Exploring the Role of Narrative therapy in Obesity: Overcoming Body Image Disturbances

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Health, Culture and the Human Body

Exploring the Role of Narrative ,erapy in Obesity: Overcoming Body Image Disturbances

Somayeh Sadat McKian1

“My body is like a swamp. Whatever I pour into my body, it begins to sink. I have been sunk into myself too. Every day, I sink more than before. My body is the only thing that I really want to throw away. But it seems as if I myself cannot do it. How come I got captured into my body? Who would believe that I took several actions so as to step away from my body but every time I became more frustrated than before. Wherever I take my body, it is still the same shape. It seems that the universe does not intend to look at me in another shape. %at is why the world has become monotonous and unchanging to me.”

%is note seems to be like a short story, perhaps similar to the des-tiny of a man. It could be written by a famous author, or it could be a narration of an obese woman about herself and her status. %e latter is correct, of course. I suggest it is better for a nutritionist to wait a bit a)er hearing the above-mentioned sentence before saying immediately “weigh yourself with a pair of scales”!

%e way you cut your meat re'ects the way you live Confucius, Chinese philosopher

IntroductionObesity has been widely regarded as a public health concern because

1 MA in General Psychology, Faculty of Psychology and educational Sciences, Allameh Tabataba`i University, Young Researchers and Elite Club, Tehran, Iran. E-mail: [email protected]

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of its adverse impact on individuals’ health. Obesity and overweight have became epidemic throughout the world. Epidemiologists more than 30 years ago recognized a continuous trend towards a growing spread of obesity in Europe, the US, Asia and the Middle East (Field et al. 2002, 3). From the point of view of general health, the growth of e*ective inter-ventions for curing obesity is an important subject. It is widely accepted that obesity is strongly correlated with a variety of medical conditions such as cardiovascular diseases, type 2 diabetes and some types of can-cer. (Xu et al. 2011, 268). Also, obesity and overweight are a problem that is mainly related to lifestyle habits (Kelishadi et al. 2013, 211).

%e World Health Organization (1998) de(nes overweight as a body mass index (BMI) between 25 and 29.9 and obesity as body mass index above30 (Schwartz and Brownell 2004, 44). Classically, the treatment of obesity has been based on altering behaviours, diet, and the amount of physical exercise (Doak et al. 2006, 112). %is type of treatment is questioned today, following the observation that, though it o)en proved positive in the short term, it turned out to be not very e+cient in main-taining the weight in the longer term (Lachal et al. 2012, 1099). Body image research, which began in the 1980s, has dramatically increased in line with the growing awareness of this problem. A negative body image is one of the key factors contributing to eating disorders (Chisuwa and O’Dea. 2010, 9). Greater body dissatisfaction, which is more commonly observed among adolescent girls, contributes signi(cantly to lower self image. Body dissatisfaction is also a risk factor for clinical eating disor-ders, which are common among girls (Tiggemann and Miller 2012, 79). Preventing obesity and overweight has become a top priority in e*orts to improve public mental health. Although much research is needed to address this problem, it is important to approach obesity with an un-derstanding of body image disturbances that obese youths face, which is pervasive and can have serious consequences for mental and physical health.

Diet therapy will always apply methods to improve the female body and its physical attractiveness by decreasing the Body Mass Index. But when body image dissatisfaction exists, success in body weight reduc-tion may decrease. Actually obesity is a progressive chronic condition associated with failed attempts at change and repeated relapses. Also

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self-esteem and body image are in'uenced by obesity (Christiansen et al. 2012, 2). %ere are new approaches that seem to be helpful in manag-ing weight and body image. We suggest that narrative %erapy, as a new approach, along with diet therapy, can prevent theses relapses. %e ways in which individuals evaluate their body mass index and body image might be a determinant of di*erences in life narratives of obese women as dietary and physical activity patterns. Narrative therapy intervention has been developed for clinical disorders. %e centrality of narrative to some forms of therapeutic practices dates back at least to the end of the nineteenth century in the writings of Sigmund Freud. A primary as-sumption of Freud’s psychoanalytic theory is that “the symptom carries a meaning and is connected with the experience of the patient” (Mat-tingly and Garro 2000, 6). %us, it is hypothesized that obesity is one of our narratives that may impact the e*ectiveness of diet therapy by a*ecting body image quality. In addition, the body mass index of obese and overweight women could also be a*ected by life narratives. %us, the present chapter aims to introduce the e*ect of narrative therapy on the body image of Iranian women with overweight and obesity. One of the authors, McKian, used this method in her master thesis in psychol-ogy. %e purpose of the thesis was to determine if the addition of narra-tive therapy targeting obesity and overweight to a diet therapy program would improve body image and decrease body mass index in obese and overweight women.

