I have been interested in the role of music therapy with treatment of eating disorders for several years, so I was glad to find this article on music therapy with adolescents suffering with anorexia nervosa. The whole of this article was very interesting to me but the point that piqued my interest the most was the methods of music therapy used to help treat persons with eating disorders. Also, the lack of research in the treatment of eating disorders was something I was surprised to find as I began reading this article. In McFerran's article I found that she used several music therapy methods in her experience with the treatment of eating disorder patients. McFerran suggests, " The use of song writing has been particularly effective in freeing patients to express themselves in a creative way that also articulates important aspects of their experience." She also says "song writing has been a powerful medium for sharing difficult stories with family members and loves ones". This article stresses the importance music therapy plays in the role of identifying and expressing emotions. This helped to describe to me what techniques could be used in a music therapy session with an adolescent with an eating disorder.
McFerran also relates the lack of research in the long-term treatment, "Although the lack of evidence available from the music therapy literature is noteworthy, this is more reflective of the difficulties faced by all disciplines working the eating disorder field." This statement made me want to research what was known about the treatment of eating disorders, especially in the area of music therapy. This article has catapulted my desire for my literature review that will continue to a research project next semester. I feel that Katrina McFerran has shed some light on the important subject of music therapy and eating disorder treatment. I look forward to continue learning more about the subject of eating disorders and how music therapy can help to treat individuals seeking help.
In the article “Dangerous Liaisons: Group Work for Adolescent Girls who have Anorexia Nervosa,” Katrina McFerran discusses the concept of anorexia and how music therapy interventions can help steer young girls away from eating disorders.
I am constantly aware of the ridiculous media and advertisements that are prevalent in our society. The author writes that there is no proven link between body image and anorexia, but I think that the relationship between the two is clear. Two of the people who previously responded to the article had some interesting thoughts. Wrenn Compére commented that the author seemed to be missing something and Wen-Tzu Chang used specific references to back up his claim that the media and self-image are connected. I agree with both of their reactions. People in our society are constantly viewing images of beautiful women, and modeling themselves after what they see. When in reality, these women do not look so perfect. They have airbrushed make-up and digitally enhanced features and even limbs. We usually don’t notice this enhancement until a magazine accidentally publishes a Photoshop mistake: a missing leg, one arm extremely smaller than the other, or even an extra hand or foot. There is so much Photoshop editing going on in magazines these days, it’s hard to imagine what the models would look like in real life.
The people that young girls are looking up to are not real role models. Young girls think they aren’t beautiful unless they look like the women in the magazines. But it’s impossible to look like these women, because you can’t Photoshop real life.
And even before the photoshopping is done, most models aren’t at a healthy body weight. It’s no wonder that young girls become anorexic with these unnatural beauty standards. Naomi Edelman even provides a comment, in response to this article, that anorexia is a form of asceticism, “denying the physical body pleasure.”
When I see these images, I tend to think, “Gosh, I wish I could look like that.” I realize that these pictures aren’t always accurate displays of real people, but viewing the image immediately puts a dent in my self-esteem. I think that this affects a lot of women, even if they’ve never had an eating disorder.
I’ve seen models and runway stars on TV that appear deathly skinny. This is one thing that makes me really upset. Since a computer is not editing these shows, the real life factor has a greater influence on girls. Girls may think that they want to be that skinny, but in my opinion, some of these women look like they could be starving in a third world country. Yet, these are the women that our society puts on the runway for the “latest fashions.”
The author uses her own clinical experience when she says, “The use of songwriting has been particularly effective in freeing patients to express themselves in a creative way that also articulates important aspects of their experience.” I agree with Amy Adams, who commented on the importance of songwriting as a helpful music therapy intervention for girls with anorexia. I can see how this helps girls sort out their emotions about their body image and reflect on who they are inside. Music is such a great outlet for expressing emotions that are deep inside us.
I think that expressing emotions would help girls with anorexia because the disorder itself is deeply emotional. The idea that they are struggling within themselves to be someone else, a "skinner" person, shows the emotional struggle they face. They are starving their own body of food, the very thing that keeps them alive. If the girls can write a song about how they are feeling and what they are experiencing, it will not only allow them to hear their thoughts and emotions out loud, but others will hear it as well. In group music therapy, peers that are going through the same problems can comfort each other and relate to the songs being written by the other girls.
