4 Art and therapy There were times when Grace's artwork expressed her emotions and direction in life better than words alone. We included her art in the therapy, enabling me to "see" and share her experiences more fully. During our conversations she formulated words to describe what she was depicting in her art. I am including some examples of this art and therapy process as we used it to help Grace strengthen her voice against anorexia.
6.4.4.1 Weeding Anorexia out
Anti-anorexia is like weeding the soil of the mind; it is an ongoing process, it is a lifelong process. The more fertile the soil of the soul, spirit and mind the more weeds there seem to be. The weed metaphor describes Perfectionism. The weed of perfectionism should be plucked out by its roots: it does not help to treat the symptoms only. Society will have to face the ways in which it fertilizes the roots of Perfectionism, e.g. by prescribing that our value as human beings has to be earned through performance. Anorexia/bulimia leads to institutionalised treatment, and sometimes the symptoms disappear, but the roots remain firmly embedded in the fibre of society. |
