The Social Construction of Anorexia Nervosa
Publication Year: 1999
`A readable book that contains simplified information of some complicated concepts. It will prove of benefit to those readers in the field of women and social studies' - European Eating Disorders Review The concepts presented in this book are carefully argued, succinctly organized, and genuinely stimulating.... It provokes clinicians to think about treatment and the effect of diagnostic practices, it provokes researchers to ask different questions, and it provokes students to read beyond dominant and conventional texts. This is a timely and important publication that deserves to feature prominently in the ongoing study of anorexia nervosa' - Journal of Community & Applied Social Psychology
- Front Matter
- Back Matter
- Subject Index
Part I: Early Ideas about Self-Starvation and Anorexia Nervosa
- Chapter 1: From Religion to Madness: Religious and Medical Interpretations of Self-Starvation
- Chapter 2: The Late Nineteenth Century Medical Discovery of Anorexia Nervosa
- Chapter 3: Early Social, Cultural and Feminist Theories of Anorexia Nervosa
- Chapter 4: Constructions of Gender and Identity in Anorexia Nervosa
- Chapter 5: The Multiplicity and Diversity of Causes of Anorexia Nervosa
- Chapter 6: Clinical Treatments for Anorexia Nervosa
Part III: Postmodernism, the Body and Therapy: Implications for Practice
Inquiries in Social Construction[Page ii]
Kenneth J. Gergen and John Shotter
Inquiries in Social Construction is designed to facilitate across disciplinary and national boundaries, a revolutionary dialogue within the social sciences and humanities. Central to this dialogue is the idea that all presumptions of the real and the good are constructed within relations among people. This dialogue gives voice to a new range of topics, including the social construction of the person, rhetoric and narrative in the construction of reality, the role of power in making meanings, postmodernist culture and thought, discursive practices, the social constitution of the mental, dialogic process, reflexivity in theory and method, and many more. The series explores the problems and prospects generated by this new relational consciousness, and its implications for science and social life.
Also in this series
Constructing the Social
edited by Theodore R. Sarbin and John I. Kitsuse
edited by H. Lorraine Radtke and Henderikus J. Stam
edited by Herbert W. Simons and Michael Billig
The Social Self
edited by David Bakhurst and Christine Sypnowich
Eero Riikonen and Gregory Smith
Social Constructionism, Discourse and Realism
edited by Ian Parker
© Julie Hepworth 1999
First published 1999
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted or utilized in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without permission in writing from the Publishers.
SAGE Publications Ltd
6 Bonhill Street
London EC2A 4PU
SAGE Publications Inc.
2455 Teller Road
Thousand Oaks, California 91320
SAGE Publications India Pvt Ltd
32, M-Block Market
Greater Kailash - I
New Delhi 110 048
British Library Cataloguing in Publication data
A catalogue record for this book is available from the British Library
ISBN 0 7619 5308 6
0 7619 5309 4 (pb)
Library of Congress catalog record available
Typeset by Type Study, Scarborough, North Yorkshire
[Page v]For Lawrence and Naomi, with Love[Page vi]
In writing the acknowledgements I finally get to thank everyone who has given me so much support from the beginning of my research and writing. I thank especially Christine Griffin who has inspired and supported me throughout, and to whom I owe so much personally and intellectually. I thank the School of Psychology at the University of Birmingham, UK, for providing me with such an enjoyable and challenging academic environment in which I developed the ideas that underpin this book. I am grateful to the librarians at the University of Birmingham, and particularly the archivists for their assistance with retrieving historical medical documents from the Medical School Library and the British Museum.
I thank Ziyad Marar, who commissioned the book, Naomi Meredith and Lucy Robinson at Sage for their editorial advice. In particular I gratefully acknowledge the support and intellectual contribution of Kenneth J. Gergen in the development of the book. More recently, thanks to Sue Widdicombe for comments.
Numerous friends, family members and colleagues provided me with continuous support and enthusiasm for the research and writing of the book. I thank all of you for that. I am especially grateful to Gary J. Krug, my partner, for many discussions, for his intellectual contributions, and the space to write when there was always so much else to do. I also thank Peter Hepworth, my grandmother, Alice, and Madeleine Murtagh for their support. Special thanks to Lawrence and Naomi who provide me with inspiration always, and have supported my writing this book in any way they could.
