Introduction

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Sample One: Critical Review of One Book

Inver Hills College

Rough-draft Critical Review
Eng 1114-91, Spring 2006
© 2006 by Laura Beres

A Critical Review of Man’s Search for Meaning

by Laura Beres
Introduction
In Man’s Search for Meaning, Viktor E. Frankl tells the very personal story of his experience as a prisoner
in a concentration camp during the Holocaust. He presents this story in the form of an essay in which he shares his
arguments and analysis as a doctor and psychologist as well as a former prisoner. This paper will review Frankl’s
story as well as his main arguments, and will evaluate the quality of Frankl’s writing and focus on any areas of
weakness within the story.
Summary
This section contains a summary of Man's Search. Frankl begins his book by stating that his purpose in
writing the book is not to present facts and details of the Holocaust, but to provide a personal account of the
everyday life of a prisoner living in a concentration camp. He states, “This tale is not concerned with the great
horrors, which have already been described often enough (though less often believed), but…it will try to answer this
question: How was everyday life in a concentration camp reflected in the mind of the average prisoner?” (21).
Frankl then goes on to describe the three stages of a prisoner’s psychological reactions to being held captive in a
concentration camp.
The first phase, which occurs just after the prisoner is admitted to the camp, is shock. The second phase, occurring
once the prisoner has fallen into a routine within the camp, is one of apathy, or “the blunting of the emotions and the
feeling that one could not anymore” (42). The third phase, which occurs after the prisoner has been liberated from
the camp, is a period of “depersonalization”, in which “everything appears unreal, unlikely, as in a dream” (110). In
this phase, released prisoners also feel a sense of “bitterness and disillusionment” when returning to their former
lives (113). Frankl describes each of these phases using psychological theory and provides personal experiences to
exemplify each of the stages.
Author’s Arguments
As described above, Frankl’s main purpose for writing this book is to present and analyze the average
prisoner’s psychological reactions to the everyday life of a concentration camp. His three main arguments are his
presentation and analysis of each of the psychological stages that the average concentration camp prisoner
experiences: shock, apathy and depersonalization. He bases his analyses of each of these stages on the actions of
the prisoners and his own personal thoughts and reactions as he experienced life in a concentration camp.
For example, Frankl argues that the second phase of apathy forces “the prisoner’s life down to a primitive
level” (47) in which “all efforts and all emotions were centered on one task: preserving one’s own life and that of
the other fellow” (47). He bases this theory on events he witnessed while living in the camp himself, and states, “It
was natural that the desire for food was the major primitive instinct around which mental life centered. Let us
observe the majority of prisoners when they happened to work near each other and were, for once, not closely
watched. They would immediately start discussing food” (48). Frankl continuously uses examples from his
experiences in the concentration camp to illustrate and strengthen his psychological arguments throughout the text.
Evaluation
This section contains an evaluation of Frankl’s book. Firstly, the author is a survivor of the Holocaust and
was a prisoner of a concentration camp himself, which gives him the personal insight to be able to comment on the
psychological conditions of an average prisoner. However, this also creates a bias and because of his personal
experience, he is unable to be entirely objective in writing his analysis. Frankl acknowledges this bias in the
beginning of his book, by stating, “Only the man inside knows. His judgments may not be objective, his evaluations
may be out of proportion. This is inevitable. An attempt must be made to avoid any personal bias, and that is the
real difficulty of a book of this kind” (24-25). Although he is aware of this bias, it creates a partiality that will sway
the readers throughout his story and it serves as a minor weakness in his writing style.
A second weakness in Frankl’s writing is in the assumptions he sometimes makes to prove his point. He
makes overarching generalizations several times in his book, making statements that, although may have been true
for himself and those around him, might not have been true for every prisoner in every concentration camp during
the Holocaust. For example, in one instance, he says, “The prisoner of Auschwitz , in the first phase of shock, did
not fear death” (37). It is very bold to say that no prisoner of Auschwitz, one of the most well-known and deadly
concentration camps of the Holocaust, did not fear death, as death was all around them and was a very real threat in
their daily lives. Although he might have not feared death during his phase of shock, it is impossible for him to
guarantee that no prisoner was at all fearful of death in this first psychological phase, and for him to make
overarching assumptions like this is a weakness to the overall quality of his book.
Finally, Frankl sometimes becomes too technical and verbose in his writing style, which makes it very hard
for the average reader to understand. One example of this is as follows. Frankl states, “I remember an incident
when there was an occasion for psychotherapeutic work on the inmates of a whole hut, due to an intensification of
their receptiveness because of a certain external situation” (102). This sentence, which is overly wordy and
complicated, makes it difficult for the average reader to understand exactly what he is saying. A reader can easily
get frustrated when trying to decipher the author’s meaning due to overly complicated language, and this is a third
weakness of Frankl’s writing.
Conclusion
This critical review has evaluated the book Man’s Search for Meaning by Viktor E. Frankl. The
psychological theories that Frankl presents are very interesting and he does a good job of illustrating these theories
with his own personal experiences. However, his writing is weakened by the presence of bias, the overarching
assumptions he occasionally makes, and his sometimes overly technical and verbose language.
