You are on page 1of 14

Kathryn Mecham Laura Dutson ENGL 311 7 April 2014 Battling Anorexia Nervosa in Dancerswith Dance: Dance/Movement Therapy

as a Potentially Effective Treatment Method for Dancers with AN

The body is sometimes regarded as a machine, or tool for carrying your spirit through life. However, the body does not function at a completely separate state from the spirit. Body, mind, and spirit connection is viewed in Eastern cultures as a way to maintain or strengthen your health and well-being. In western culture we focus less on this connection, and more on the physicality of the body. Ballet is the group of dancers that I am suggesting we address in this paper. A successful ballerina must reach a level of virtuosity and the emotional connection with the audience, but if she is focused on her body this becomes an impossible task. If the perspective of the ballet dancer could be changed to see that in order to achieve greatness she must maintain her overall health, instead of focusing on strictly technique. George Balanchine is one of the major choreographers and directors that established classical ballet in North America. He preferred the look of a tall, slender, dancer and this favoritism came across clearly as he taught class, led rehearsal, and choreographed for his various muses. This desire to have Mr. Bs idealized body became a drive in the aspiring ballet students across America. While Balanchine is idolized for his artistry and genius, he has also been blamed for leaving the mark of disordered eating on the world of classical ballet. Company directors today face the issue of hiring extremely talented, but struggling ballerinas. Ethically they are put in a position that requires them to take a side; turn a blind-eye

Mecham |2

and pretend the dancer is healthy; or refuse to hire the dancer on the basis of their health not being appropriate for a professional career. Monica Mason, near the end of her career as the Royal Ballets director made the following statement in an effort to unite the dance community in promoting healthy dancers: What we are looking for is a healthy, talented, gifted individual, and even in a company like the Royal Ballet the sizes and shapes of people vary enormously (STAGE.CO.UK). With such a strong statement coming from one of the leading ballet companies in the world, it becomes a questions of whether the dancers are hearing them. Even though there are influential figure-heads of ballet making these social statements, and we now have scientific and medical advances that promote the healthy dancer, the fact of the matter is that tradition and individual obsession continues to exist. Like any disease, Anorexia Nervosa (AN), has risk factors. Some of these risk factors are more prevalent in the dance world, especially the traditional ballet studio. Wendy Oliver, wrote an article entitled Body Image in the Dance Class, and listed some of the possible influences or risk factors that may influence the triggering of anorexia nervosa in a ballet student. competitive environment, negative comments from the teacher about students bodies, tightfitting dance clothes, and the constant use of mirrors. In this article she addresses the possible ways to reduce or limit the risk factors in the classroom, but this will not solve the problem, only make it slightly less likely for the dancer to develop anorexia nervosa early-on in their training. I have broken down what influences the dancer to develop anorexia nervosa into two sections. First, is the risk factors, and second is the actual trigger. I view this much like an autoimmune disease; where-in you have factors that increase the likely-hood of developing a disease, but the trigger comes when a maximum is reached or there is a triggering event that allows the factors to take effect. The triggers for dancers can be difficult to uncover, and a lot of them

Mecham |3

develop gradually over a period of time slowly letting additional factors or experiences influence their further development in the disorder. One of the major arguments against dancers becoming serious technicians in ballet is the increased risk of developing an eating disorder. Some of these risk factors include the emphasis on body, shape, and line. Exactly how the body is used and how it looks in a leotard and tights; as well as, the almost constant presence of the mirror in classical ballet studios. As if these risk factors arent enough, the aspiring ballerina has to face the normal struggles of going through puberty and development. The issue here is that these risk factors come together with the element of perfectionism, and at that point the ballerina may be stuck too deep in their psychology to let it go, or even recognize what is happening to them. Christina Ilisije is a dancer who began to let the risk factors affect her in high school, but it was the collegiate setting that triggered her full development of the disorder. She eventually published a short article chronicling her journey and advising other dancers to seek help and think of dancing, not how you look. What seems to have triggered her anorexia to becoming severe was the simple but potent thought of, My goal was to get into good shape, and to me that didnt mean improving my stamina or strength, but appearing more dancerly (Ilisije, 56). Other dancers may develop the eating disorder seemingly overnight after an episodal trigger like a negative comment or embarrassing moment that they may connect to their body shape. While these triggers may seem sudden, they must have already been developing the disorder previous in order to allow it to take hold of them so suddenly. Some dancers will realize what is happening to them early on, or there will be an intervention within a few days of beginning; but those dancers who develop it gradually and maintain it over a long period of time are perhaps those who are most difficult to treat. The