According to the author, there is little research on the effects of music therapy on girls with anorexia. I think that studies could be done on the correlation of music therapy and self-image. Music therapy can help people find hope and new direction. This could be researched by collecting data from clients before and after sessions for a number of weeks, asking the client to rate her self-image on a scale of one to ten. This could be a great study that would show a rationale for music therapy and how it can positively influence people's lives. I hope to see more research involving music therapy and anorexia in the future, because it seems like music could have a life changing effect for young girls trying to overcome their eating disorders.
In the Voices essay, A Response to Dangerous Liaisons: Group Work For Adolescent Girls Who Have Anorexia Nervous, Katrina McFerrin introduces the eating disorder, as a mental illness with genetic predisposition that affects mainly young women. The disorder focuses not just on being thin but having control over some aspect of one’s life. Therapies that have been used, and are frequently discussed in theoretical writing on the disorder are Cognitive Behavioral Strategies, Family Therapy, Psycho-Education and Psychotherapy. McFerrin goes on to discuss her planned intervention with adolescent girls in an inpatient program, doing group music therapy with that will run for 20 sessions. She mentions that anorexia nervosa is a very difficult illness to document, since it cannot always be documented quantitatively, and that music therapy has been found beneficial for those groups whose progress is hard to document such as clients with dementia. McFerrin writes, “The music therapy literature provides many descriptions that suggest no harm will be done by such a project and that the benefits may be significant. In the literature reviewed, most authors employ a psychodynamic framework in explaining their work” (McFerrin, Voices (5) 1). This type of work can be applied directly with music therapy.
“Anorexia Nervosa is a form of severe and deliberate self-starvation, sometimes leading to death. (Bettencourt, M and Economos, C, 1998, pp.61)” There is an intense pressure on young women to be thin in this society.
Adolescent females, especially in Western society are struggling more and more with disordered eating. Is this because of peers? Caused by the media? Trauma? Controlling parents or school? In psychoanalytic theory, Anna Freud speaks of the term ascetism, denying the physical body pleasure, which is a strategy used in adolescence to cope with stress” (Crain, 2005, pp. 263). Perhaps what begins in ascetism, striving for physical ‘perfection’, or the want to fit in, opens up into a dangerous and deadly disorder. Whatever the root, the disorder revolves around the need for control. One is able to control one’s own body if nothing else in her life. She has control over what goes in, what comes out, and sees this take a physical shape through the shape of her body. “Figure control is one of the few forms of control that women have been allowed to exercise” (Mayer, V, Hagborn, 1980, 1 (4)).
This brings me to how music therapy can benefit individuals with anorexia nervosa. Since they have the need for this control, which is turned inward into the body, there is a real separation of body and self. There is a confusion over what the self is, and in late stages of anorexia, self may be defined by food, intake of calories, weight and or exercise. There is only so much that an inpatient hospital program can do physically by nourishing the body back to health temporarily. “At least 50% of the patients who successfully control their anorexia nervosa with inpatient treatment will relapse within one year. (Hsu, 1980)” The real focus is on how a person can find identity; feel validated for her soul express herself externally rather than holding issues internally. I think that psychodynamic music therapy, as McFerrin also mentions, would be a great tool in helping the self become whole.
Psychodynamic music therapy can be used in either individual or group therapy. As Mary Priestly describes, in her writing about Analytic Music Therapy, a type of Psychodynamic music therapy work,
Through the music experience, the client can open up the world of the unconscious, bringing out emotions such as anger, sadness, guilt or hurt that were repressed and turned inwardly. The next step is to work on what to do with these emotions. As Priestly says, they can be accepted, rejected or used in creative expression. Music therapy among other creative arts therapies such as art, dance and drama can be used to explore and express these emotions. In this process, clients will work on becoming whole again-owning their musical and artistic expression, and developing a positive sense of self.
