Understanding Eating Disorders: Conceptual and Ethical Issues in the Treatment of Anorexia and Bulimia Nervosa (Issues in Biomedical Ethics)

## Abstract Understanding Eating Disorders is an original contribution to the field of healthcare ethics. It develops a new theory concerning the moral basis of eating disorders, and places such disorders for the first time at the centre of philosophical discourse. The book explores the relationship that people have with food and their own body by looking at genetics and neuro-physiology, sociology and family studies, clinical psychology and psychiatry, and frames abnormal eating at the extreme of a spectrum of normal behaviours, directed by moral values. Giordano argues that abnormal eating is not a psycho-pathological phenomenon, but the coherent implementation of ordinary moral values with a long tradition in Western culture. The book also contains a detailed analysis of UK legislation, accompanied by a timely critique of the law on treatment of mental disorders in general and of eating disorders in particular. Contents......Page 8 Introduction......Page 18 1. Autonomy v. Paternalism......Page 20 2. The Value of Autonomy in Psychiatric Health Care......Page 22 3. Understanding Eating Disorders......Page 25 Part 1. Scientific Understanding of Eating Disorders......Page 30 1. Introduction......Page 32 2. ‘Anorexia’ and ‘Bulimia’: The Terminology......Page 35 3. Eating Disorders: Epidemiology and Prevalence......Page 36 5. The Society of the Eating-Disordered Person......Page 38 6. Diagnosis and Description......Page 39 7. Eating Disorders and Perception of Body Image......Page 40 8. The Effects of Abnormal Eating: Secondary Symptomatology......Page 44 9. Ethical issues......Page 47 1. Introduction......Page 50 2. The Ethics of Paternalism......Page 52 3. Autonomy......Page 53 4. Paternalism......Page 55 5. Freedom of Action and Autonomy: Two Different Types of Paternalism......Page 57 6. Strong and Weak Paternalism......Page 58 7. Autonomy v. life and health......Page 59 8. Practical Similarities between Respect for Autonomy and Protection of Welfare......Page 60 9. Welfare or Autonomy?......Page 61 10. The Value of Autonomy and Weak Paternalism......Page 70 11. Objections......Page 71 12. Conclusions......Page 73 1. Introduction......Page 75 2. ‘That man committed suicide because he was mentally ill’......Page 76 3. ‘I had to wash my hair ten times today because voices commanded me to do so’......Page 78 4. What do we Mean when we Say that a Person has a Mental Illness?......Page 80 5. The Fallacy of Psychiatric ‘Explanations’......Page 82 6. Conclusions......Page 86 1. Introduction......Page 89 2. Genetic and Eating Disorders......Page 91 3. The ‘Addiction’ Model......Page 93 4. Similarities between Eating Disorders and Substance-Use Disorders......Page 94 5. Are Eating Disorders a Form of Addiction?......Page 96 6. Starvation and Addiction......Page 98 7. Addiction to Sweet Foods: Reactive Hypoglycaemia......Page 99 8. The Role of Central Nervous System Neurotransmitters......Page 100 9. Hypothalamic Abnormalities......Page 101 10. Conclusions......Page 104 Part 2. The Value of Lightness......Page 108 1. Introduction......Page 110 2. The Central Feature of Anorexia Nervosa: The Pursuit of Lightness......Page 111 3. The Pursuit of Lightness and Fear of Intrusions......Page 112 4. The Unbearable Lightness of Being: A Representation of Anorexia Nervosa......Page 114 5. Lightness as a Defence from the Invasions of Personal Space......Page 117 6. Is Lightness a Contemporary Obsession?......Page 118 7. Light Beauties......Page 120 8. The Ancient Myth of Lightness......Page 122 9. Slimness and Lightness in Literature and the Arts......Page 123 2. Lightness as a Positive State......Page 126 3. ‘Dans l’eau de la claire fontaine’......Page 127 4. The Value of Lightness......Page 128 5. The Life and Work of Emily Dickinson: Lightness and Spirituality......Page 129 6. Moral Integrity and Spirituality......Page 132 7. Moral Integrity and Christian Asceticism: The Value of Lightness......Page 135 8. The Moral Value of Lightness......Page 138 9. Food Restriction and the Body/Mind Split......Page 139 10. Kant and the Mortification of the Flesh......Page 143 11. Moral Integrity and Hunger......Page 144 12. The Contemporary Significance of Ancient Moral Values......Page 145 13. Conclusions......Page 148 Part 3. Families, Society, and Eating Disorders......Page 152 1. Introduction......Page 154 2. The Family of the Eating-Disordered Person......Page 156 3. The Father of the Anorexic Person......Page 158 4. The Mother of the Eating-Disordered Person......Page 159 5. The Family Expectations of the Future Eating-Disordered Person......Page 161 6. Conclusions: The Effects of these Expectations on the Future Eating-Disordered Person and the Struggle for Control......Page 162 1. Introduction......Page 163 2. Why Women?......Page 164 3. Factors that are Thought to be Related to the Spread of Eating Disorders......Page 165 4. The Role of Women in Modern Western Societies......Page 166 5. Contradictory Aesthetic Expectations of Women......Page 169 6. Eating Disorders as a Response to Familial and Societal Expectations......Page 170 7. Conclusions......Page 172 9. Victims or Persecutors? The Moral Logic at the Heart of Eating Disorders......Page 174 2. Why are People Made to Suffer by Others’ Inappropriate Expectations?......Page 175 3. What Makes People Treat Eating Behaviours as an Instrument of Power?......Page 177 4. Conclusions......Page 179 1. Introduction......Page 181 2. The Need for Neutrality in the Analysis of Mental Phenomena......Page 184 3. ‘Whatever has a Beginning has also a Cause of Existence’: The Logical Fallacy Involved in the Search for the Causes of Eating Disorders......Page 186 4. Eating Disorders: The Role of the Person......Page 188 5. The Role of the Individual in the Articulation of External Influences......Page 189 6. Conclusions......Page 191 Part 4. Law, Ethics, and Ending Lives......Page 194 1. Introduction......Page 196 2. Hospitalization and Treatment of People with Mental Disorders: Coercive Assessment and Treatment......Page 200 3. Can People with Mental Illness be Competent to Make Medical Decisions?......Page 202 4. Competence in English Law......Page 205 5. The Case of Anorexia Nervosa......Page 208 6. Eating-Disordered Patients and Competence to Refuse Treatment......Page 210 7. Treatment for Eating Disorders is Enforceable, Irrespective of Patients’ Competence......Page 211 8. Force-Feeding can be Enforced under the MHA 1983: The Cases......Page 213 9. Force-Feeding is Clinically Appropriate and Ethically Uncontroversial......Page 218 10. Force-Feeding may be Necessary to Render Other Therapies Meaningful......Page 219 11. Coercive Treatment is Always a Clinical Mistake......Page 220 12. Why is a Mental Statute Necessary?......Page 222 13. Conclusions......Page 225 1. Introduction......Page 228 2. Autonomy as Self-Control......Page 230 3. Autonomy and Information in Psychiatry......Page 233 4. Information and Self-Perception......Page 234 5. Information Relating to Food......Page 236 6. Eating Disorders and Beliefs......Page 238 7. The Cognitive Approach to Eating Disorders......Page 241 8. The Ethics of Paternalism towards People with Eating Disorders......Page 243 9. Factors that Limit the Strength of Paternalism towards the Eating-Disorders Sufferer......Page 244 10. Conclusions......Page 249 1. Introduction......Page 252 3. Competence......Page 255 5. A Paradoxical Distinction between Passive Euthanasia and Refusal of Treatment......Page 259 6. Refusal of Artificial Feeding is not ‘on a Par’ with Refusal of Treatment in Debilitating Chronic and Terminal Illnesses......Page 262 8. Why Draper should have Made the Brave Claim......Page 263 9. Draper has not Made the Brave Claim, although She Should Have......Page 264 10. Why Draper has not Made the Brave Claim......Page 265 11. Can we Defend the Brave Claim in the Case of Anorexia Nervosa?......Page 266 12. Conclusions......Page 267 14. Conclusions: The Need for Change......Page 271 Bibliography......Page 282 C......Page 310 G......Page 311 M......Page 312 R......Page 313 W......Page 314

