The Benefits of Writing Versus the Ethics of Publishing

Exploring pre-publication ethics for books on eating disorders and beyond.

Reviewed by Davia Sills

Key points

• In pre-publication testing, an anorexia recovery memoir passed the test—not doing harm, and even doing good.
• The question “Should this be published?” should be asked more often by writers, agents, and publishers.
• Precedent exists in the eating disorder realm for writers asking the question and answering “no.”
• Practical examples of how to generate an answer open avenues for ethically informed publication practices.

In part 1 and part 2 of this post, I described how I found myself inadvertently writing a recovery memoir—a type of book that my own research had shown is often harmful to people with an eating disorder—and how I realized once I had a full draft that it was ethically important to find out how readers would respond to it before deciding whether to publish it.

The experimental design involved clear “don’t publish” criteria: If there was a worsening in participants’ scores on the main clinical severity measure we used (the EDE-Q; Fairburn & Beglin, 2008), and if that worsening was greater in the group reading the memoir than the group reading the control text, and if the effect size of the difference was large by a statistical definition (Cohen’s d >0.8). There was no expectation that the book should do good, only that it should not do demonstrable harm.

The book passed the test: It did not do harm beyond the threshold we’d decided was acceptable. Indeed, reading it turned out to do significant good on both the measures we used. Interestingly, this also proved true for the book read by the control group (Ten Zen Questions by fellow Psychology Today contributor [and my mother!] Sue Blackmore, a first-person book about Zen meditation). The paper reporting on our rationale, methods, and results was recently published in the Journal of Eating Disorders, entitled “Ethics-testing an eating disorder recovery memoir: a pre-publication experiment” (Troscianko, Riestra-Camacho, & Carney, 2024).

The unexpected main finding raises all kinds of new questions about what factors were actually doing the good: something shared by the two books or something about the structured reading setup with questions being asked at intervals? As ever, one experiment opens the door to more. For now, though, it’s satisfying to have taken this fundamentally question-asking book (the first line is “So, what was it like, heading off to university age 18 with the all-clear from the child psychiatrist?”) and asked some difficult and important questions of it. Specifically, to have asked and also answered a very simple one: “Should this book be published?”

I’ve grown very interested in why this simple question doesn’t apparently get asked more often: why it’s so often assumed that the answer to “Should I write this book?” is the same as the answer to “Should I publish it?”. I’ve been observing with interest where counterexamples have popped up that show a pause for question-asking being inserted between writing and publishing.

A very literal example of taking a pause comes from recovery coach Tabitha Farrar. Having kindly agreed to help with recruitment for the study, she created a YouTube video (“Your opinion on recovery memoirs, please!”) in which she mentioned having written a book about her own experience of anorexia. She had doubts about publishing it even while she was writing, and then she set the complete draft aside for six months before rereading it. When she did so, her immediate verdict was that the book would “trigger the s**t out of everyone that reads it.” So she decided that she would not publish it and that she never will.

Also focused on eating disorders, June Alexander offers memoir mentoring that frames memoir-writing as a method of self-healing. She stresses the value of writing about one’s own illness and recovery experiences but equally the importance of asking careful questions about what to do with the resulting text. Beyond the eating disorder world, the well-known memoirist Tucker Max runs a high-ticket memoir-writing course that separates writing from publishing, making clear in his publicity material that the writing is the important part and that for many individuals, getting a couple of copies printed for their family is as far as publication ever needs to go.

Of course, asking the question, “Should I publish this?” is only the first step. What options arise once we have asked the question, and it isn’t immediately clear to us what the answer is: yes or no, publish or don’t?

One example of how to work out an answer that doesn’t need the time, money, and research expertise required to conduct a randomized controlled experiment comes from MeaningFULL: 23 Life-Changing Stories of Conquering Dieting, Weight, and Body Image Issues, a volume published by another Psychology Today contributor, Alli Spotts-De Lazzer. In the design and writing phase, she had already taken some important steps to skew the likely answer to the “Should I go ahead and publish?” question towards yes: She had paid careful attention to the ratios of suffering and healing, to the range of featured narratives, and to the amount of detail given when disordered behaviors were being described.

She had also incorporated a range of tactics that—rather like the dialogue form used in The Very Hungry Anorexic, as I described in Part 1—create a varied tapestry of perspectives that seems likely to guard against unhelpful immersion into an unhealthy mindset. For instance, each contributor’s story is followed by a short note from Spotts-De Lazzer that adds context, teases out themes, and poses thought-provoking questions, and each contributor also gives some space to tease out generalizable lessons from their own experience.

Then, once she had a full manuscript, she sent it out to lots of readers (including mental health professionals and people with an eating disorder) and made substantial edits based on their comments. This is a great example of how to be ethically responsible without the overheads of a fully controlled experiment. It offers a nice model for how to approach the “Should this be published (and, if so, does it need editing)?” question systematically, both before and after a full text exists.

Especially in areas where comparison, ambivalence, and harmful glamorization are widespread, including many forms of illness and addiction, I hope that publishers and agents might also start to get more interested in asking, at the relevant stages of a book’s conception, creation, and publication, stark yes/no questions like “Should this be published?” as well as exploratory open questions like “What would make this as useful as possible for readers?”, “What would make it harmful for readers?” and “What benefits have you experienced from writing this, and how do they relate to those you hope or intend for your readers?”.

Such processes would be related to the increasingly common “sensitivity read,” which is intended to improve the accuracy of portrayals of specific types of characters or experiences. Reflective prompts for authors and feedback gathering with prospective readers are two examples of how authors and those who work with them could explore the ethics of what they’re doing and why—including by being willing to ask the simple yes/no and, if needed, to choose “no.”

In the meantime, I’ll be keeping an eye out for other examples of how writers address this key ethical question for themselves, in collaboration with prospective readers or otherwise. If you know of any individuals who have done or are doing this kind of thing, please do get in touch!