Literature review Body image One of the most common psychological problems of obese women

is the perception of a fault in their body image. %e physical appearance is an important part of body image, given that physical appearance is the (rst information source that people use for inducing other people to socialize with them. Previous studies have found a positive relationship between body mass index (BMI) and body image dissatisfaction (BID) among obese individuals compared to the non-obese. Yet, BID has been found to increase as the severity of obesity increased (Gavin et al. 2010, 574).

Body image is an internal re'ection of the outside appearance of peo-ple, and this re'ection includes physical aspects, perception and men-

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tality shown towards them (Pruzinsky 1990, 102). %e main dimensions of these mentalities include factors of evaluation (dissatisfaction with the body), investment (imaginatively designing oneself and the impor-tance of the ideal appearance which has been created inside the person by him- or herself) and a*ects (Bohne et al. 2002, 102). In addition to our own perception of our body, including evaluation of our size, there is an emotional or attitudinal aspect to our image – the evaluation of our body, i.e. the way we feel about our body. %is is the aspect on which we usually focus when we talk about negative body image in people with eating disorders, using the term body dissatisfaction or disparage-ment. More recent psychologists have added a third component –our behaviour (Bell and Rushford. 2008, 1). While treatments exist for im-proving body image in overweight individuals, the key question is how such programs can be integrated with dietary patterns. Strong gender disparities exist in the prevalence of excess weight in developing coun-tries, particularly in the Middle East and North Africa (MENA), where the prevalence of overweight and obesity is much higher in women than in men (Kelishadi et al. 2013, 211). Body image disturbance is higher in western white or Caucasian women (Altabe 1998, 155), but due to globalization, individuals in non-Western cultures are increasingly ex-posed to Western ideals. Concern about physical appearance has been found to be twice as common among women as among men. (Harris and Caar 2001, 226). Diet therapy will always seek methods to improve the female body and physical attractiveness with decreasing Body Mass Index. On the other hand, Body image concerns are associated with more unhealthy weight control behaviours and lower well-being (Ver-stuyf et al. 2012, 1). It is widely assumed that people who are obese must feel bad about their bodies, and their everyday talk is rich with stories and metaphors about body and weight. %ese narratives can capture the essential nature of an experience. Remember the story at the beginning of the chapter: “My body is like a swamp. Whatever I pour into my body, it begins to sink”. %e sense of repetitive, painful and self-defeating na-ture of the body experience is instantly apparent. %ose metaphors show the narrator’s lived experience about her body.

Analyses of narratives relating to BMI reveal how obese women feel and think about their body. Traditionally, such narrative processes have

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been tackled by diet therapy. Furthermore, there are few studies on the understanding of everyday life narratives of obese and overweight women. A review of the literature exposes the gap in our knowledge about the e*ects of treatment on body image perception with narrative therapy in overweight and obese women.

Once upon a time, obesity: surveying the role of narrative therapy“I have to wait and see how the other responds to what I say or do

before I say or do the next thing .%e next thing I say or do must be in'uenced by the others’ response to what I just said. %e actions are not shaped by any theories or hypotheses, but by a dialogical process” (Andersen 1997, 130). People live in a world that their language de(nes for them. %e actual use of language, verbal or written (pictorial) com-munication can be analysed from a psychological point of view as well; content analysis as a procedure has been used in psychology for a long time (László 2008, 131).

While later traditions elaborated a great deal on the concept of obesity, this does not allow us to recognize the meaning of obesity in individuals easily. Most people in the world in one period of their life face up to the narrative of the obesity, dysfunctions in body image and increasing Body Mass Index. As a whole, we want to add to the knowledge about charac-teristics of their narratives and body image disturbances related to their Body Mass Index. A focus on stories is a way of thinking – more speci(-cally, narrative thinking (Clandinin and Connelly 2000, 16). Psychother-apists are concerned with people’s stories: they work with case histories and use narrative explanations to understand why the people they work with behave the way they do (Wells 2011, 9). McAdams has used narrative concepts as discussed in his 1993 volume to pursue a broad range of ques-tions regarding the relationship between narrative and personality theory (McAdams et al. 1996, 340), the relationship between narrative identity and personality traits and motives (McAdams et al. 2004, 763) and the relationship between narrative themes and psychiatric conditions (Adler et al. 2006, 49). Narrative therapists base their ideas on poststructuralist philosophy. Poststructuralism is a response to “structuralism,” which is one label for a worldview that is still dominant in a range of (elds, in-cluding counselling and psychology (Combs and Freedman 2012, 1035). As a matter of fact, psychological science in recent decades has seen the