Mecham |4

typical progression of anorexia nervosa is a gradual to extreme increase in severity the longer the disorder is allowed to continue without intervention. Stephan Zipfel and colleagues published an article after conducting a study on the long-term recovery status of those who had anorexia nervosa. The following statement is from this article: [] longer duration of illness before first inpatient treatment and a low body-mass index were associated with a poor outcome, emphasizes the importance of early identification and intervention (Zipfel, 721). Rates of recovery varied but it seemed that it was a consistent conclusion that the earlier the disorder is treated, the more hope the victim has for recovering. Recommended routes for recovery of eating disorders in dancers is fairly ambiguous. In general, recovery is determined per the individual and influenced by the level of severity. There are different treatment options for each stage of recovery, but the most well-known or employed are more than likely the first two steps in most casesweight gain and psychotherapy. The primary focus for underweight victims is going to be stabilizing the Body Mass Index and thereby stabilizing most of the symptoms like emotional and psychological issues, as well as physical repercussions (Pike, 459). However, the dancer would have a difficult time giving up dance in order to go through therapy. Instead of giving it up long-term to avoid the triggers, I propose that dancers are provided more of an opportunity to learn how to cope with the disorder. Dance is a part of their identity and it would be devastating to them to lose that. In some cases the dancer does recover because they realize, If I dieted again, I was going to lose my dream of becoming a dancer, like Dion MacArthur did (Rea, 95). However, not all dancers achieve that level on their own and when faced with the option of quitting or dancing (risking relapses), they will more often than not choose to take the risk. This presents a problem because they are not prepared to cope with

Mecham |5

the eating disorder in the dance setting with only the help of a psychologist, dietitian, or medical professional. If dance can be turned around in order to be used against eating disorders, instead of as a risk factor and trigger for eating disordersmore dancers might have success in recovering. More long-term studies of anorexia nervosa have shown that while some anorexia nervosa victims may have made progress in recoverythere were relapses, there are few that ever fully recovered. Once the victim has physically recovered they have a long-term, and sometimes lifelong, battle with the emotional and psychological left-overs from anorexia nervosa. One victim reported how important art and creative expression was and is for her, providing a way to express difficult emotions and healing the rift she felt. She became whole and well (Cwikel, 408-9). In this case creative expression helped the victim to learn how to cope and live stronger day-to-day. Thus if dancers can learn how to use dance in a positive form of creative expression they will be able to better resist relapsing and possibly fully recover. Dance Spirit has published several articles over the years that emphasize that a malnourished dancers cannot dance professionally. They recommend seeking help, or for friends and family to reach out to the dancer with anorexia nervosa and suggest that they get help. While this is a valid method of helping some of the victims, it does not always work. If we reference back to Christina Ilisije, she interpreted her teachers concern about her weight as a compliment (Ilisije, 56). This is a clear demonstration of a psychological imbalance that requires therapy and recovery assistance on a multi-plane level as opposed to treating only one symptom. Through comparing eating disorder treatments outside of dance to eating disorders in dance we can better understand what might be more effective treatment that can be implemented among dancers with anorexia nervosa. We can also bring in studies on the movement connection