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 Sample Two: Critical Review of One Essay

SPECIAL NOTES: This short, rough-draft critical review examines only one short, argumentative essay
and has no other sources.
University of Minnesota
Eng 3027, Advanced Expository Writing
Critical Review
© 2001 by Petter Woll
Review of "Condom use will increase the spread of AIDS"
by Petter Woll
Introduction
The use of condoms to prevent unwanted pregnancies and, even more important, the spread of
sexual transmitted diseases (STDs) has been controversial. This critical review examines an article that
links condom usage to the spread of AIDS. The article, "Condom use will increase the spread of AIDS,"
was written by Anthony Zimmerman, a Catholic priest. As the title of the article indicates, the author is
against the use of condoms to prevent the spread of AIDS and other STDs. In fact, he claims that
teaching children how to use condoms will eventually increase the spread of AIDS. Although the author
has some good points, his article is biased and contains some misinterpretation of data from others’
analysis of the effectiveness of the condom.
Summary
This sections contains a summary of the article "Condom use will increase the spread of AIDS." In
his introduction, Zimmerman says that condom usage "may break its [AIDS] spread in the short run; but
accelerates its spread in the long run" (p. 111). He bases his conclusion on an analysis done for the
World Health Organization (WHO) published in Population Reports. The results from this analysis
indicated that condoms users have a one-third lower risk for acquiring STDs compared to non-condom
users. This, however, provides small comfort for the author. He says that using a condom is like playing
Russian roulette.
There are two reasons why condom usage will increase the spread of AIDS. Firstly, the promotion
of condoms by the authorities, like teachers and health workers, increases sexual promiscuousity. This
leads to miseducation of adolescents, breaking down their natural and cultural barriers against sex before
marriage. Secondly, condom usage promotes a false sense of security and a pseudo-responsibility.
According to the author, the most prevalent HIV virus is the one that spreads more easily through
sodomitic (anal) intercourse among homosexual men. However, if today’s trend continues, the African
type, which spreads through heterosexual intercourse, "may strike our schools like the atom bombs which
devastated Nagasaki and Hiroshima" (p.113).
In his conclusion, the author draws parallels to the Black Death that haunted Europe during the
fourteenth century. This is the scenario he pictures if schools promote sexual education. It is already
happening in Uganda, he says, where AIDS is endemic.
Arguments
This section looks into the author’s arguments and what these arguments mean to the general
population. In addition, counterarguments from the public and professional spheres are contrasted with
those of the author.
AUTHOR’S ARGUMENTS AND IMPLICATIONS
 The main purpose for the article written by Zimmerman is to abolish the promotion of condom use
in the society. He argues for this by saying that promotion of condom use will increase the spread of
AIDS. According to the author, there are two reasons for this. One is that the promotion of condom usage
will increase sexual immorality: that is, more sex before marriage. If people are more frequently exposed
to sex, they will have sex earlier in adolescence, compared to if they are exposed less frequently.
Exposure increases the risk of acquiring HIV and, thus, developing AIDS. The other reason why condom
usage will increase the spread of AIDS is that it leads to a false sense of security and something the
author calls pseudo-responsibility. People, he says, who promote condom usage advertise condoms as
reducing the risk of transmitting HIV. This, according to the author, misleads ordinarily people to think that
all sex is safe, and therefore it increases their sexual behavior.
The implication of the author’s arguments is that to reduce the spread of AIDS and avoid a future
catastrophe having the same devastating effects as the black plague in Europe on the 14 th century,
promotion of condom use must be stopped.
CONTRASTING OPINIONS
Zimmerman has a very moralistic view on sexuality that is not compatible with the public’s view.
The trend today is that young people start having sex earlier than before. Also, there are few people who
wait to have sex until they are married. This trend was illustrated by the controversial movie, "Kids," made
by a sixteen-year-old American boy, which has been highly debated by health workers.
The view on condoms in the sphere of public health is that they are our best means of reducing
the spread of sexual transmitted infections like HIV. In one study that looked at the transmission rate
among heterosexual partners with one partner infected by HIV, among the 123 couples that consistently
used condoms, none of the partners became infected, whereas 12 of the 122 who didn’t consistently use
condoms became infected.
For optimum effect in using a condom, correct use and storage is a necessity. Therefore, health
workers travel around to schools to teach adolescents to use condoms correctly. This method belongs to
the principles of harm reduction, which says: "You should not use, but if you do…." Several studies have
confirmed that up to the present time, this is the most effective method for preventing the spread of STDs.
Some people go as far as to say that condoms should be made as common as toothpaste and toilet
paper, in order to protect us against infections.
Evaluation
This section contains an evaluation of the article. Firstly, the author’s arguments appear to be
biased towards his Christian beliefs. He is a Catholic priest and has a very moralistic view of sex. In his
opinion, sex before marriage is immoral. A minority in the American population would support this kind of
view. His views on sexuality are, in short, not consistent with current views within the population.