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emergence of patterns and an increasing number of approaches to cure which have made changes to individual and family therapies and have put it on a new and innovative path. Some of these approaches are a re'ection of the phenomenon which is called the post-modern point of view. %e intellectuals following this perspective believe that knowledge and recog-nition are relative subjects dependent on their context. In their view, our belief system is solely re'ecting structures of social mentality, i.e. di*erent perspectives, rather than the absolute reality that we have created about our world (Lyotard 2003, 209).

Narrative practitioners assume that people’s experiences of prob-lems are shaped by stories, which are constructions. But these are not individual constructions. In any social group, small or large, we are all participants in each other’s stories. We each shape, and are shaped by the beliefs, intentions, and actions of others. Collectively, we all partic-ipate in discourses. Rachel Hare-Mustin (1994) de(nes discourse as “a system of statements, practices, and institutional structures that share common values.” She goes on to say that “discourses bring certain phe-nomena into sight and obscure other phenomena. […](pp. 19-20) […] Post structuralism includes the assumption that since we are all part of culture we can all be caught up by discourses, and therapists can un-doubtedly reproduce these discourses in the therapy room without even recognizing it (Hare-Mustin 1994; Combs and Friedman 2012: 1036)

It is clear that the di*erence between primary assumptions in mod-ern and postmodern approaches can raise dilemmas in psychological treatments. Narrative therapy is one of the examples that have been pre-sented about eating disorders, and it seems that it can be e*ective in improving the psychological condition of the a*ected individuals. Some (ndings indicate that the di+culties associated with appearance have less to do with beauty per se, but are more likely associated with nar-ratives of loss, aging, decline and death. A narrative analytic approach looks at the story being told by the teller and fully acknowledges that in-dividuals construct the “self ”, both past and present, through narrative. %is o)en involves a description of an event or action and an analysis of its meaning which provides insight into the narrator’s sense of self (Silver and Reavey 2010, 1642).

Narrative approaches also stress that it is essential for us to try and

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formulate coherent stories, which enable us to connect both negative and positive happenings, to consider alternative possibilities and to allow re'ection on and integration of the events in our lives (Johanstone and Dallos 2009, 187). %e identity of the self and also the possibility of iden-ti(cation with others and that of noticing and change are all borne within narrative. In the Ricoeurian concept, the mode of action of psychotherapy is no more than a dialogic construction of a life story by the joint inter-pretative work of the therapist and patient. %is interpretation will restore the damaged coherence of the patient’s autobiography (László 2008, 47).

All people have stories to tell about their lives and who they are in the world. %ere are many events that live outside the problem-saturat-ed dominant stories but have been overshadowed, taken for granted or not noticed as being signi(cant. %rough inquiry these events could be further verbalized into existence and brought into alternate story lines. %is process is referred to as “re-storying”. It is a collaborative practice, where the person consulting the therapist remains the primary author, while the therapist asks questions that help the person move from the known and familiar accounts of his or her life toward what is possible to know and do and toward what (ts more closely with that person’s pref-erences for life (Malinen et al.2012, xvii). %rough narratives of people we can identify and reach their emotions, excitement and their perspec-tives. By the narratives that they have expressed, humans start to take action, and this process will lead them to feel that they are capable of anticipating and controlling their own lives. In fact, narratives are in-tended for constructing the individual’s experiences (Brown 2007, 29). A primary way individuals make sense of experience is by casting it in a narrative form (Riessman 1993, 4).

%e “narrative turn” has entered history, anthropology and folklore, psychology, sociolinguistics and communication studies, cultural stud-ies, and sociology. THe professions, too, have embraced the concept, along with investigators who study particular professions: law, medi-cine, nursing, education, and occupational therapy. %e narrative turn is part of a larger “turn to language” in the human sciences, evidence of a blurring of genres between the humanities and sciences […]. Although narrative may have some roots in phenomenology […], applications now extend beyond lived experience and worlds “behind” the author. A

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central area of narrative study is human interaction in relationships—the daily stu* of social work, counselling, and psychotherapy (Riessman and Speedy 2007, 427).

Narrative analysis is useful when the interest is in how and why a story is constructed as it is, what it accomplishes and how the audience a*ects what may be told (Wells 2011, 7).

