Book Review: Starving To Live: The Paradox of Anorexia

★ Starving To Live: The Paradox of Anorexia by Alessandra Lemma-Wright, Central Book Publishing Ltd (1994) 95pp, £8.99 PB.

Lemma-Wright aims with this slender volume to provide "a brief but comprehensive overview of anorexia, covering research, theory and practice", and further to set this within "the context of an existential analysis of anorexia".

The overview of anorexia provides perhaps the most accessible introduction to this important and controversial subject currently available and is admirable in both vividness - significantly assisted by the insertion throughout the text of appropriate case study material drawn from the author's own practice - and comprehensiveness. Such a clear and concise organization of the material will be invaluable to any student considering research on an aspect of anorexia (or bulimia, on which she touches briefly and about which she provides useful information which helps clarify the similarities and distinctions between what she refers to as "probably related and overlapping 'disorders' of eating").

Given the constraint imposed by a mere ninety pages of text, it is difficult to see how this overview could have been bettered: moreover Lemma-Wright achieves possibly the most important goal of an introductory text - that of engaging and enthusing the reader so that he or she will be encouraged to read further and in greater depth.

The book is not, however, entirely without its difficulties and these become especially apparent once Lemma-Wright embarks on the fourth of her seven chapters, in which she attempts to go beyond the labels and the research findings which she has presented in earlier chapters by stressing "the importance of gaining insight into the client's experience of herself and her world"..."by attempting to think in terms of the anorectic's 'worldview'".

It should be immediately apparent that there exists a fundamental contradiction between an openness on the part of the therapist to the client's own experience of herself and the concept of the anorectic's worldview: at the very least we should be alerted to the danger, which we all must live with in our practice, of attempting to fit the client into some pre-conceived category, thus effectively losing sight of their individuality, the unremitting attempt to engage with which is a necessary condition of the existential approach. Certainly it is difficult to see how an I-Thou relatedness could develop out of a situation in which the client is perceived as a member of a category or type.

Perhaps in making this observation we are speaking to the converted for, after all, Lemma-Wright states quite clearly in her first chapter that labels and the information they contain greatly influence how we see and understand that which the label purports to describe. Further, she notes that some labels "implicitly assume that the cause of...behaviour and distress is 'an illness of some kind'". Nevertheless Lemma-Wright goes on, despite misgivings, to use 'anorectic' for purposes of 'clarity', offers a working definition of anorexia nervosa, and writes of the difficulty in diagnosing anorexia, of pathology, and of aetiology. She also speaks of 'ontological insecurity', a concept which is highly problematic - as Cohn reminds us in

Simon du Plock