I am grateful to the United Kingdom Economic and Social Research Council who provided funding support during the initial stages of the research. More importantly, I thank Anthony Worsley and acknowledge the institutional support of the University of Adelaide while writing the manuscript. Thanks to Anthea Page for assisting with the initial manuscript layout.
I would also like to thank the interview participants, the health care workers, who despite having many clinical demands on their time also found the time to talk at length with me.
Chapter 2 has been published previously as ‘The discovery of anorexia nervosa: discourses of the late 19th century’, in Text, 10 (4), pp. 321–38 (1990). I gratefully acknowledge Christine Griffin, who co-authored this paper with me, for allowing the use of this work in the book. The work is printed with permission of Mouton de Gruyter, a Division of Walter de Gruyter GmH & Co.
References[Page 131]Acland, T.D. (ed.) (1894) A Collection of the Published Writings of William Withey Gull: Memoirs and Addresses. London: The New Sydenham Society.American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders. Revised,4th edn(DSM-R). Washington, DC: APA.1983) Political Anatomy of the Body: Medical Knowledge in Britain in the Twentieth Century. Cambridge: Cambridge University Press.(1882) ‘Anorexia in young girls unaccompanied with visceral disease’. Proceedings of the South Australian Branch of the British Medical Association. Adelaide: Frearson and Brother.(1983) Simulations. New York: Semiotext.(1988) The Ecstasy of Communication. New York: Semiotext.(1985) Holy Anorexia. Chicago: University of Chicago Press.(1992) Situating the Self: Gender, Community and Postmodernism in Contemporary Ethics. Oxford: Polity Press.(1990) ‘A review of ECT for children and adolescents’, Journal of the American Academy of Child and Adolescent Psychiatry, 29 (2): 302–7. http://dx.doi.org/10.1097/00004583-199003000-00022and (1988) ‘Anorexia nervosa and the crystallization of culture’, in I.Diamond and L.Quinby (eds), Feminism and Foucault: Reflection on Resistance. Boston: Northeastern University Press.(1990) ‘Reading the slender body’, in M.Jacobus, E.Fox Keller and S.Shuttleworth (eds), Body/Politics: Women and the Discourses of Science. London: Routledge.(1993) Unbearable Weight: Feminism, Western Culture, and the Body. London: University of California Press.(1974) Eating Disorders: Obesity, Anorexia Nervosa and the Person Within. London: Routledge and Kegan Paul.(1978) The Golden Cage: The Enigma of Anorexia Nervosa. London: Open Books.(1988) Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease. London: Harvard University Press.(1992) ‘Identification and power in feminist therapy: a reflexive history of a discourse analysis’, Women's Studies International Forum, 15 (4): 487–98. http://dx.doi.org/10.1016/0277-5395%2892%2990082-7(1986) ‘Social constructionism and the development of medical sociology’, Sociology of Health and Illness, 8 (2): 137–69. http://dx.doi.org/10.1111/1467-9566.ep11340129(1986) The Hungry Self: Daughters and Mothers, Eating and Identity. Virago Press: London.(1911) ‘The psychological dangers to women in modern social development’, in O.Lodge (ed.), The Position of Women: Actual and Ideal. London: James Nisbett.(1986) ‘By love possessed’, The New York Review, 30 January, 3–4.(1894) ‘Anorexia nervosa’, The Lancet, 27 January, 202–3. http://dx.doi.org/10.1016/S0140-6736%2801%2966054-9(1984) Michel Foucault. New York: St. Martin's Press.and (1990) ‘Towards 2000 – Planning the dietetic odyssey’. Dietitians Association of Australia National Conference Proceedings, No. 9, 33–6.(1996) ‘The Government and Ethics of Nutrition’. Unpublished PhD Thesis, Murdoch University, Australia.(1998) ‘The government and ethics of health promotion: the importance of Michel Foucault’, Health Education Research.(1980) Anorexia Nervosa: Let Me Be. London: Academic Press.