In her thesis, McKian chose narrative therapy in order to gain insight into how obese women experience everyday life narrative. Narrative protocol is well suited to provide insight into themes from the inter-viewee’s life story from the subjects’ own perspectives. To gain insight into such processes, a narrative approach was adopted. %is method helps to “elucidate the complicated narratives of body image in wom-en’s lives”. Because weight-related stigma has a more signi(cant impact on body image for women than men (Antin and Hunt 2013, 17), it is hypothesized that obesity is one of our narrative that may impact the e*ectiveness of diet therapy by a*ecting body image quality. In addi-tion, the body mass index of obese and overweight women could also be impacted by life narratives. %us, the study aimed to introduce the comparison between e+cacy of narrative therapy and diet therapy on Body Image and Body Mass Index in Iranian women with overweight and obesity. Obesity may not be the same for all women; As a result, we have to explore how women’s life narratives in'uence their body image and Body Mass Index consequently.

Narratives come soon in your spoon: the role of society In the history of humanity there have been many more taboos on

food than sexual taboos (Rivière 1995, 189), and the social and cultural dangers are much greater. Eating has never been a minor issue. Food is a rich topic for research. Dietetics is probably one of the oldest forms of human knowledge (Kaufmann 2010, 12). %ere is not just one story about food or obesity. Everyone in the world has got a special narra-tive about them. %e strong cultural value placed on slimness, especially for women, unfortunately may take precedence over health. To address the impact of women’s body image dissatisfaction e*ectively requires an understanding of the multiple contexts of women’s lives (Paquette and Raine 2004, 1047). Modern Western culture emphasizes slimness, denigrates excess weight, and stigmatizes obese individuals, making it

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likely that obese people internalize these messages and feel badly about the physical presence that brands them. It is also important to keep in mind that it is not always obvious what exactly our body is and how we perceive it. All branches in the humanities try to explain the cultural construction of the human body. Especially the post-modern discussion about the body has in'uenced disciplines like sociology, cultural and gender studies as well as the history of biology and medicine.

Participants and methodology %is was an interventional Quasi-experimental study. Participants

were selected among overweight or obese women who referred to the nutrition and diet therapy clinic of Shahid Beheshti University of Med-ical Sciences, Tehran, Iran, for reducing their weight. 30 overweight or obese (BMI≥ 25) women who were 18 to 36 years old were randomly selected. Since narrative therapy is a kind of clinical intervention treat-ment, the number of samples was determined according to previous studies in this (eld (Carless and Douglas 2008, 581). A)er explanation of the purpose of the study, participants were randomly divided into 3 equal groups (two intervention groups and one control group). One of interventional groups (n=10) received low calorie diet by a nutrition specialist for 5 weeks according to their age, height, and weight (group 1) and the other one (n=10) received 10 sessions of narrative therapy addition to low calorie diet (Group 2). Both groups were asked to adjust their physical activity according to the opinion of the nutritionist and not to change their routines. 10 persons in the control group received no intervention (group 3) and were asked to maintain their daily routine of physical activity. %ese individuals were selected from the waiting list of referrals to the clinic for starting weight reduction programs. Demo-graphic data of all participants, consisting of marital status, number of children, education, and occupation status were collected using a ques-tionnaire. Exclusion criteria included pregnancy, taking antipsychotic drugs, having cardiovascular and chronic kidney disease or thyroid disease, any kind of eating disorders, su*ering severe distress (such as divorce or separation from partner). Women were also excluded if they were currently enrolled in another weight loss program. %e local ethics committee of Allameh Tabataba`i University approved this study. Writ-ten informed consent was obtained from all subjects.

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Conclusion %e meaning of the communications and dialogue depends on their

utility in social relationships and conversation analysis, which means that the protocol that is designed for Iranian women depends on social, cultural, economical, political and psychological features of obesity in woman from di*erent cities in Iran, and these narratives can be di*er-ent from those of other women from various countries. I believe this is the biggest dilemma. Everyday language of morbidly obese women is full of metaphors about body image and body appearance, as I men-tioned in the story at the beginning. %ese metaphors and their context are valuable aids in therapy. Overcoming body image disturbances is an active process that is at the heart of my work in narrative therapy for obese and overweight women.

%e key theoretical concept that I am linking to descriptions of ther-apeutic practice is considering the e*ect of narrative therapy on a devel-oping body image. %is method is more suitable than the other methods with greater results in weight loss. I think the necessity of this interven-tion together with diet on improving the problem of obesity is perceived in many countries.

