A new study run by Oxford University researchers is investigating the effects of reading a memoir about recovery from anorexia prior to publication.
What effects can reading and writing have on an illness, and vice versa? June Alexander and I share an interest in how memoirs and other first-person writing interact with eating disorders and recovery. The focus of June’s research and professional practice is more on life writing, while mine is on the reading of it, but of course the two are always in interplay with each other: not least because every writer is also their own first reader, and because most writers also spend a lot of time reading. I’m delighted to invite you to take part in a new study designed to shed light on the experience and consequences of reading a recovery memoir before its (potential) publication. Key practical decisions (whether or not to publish at all, and if so, what edits to make) will be contingent on the study findings, so participants will directly shape the publication process. In this post I outline the background to the current study, and say a little more about what it involves.
The work June and I are both doing is a response to the lack of systematic evidence at the intersection of eating disorders and textual engagement. The empirical eating disorder-specific research that’s been done so far in the realm of memoir/fiction-reading has, to my knowledge, mainly been conducted by me and by my colleague Rocío Riestra Camacho (for an early precedent involving healthy undergrads reading an eating-disorder or control memoir, see also Thomas et al., 2006). In a large-scale survey study conducted in collaboration with the UK eating disorder charity Beat and published in the Journal of Eating Disorders in 2018 (Troscianko, 2018a), I found that fiction about eating disorders (which in practice our respondents, most of whom had personal experience of an eating disorder, also took to include memoir) was perceived to have had almost universally negative effects on all the dimensions we investigated, sometimes thanks to deliberate self-triggering. By contrast, fiction that has nothing to do with eating disorders was generally perceived as having been neutral or positive in its effects.
In a more recent study conducted as part of her PhD, Rocío presented her cohort of healthy volunteers with two works of young adult sports fiction by Miranda Kenneally: one group read both as published, the other group with a reading guide (presented via pop-up messages in the margin) specially designed to help readers draw out positive lessons from the texts with respect to eating, the body, and exercise. The choice of genre was an interesting one: sports fiction obviously thematizes food, exercise, and the body, but in a context quite different from an eating disorder. The study found a significant difference between groups on level of espousal of gendered body stereotypes, which reduced for the group reading with the guide. There were also statistically nonsignificant trends towards improved results on the EAT-26 (a standard measure of eating disorder susceptibility) in the reading-guide group and towards worsened results in the control group who read the books in their standard form. You can hear more about how Rocío designed the experiment and what she learned in a recent Textual Therapies podcast episode. (The podcast also includes some other episodes that may be of interest to you, including one on narrative workshops to combat fat stigma, a reverse-format episode where a colleague and friend interviewed me on bibliotherapy, failure, and post-academic careers, as well as other topics including cancer and wigs, Disney and mental health, and narrative in public health.)
So, the little evidence we have highlights the real potential for reading to have eating disorder-relevant effects, in both desired and undesired ways. As far as I know, however, no experimental research has been conducted involving participants with an active eating disorder reading an entire book that isn’t a self-help book. Memoirs are a troublesome genre: They may often or usually be written with the professed aim of being useful to readers, yet the same authors often also remark that reading other people’s memoirs about eating disorders exacerbated their illness (Jones, 2020). Memoirs may of course be written with “usefulness” aims that aren’t therapeutic—most often, with a vague “awareness raising” intention (which may or may ever get meaningfully furthered). Or the intent may be explicitly or implicitly self-therapeutic, or “cathartic”: more about what the writing process does for the writer than about what the finished product may or may not do for its other readers. This is one tricky place where the intersections between my work and June’s become particularly interesting. In any case, most authors don’t attempt to systematically find out, before or after publication, what uses readers put their books to, or what responses they may have elicited in readers, inadvertently or otherwise.
June and I agreed in the emails we exchanged prior to this post that contextual factors seem to play a huge role in how text creation/reception contributes to the trajectory of someone’s life: From the current status of a reader’s illness or recovery, the mindset we approach the text with, or the opportunity (or lack of it) to reflect on the reading with someone else, the words in the book are only one part of what determines how the experience and subsequent consequences of a readerly encounter play out. Potentially quite a small part—other research I’ve carried out in non-health related context (e.g. an experiment investigating the mental imagery readers generate when they read the opening paragraph of Kafka’s novel The Castle), as well as studies conducted by other researchers, suggest that textual features like narrative perspective may be a lot less significant in shaping readers’ responses than literary scholars have long liked to believe, especially in comparison to other factors like age or reading experience.
In the eating-disorder context specifically, the radically changing ratios of egosyntonic versus egodystonic aspects over the time and course of the illness may further heighten the potential for contextual factors to outweigh textual ones—though it may also be possible to design texts specifically to disrupt and/or capitalize on such dynamics (Alexander, 2017).
June and I also share a sharp appreciation for the potential of the written word to do harm as well as good (see her paper McAllister et al., 2014), as well as having highly personal investments in the research and coaching/mentoring we do, so I take great pleasure in announcing on the Diary Healer blog an opportunity to take part in an experiment designed to contribute to our knowledge in the area. As I outlined in my Psychology Today post on “Consuming fictions”, when it comes to narrative reading and eating disorders (or illness in general) the assumptions far outweigh the known facts. There’s quite a bit of evidence on the benefits of self-help bibliotherapy (reading a relevant self-help book with or without professional guidance), but we know very little about books in other genres, like novels, short stories, or memoirs. This is a gap that needs filling (Troscianko, 2018b), and the current study will do a little to help further that aim.
This study, on which Rocío and I are collaborating, will be the first to assess the effects of reading a book about recovery from anorexia versus the effects of reading a book with no relation to eating disorders (though with structural and thematic similarities in other respects). The book about recovery is called The Hungry Anorexic. The book hasn’t yet been published, and the experiment will determine whether it gets published—in its current form, in an edited form, or not at all. Precise statistical cut-offs have been specified in advance, and if the book “fails” these tests, it will not be released. If specific elements turn out to be significantly problematic, they will be revised.
This project invites a new kind of readerly involvement in the authorial process, and I’m excited to find out what happens when readers get to shape the publication trajectory of a text.
If you decide to enrol, the experiment will involve you reading one of the books (you’ll be assigned randomly to one group or the other) within a roughly two-week period, and completing some questionnaires and open-ended questions one week before, at intervals during, and two weeks after. You’ll be asked not to read any other books about eating disorders during the five weeks of the study. If you’re interested in taking part, and you’re 18 or over, currently have a restrictive eating disorder or are recovering from it, have a BMI of 15 or over, and are fluent in English, as well as identifying as female, you’re warmly invited to read more and consider signing up. Everyone who completes the study can choose to be entered into a prize draw to win one of four prizes of GPB 100 (roughly AUD 190 / USD 140).
You can read more and sign up for the study here: https://www.torch.ox.ac.uk/event/participants-invited-for-an-experiment-on-reading-and-eating-disorders. Feel free to get in touch with me at firstname.lastname@example.org if you have any questions not addressed by the information sheet. And do please ask yourself honestly whether you have capacity to read an entire book over a period of roughly two weeks, and complete the initial questionnaire only if the answer is a definitive “yes”!
If you’re interested in reading in the recovery context, but don’t want or aren’t able to take part in this experiment, you might like to check out the final section of the Psychology Today post I mentioned earlier for some recommendations on how to read in recovery. In brief: read things you love that have nothing to do with eating disorders, and keep eating!
We look forward to hearing from you if you’re interested, and to sharing the results of this study on the Diary Healer blog in the future.