(1993) ‘The value of qualitative research in nutrition’, Annual Review of Health Social Sciences, 3: 109–18.([Page 132]1979) Anorexia Nervosa. London: Heinemann.and (1988) Power Under the Microscope. Netherlands: Foris.(1991) Images of Postmodern Society. London: Sage.(1991) Putting Difference to Work. New York: W.W. Norton.(1982) Michel Foucault. Beyond Structuralism and Hermeneutics.and (2nd edn. Chicago: University of Chicago Press.1978) ‘The “sick” women of the upper classes’, in J.Ehrenreich (ed.), The Cultural Crisis of Modern Medicine. New York: Monthly Review Press.and (1979) For Her Own Good: 150 Years of Experts' Advice to Women. London: Pluto Press.and (1991) The Body: Social Processes and Cultural Theory. London: Sage., and (1981) ‘Is feminism a threat to scientific objectivity?’, International Journal of Women's Studies, 4: 378–92. http://dx.doi.org/10.1016/S0148-0685%2881%2996691-4(1993) ‘The use of electroconvulsive therapy in patients with intractable anorexia nervosa’, International Journal of Eating Disorders, 13 (2): 195–201. http://dx.doi.org/10.1002/1098-108X%28199303%2913:2%3C195::AID-EAT2260130207%3E3.0.CO;2-5(1979) ‘Gastronomie et gastro-anomie: sagesse du corps et crises bioculturelle de l'alimentation?’Communications, 31: 189–210. http://dx.doi.org/10.3406/comm.1979.1477(1993) ‘Poststructuralism in family therapy: interrogating the narrative/conversational mode’, Journal of Marital and Family Therapy, 19 (3): 221–32. http://dx.doi.org/10.1111/j.1752-0606.1993.tb00983.x(Fisher, S. and Todd, A.D. (eds) (1983) The Social Organisation of Doctor-Patient Communication. Washington, DC: Centre for Applied Linguistics.1971) Madness and Civilisation: A History of Insanity in the Age of Reason. London: Tavistock Press.(1973) The Birth of the Clinic: An Archaeology of Medical Perception. London: Tavistock Press.(1974) The Archaeology of Knowledge. London: Tavistock Press.(Foucault, M. (ed.)(1982) I, Pierre Riviere, having slaughtered my mother, my sister, and brother: A case of parricide in the 19th century. London: University of Nebraska Press.1977) Discipline and Punish: The Birth of the Prison. New York: Vintage Books.(1980a) The History of Sexuality. Vol. 1: An Introduction. New York: Vintage Books.(Foucault, M. (ed.)(1980b) Herculine Barbin, Being the Recently Discovered Memoirs of a Nineteenth Century Hermaphrodite. Trans. RichardMcDongall. New York: Colophon.1988) ‘The political technology of individuals’, in L.H.Martin, H.Gutman, and P.H.Hutton (eds), Technologies of the Self: A Seminar with Michel Foucault. Amherst: University of Massachusetts Press.(1973 ) New Introductory Lectures on Psychoanalysis, in A.Richards (ed.), Freud Pelican Library, Vol. 2. Harmondsworth: Penguin.(1972) ‘Deprivation dwarfism’, Scientific American, July, 101–7.(1982)Anorexia Nervosa: A Multidimensional Perspective. New York: Bruner Mazel.and (1983) ‘The development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia’, International Journal of Eating Disorders, 2: 15–34. http://dx.doi.org/10.1002/1098-108X%28198321%292:2%3C15::AID-EAT2260020203%3E3.0.CO;2-6, and (1983) Local Knowledge: Further Essays in Interpretive Anthropology. New York: Basic Books.(1985) ‘The social constructionist movement in modern psychology’, American Psychologist, 40: 266–75. http://dx.doi.org/10.1037/0003-066X.40.3.266(1991) The Saturated Self: Dilemmas of Identity in Contemporary Life. New York: Basic Books.(1992) ‘Beyond narrative in the negotiation of therapeutic meaning’, in S.McNamee and K.Gergen (eds), Therapy as Social Construction. London: Sage.and (1984) Opening Pandora's Box: A Sociological Analysis of Scientists' Discourse. Cambridge: Cambridge University Press.and ([Page 133]1968) Asylums. London: Penguin.(1982) ‘The Good, the Bad and the Ugly: Images of Young Women in the Labour Market’. Stencilled occasional paper, Centre for Contemporary Cultural Studies, University of Birmingham.