Dennstedt-Dissertationfinal.Pdf
Total Page：16
File Type：pdf, Size：1020Kb
THE INTERPLAY OF SUBSTANCE MISUSE AND DISORDERED EATING PRACTICES IN THE LIVES OF YOUNG WOMEN: IMPLICATIONS FOR NARRATIVE THERAPEUTIC PRACTICE PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Tilburg, op gezag van de rector magnificus, prof. dr. Ph. Eijlander, in het open-baar te verdedigen ten overstaan van een door het college voor promoties aan-gewezen commissie in de Ruth First zaal van de Universiteit op dinsdag 09 februari 2010 om 16.15 uur door Christine Lee Dennstedt Geboren op 12 November 1974 te Nanaimo, British Columbia, Canada Promotores: Prof. Dr. S. McNamee and Prof. Dr. J.B. Rijsman ii ABSTRACT The majority of studies pertaining to substance misuse and eating disorders are dominated by concurrent disorders research. Within that framework, traditional medical, psychological, biochemical models, and the disease model of addiction prevail. Studies that consult young women about their ideas and knowledge for how to best address these problems in therapy are relatively rare within these fields. Using a narrative approach to therapy, I explore the interplay between these problems, and the ways in which disordered eating practices and substance misuse problems can “feed off of each other,” thereby keeping young women ensnared in their grips. Twelve young women (insiders) who attended a residential substance misuse program were interviewed about their personal experience with substance misuse and disordered eating practices in an attempt to explore and identify ways in which helpers and young women can use these similarities to their advantage. Using case examples from 12 semi-structured interview conversations, I demonstrate the merits of co-research practices, and detail the practical and therapeutic applications of a narrative therapeutic approach when working with young women struggling with these problems. Interviews were audio-taped, transcribed, sorted and assigned to thematic categories. The results suggest the importance of highlighting the interplay between these problems and illuminate the young women’s insider knowledge regarding these problems. Based on these results, suggestions for ways to best address these problems are offered. In order to contextualize the problems and locate them iii within their political and social cultural context, the above ideas are framed within historical accounts of alcohol and drugs, disordered eating, mental illness, social construction, and narrative therapy ideas. This study may benefit counsellors, health- care professionals, parents, and teachers who know or are working with young women who struggle with substance misuse and disordered eating practices in that the study offers practical ways to assist persons in reclaiming their lives from these problems. iv DEDICATION This is dedicated to all the young women whose voices are included in this dissertation. Without your words this writing would not have been possible. I hope that your voices are well represented in this manuscript. I thank you for your courage to speak with me, and I hope your words inspire and assist other young women who are struggling to free themselves from substance misuse and disordered eating to find freedom from these problems. v ACKNOWLEDGEMENTS There are a number of people I would like to thank for helping me complete this dissertation. I would especially like to thank my supervisor, Sheila McNamee. Her unending support, suggestions, critiques and guidance helped shape and enrich this writing. Many thanks to Arlene Katz, Stephen Madigan, Vikki Reynolds, Colin Sanders, Julie Tilsen, and Aileen Tierney for helpful conversations about the ideas, as well as reviewing sections of the manuscript. Thank you to all the therapists who helped me further develop my ideas; Ali Borden, Karl Tomm, Stephen Madigan, Josie Gellar, and Erin Dunn. For encouragement and interest in the ideas, I would also like to thank Allison Rice, Lorraine Grieves, and Dennis Dion, who provided invaluable information during the forced sort and readings and re-readings of my many drafts. Our work together at Peak House inspired much of the ideas explored in this dissertation. To all the staff at Peak House, thank you for contributing to and inspiring this writing in so many rich ways. Heather Elliott, your voice richly informs my therapeutic work, thank you for supervising my work, and our many conversations over tea. Jen Uegama, thank you for your graphic design work and for being a very good friend over so many years. To my friends who kept me connected and who where always ready to lend an ear, go for a bike ride, or talk over coffee. My family, my mother, Lee, my father, Bob, and my sister, Angela, thank you for always loving, supporting, and encouraging me in whatever it is that I choose to do. Finally, this dissertation would have been impossible without the vi unwavering support of my partner Clark Lewis. I am now ready to join you on our next adventure. vii TABLE OF CONTENTS Abstract .....................................................................................................................iii Dedication ......................................................................................................................v Acknowledgements ........................................................................................................vi Table of Contents .........................................................................................................viii List of Figures ...............................................................................................................xii List of Tables ...............................................................................................................xiii Chapter 1 Introduction .................................................................................................14 How I Came to this Work ..........................................................................................17 The Problems Overlap ...............................................................................................19 Isolating Two Problems .............................................................................................20 Disrupting the Isolation..............................................................................................22 Traditional Ways of Understanding Disordered Eating Practices and Substance Misuse.......................................................................................................23 Youth’s Voices ..........................................................................................................28 Chapter 2 The interplay between disordered eating practices and substance misuse..........................................................................................................31 The Narrative Re-authoring Perspective.....................................................................44 Storying our world .................................................................................................45 Externalizing practices...........................................................................................47 Alternate Stories.....................................................................................................50 A Socio-Political Approach........................................................................................51 Narrative therapy and power..................................................................................53 Responses to Common Critiques of the Narrative Approach ......................................55 In Closing ..................................................................................................................59 Chapter 3 The Historical Context .................................................................................64 Eating Disorders ........................................................................................................64 Medieval Europe....................................................................................................65 The Protestant Reformation and 17th and 18th Centuries .........................................65 The 19th Century: Anorexia is named......................................................................66 The 20th Century.....................................................................................................71 The Flapper Era.....................................................................................................71 The Sixties..............................................................................................................73 Present day understandings....................................................................................75 Historical Perspectives on Drugs and Alcohol............................................................77 Alcohol ..............................................................................................................77 viii The ascendance of drug use....................................................................................86 Present day understandings....................................................................................91 Harm Reduction.........................................................................................................93 Crafting Alternative Understandings of Eating Disorders and Substance Misuse........94 Changes in the Way the Problem is Understood .........................................................96