Controlling obesity is a subject that can be discussed critically. Since obesity is a phenomenon which is complicated, consisting of multiple factors which can intervene in antecedents and consequences of envi-ronmental, psychological and social factors, controlling and curing it is outside the reach of a single (eld only. Based on analyzing the body image, a new approach for curing obesity was designed. %is approach is used for minimizing the weight increase following weight loss. It has been designed in order to overcome the psychological impediment of long-term learning of e*ective behaviour for controlling weight, and it helps the patients to learn the required and needed skills for controlling their weight successfully and revising the narratives related to their body, learning the body metaphors and then applying them. On the one hand, no research has studied the e*ect of narrative therapy on body image and Body Mass Index of women with obesity till now, and on the other hand studying the obese individuals’ narrative is e*ective in addressing their body image and has e*ective consequences in decreas-ing the Body Mass Index. %erefore this study aimed at comparing the

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e*ect of narrative therapy and diet on the index of body image of obese women. It is hypothesized that obesity is one of our narratives that may impact the e*ectiveness of diet therapy by a*ecting body image quality. As a result, narrative therapy may help nutrition specialists in their abil-ity to talk with the patients in order to construct more open narratives about their body and fatness and retain their focus on the importance of relationship and dialogue between nutrients and obese women.

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Health, Culture and the Human BodyEp!dem!ology, Eth!cs and H!story of Med!c!ne, Perspect!ves from Turkey and Central Europe

"lhan "lkılıç, Hakan Ertin, Rainer Brömer, Hajo Zeeb (Eds.)

BET!M CENTER PRESS


1"lk

ılıç,

Ertin

, Brö

mer

, Zee

b (Ed

s.)

BET!M CENTER PRESS

Migration and Health, Infectious Diseases, Beginning of Life/Reproductive Medicine, End of Life, Human Body, and Interculturality and Ethics – these six main themes have been studied from historical, ethical, and epidemiological perspectives, keeping the sister disciplines in a transdisciplinary view.

"e contributions re#ect the themes of two meetings in Mainz/Germany and Istanbul/Turkey. "e book is attempting at a synthesis of the di$erent perspectives and methodological approaches with a focus on Central Europe and Turkey. "e authors and editors have revisited the %eld and bring together a more comprehensive approach to Health, Culture and the Human Body.


9 7 8 6 0 5 8 6 9 5 7 1 9


Ep!dem!ology, Eth!cs and H!story of Med!c!ne, Perspect!ves from Turkey and Central Europe

Editorsİlhan İlkılıçHakan Ertin

Rainer BrömerHajo Zeeb

Betim Center Press


Istanbul 2014

Editorsİlhan İlkılıç, Hakan Ertin, Rainer Brömer, Hajo Zeeb

PublisherHayat Foundation for Health and Social Services

ContactKızılelma Cad. Topçu Eminbey Çıkmazı Sk. No. 30

Fındıkzade, Fatih / İstanbul0212 588 2545 Fax. 0212 632 8579

www.betimcenter.org

ProductionSelika

Design ApplicationAhmet Yumbul

Printing and BindingPınarbaş Matbaacılık Ltd. Şti.

ISBN978-605-86957-1-9

© 2014

Bütün hakları saklıdır. Yazılı izin olmadan, tanıtım amaçlı

kısa alıntılar dışında hiçbir yolla çoğaltılamaz.

Preface

MIGRATION AND HEALTHHistory

Medical selection in the recruitment of migrant workers (“Gastarbeiter”) Sascha Topp

%e Historical Development of Health-Conditions Among Female Immigrants from Turkey in the Federal Republic of Germany Asli Topal-Cevahir

%e Political Making of Care Worker Migration: %e Austrian Example Lukas Kaelin

Epidemiology

%e Role of Illness Perceptions in %e Health Care Provision of Turkish Migrants Patrick Brzoska, Yüce Yılmaz-Aslan, Oliver Razum

Storytelling for and Along with Turkish Caregivers in Germany: the saba Study Susanne Glodny, Yüce Yılmaz-Aslan, Oliver Razum

Contested Medical Identities, Migration of Health Care Providers and Middle Eastern Students at Western Universities Frank Kressing

Health Policies and Cultural Sensitivity in the Care for Elder Turkish Migrants in Austria and Germany and the Role of Turkish Migrants Nevin Altıntop

Medically Unexplained Physical Symptoms Among Turkish Migrant Merlijn van Schayk, Karen Hosper

