A novel method of family therapy for persons suffering from eating disorders, therapeutic letter writing (TLR), is presented. The protocol used for letter writing, its advantages and limitations, and a variety of applications are reviewed. The concept of TLR grew out of the study of narrative therapy, and was strongly influenced by ideas of Lorraine Wright and Maureeen Leahey about nurses and families, as well as the work of W.R. Miller around stages of change. This article will review: the process of TLR; therapeutic uses of eating disorders linked to TLR, including those relevant to families divided by distance or understanding; and the advantanges and disadvantages of TLR. Finally, a case study is discussed.
The gulf between the thinking of physicians and lawyers is most vividly illustrated by their different concepts of alcoholism. To the physician, alcoholism is a disease: an alcoholic is a sick person. To the jurist (or at least to the law, as written and practiced) alcoholism is a bad habit and the alcoholic has a character defect. To be sure, many individual judges and attorneys accept the thesis that alcoholism is a disease; but this only complicates the problem because the word "disease" means one thing to the doctor and something quite different to the lawyer. Since psychiatrists frequently report to judges, probation officers and lawyers on problems of alcoholism, it is worth taking time to review this semantic confusion.
The Social and Legal Concept of AlcoholismTo the doctor, disease is a deviation from health. Alcoholism is unhealthy, and therefore by this broad definition it is a disease. Since the alcoholic deviates from the norm of good health, he is in that sense a sick man.However, the word "disease" presents quite a different picture to the layman. In nonmedical eyes, a disease is an affliction; something which "falls upon" a person; something he does not seek; it requires treatment by a doctor, and the treatment consists in the doctor doing something to the patient. When the doctor tells the court that this defendant has a sickness, namely alcoholism, he does not mean to put the alcoholism in the same semantic category as pneumonia or pernicious anemia. But that is precisely the way the judge will read the report. He will reason-and this fallacy is understandablesomething like this: "In pneumonia a patient might have a delirium during which he might assault his attendant. This assault is obviously the result of an unfortunate illness which the patient did not seek, and which the doctor will cure with sulfa drugs. But the psychiatrist says that alchoholism too is an illness. I must believe him 132
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