Priestly gives an example of delving into the unconscious with a female patient. She says that sometimes physical symptoms are messages telling you something about your physical body, but other times they are communications about an emotion or emotions one has bypassed in conscious experience. She can then get in touch with the bypassed emotion through the tension released in the music, and finally allow herself to experience that emotion. This can also be transferred to clients with anorexia nervosa, taking what is held on a bodily level (obsession with thinness, weight, calories, etc), and find out what problems and emotions are at the heart of the issue. Priestly states that when the client actually feels this emotion, “it may be very painful indeed. Such mechanisms are not in use for nothing. But when one experiences one can talk about, think about and work on; when the emotion is hidden one is helpless. (Priestly, 1994, pp.45)”
The relationship between eating disorder behaviors and attitudes and one's exposure to and use of image in the mass media is widely acknowledged, especially for women. (Caney & Louw, 2006)
When I was little, we were never taught that we are too fat to "fit into" the society. In contrast we were taught, "Having a good appetite is a blessing". As we were growing up, this concept has changed at the same time. Nowadays, people judge you by your appearance mostly; indeed, professionals state that "overweight people were been seen as lacking self-discipline." (BBC News, 2005)
What's overweight, what's normal and skinny? Where are these standards coming from? Have they existed within cultures for years, centuries or are they created by mass media, such as magazines and television?
In Fat is a worry but thinness is also a problem, Dr. Goldin, a top child psychiatrist, indicates that "Overweight has caught the attention of the popular media but there's an opposite problem that needs to be noticed too: obsessive thinness." Continuing, Dr. Goldin points"out that the age of eating disorders is between 15 and 25, and more found within young females, although, the factors that occurs this new issues among young people could also be including both emotions or pressures and relationship problems" (Goldin, 2006)
The standard of body shape has influenced the preference diet/ diet habit, which leads to a new modern issue--Anorexia. As McFerran states, "Anorexia has been brought about by the increasing expectations on women to align themselves with images from the media." (McFerran, 2005) Studies have found the relation between media exposure and levels of body dissatisfaction and disorder eating. For instance, adolescent girls who read fashion magazines are more likely to want to lose weight and diet because of magazine images and articles which have negative effects on them such as making them have lower social self-esteem and appear less self-efficient. (Bardone-Cone & Cass, 2007).
The unrealistically thin-ideal body type promulgated in the traditional mass media, magazines and television, has a negative impact on body image in women. (Bardone-Cone, & Cass, 2007)
Adolescents who are more body-conscious are adopting behaviors to improve their appearance and weight that could be considered dangerous and unhealthy." (Duff, 2007)
Media and advertising have defined the world through the depiction of perfect bodies, even that may be misleading. Advertising that courts through promoting dissatisfaction and exaggerating insecurities can produce victims among the vulnerable, therefore, it is important to teach children to be more critical when viewing images in the media. It's not only the parent's job to evaluate and criticize those negative message in this media dominated world. (Duff, 2007)
Reference
Bardone-Cone, A.M., & Cass, K.M. (2007). What does viewing a pro-anorexia website do? An experimental examination of website exposure and moderating effects. International Journal of Eating Disorder. Retrieved from www.interscience.wiley.com.
BBC News (October 25, 2005). Overweight job hunter "lose out".
Carney, T., & Louw, J. (2006). Eating disordered behaviors and media exposure. Soc Psychiatry Psychiatr Epidemiol, 41, 957-966.
Duff, K. (2007), Yes-You can be too thin. Townsend Letter.
Goldin, J. (October 11, 2006). Fat is a worry but thinness is also a problem. Western Morning News, .
McFerran, K. (2005). Dangerous Liaisons: Group work for adolescent girls who have anorexia nervosa. Voices: A World Forum for Music Therapy. Retrieved December 22, 108, from https://normt.uib.no/index.php/voices/article/view/215/159.