08

19

39

63

79

99

113

127

137

TABLE OF CONTENTS

Ethics

Medical Care for Migrants Without Health Insurance in Germany and the Role of Civil Society Fiene Wolf, Christa Blum, Jakov Gather, Hannah Windeln, Eva-Maria Schwienhorst

INFECTIOUS DISEASESHistory

European Physicians/Specialists During the 1893–95 Cholera Epidemic in Istanbul Nuran Yıldırım, Hakan Ertin

“Ethnology and Dermatology”. Lorenz Rigler and Alfred Marchionini in Turkey (1842-56 and 1938-48 respectively) Werner Friedrich Kümmel

Syphilis Control in the Age of Abdülhamid II Nil Sarı

“A&icted by God.” Ernst v. Düring and Endemic Syphilis in Anatolia Around the Year 1900 Werner Friedrich Kümmel

Düring Pasha’s Services for the Ottoman Empire Nuran Yıldırım

%e Impact of Syphilis on the Military Capacity of the Ottoman Army During the First World War Murat Yolun

A Sanitary Journal for Common People: Yaşamak YoluCeren Gülser İlikan Rasimoğlu

Epidemiology

Awareness of Sexually Transmitted Diseases Among Adolescents with and Without Migrant Backgrounds in Bremen, Germany Florence Samkange-Zeeb, Saskia Pöttgen, Beate Schütte, Hajo Zeeb

Current viral hepatitis B status and policy in Turkey and the relevance to major immigration countries Mehlika Toy

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Doctors’ and Parents’ Perspectives on Communication Regarding HPV Vaccination in Bulgaria Elitsa Dimitrova, Yulia Panayotova, Irina Todorova, Anna Alexandrova-Karamanova

Ethics

Integration of People With HIV/AIDS to Social Life: AIDS in Turkey and Socio-ethical Re'ections M. Kemal Temel, Hakan Ertin

BEGINNING OF LIFE/REPRODUCTIVE MEDICINEHistory

%e Stone Tekija as a Cultic Place for the Cure of Infertility and the Prevention of Various Diseases: Exploring Macedonian Folk Medicine Dragica Popovska

Epidemiology

Advances in Perinatal and Neonatal Care for High-Risk Newborns: Ethical Implications - a German Perspective Herwig Stop#uchen

Ethics

%e Dignity of the beginnings of Human Life Hans-Martin Sass

End-of-life decisions at the beginning of life İlhan İlkılıç

Contemporary Cultural and Clinical Con'icts at the End-of-Life in Neonatology Ethics Ayesha Ahmad

%e prohibition of egg donation as an issue of medical ethics Clemens Heyder

Abortion According to the Turkish Law Hakan Hakeri

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365

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393

403

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483

END OF LIFEHistory

Concepts About Death %roughout Turkish History. A Historical Perspective of Religious Ethics in Connection with a Dying Patient Nil Sarı

Epidemiology

Psychological, Religious, Legal and Folkloric Dimensions of Death Tuğba Gencer, İbrahim Başağaoğlu

Ethics

End-of-Life-Decisions in Germany: Crucial Aspects of the Medico-Ethical Debate and Clinical Practice Monika Bobbert

Ethical Evaluation of the Pharmacy Services for Geriatric Patients Sözen Şahne, Sevgi Şar

Be Healthy to Live – Live to be Healthy? Bioethics, Biopolics in Aging Society Petra Kutscheid

Advisory Ethics Committees for Arti(cial Nutrition and Hydration in Patients Hanzade Doğan

Ethics of (Palliative) Care and the Question of Euthanasia Dejan Donev, Željko Kaluđerović

Demise and Death from the Perspective of Philosophy of Law; Especially Violations of Dignity Altan Heper

Legal Situation of Organ and Tissue Transplantation in Turkey Yener Ünver

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HUMAN BODYHistory

Representations of the Female Body in Feminist Zines Melanie Boeckmann

Epidemiology

Exploring the Role of Narrative %erapy in Obesity: Overcoming Body Image Disturbances Somayeh Sadat McKian

INTERCULTURALITY AND ETHICS

Epidemiology

%e Need for Cultural Competence in Health Care: %e Case of Roma Population in Poland Agata Strządała

Ethics

Interculturality and Ethics in Health Care İlhan İlkılıç

Cross-Cultural Ethical Con'icts in Health Care. Developing Cultural Competence in Health Care Personnel and Ethics Consultants Tatjana Grützmann

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Exploring the Role of Narrative therapy in Obesity: Overcoming Body Image Disturbances

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