Larisa's Reviews > Brain over Binge: Why I Was Bulimic, Why Conventional Therapy Didn't Work, and How I Recovered for Good

I am all for a book about eating disorders that avoids romanticizing them or otherwise falling into stereotypical narratives about their significance. I also like that this book considers issues in the philosophy of psychiatry (albeit in an very casual way), especially those connected to responsibility.

That said, I have five major issues with this book (aside from the fact that it's repetitive and far too long): First, the author overgeneralizes from her own experiences of therapy despite saying that she's not doing that throughout. She spends too little time and attention on the ways in which her own symptoms and approach to therapy may have informed her success with the Rational Recovery/Brain Over Binge method compared with other approaches she'd tried. Second, she keeps saying how the fact that her animal brain gave her urges to binge didn't make it unhealthy. I think what she's trying to say there is that those urges to binge are a kind of evolutionary glitch related to certain survival instincts and the fact that lower brain structures aren't particularly responsive to rational argument rather than some fundamental defect of hers. But arguably that glitch is itself unhealthy, and it's unclear what she's trying to do by saying that it isn't - to distinguish herself from people with "real" mental illness? It just made me kind of squeamish. Third, Hansen talks as though she had the choice to stop being bulimic at any time simply because she has free will and therefore has a choice not to binge. Even if that were true, it ignores the fact that some choices are a lot harder to make and to carry out than others. Fourth, she seems to endorse the view that her true self is just her "human brain" as if her lower brain is morally inferior or something. Hate to say it, but we wouldn't be alive without our lower brains, and it is a dangerous road to go down equating free will solely with rationality and rationality with certain brain regions and not others! Finally, the recovery approach she talked about involving mindfulness and distancing herself from her urges to binge sounds very much like certain therapeutic techniques from e.g., dialectical behavioral therapy that are becoming much more popular in eating disorder treatment. And Hansen talks as though CBT never involves revaluing urges to engage in pathological behavior - I would have thought talking about them as deriving from "cognitive distortions" is a kind of revaluing. Her method is also a psychological process with neurological consequences, not the other way around, so the way she presents it in terms of directly intervening on her brain is a bit misleading.

I am all for pluralism in eating disorder treatment, especially because the orthodox treatment methods have a relatively low success rate, but I think this book presents a view that is just the beginning of an alternative as an all-but-universal solution to binge eating and bulimia.