Katrina McFerran offers a compelling argument for the use of group work with anorexic teen girls: a population whose competitive edge, it has been argued (Murray, 2002), might cause the intervention to backfire in unintended, destructive ways. In her article "Dangerous Liaisons: Group Work for Adolescent Girls who have Anorexia Nervosa," McFerran provides an overview of recent literature regarding the disorder. Despite the plethora of current research linking the spike in disordered eating with the increasing bombardment of young girls by idealized media images of female beauty (Brown & Lamb, 2006; Martin, 2007), the author chooses to emphasize the lack of a proven causal link between body image and a diagnosis of anorexia nervosa. She seems here to be missing an important opportunity to call attention to a very probable contributor to an increasingly deadly condition. The omission is especially surprising, as her article goes on to shed important light upon the benefits of group work with this population, with her upcoming study aiming to lay the groundwork for future research in this area.
Still, this lack of empirical data, along with the author's observation that adolescents tend to discount the impact of popular culture on their lives (Of course they do! In her video "Killing Us Softly," Jean Kilbourne asserts the universal tendency of all of us to consider ourselves individually exempt from the influence of marketing!), leads McFerran to emphasize a construction of anorexia as a mental illness. Within the framework of this construction, McFerran describes a "Catch 22," in which patients find themselves inappropriately isolated in a hospital setting, yet obliged to be there, since physical stabilization is a pre-requisite for participation in outpatient group therapy. Add to this isolation a fear of "cross contamination" -- the worry that group settings might stimulate unhealthy competition, interaction, and comparison among the girls -- and the likelihood of group work seems greatly compromised.
Yet it is here that McFerran pushes beyond the research proscribing group settings, seeming to follow her intuition in advocating for fellowship and cooperation to be a part of the challenging journey out of anorexia. Such interventions, argues the author, if competently facilitated, can enhance and deepen the recovery of adolescents, who naturally turn to their peer group in order to define their emergent Selves. McFerran's intuition seems to draw deeply from her own clinical experience with this tender population. Although she does not undermine the potential dangers of competition and comparison in such a delicate process, she does suggest that the benefits of group work far outweigh its risks. Bolstering her perceptive instinct by having sought and received encouragement from numerous experts in the field, McFerran's project aspires to gather information about Music Therapy group work with those who have eating disorders. Her hunch and her hope (and mine, as well!) is that it will lead to a demonstration of the benefits of this type of intervention, strengthening the argument in favor of group-oriented Music Therapy with this population.
While McFerran qualifies her project as a "very small step" toward providing the medical world with evidence of the profound benefits of Music Therapy, I feel that she may be underestimating her contribution. Compassionate, skillful facilitation of song writing, as she describes it, leads to an externalization of daunting emotions, even as it creates a window-like opportunity for families, friends, and medical support staff to better perceive the arduous situation of these young women. Far from being insignificant, I would liken McFerran's endeavor to a pebble being thrown into still water, its effects rippling outward, and ever outward.
Songs generated by a group of mindful, well-guided teenagers can thus function as a wellspring, which will swell into a deep pool of creativity. This body of work, in turn, becomes a resource, feeding the rivers with the imperative nature of its voices, creating vital channels for understanding the heartrending plight of so many young people. May it gather the momentum necessary to thwart the powerful currents of unrealistic, media-driven imagery, that our young women may discover more nourishing ways to channel their immense energy and intelligence, and to discover, at long last, their authentic, inner beauty.
References
Brown, L.M., and Lamb, S. (2006). Packaging Girlhood: Rescuing Our Daughters from Marketers' Schemes. New York: St. Martin's Press.
Herrin, Marcia, and Nancy Matsumoto (2002). The Parent's Guide to Childhood Eating Disorders. New York: Henry Holt.
Kilbourne, Jean (2000) Killing Us Softly 3 (DVD). Media Education Foundation.
Martin, C. (2007). Perfect Girls, Starving Daughters: The Frightening New Normalcy of Hating Your Body. New York: Free Press.
McFerran, Katrina (2005). Dangerous Liaisons: Group Work for Adolescent Girls who have Anorexia Nervosa [online] Voices: A World Forum for Music Therapy. Retr. Nov.2, 107, from http://www.voices.no/mainissues/mi40005000173.html.
Murray, B. (2002). Partners in Illness: Patients Trading Thinness Tips. Monitor on Psychology, 33(3), http://www.apa.org/monitor/mar02/partners.html.