(1868) ‘The Address in Medicine: delivered before the annual meeting of the B.M.A. at Oxford’, The Lancet, 8 August.(1874) ‘Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica)’, Transactions of the Clinical Society. London, 7, 22–7.(1888) ‘Anorexia Nervosa’, The Lancet, 17 March, 516–17. http://dx.doi.org/10.1016/S0140-6736%2800%2948519-3(1994) ‘Histories of suspicion in a time of conspiracy: a reflection on Aubrey Lewis's history of paranoia’, History of the Human Sciences, 7 (3): 89–109. http://dx.doi.org/10.1177/095269519400700304(1984) ‘The new myth of the witch’, Trouble and Strife, 2, Spring.(1956) ‘Deliberate disability’, British Medical Journal, 18 February, 361–7. http://dx.doi.org/10.1136/bmj.1.4963.361, , and (1984) Changing the Subject: Psychology, Social Regulation and Subjectivity. London: Methuen., , , and (1991) A Post-Structuralist Analysis of the Late 19th Century Medical Discovery of Anorexia Nervosa and Contemporary Discourses on Anorexia Nervosa Used by Health Care Workers. Unpublished PhD Thesis, University of Birmingham, UK.(1994) ‘Qualitative analysis and eating disorders: discourse analytic research on anorexia nervosa’, International Journal of Eating Disorders, 15 (2): 179–85. http://dx.doi.org/10.1002/1098-108X%28199403%2915:2%3C179::AID-EAT2260150209%3E3.0.CO;2-R(1995) ‘The seduction of diet’. Conference Proceedings Framing Communication: Exclusions, Edges and Cores. Australian and New Zealand Communication Association National Conference, 5–7 July, Perth.(1997) ‘Evaluation in health outcomes research: linking theories, methodologies and practice in health promotion’, Health Promotion International, 12 (3): 233–8. http://dx.doi.org/10.1093/heapro/12.3.233(1990) ‘The discovery of anorexia nervosa: discourses of the late 19th Century’. Text, 10 (4): 321–38. http://dx.doi.org/10.1515/text.1.19220.127.116.111and (1995) ‘Conflicting opinions? “Anorexia nervosa”, medicine, and feminism’, in, S.Wilkinson and C.Kitzinger (eds), Feminism and Discourse. London: Sage.and (1997) ‘Hepatitis C and policy implementation: ethics as a dialogic process’, Australian and New Zealand Journal of Public Health, 21(1): 4–7. http://dx.doi.org/10.1111/j.1467-842X.1997.tb01643.xand (1990) ‘Constructing realities: an art of lenses’, Family Process, 29: 1–12. http://dx.doi.org/10.1111/j.1545-5300.1990.00001.x(1989) Subjectivity and Method in Psychology. London: Sage.(1991) ‘The silent participant: Bryan Turner on anorexia nervosa’, Australian and New Zealand Journal of Sociology, 27 (2): 232–4.(1995) ‘The social construction of medical knowledge’, Social History of Medicine, 8 (3): 361–81. http://dx.doi.org/10.1093/shm/8.3.361(Kennedy, E. and Mendus, S. (eds)(1989) Women in Western Political Philosophy. London: Wheatsheaf.1959) The Psychoanalysis of Children. Revised ed. London: Hogarth Press.(1992) ‘Visual ethnographies and the postmodern self: reflections on aesthetics and metatext’, in N.K.Denzin (ed.), ‘Studies in Symbolic Interaction’. A Research Annual. London: JAI Press Inc.(1994) ‘Health promotion and empowerment: reflections and professional practice’, Health Education Quarterly, 21 (2): 253–68. http://dx.doi.org/10.1177/109019819402100209(1997) ‘Participation in health promotion: the “hardware” and the “software”’, in R.Labonte (ed.), Power, Participation and Partnerships for Health Promotion. Victorian Health Promotion Foundation, Australia.(1964) Sanity, Madness and the Family. London: Penguin.and (1873) ‘On Hysterical Anorexia’, Medical Times and Gazette, 6 September: 265–6; 27 September: 367–9.(Lawrence, M. (ed.)(1984) The Anorexic Experience. London: The Women's Press.Lawrence, M. (ed.)(1987) Fed Up and Hungry. London: The Women's Press.1979) ‘Self-starvation’, Spare Rib, No. 83.and ([Page 134]1980) ‘Is it bad not to be thin?’, American Journal of Clinical Nutrition, 33: 174–6.