Furthermore, he shows prejudice against homosexuals and Africans. He holds these two groups as the
source of the HIV virus. The fact that the virus is more prevalent in these two groups does not mean that
they are the source of the spread. In his article he says that "the ghetto of sodomites is going into
extinction, and that could lead to the extinction of AIDS." This is an extremely prejudiced statement, and it
has parallels to Hitler’s statements about Jews: if we eliminate all the homosexuals, we can get rid of
AIDS.
Another negative point about this article is that it is very argumentative with little support. The
author throws out statements, giving no evidence or supporting details for them. This is bad writing, and
the author loses his creditability.
Finally, he misinterprets information from other data and gives the wrong information or only parts
of the truth. The data from the analysis done for the WHO indicate that condoms significantly decrease
the risk of transmitting HIV. However, Zimmerman overlooks this, and instead interprets it to show that
condoms increase the spread of HIV. Furthermore, he refers to the endemic situation in Uganda, and
claims that this is the situation we are going to experience in the future if the promotion of condoms
continues. What he fails to mention is that the situation in Uganda could have been avoided with the
promotion of condoms. The number one cause of the spread of HIV is unprotected sex, and with the
correct use of condoms, the spread can effectively be reduced.
Conclusion
This critical review has evaluated the article "Condom use will increase the spread of AIDS" by
Anthony Zimmerman. The arguments in the article show the presence of bias, prejudice, argumentative
writing without supporting details, and misinformation. These points weaken the author’s arguments and
reduce his credibility.
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Sample Three: Researched Critical Review of Three Essays Using

MLA Style

SPECIAL NOTES: This critical review examines three essays and has additional sources.
University of Minnesota
Eng 3027, Advanced Expository Writing
Critical Review
© 2000 by Sarah Pearson
A Critical Review of Three Articles on Music and Feminist Pedagogy
by Sarah Pearson
Introduction
The importance of feminism in music has come to the forefront in many colleges and
universities. However, for several reasons, one of which is that scholars hold differing views on the
relevancy and appropriateness of feminism in the musical realm, feminism has not been included as
quickly in music as in other fields. Neuls-Bates offers another reason for this lack of speed: "The
discipline of women's studies has been slower to develop in the field of music . . . mainly because of the
necessary, time-consuming tasks involved in obtaining performances of composer's works" (265). In
other words, music is slow to incorporate women’s studies because of the intense effort required to
change an already well-respected, dependable curriculum. This critical review will examine three different
articles on this issue and evaluate their contents based on a set of criteria. Each of the articles, published
in College Music Symposium, is written from a feminist viewpoint. The authors discuss the importance of
including a feminist curriculum within the college setting, noting the positive benefits of using it in the
classroom. Their main argument is that not enough of this type of teaching is being used in
conservatories. One article is well written with supporting details and potential solutions, while the other
two include only general observations and offer no solutions.
Background
Some background about this issue is useful. Prior to the 1970’s, white middle- and upper- class
males dominated colleges. Because of this, women’s issues often were ignored. In the early 1970's,
joint efforts were made by women across the country to try to persuade colleges and universities to
incorporate women’s issues into their curriculum. They felt that this incorporation would fill a vacancy for
women attempting to earn a degree. Many people believed that exploring the numerous ways women
helped to shape society would result in higher self-esteem among women and give them a better
understanding of the world. Slowly the schools began implementing programs for women and started
using textbooks that focused more attention on women’s achievements in particular fields. Currently
many departments within colleges have at least a small part of their curriculum devoted to women.
Feminists spent countless hours convincing departments to add these issues. It has particularly been a
struggle for both feminists and music departments to agree on what subjects should or should not be
included in an already well-established field.
Summary
A summary of the articles shows that the first one, "Feminist Scholarship and the Field of
Musicology: I" by Jane M. Bowers, discusses the issues of feminism and its place in music. Published in
College Music Symposium, this article focuses on the subject of music history. Bowers argues that the
"great" male composers dominate music history, and almost nothing is said about women
composers. That music history lacks a feminist viewpoint is not surprising, she argues, as nearly all the
disciplines in the arts have little emphasis on women’s issues. One reason for the void is that many
scholars have felt that it was not suitable to incorporate women’s issues into their particular field.
According to Bowers, "[T]he scope of musicology is . . . not defined by lived social realities, and hence its
purview, like those of philosophy and literature, is similarly less suited to the incorporation of women . . ."
(83). She believes this presents a dilemma to feminists, who must now explain why women’s studies are
relevant to music. Bowers goes on to discuss historical ideas about women and their function in music.
She cites recent discoveries about the influence of women musicians in the nineteenth century. In her
conclusion she restates the argument that there is a lack of research and studies being done on women
in music. She suggests searching for ways to emphasize women’s compositions by focusing on the
differences between men and women’s compositional styles, and looking at the instrumental music of
women.
The second article, "Women, Women's Studies, Music and Musicology: Issues of Pedagogy and
Scholarship" by Susan Cook, also focuses on the importance of including women in research. Also
published in College Music Symposium, this article contends that women's studies need to be included in
more music courses. Because of a lack of research of women in music, teachers are unable to integrate
the subject into their curriculum. Even with some research available, professors are unsure how to use it.