Mecham |6

to the psycho-emotional well-being of the individual. If movement is effective with non-dancers struggling with anorexia nervosa, and if movement is effective treatment for mental and emotional health, then it would make sense that dancers would do well with a dance/movement therapy regime. Anorexia nervosa is a disorder that is not limited to the world of ballet. Much like dance/movement therapy it has grown in scientific study and exposure on a more global scale only recently. Women seem to be suffering on a much more wide-scale from anorexia nervosa in every career field. A news report focusing on Brazils fashion week listed off a model who collapsed at a photoshoot in Japan then later died due to anorexia nervosa. This particular model was 58 and weighed about 80 lbsan extremely unhealthy weight for someone of that height. The article continued to list various figures in the industry who had recently lost their lives to anorexia nervosa (Erstein, 6). Beyond the dance and fashion industry, even Miss America is susceptible to anorexia nervosa: At 12 years old, the girl who would become Miss America 2008 went on her first diet. Four years later, she was being treated for anorexia, a battle that lasted a year, and even at 20, is one she still occasionally fights. Miss America 2008 is quoted as saying, Every day I have to commit to being recovered (Johnson, 4). Anorexia nervosa is truly a daily and lifelong battle, regardless of the severity of the case. Dance/movement therapy, as previously stated, has only recently become a recognized treatment method for anorexia nervosa. There have been numerous case studies working with differing applications for dance/movement therapy and in most cases it proves effective. Why it proves effective would have to be related to what I believe is a connection between the physical act of movement and touch with the psycho-emotional health of the individual.

Mecham |7

Dance/movement therapy is a fairly recent development in therapy, often times involving the collaboration of a psycho-therapist and a physio-therapist (meaning trained and certified dance therapist). Very few universities in the US offer specific training in dance/movement therapy, and it sometimes comes across as an inaccurate portrayal of what dance is to formally trained dancers. But the general idea of a dance/movement therapy session is that those who are within a demographic, are brought together into a space. This space may or may not have mirrors, and props are often used to help the patient have a tangible sensation or visual aid for the process they are going through. Some sessions will result in improvisation of the patients, while others will be a following of the directions given by the therapist(s). Perhaps the most effective dance therapy involves using the two different therapists to direct the session as they see appropriate. This collaboration allows for an intertwining of the physical experience and development, with the emotional opening, releasing, and rebuilding that needs to occur in any person to function at their most efficient state of mind. In order to better understand how dance/movement therapy would be effective for the eating-disordered dancer, the reader must first understand the inner workings of dance/movement therapy in relation to what it entails, why it works, and how it would be adapted for psychoemotional health and eating disorders over physical rehabilitation; although, a victim of severe eating disorders would have to first be brought back to a stabilized physical condition and weight in order to then be eligible to healthily participate in dance/movement therapy. Anne M. Krantz wrote an article which discusses this connection of the mind, body and spirit. If the dancer does not develop connections during development or if something has been interrupted, then the dancer could benefit from the following process:

Mecham |8

The model presented here is also informed by relational and developmental theory to enhance understanding of cumulative effects of early and repeated failures in developmental and interactional foundations which disrupt the experience of self, body, affect, and relatedness. These are seen as part of a dynamic system of internal, interpersonal, and cultural factors which lead to an eating disorder (Krantz, 100). Just as Krantz states, it is important to re-establish the phases of physical and emotional development and rediscover the mind, body, spirit connection. As dance/movement therapy is becoming more of a common context for the treatment program of these disorders, it is being implemented into rehabilitation centers for both in-patient and out-patient treatment (Kreuger). These programs are typically 8-12 weeks and can require the expertise of an entire team with differing emphases, working towards the same goal (Kreuger, Franks). The question here is not whether dance can be used as therapy for teens with disordered eating; but instead arguing that one of the reasons it works is due to possiblepositive physical contact, and physical action that occurs during dance/movement therapy sessions. Dancers are typically kinesthetic learners on some level, and can easily pick up movement even on a subtle level demonstrated by another individual. But they are also very honest with their body movement. Ballet does train the dancer to appear at ease, and pleasant no matter what level of pain they are experiencing, and regardless of the amount of effort being expended. However, when the dancer is not in the ballet context, their movement will be very telling of their current emotional state or thoughts. In other words, while off stage it is easy to discern the emotional and physical state of the ballerina through her body language.