simona Giordano Presents The First Full Philosophical Study Of Ethical Issues In The Treatment Of Anorexia And Bulimia Nervosa. Beginning With A Comprehensive Analysis Of These Conditions And An Exploration Of Their Complex Causes, She Then Proceeds To Address Legal And Ethical Dilemmas Such As A Patient's Refusal Of Life-saving Treatment. Illustrated With Many Case-studies, understanding Eating Disorders Is An Essential Tool For Anyone Working With Sufferers Of These Much Misunderstood Conditions, And For All Those Ethicists, Lawyers, And Medical Practitioners Engaged With The Widely Relevant Issues They Raise.

Synopsis: Simona Giordano presents the first full philosophical study of ethical issues in the treatment of anorexia and bulimia nervosa. Beginning with a comprehensive analysis of these conditions and an exploration of their complex causes, she then proceeds to address legal and ethical dilemmas such as a patient's refusal of life-saving treatment. Illustrated with many case-studies, Understanding Eating Disorders is an essential tool for anyone working with sufferers of these much misunderstood conditions, and for all those ethicists, lawyers, and medical practitioners engaged with the widely relevant issues they raise Giordano presents the first full philosophical study of ethical issues in the treatment of anorexia and bulimia nervosa. She analyses these conditions, explores their complex causes, then addresses legal and ethical dilemmas such as a patient's refusal of life-saving treatment. Essential for anyone working on these much misunderstood conditions Starting with an analysis of these conditions and an exploration of their complex causes, Giordano then proceeds to address legal and ethical dilemmas such as a patient's refusal of life-saving treatment. The book is illustrated with many case-studies