According to Woods, whom Cook quotes, "We continue to operate within a conservative methodology,
whether compensatory or contributory, that is not necessarily feminist and not specifically female. Rather
it tends to relate and relocate women to the accepted canon of great artists and great works" (95). Instead
of incorporating women into the canon, Cook believes professors are pushing them to the fringes,
including them only when time will allow. Cook then mentions numerous studies done recently that have
helped advance feminist ideas in the classroom. She feels this is a start, but much more research is
needed in order to push professors into using the information in their lectures.
Cook also discusses ways in which feminism has changed teaching styles. She believes the
traditional lecture has begun to give way to an open forum, with the teacher leading the discussion. There
is also an emphasis on equality in all classroom situations: for example, teachers offer students more
freedom concerning grades, class management, and lecture (98).
The third article, also published in College Music Symposium, is "Application of Feminist
Pedagogy: An Introduction to the Issues" by Barbara Coeyman. It looks at ways of incorporating
feminism into the current curriculum. Unlike in the first two articles, the author does not emphasize
research and its importance to changing the curriculum; rather, she focuses on possible outcomes if
feminism is applied in the classroom. Her main argument is that the current music curriculum can be
enhanced and can lead to an enlightened classroom if feminism is applied.
Throughout the article, Coeyman attempts to justify feminist pedagogy by contrasting it to
traditional teaching. She argues that "[traditional teaching] emphasizes formal constructions, static
content, and context-free artistic creation" (77), whereas feminist pedagogy emphasizes students'
creativity and encourages professors to become more involved in the actual learning process. Coeyman
further promotes feminist pedagogy by discussing its four main principles, which, according to her,
include diversity, a voice for everyone, responsibility, and application to real life situations. She suggests
several ways of applying these ideas through personalizing classroom lectures, including women
composers in the canon, and allowing students to "learn by doing" ( 83).
Analysis of Arguments
All three of these articles contain similar arguments about feminism and music education. First,
the authors believe that more feminist issues need to be incorporated into music classes. Second, they
imply that a music student’s education is not wholly complete without the feminist viewpoint. Lastly, Cook
and Coeyman argue that feminist pedagogy can unite students and faculty inside and outside of the
classroom.
More in Curriculum
First, each author states that music courses do not emphasize women’s issues enough and need
to begin incorporating more into the curriculum. Bowers states, "If more than scant attention were paid to
the interaction of music history with social history, as well as to the attempt to include music as an aspect
of and in relation to culture in the large-areas which are virtually neglected within musicology-women
would also become a more relevant subject for study" (84). By this statement Bowers shows her belief
that feminist ideas could be incorporated into music curriculum if scholars would exert a little more effort.
Both Cook and Coeyman agree with Bowers that most music courses do not place enough
emphasis on women. The main argument among instructors is that there is not enough research
available to be able to add it to the curriculum. However, according to others such as Neuls-Bates, "[A]t
the present time there are quite sufficient materials to implement courses about women in music . . ."
(Zaimont 265). Thus the authors' arguments in this regard have some validity.
Complete Education

Second, the authors imply that a student's education is not complete without the feminist
viewpoint. While neither directly state this, both Cook and Coeyman allude to this idea. Cook closes her
article by stating that feminist pedagogy can add to the overall musical experience (98). Coeyman follows
the same lines by stating that including feminism in the classroom can inspire both students and faculty
and can benefit the overall person (77, 85).
Bowers, unlike the first two, does not focus on the education aspect, yet she promotes this idea through
her constant emphasis on continued research of women. Commenting on a survey of articles focusing on
women, she states, "Their central concern was the degree to which research on women had achieved a
place in the mainstream of the disciplines where it had previously been absent" (81). This statement and
numerous others throughout the article show her belief that research is important and can improve the
overall education of a person.
All of these authors argue fervently that feminist ideas can enhance music students'
education. However, none offer any evidence that this is true.
Unity of Students and Faculty
Lastly, the articles by Cook and Coeyman offer the idea that feminist pedagogy can unite students
and faculty. They both propose this through discussion of alternative classroom teaching techniques.
Cook suggests that a more nontraditional lecture format can provide an encouraging atmosphere
in which students can learn. She states that nontraditional teachers can " help all students to find their
own answers and give birth to their own ideas" (97). Thus she is arguing that if teachers use feminist
methods, they will stimulate students to think for themselves and producing better communication in the
classroom.
Coeyman also argues that letting students become more involved in the classroom allows for
better communication between the professor and student, creating a feeling of shared power (83), again a
feminist method. By emphasizing these and other feminist methods, such as a relaxed, non-threatening
classroom experience, these authors promote the belief that feminist pedagogy can bring the professor
and student together.
Evaluation
 Although all of these articles offer well-supported arguments, they also have weaknesses. At
times some of them appear to lack solid solutions to the problem, tend to show bias towards the feminist
viewpoint, and may exaggerate the oppression of women composers in music.
Lack of Solid Solutions
A lack of solid solutions appears to exist in Bowers' and Cook's articles. Bowers, in particular, fails
to offer a solid solution as to how to incorporate more feminist issues into the music history
curriculum. While she suggests alternatives to research within music, she omits discussing solutions to
changes in the current curriculum.
