Research news

My latest experiment was designed to find out more about how reading recovery memoirs affects people with or in recovery from a restrictive eating disorder, to decide whether a book I semi-accidentally wrote is ethical to publish. You can find out more about the origins of the project via this blog post. Or see a video on the study kindly made by recovery coach Tabitha Farrar to help with participant recruitment. The paper reporting on the study findings came out in summer 2024:

Troscianko, E. T., Riestra-Camacho, R., & Carney, J. (2024). Ethics-testing an eating disorder recovery memoir: a pre-publication experiment. Journal of Eating Disorders, 12(1), 114.

In this study, 64 participants with an eating disorder read either this book or a control text (about Zen meditation) over a roughly 2-week period, completing standardized measures before and afterwards, and responding to open-ended questions at intervals during the reading. Publication would go ahead only if the scores on the main clinical measure for readers of the memoir did not significantly worsen (as statistically defined in advance) and did not do so significantly more relative to readers of the control text. The book passed the test; in fact, for readers in both groups, scores on both standardized measures improved significantly, with medium to very large effect sizes. The free responses shed further light on the health-relevant dynamics of readerly responses to narrative material either with or without an explicit health focus.

These results mean that the book has now also been published! You can read about it at https://hungerartist.org/the-very-hungry-anorexic/

Two research themes

My research approaches eating disorders from two main angles. The first is a behavioural, dynamical-systems perspective. The latest on this was published in July 2020 in Frontiers in Psychology:

Troscianko, E.T., and Leon, M. (2020). Treating eating: A dynamical systems theory of eating disorders.
[open-access here, or read a blog intro to the paper here]

This is my fullest attempt so far to articulate what I think eating disorders are and how I think we should be treating them. The essence of it is that behavioural change is the most effective way to bring about both physiological and psychological change. That is—to treat the disorder, treat the eating. (This should not be controversial, but somehow is.) I’m now expanding this perspective with ideas inspired by my coaching work: that alongside a high-behaviour approach, we also need a high-agency approach in which the individual who is recovery has the freedom to make their own decisions about what they are aiming for and the actions that will get them there.

The second angle is bibliotherapy, or reading for therapeutic purposes. This empirical paper in the Journal of Eating Disorders reports on the results of a large online survey asking people about their reading habits in connection with their eating disorder:

Troscianko, E.T. (2018). Literary reading and eating disorders: Survey evidence of therapeutic help and harm.
[open-access here]

This study generated an unexpected, and unexpectedly strong, result: that individuals typically perceive reading fiction about eating disorders as strongly detrimental to their health on multiple dimensions, whereas they reported reading their preferred type of other fiction as mostly neutral or positive, especially for mood. This goes against mainstream thinking that reading about the condition you have should be helpful, and offers far more concrete evidence than we had before that reading can play a significant role in how an eating disorder develops or is recovered from.

In a paper for Medical Humanities, I made a more theoretical case for the relevance of reading to mental health, and especially eating disorders:

Troscianko, E.T. (2018). Fiction-reading for good or ill: Eating disorders, interpretation, and the case for creative bibliotherapy research
[journal record here, or download: Fiction-reading-for-good-or-ill_eating-disorders-interpretation-and-creative-bibliotherapy-research_Troscianko-2018]

(Here’s also a little audio clip for the Medical Humanities blog of me talking about how the research happened and why I think it’s important, and a blog post outlining the main findings so far, along with some more personal angles.)

In a paper in Wellcome Open Research (2022), my colleagues James Carney and Emily Holman and I presented methods and findings from a pilot study of group bibliotherapy (taking part in a fiction reading group for therapeutic or health-enhancing purposes), finding that keeping discussion on-topic (i.e. it actually being about the book we’ve been reading) was one of the main predictors of whether the discussion remained emotionally healthy or not.
[open access here]

I also collaborated on an experiment for which my colleague Rocío Riestra-Camacho created a specially tailored reading guide, designed to help participants identify the anti-eating disorder messaging in two works of young adult sports fiction. We found trends towards positive effects in the group that read with the guide, especially as regards gendered body ideals, and trends towards negative effects on most dimensions in the group that read without. This experiment directly informed the methods used for the (2024) pre-publication study described above.

Riestra-Camacho, R., Carney, J., & Troscianko, E. (2023). Can narrative bibliotherapy reduce vulnerability to eating disorders? Evidence from a reading experiment. Empirical Studies of the Arts. [download: Can-narrative-bibliotherapy-reduce-vulnerability-to-eating-disorders_Riestra-Camacho-Carney-Troscianko-2023]

You can also read short pieces I’ve written or contributed to on bibliotherapy:

for Medium.com: How do your reading habits shape your health—and vice versa?
for The Conversation: New research explores how reading affects eating disorders – for good and ill
and for the Oxford University Arts Blog: Artistic licence: Why a book might not save your life

If you’re currently suffering from an eating problem or your recovery is still fragile, my simplest recommendation would be: read stuff you love reading, and ditch the ED stuff.

How they relate to each other

If you’re wondering how these two approaches fit together, since one seems quite squarely behaviourist and the other rather more psychological in focus: I don’t see any conflict. To me it’s clear that you don’t get over an eating disorder without sorting out your eating, but there are many other factors that make it harder or easier to get to the point of acknowledging that and acting accordingly. The research and clinical worlds still understand both the “sorting out your eating” and the other factors that feed into the capacity to do so (or its absence) remarkably badly, despite many decades’ accumulated research, and the effects of cultural inputs like fiction and poetry are just one example of that general ignorance. This big-picture state of affairs is a major reason why I’ve concluded that allowing individuals to exercise their own self-knowledge and agency in service of their own recovery is a large part of what is needed next: for professionals to simply get in the way less.