(1992) ‘Nothing in common but their first names: the case of Foucault and White’, Journal of Family Therapy, 14 (3): 281–4. http://dx.doi.org/10.1046/j..1992.00459.x(1893) ‘Hysterical tremor and hysterical anorexia (anorexia nervosa) of a severe type’. The American Journal of Medical Science106: 264–277.(1978) Medicine: An Illustrated History. New York: Harry N. Abrams.and (1988) ‘Challenging the orthodoxy: towards a feminist theory and practice’, Feminist Review, Spring, 28: 16–55. http://dx.doi.org/10.1057/fr.1988.3and (1981) The Art of Starvation. London: Virago.(1993) Anorexic Bodies: A Feminist and Sociological Perspective on Anorexia Nervosa. London: Routledge.(1992) ‘The application of Michel Foucault's philosophy in the problem externalizing discourse of Michael White’, Journal of Family Therapy, 14 (3), 1265–279.(1977) Adolescent Girls at Risk. London: Pergamon Press.and (1895) ‘A fatal case of anorexia nervosa’, The Lancet, 19 January, 149–50. http://dx.doi.org/10.1016/S0140-6736%2801%2990912-2(1985)The Assault on Truth. London: Penguin.(1992)The Sociology of Food: Eating, Diet and Culture. London: Sage., and (1978) Psychosomatic Families: Anorexia Nervosa in Context. Cambridge, MA: Harvard University Press., and (1975) Psychoanalysis and Feminism. London: Penguin.(1977) ‘Fasting girls and our attitudes to them’, British Medical Journal, 2: 1652–55. http://dx.doi.org/10.1136/bmj.2.6103.1652(1694)Phthisiologia: or a Treatise of Consumptions. London: Smith and Walford.(1982) ‘Why an analysis of scientific discourse is needed’, in K.D.Knorr-Cetina and M.Mulkay (eds), Science Observed: Perspectives on the Social Study of Science. Beverly Hills, CA: Sage., and (1958) ‘Anorexia nervosa: facts and theory’, American Journal of Digestive Diseases, 3 (4): 249–74. http://dx.doi.org/10.1007/BF02232408(1987) ‘Social constructionism and medical sociology: a reply to M.R. Bury’, Sociology of Health and Illness, 9 (2): 107–26. http://dx.doi.org/10.1111/1467-9566.ep11343869and (1993) Goals and Targets for Australia's Health in the Year 2000 and Beyond. Canberra: Australian Government Publishing Service., , , and (1978) Fat is a Feminist Issue. London: Hamlyn.(1986) Hunger Strike: The Anorectic's Struggle as a Metaphor for Our Age. London: Faber and Faber.(1980)Anorexia Nervosa. London: Penguin.(1989)The Crisis in Modern Social Psychology – and How to End It. London: Routledge.(1992) Discourse Dynamics: Critical Analysis for Social and Individual Psychology. London: Routledge.(1995) Deconstructing Psychopathology. London: Sage. http://dx.doi.org/10.4135/9781446221563, , , and (1958) Witchcraft. London: Penguin.(1994) ‘Community development in health promotion: empowerment or regulation?’, Australian Journal of Public Health, 18 (2): 213–17. http://dx.doi.org/10.1111/j.1753-6405.1994.tb00230.x(1987) Discourse and Social Psychology: Beyond Attitudes and Behaviour. London: Sage.and (1995) ‘The “problem” of Michael White and Michel Foucault’, Journal of Marital and Family Therapy, 21 (3): 309–18. http://dx.doi.org/10.1111/j.1752-0606.1995.tb00164.x(1992) Starving in the Silences. Sydney: Allen and Unwin.(1993) ‘Towards a Critical Sociology of Freedom’. Inaugural lecture delivered on 5 May 1992, Goldsmiths College, University of London. Goldsmiths College Occasional Paper.([Page 135]1994) ‘Government, authority and expertise under advanced liberalism’, Economy and Society, 22 (3): 273–99.(1996)Inventing Our Selves: Psychology, Power and Personhood. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511752179(1992) ‘Political power beyond the state: problematics of government’, British Journal of Sociology43 (2): 172–205. http://dx.doi.org/10.2307/591464and (1991) ‘How advertisers portray women in the “glossies”’. Research presented at the Women and Psychology Conference, July.(1936) ‘Anorexia nervosa’, The Lancet, 17 October, 893–9. http://dx.doi.org/10.1016/S0140-6736%2800%2980981-2(1994)The Original Mediterranean Cuisine. Adelaide: Wakefield Press.