Like Bowers, Cook also neglects to provide any solutions to the problem. She focuses on the
differences between traditional teaching and feminist pedagogy, discussing possible types of alternative
teaching methods. Though she notes that change is necessary, she fails to offer suggestions as to how
these changes could be integrated into the classroom (98). In contrast to the first two articles, Coeyman
does focus on possible ways to begin incorporating feminism into music courses. She suggests using
women's compositions during lessons, offering non-musical courses that can amplify students' music
classes, and giving students a larger voice in how a class is run (83-84). Combined with some aspects of
traditional teaching, these methods could help enhance music students' education.
Bias
All three articles are also infused with a bias towards feminism. In her article, Bowers portrays this
bias when she states, "However inadvertent the neglect of women ensuing from these patterns of
musicological research, the result has perpetuated the myth of female insignificance" (83). Her use of the
words "neglect" and "female insignificance" show her strong feelings about feminist issues.
Cook and Coeyman use this same type of wording in their articles, but also show their bias
through ignoring the positives of traditional teaching. They comment only on the negative aspects,
making their suggestions seem more valid. Coeyman especially uses this tactic when she describes
ways to change traditional lecturing. For instance, as quoted before, she labels traditional studies as
"static," "context-free," and "dictatorial" (77). By using these terms she degrades standard teaching and
enhances her own ideas about alternative methods.
Exaggeration
Each author also exaggerates the oppression of women musicians in the nineteenth
century. First, Bowers continually comments on her belief that women musicians have not been treated
fairly throughout history. She states, "Further, women's compositions were frequently reviewed in
gender-biased ways, and overt discrimination . . . was used against women who tried to enter male
domains" (87). This statement is only partly true. Clara Schumann was one example of a woman who
composed and performed across Europe. According to Green, "Clara Schumann . . . was the
acknowledged peer of the top male performers of the day" (60). Many other women musicians were also
well-respected in the music field such as Fanny Mendelssohn, Cecile and Natalie Chaminade, Amy
Beach, and Sofia Gubaidulina. Bowers fails to acknowledge the impact these women had on music and
ignores the freedom they had in performing and composing.
Cook and Coeyman do not directly exaggerate the oppression. However, they often allude to it.
Cook comments on continued open hostility to women's studies programs in higher education,
while Coeyman describes the field of music as a white male- dominated scene (Cook 93; Coeyman 75).
While neither openly state it as Bowers does, they still assume that all women were excluded from music
and have just recently begun to be accepted. Contrary to this, in recent years many universities have felt
it imperative to include women’s studies in their curriculum. According to the College Music Society, for
example, "To combat the trend toward tunnel vision [in music] and to ensue that students and faculty
integrate knowledge from various disciplines, educational requirements need to be expanded and
reinvigorated" (6). Contrary to Cook and Coeyman’s beliefs, many music departments have realized their
curricula need to include more than just one race or gender’s point of view.
Conclusion
 This critical review has considered three different articles. Each article focuses on the issue of
feminism and its place in the college music setting. Bowers and Cook look at the research aspects,
observing that a lack of research inhibits inclusion of women in the classroom. Coeyman concentrates on
the importance of including women in history lectures and offers suggestions for alternative teaching
methods. While all three articles are well written, they fail to discuss the benefits of traditional teaching,
focusing only on the positives of feminism. They believe feminism will foster growth in the education of
many students. According to Ropers-Huilman, "[F]eminist teaching provides options for teachers and
administrators as they seek to educate and encourage respectful communities grounded in difference"
(19). However true this may be, to say that this will only happen by using a feminist pedagogy is one-
sided, and this one-sidedness is evident in the arguments of all three authors’ articles. Their arguments
insinuate that feminist teaching is the only solution to improving a music school’s curriculum. This
misleads the reader and focuses the attention on feminism while ignoring all other viewpoints.
Works Cited
Bowers, Jane M. "Feminist Scholarship and the Field of Musicology: I." College Music Symposium 29
(1989): 81-92.
Coeyman, Barbara. "Applications of Feminist Pedagogy to the College Music Major Curriculum: An
Introduction to the Issues." College Music Symposium 36 (1996): 73-90.
College Music Society. Music in the Undergraduate Curriculum: A Reassessment. Boulder : College
Music Society: 1989.
Cook, Susan C. "Women, Women’s Studies, Music and Musicology: Issues of Pedagogy and
Scholarship." College Music Symposium 29 (1989): 93-100.
Green, Lucy. Music, Gender, Education. Cambridge : University of Cambridge Press, 1997.
Neuls-Bates, Carol. "Creating a College Curriculum for the Study of Women in Music." The Musical
Woman: An International Perspective. Ed. Judith Lang Zaimont. Westport : Greenwood Press,
1983. 265-284.
Ropers-Huilman, Becky. Feminist Teaching in Theory and Practice. New York : Teachers College Press,
1998.

Additional Sources
Banner, Lois. Women in Modern America: A Brief History. 2nd ed. Orlando: Harcourt Brace Jovanovich,
1984.