Along with that high-agency angle, which I’ll be publishing a new paper on soon, I think the most promising overarching framework for eating-disorders research is a dynamical-systems approach that understands body, mind, and behaviour as connected by complex feedback interactions. If you’d like to read more about how I see this model playing out, and therefore how I understand the two focal points of behaviour change and literary reading as intersecting, see the final section of the Frontiers (2020) paper above (“Putting it all together”) or this book chapter on “Feedback in reading and disordered eating” (2017).

My background in cognitive literary studies: What happens when we read

My academic background is in cognitive literary studies: investigating psychological interactions between texts and readers. I coined the term “cognitive realism” to describe texts that represent some aspect of the human mind in a way that corresponds how it actually works in the mind of the reader, and I’ve explored all kinds of ways in which cognitively realistic and unrealistic texts might prompt us to respond to them differently, in terms of emotional responses as well as the mental images we experience and the meanings we generate. You can find out more about my work on visual perception and the “Kafkaesque”, on memory in Proust (yes, that madeleine—but saying something new about it!), on cognitive dissonance in Flaubert, and much else besides, on my personal website or via ResearchGate.

Moving into the health humanities: What health-relevant things happen when we read

My interest in the links between fiction-reading and mental health started with a story by Franz Kafka called, fittingly enough, “A Hunger Artist” (Ein Hungerkünstler, which you may like to read in the German original or in a translation by Ian Johnston). In this story, published in 1919, a man fasts for other people’s entertainment, but gradually those people are losing interest. As his audiences dwindle, the hunger artist keeps fasting. I had already read the story many times, but suddenly, rereading it again, I realized something strange—or two things. First, the hunger artist is never once described as feeling any hunger. Second, I had never once noticed that the hunger artist isn’t described as feeling any hunger. Given my own past experience of anorexia, which involved being hungry almost all the time, this struck me as odd. I wrote an article exploring how the text’s evocation of starvation might prompt different responses from readers with different personal histories, and how easy it is to fall into the trap of interpreting what you assume is in a text rather than what is—especially when it comes to judgements about bodies and (not) eating, which are so culturally freighted.

Soon afterwards, I established a partnership with the leading UK eating-disorders charity, Beat, to start to explore the connections between fiction-reading and mental health empirically. We ran an online survey that attracted nearly 900 respondents. Their thoughtful, detailed responses generated four publications:

  1. an account of the survey methods and findings in the Journal of Eating Disorders, presenting the clear though counterintuitive finding that reading about eating disorders is perceived as almost universally damaging [open-access here]
  2. an argument for the wider importance of taking fiction-reading seriously in mental-health research, in Medical Humanities [download: Fiction-reading-for-good-or-ill_eating-disorders-interpretation-and-creative-bibliotherapy-research_Troscianko-2018]
  3. a chapter in Cognitive Literary Science on the mind-body feedback loops in which reading can play a role [download: Feedback-in-reading-and-disordered-eating_Troscianko-2017]
  4. and a chapter in Aesthetic Illusion in Literature and the Arts on how readers talk about the ways they get immersed in what they read, and what therapeutic relevance this might have [download: How-should-we-talk-about-reading-experiences_Troscianko-2017_formatted-preprint].

I also helped design and run a reading-group project called “Books, Minds, and Bodies”, which brought together academics from the cognitive, medical, and neurosciences, and from anthropology, literary studies, and psychiatry with members of the Oxfordshire public to share the experience of reading aloud and discussing a novel in order to explore the therapeutic benefits of reading fiction. Our write-up of our findings—about enjoyment, emotional volatility, and the importance of staying on topic with the book being read—was published in Wellcome Open Research in 2022.

Troscianko, E.T., Holman, E., and Carney, J. (2022). Quantitative methods for group bibliotherapy research: A pilot study. Wellcome Open Research, 7, 79 
[open access here]

Current work

More recently, I’ve been building on these activities with other empirical projects designed to pin down the cause-and-effect relationships between different kinds of reading and helpful or harmful effects on mental health, with collaborators Rocío Riestra Camacho and James Carney. I’ve also started work on a book project with Paul Jenkins, provisionally entitled Full Recovery, Remission, or Something Else: Eating Disorders and Beyond.

The book starts from the fact that ideas about recovery from an eating disorder are often unhelpfully narrow, linear, limited, and in other ways self-defeating. We believe that individuals in recovery and those who support them (in a professional capacity, or otherwise) could benefit from a critical discussion of recovery that reflects clinical reality and encourages aspirations beyond this limited view. The book will offer:

  • an account of why disordered eating is often seen as perplexing and is therefore a useful vehicle for asking big questions about “mental” illness and recovery;
  • an overview and in-depth analysis of the competing models of full recovery versus remission and their existential stakes;
  • an explanation of what allows the remission model to persist and why, in its current form, it should not.

In this area we urgently need fewer assumptions (e.g. either that art is useless in health terms or that it’s obviously always edifying) and more testing of them. Please get in touch if you have ideas for research that ought to be done and would like my input. I may not be able to help, but I can try, or I can point you towards others who might be able to.