(1982)Biological Politics: Feminist and Anti-Feminist PerspectivesLondon: Tavistock.(1986)Sexual Contradictions: Psychology, Psychoanalysis and FeminismLondon: Tavistock.(1982) Museums of Madness. London: Penguin.(1993)The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900. London: Yale University Press.(Seidman, S. and Wagner, D. (eds)(1991) Postmodernism and Social Theory. New York: Basil Blackwell.1974)Self-Starvation: From the Intrapsychic to the Transpersonal Approach to Anorexia Nervosa. London: Human Context Books.(1993)The Body and Social Theory. London: Sage. http://dx.doi.org/10.4135/9781446215470(1989)Texts of Identity. London: Sage.and (1987) The Female Malady: Women, Madness and English Culture 1830–1980London: Virago.(1914) Ueber embolische Prozesse in der Hypophysis, Virchows Archiv (Pathologische Anatomie), 217: 226–39. http://dx.doi.org/10.1007/BF01989185(1983) Foucault, Marxism and Critique. London: Routledge and Kegan Paul.(1895) ‘Emsworth cottage hospital, case of anorexia nervosa; necropsy’, The Lancet, 5 January, 31–2. http://dx.doi.org/10.1016/S0140-6736%2802%2906375-4(1986) Structuralism. London: Paladin.(1986) The Female Body in Western Culture: Contemporary Perspectives. Cambridge, MA: Harvard University Press.(1993) The Shared Table: Ideas for an Australian Cuisine. Canberra: Australian Government Publishing Service.(1993) The Body Social: Symbolism, Self and Society. London: Routledge.(1971) Manufacture of Madness. London: Routledge and Kegan Paul.(1972) The Myth of Mental Illness. London: Paladin.(1982) ‘The government of the body, medical regimens, and the rationalisation of diet’, British Journal of Sociology, 33 (2): 252–69. http://dx.doi.org/10.2307/589935(1984) The Body and Society, Explorations in Social TheoryOxford: Basil Blackwell.(1987) Medical Power and Social Knowledge. London: Sage. http://dx.doi.org/10.4135/9781446250426(1990) ‘The talking disease: Hilde Bruch and anorexia nervosa’, Australian and New Zealand Journal of Sociology, 26 (2): 157–69.(1991) Women's Madness: Misogyny or Mental Illness?Hemel Hempstead: Harvester Wheatsheaf.(1990) ‘The first Australian case description of anorexia nervosa’, Australian and New Zealand Journal of Psychiatry24: 109–12. http://dx.doi.org/10.3109/00048679009062893and (1990) ‘Anorexia nervosa in 19th century America’, The Journal of Nervous and Mental Disease, 178: 531–5.and (1989) The Family Approach to Eating Disorders: Assessment and Treatment of Anorexia Nervosa and Bulimia. New York: PMA Publications., and (1991) The Aesthetics of Disappearance. New York: Semiotext.([Page 136]1991) Fragmentation and Redemption: Essays on Gender and the Human Body in Medieval Religion. New York: Urzone, Inc. Zone Books.(1991) ‘Deconstruction and therapy’. Dulwich Centre Newsletter, No. 3.(1989) Literate Means to Therapeutic Ends. Adelaide: Dulwich Centre Publications.and (1990) Narrative Means to Therapeutic Ends. New York: W.W. Norton.and (1993) ‘Deconstruction and Therapy’. In S.Gilligan and R.Price (eds) Therapeutic Conversations (pp. 22–61). New York: W.W. Norton,(1964) The Child, The Family and the Outside World. London: Penguin.(1982) ‘The Beverley Hills eating disorder: the mass marketing of anorexia nervosa’, International Journal of Eating Disorders, 1 (3): 57–69. http://dx.doi.org/10.1002/1098-108X%28198221%291:3%3C57::AID-EAT2260010307%3E3.0.CO;2-Kand (World Health Organisation (1986) ‘Health promotion: Ottowa Charter for Health Promotion’, Health Promotion, 1 (4): 1–5.World Health Organisation/UNICEF (1978) ‘Alma Ata 1978 Primary Health Care Health Care For All Series 1’Geneva: WHO.1993) ‘Toward an ethic of empowerment for health promotion’, Health Promotion International, 8 (3): 225–35. http://dx.doi.org/10.1093/heapro/8.3.225(1994) ‘Using a narrative metaphor: implications for theory and clinical practice’, Family Process, 33: 233–45. http://dx.doi.org/10.1111/j.1545-5300.1994.00233.xand (