Kimball, Roger. Tenured Radicals. New, York: Harper & Row, 1998.
Langer, Cassandra. A Feminist Critique. New York: Harper Collins, 1996.
Levine, Lawrence. The Opening of the American Mind. Boston: Beacon Press, 1996.
Mark, Michael L. Contemporary Music Education. 3rd ed. New York: Simon & Schuster Macmillan, 1996.
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 Sample Four: Critical Review of Four Essays Using APA Style

SPECIAL NOTES: This critical review of four professional journal essays is in APA format. There is no
bibliography, as all sources are sufficiently referenced in this semi-formal paper. Main subtitles are
underlined; sub-subtitles have all letters capitalized.

A Critical Review of Studies Showing the Prevalence

of Disordered Eating and Insulin Misuse among IDDM Patients
by Anonymous
Introduction
This critical review discusses four studies that examine the prevalence of eating disorders and
eating problems among insulin-dependent diabetes mellitus (IDDM) patients and the misuse of insulin
involved. In the British Medical Journal article “Eating Disorders in Young Adults with Insulin-dependent
Diabetes Mellitus: A Controlled Study”, the findings of Christopher Fairburn, Robert Peveler, Beverly
Davies, J. I. Mann, and Richard Mayou suggest that eating disorders are not more common among IDDM
patients compared to non-diabetics. The results presented by Anne Rydall, Gary Rodin, Marion Olmsted,
Robert Denenyi, and Denis Daneman (1997) in the New England Journal of Medicine article “Disordered
Eating Behavior and Microvascular Complications in Young Women with Insulin-dependent Diabetes
Mellitus”, imply that there is a common “coexistence of eating disorders and IDDM among young females”
(p. 1849). In the Journal of the American Dietetic Association article “Insulin Misuse by Women with Type
1 Diabetes Mellitus Complicated by Eating Disorders Does Not Favorably Change Body Weight, Body
Composition, of Body Fat Distribution”, Sandra Affenito, Nancy Rodriquez, Jeffrey Backstrand, Garry
Welch, and Cynthia Adams suggest that there is a high prevalence of eating disorders among the IDDM
population. In the Journal of American Academy of Child and Adult Psychiatry article “Eating Disorders
and Maladaptive Dietary Insulin Management among Youths with Childhood-onset Insulin-dependent
Diabetes Mellitus” Myrna Pollock, Maria Kovacs, and Denise Charron-Prochownik suggest that eating
disorders and problems are not as common among young adults as it is thought. All of the articles imply
that insulin misuse is a common method for controlling weight among IDDM patients with eating disorders
or problems. Two of the studies have strong elements that are worth noting. Each study has at least one
weakness. These include bias, contradiction, and limits of the study.
Background
According to the World Book Encyclopedia (1995), people with insulin-dependent diabetes
mellitus (IDDM or type 1 diabetes) have insufficient amounts of insulin in their bodies, and they are
unable to use and store glucose quickly. This leads to buildup of glucose in the blood. Injecting insulin
allows the body to use glucose normally. Despite a strict diet, the daily dose of insulin may cause rapid
weight gain in some IDDM patients, and this may trigger and eating disorder. The combination of IDDM
and eating disorders is quite common. According to Bonnie Irvin (1997), “it is not known if eating
disorders are more common among diabetics, but it is highly probable” (p. 28). Eating disorders pose a
serious health risk to those with IDDM. Lowering or skipping insulin doses gives these people a special
method of losing weight. According to Cheryl Rock and Kathryn Zerbe (1995), the dietary restrictions
focus on food, and increased body awareness of diabetics are risk factors for an eating disorder. Insulin
withholding can cause severe health complications, and diabetes “heightens the risks of mortality
associated with eating disorders” (Rock & Zerbe, 1995, p. 81). According to Irvin (1997), “insulin purging”,
(reducing or withholding insulin to control one’s weight) is now “recognized in DSM IV’s diagnostic criteria
for bulimia” (p. 28).
Summary
This sections provides a quick glance at each study. All of the studies varied in the subjects and
methods used. Some specifically studied eating disorders, while others looked at eating problems or
disordered eating. Some studied both. All of the studies also examined other aspects associated with
eating disorders or diabetes. (Note: this critical review specifically focuses on eating problems and/or
disorders, diabetes, and insulin misuse because these are the common elements in these studies.)
“Eating Disorders in Young Adults with Insulin-dependent Diabetes Mellitus: A Controlled Study”
compared the prevalence of eating disorders among a sample of IDDM patients and a sample of non-
diabetics. The diabetic group consisted of 46 men and 54 women, and the control group consisted of 67
non-diabetic women only. Each subject was given an eating disorder examination to measure clinical
features of eating disorders. Those with diabetes were given an interview adapted to distinguish behavior
simply motivated by diabetes. All subjects also completed an eating attitudes test. Fairburn et al. found
no significant difference in the prevalence of eating disorders among diabetic women and non-diabetic
women. None of the men met criteria for an eating disorder. Many of the diabetic women underused
insulin to control their weight, and 4 out of the 6 currently doing so had an eating disorder.