Mecham |9

Therefore, it would make sense that if the ballet dancer with anorexia nervosa is placed in a casual dance setting, with new movement and no emphasis on aesthetic, they would be forced into revealing their state of mind through body language. It would then reason to say that if the psycho-therapist and dance/movement therapist are able to observe they would receive a more accurate analysis of the progression in recovery than if the ballet dancer with anorexia nervosa were going through regular therapy sessions (in which they would be prone to lying). Many dancers are familiar with the work of Martha Graham as a founder of modern dance in the 20th c. Graham believed that the emotional center was in the bodys core (abdominal and spine regions) and through this developed her theories and movement exercises based on contraction and release. Graham was always committed to becoming her character on stage, so perhaps this is why she was so successful in displaying the essence of grief and inner turmoil with her piece, lamentation. The connection of her inner state of being to the execution of the movement was tangible, it was so clear. She must have known, even without added scientific knowledge, that movement is closely tied to the emotional and mental state of the soul. Regardless of the strong ties to the movement, the dancers continue to be susceptible to the risk factors and triggers of anorexia nervosa in the ballet classroom. If dancers are at such a high risk for developing anorexia nervosa, why do they dance? Janet L. Castillo, dancer, choreography, and TV personality, addresses this topic on her website: For dancers, dance is a part of their identity, and if you are trying suppress an identity there are repercussions. These struggles are real and yet if dancers were able to reframe their thought process, the journey may not be so difficult. The truth is that being a dancer is not something one gives up. It is who you are. It is something that is so deep and within you that even if you tried to stop, it would be impossible. The human need you

M e c h a m | 10

have to express through dance is a gift and cannot ever be taken away. You never have to give it up because its a part of you. Its breathing. To give it up would mean not to breathe. I would argue that an ineffective method of treatment for ballet dancers struggling with anorexia nervosa, specifically, would be to take time off from dancing. Dance has thus far created who they are, everything they see as defining their identitybut instead of removing the dance, it would be retraining their thought patterning, and use of body through dance/movement therapy. Dancers can relate to movement, everything they see is movement or some form of shape with a movement equivalent. Therefore, there is no reason why we could not use dance as a tool to help dancers overcome anorexia nervosa. We have seen demonstrated the numerous studies in which movement proves to make a positive impact on the emotional and psychological health of the individual. There have also been examples of dance/movement therapy being successful in case studies using victims of various eating disorders. If the dance/movement therapy is so effective with people who are not familiar with movement and their body, then the dancers increased body awareness and senses in movement would prove to be the perfect setting for dance/movement therapy. After seeing such evidence I have to conclude that dance/movement therapy would be a more effective method of therapy for dancers suffering from anorexia nervosa than some other forms of therapyonce their weight is normalized and they are in a more stable state. I also believe it could be used in conjunction with other forms of treatment. However, due to its movement qualities, retraining of psychological patterns and building positive associations, dance/movement therapy may have more long-term effects on dancers in preventing relapses than the absence of dance during their recovery.

M e c h a m | 11

Based on the lack of direct evidence that dance/movement therapy is effective in treating ballet dancers with anorexia nervosa, the conclusion must be viewed as a potential method to explore and incorporate into recovery and rehabilitation programs for anorectic dancers. The need for more studies focusing their research on this context and demographic is needed in order to develop more concrete data. I am confident that the findings would support my argument: dance/movement therapy is better treatment for dancers suffering from anorexia nervosa, than treatment that removes dance from their lives.

