How do women with a history of SEED-AN experience navigating their lives away from and beyond their illness - A narrative inquiry study

The purpose of this study was to explore through narrative inquiry methodology the experiences of four participants as they navigated their lives away from severe and enduring anorexia nervosa (SEED-AN, Robinson, 2009). Whilst positions of what recovery can mean emerged its aim was to open up the ‘how’; how may a person journey away from a life dominated by anorexia nervosa? These first-person narratives stretched across early developmental disturbances to being caught between dread of the past, repetition in the future and their experiences in the present time. This study emerged from my own long experience of anorexia, my professional relationship within my private practice and as co-founder of Anorexic Aid, now B-eat, a UK national charity for eating disorders. This insider-researcher perspective provided what I believe to be a unique subjective and reflective dimension to this study. To analyse and frame the narratives in a way that enabled the reader to travel alongside the participants’ journey Bettelheim’s (1976) framework used to analyse fairy-tales was adapted and became a scaffold to begin the analysis. A cross-case analysis followed with Connelly & Clandinin’s (1990) three-stage narrative inquiry analytic tool adapted for this purpose. From scrutinising the transcripts in this way what began to emerge was a sense whereby relationships for all the participants were viewed as unsafe and unreliable and their sense of self shifted between invisible and invincible. There followed two distinct stages the first I refer to as ‘transition’ whereby from consistent, containing relationships new relational configurations displayed a shift from concrete ‘knowing’ to experiencing the idea of possibilities in the future. They also began to develop a capacity, to be reflective and reflexive. The second stage I have named ‘Integration’, where the narratives demonstrated a more grounded sense of ‘self and other’, of relinquishing the need to be special, of taking in the idea of being ‘ordinary’ and good enough. This study has provided a depth of understanding of SEED that appears to be little attended to in current research, the confusion of what are ‘normal and socially acceptable’ thoughts, feelings and actions and what may be eating disorder residues particularly around food, body shape and exercise. This study has further highlighted organisational challenges for the provision of therapy within the public sector which remains time-limited and focused on symptom alleviation; it conveys the importance of therapeutic consistency. A further outcome from this study that is relevant to all our clients who have experienced a long history of struggling with mental health has been to shine a torch on the importance of hope and encouragement in the therapeutic endeavour. It expands the importance of mentalisation and provides an additional concept of understanding ‘relapse’ as a positive experience, one not to be viewed negatively but rather a flag towards unprocessed material. To summarise this study has identified the primacy of emotional nourishment achieved with and through human relatedness.