In “Disordered Eating Behavior and Microvascular Complications in Young Women with Insulin-
dependent Diabetes Mellitus”, young women with IDDM were studied at baseline and four to five years
later to find the “prevalence and persistence of disordered eating behavior” (Rydall et al., 1997, p.
1849). The participants were 121 girls, ranging in age from 12-18, with IDDM. Each completed a self-
report survey of eating attitudes and behavior at baseline. According to Rydall et al. (1997), “behavior
relating to eating and weight psychopathology” was assessed at baseline and at follow-up with the
Diagnostic Survey for Eating Disorders (p. 1850). This questionnaire was adapted to include items
specifically relating to diabetes. According to Rydall et al. (1997), eating behavior at baseline and follow-
up was categorized into “three mutually exclusive, hierarchical categories: highly disordered, moderately
disordered, and nondisordered eating” (p. 1850). Ninety-one women participated at follow-up.
Rydall et al. (1997) found “intentional omission or underdosing of insulin and dieting for weight
loss” increased in prevalence from baseline to follow-up (p. 1852). At baseline, 26 of the 91 young women
had highly disordered eating behavior that persisted in 16 and improved in 10. Of the 65 with normal
eating at baseline 14 had disordered eating at follow-up. 12 subjects at baseline and 30 at follow-up
reported omission or underdosing of insulin to lose weight.
In the article, “Insulin Misuse by Women with Type 1 Diabetes Mellitus Complicated by Eating
Disorders Does Not Favorably Change Body Weight, Body Composition, of Body Fat Distribution”, the
relationship between improper use of insulin among type 1 diabetics mellitus (IDDM) and eating disorders
was investigated. Subjects were 90 women who had type 1 diabetes for at least one year. They were
divided into three groups: clinical (all DSM-III-R criteria met), subclinical (criteria partially met), and control
(free of eating disorders). Diagnoses of eating disorders were based on DSM-III-R criteria and confirmed
by clinical interview using the validated Eating Disorder Examination. According to Affenito et al. (1998),
the Bulimia Test Revised was administered to each subject to “assess severity and frequency of bulimic
behavior” (p. 687). Attitudes and behaviors regarding insulin misuse were determined by clinical
interview. The results showed the women with eating disorders (clinical and subclinical) misused insulin
to a greater extent to control weight than those without eating disorders. Nearly half of the women with
eating disorders reported misuse of insulin.
The objective of “Eating Disorders and Maladaptive Dietary Insulin Management among Youths
with Childhood-onset Insulin-dependent Diabetes Mellitus” was to determine the prevalence of eating
disorders and insulin misuse among IDDM youths. Girls and boys ranging in age from 8-13 were
assessed on various measures two to three weeks after IDDM onset and at various follow-ups over the
next eight to fourteen years. Eating disorders were diagnosed by using the Interview Schedule for
Children and Adolescents (ICS) which contains symptoms that are flags for possible eating disorders. 3
of the 79 subjects had a DSM-III eating disorder. Pollock et al. (1995) further reported that each of the 3
had “serious dietary indiscretion and repeated insulin omission” (p. 294). Six others had symptoms of
problematic eating behavior. According to Pollock et al. (1995) every one of the youths with eating
problems had at least “one episode of pervasive noncompliance with diabetes care” (p. 295).
Implications
POPULAR AND ACCEPTED IMPLICATIONS
This section discusses the implications of these studies, showing how they vary in popularity and
rationale. Most of the articles had results that one might expect. Fairburn et al., Rydall et al., and Affenito
et al. all implied that eating disorders and/or problems are fairly common among the IDDM
population. This is in accordance with the expectations formed from the empirical relationship between
IDDM and eating disorders. It seems logical that eating disorders would be common among this
population due to the special diet imposed on diabetics and their elevated body awareness. Those with
diabetes also have a method of controlling weight by reducing insulin doses readily available to them.
UNPOPULAR IMPLICATIONS
Some implications of these articles are not accepted so easily. Pollock et al. (1995) suggest that
only a small percentage of young adults have a combination of diabetes and eating disorders or eating
problems. This idea is not only unpopular because it goes against the common expectations mentioned
above, but also because eating disorders are thought to be the most common among the subjects’ age
range (16-26 years old when assessed for eating disorders) of this study.
Another implication that is unpopular is Fairburn et al.’s (1991) conclusion that eating disorders
are not more common among diabetic women than non-diabetic women. The findings and implications of
this study contrast those of many other studies on this topic. It can be argued that these results are due
to the efforts of the experimenters to study a representative diabetic sample and a non-diabetic control
group. According to Fairburn et al. (1991), there are no satisfactory data on the prevalence of eating
disorders in the community and few other studies have included control groups. It is possible that these
methodological differences account for the findings of this study and the implications drawn from them.
One common implication among all of the studies is not well recognized by the public. Although
the misuse of insulin among IDDM subjects was common in all of these studies, it is not seen as a
common problem outside of the medical profession. According to Fairburn et al. (1991), “insulin misuse is
not generally thought to be common, and omission or underuse of insulin specifically for weight control
has received little attention outside clinical reports of patients with eating disorders” (p. 21). These
studies suggest that the practice is widespread among IDDM patients (mostly women), and according to
Affenito et al. (1998), it is not confined to those that have a clinical eating disorder. The misuse of insulin
may seem logical due to the increased risk of eating disorders among diabetics and their access to
insulin.