M e c h a m | 12

Works Cited
Ahn, Soyeon, PhD, Alicia L. Fedewa, PhD, and. "A Meta-analysis of the Relationship Between Children's Physical Activity and Mental Health."Journal of Pediatric Psychology 36.4 (2011): 385-97. Print. Biddle, Stuart JH, and Mavis Asare. "Physical Activity and Mental Health in Children and Adolescents: A Review of Reviews." Br J Sports Med 45.(2011): 886-95. Print. Carlon, Brianne. "The Rules of Going Pro." Dance Spirit 12.4 (2008): 56-57. Print. Carter, Jacqueline C. "A Prospective Study of Predictors of Relapse in Anorexia Nervosa: Implications for Relapse Prevention." Psychiatry Research 200.(2012): 518-23. Print. Castillo, Janet L. "How to Know when It's Time to Give up on Dancing ~ Janet L. Castillo Online." Janet L. Castillo: Choreographer. Dancer. TV Personality.. N.p., n.d. Web. 5 Apr. 2014. <http://www.janetlcastillo.com/2014/03/how-to-know-when-its-timeto-give-up-on.html>. "Depression; Dance Boosts Young Girls' Mental Health." Pain & Central Nervous System Week Via NewsRx.com (2012). Print. Erstein, Kali, Cheryl L. Seelhoff, Angie Manzano, and Karla Mantilla. "Brazil: Model Dies of Anorexia." Off Our Backs: A Women's Newsjournal 36.4 (2006): 6. Print. Erstein, Kali, Cheryl L. Seelhoff, Angie Manzano, and Karla Mantilla. "United States: Doctors Say Fashion Industry Must Not Use Super-thin Models."Off Our Backs 36.4 (2006): 6. Print. Franks, Beth, and Danielle Fraenkel. "Fairy Tales and Dance/Movement Therapy: Catalysts of Change for Eating-Disordered Individuals." The Arts in Psychotherapy 18.(1991): 311-19. Print. Guarda, Angela S. "Treatment of Anorexia Nervosa: Insights and Obstacles."Physiology & Behavior 94.(2008): 113-20. Print. Heilbrunn, Sharon A. "Eating in a Dancer's World." Dance Spirit 7.2 (2003): 62-63. Print. Herzog, David B., MD. "Recovery and Relapse in Anorexia and Bulimia Nervosa: A 7.5Year Follow-up Study." American Academy of Child & Adolescent Psychiatry 38.7 (1999): 829-37. Print. Ilisije, Christina. "Off the Record: Dancer to Dancer." Dance Spirit 17.(2013): 56-58. Print.

M e c h a m | 13

Johnson, Neil. "Miss America Tells of Anorexia Battle." Tampa Tribune (Florida)18 Apr. 2009, Final ed.: 4. N.p., n.d. Web. Kim, Yeon Soo, Yoon Soo Park, John P. Allegrante, Ray Marks, Haean Ok, Kang Ok Cho, and Carol Ewing Garber. "Relationship between Physical Activity and General Mental Health." Preventive Medicine 55.(2012): 458-63. Print. Krantz, Anne M. "Growing into Her Body: Dance/Movement Therapy for Women with Eating Disorders." American Journal of Dance Therapy Fall/Winter 21.2 (1999): 81103. Print. Krueger, David W., MD, and Ellen Schofield, MA. "Dance/Movement Therapy of Eating Disordered Patients: A Model." The Arts in Psychotherapy 13.(1986): 323-31. Print. Lee, Sing. "How Lay Is Lay? Chinese Students' Perceptions of Anorexia Nervosa in Hong Kong." Soc. Sci. Med. 44.4 (1997): 491-502. Print. Manuel, Amy, and Tracey D. Wade. "Emotion Regulation in Broadly Defined Anorexia Nervosa: Association with Negative Affective Memory Bias."Behaviour Research and Therapy 51.(2003): 417-24. Print. Oliver, Wendy. "Body Image in the Dance Class." Journal of Physical Education, Recreation & Dance 79.5 (2008): 18-25. Print. Penniment, Kylie J., and Sarah J. Egan. "Perfectionism and Learning Experiences in Dance Class as Risk Factors for Eating Disorders in Dancers." (2011).Wiley Online Library. Web. Pike, Kathleen M. "Long-Term Course of Anorexia Nervosa: Response, Relapse, Remission, and Recovery." Clinical Psychology Review 18.4 (1998): 447-75. Print. Ravelin, Teija, RN, MNSc, Jari Kylma, RN, RNT, PhD, and Teija Korhonen, RN, MNSc. "Dance in Mental Health Nursing: A Hybrid Concept Analysis."Issues in Mental Health Nursing 27.(2006): 307-17. Print. Rea, Kathleen. "Warning: Dance and Anorexia Don't Mix." Dance Spirit 5.Aug (2001): 9495. Print. "Royal Ballet Director Highlights Issue of Eating Disorders Within Dance Sector."The Stage.CO.UK (2012): 5. Print. Young, Jessica L. "Bringing My Body into My Body of Knowledge as a Dance/Movement Therapy Educator." Am J Dance Ther 34.(2012): 141-58. Print.

M e c h a m | 14

Zipfel, Stephen, Bernd Lowe, Deborah L. Reas, Hans-Christian Deter, and Wolfgang Herzog. "Long-term Prognosis in Anorexia Nervosa: Lessons from a 21-year Follow-up Study." The Lancet 355.(2000): 721-22. Print.

You might also like