SIMILARITIES IN STUDIES, DIFFERENT IMPLICATIONS
Some of the studies had similar methods and/or subjects, but different results and
implications. The subjects in “Eating Disorders in Young Adults with Insulin-dependent Diabetes Mellitus:
A Controlled Study” and the subjects at follow-up in “Eating Disorders and Maladaptive Dietary Insulin
Management among Youths with Childhood-onset Insulin-dependent Diabetes Mellitus” were similar in
sex and age, but the findings were different. Fairburn et al. (1991) found that many of the diabetic women
had eating disorders and disturbed eating, while no men did. Pollock et al. (1995) contrastly found only a
small percentage of the IDDM subjects had eating disorders or problems, and one-third of the subjects
with eating problems were male.
The difference in prevalence of eating disorders and problems suggested in these studies may
be due to the criteria that Pollock et al. used to determine an eating disorder and eating problem. For the
purpose of their study Pollock et al. (1995) determined that an eating problem “required the joint presence
of maladaptive eating and repeated insulin misuse” (p. 293). In the Fairburn et al. study, insulin misuse
was not required for an eating problem. One might argue that a diabetic may have disordered eating
without misusing insulin, and therefore it should not be a requirement. Pollock et al. (1995) used
“comprehensive psychiatric evaluations and differential diagnosis” to determine eating disorders (p.
293). This method of assessment is more extensive than what would be done in a clinical setting. The
criteria and methods used by Pollock et al. may have excluded subjects that would otherwise be
considered for an eating problem or disorder. Pollock et al. (1995) also considered misuse of insulin as
the total omission of insulin rather than the omission or reduction of insulin like most other
studies. Contrastly, in the Fairburn et al. (1991) study misuse of insulin was defined as “underusing or
even omitting insulin specifically to control weight” (p. 18). The difference in criteria used for insulin
misuse may also explain the differences found on this measure.
Fairburn et al. (1991) and Affenito et al. (1995) both compared the misuse of insulin among IDDM
patients with eating disorders and IDDM patients without eating disorders. According to Fairburn et al.
(1991) there was no significant difference in the misuse of insulin among the groups. Affenito et al.’s
results suggest that the misuse of insulin is more common among diabetics with eating disorders than
among those without them. One could argue that the difference found by Affenito et al. is due to
demographic differences between the groups. Affenito (1998) et al. found the women without eating
disorders were “more educated, had more professional occupations, and were more likely to be married”
compared to those without eating disorders (p. 687). No significant differences existed between the
groups in the Fairburn et al. study. It can be argued that these differences are due to differences in the
comparison groups and that no real differences exist.
Evaluation
This section evaluates the quality of each study. Some of the studies have strong elements that
are worth mentioning. Each of these studies have at least one weakness that lowers the value of their
findings.
STRONG ELEMENTS
In two of the studies special concern was given to the instruments used to measure eating
disorders and problems among the diabetic subjects. Fairburn et al. (1991) made intensive efforts to go
beyond the shortcomings of similar studies. According to Fairburn et al. (1991), the Eating Disorder
Examination used was “adapted to distinguish behavior motivated by having diabetes and the demands
of treatment from that attributable to an eating disorder” (p. 18). Rydall et al. (1997) used the Diagnostic
Survey for Eating Disorders that was “modified to include diabetes-related items” (p. 1850). By taking
these extra steps, the authors avoid attributing eating problems and other behaviors to eating disorders
when they could simply be the result of the diabetes.
Another important part of the study conducted by Fairburn et al. (1991) is that they strived to use a
more representative sample of diabetics, and they also used a control group of non-diabetics that few
other studies have used. The use of a control group is important because, according to Irvin (1997) the
prevalence of clinical eating disorders in non-diabetic people is uncertain” (p. 17).
BIAS
Two of the studies did not making the studies blind when it may have been more effective to do
so, and the result of this may have been bias. In “Insulin Misuse by Women with Type 1 Diabetes Mellitus
Complicated by Eating Disorders does not Favorably Change Body Weight, Body Composition, or Body
Fat Distribution” by Affenito et al. (1998), the Bulimia Test Revised and a “determination of attitudes and
behavior regarding misuse of insulin” were conducted by clinical interview” (p. 687). The subjects were
broken into three groups, and the interviewer knew if each subject was part of the clinical, subclinical, or
control group. According to Fairburn et al. (1991), in “Eating Disorders in Young Adults with Insulin-
dependent Diabetes Mellitus: A Controlled Study” the eating examination was conducted by investigators,
and the investigators knew if the subjects were diabetic or not. The interpreters and interviewers of both
of these studies may have had expectations and stereotypes concerning eating disorders and
diabetes. These may have influenced how they rated, scored, or interpreted the subjects on the
measures used.
CONTRADICTION
Fairburn et al. contradict the purpose of their study. According to Fairburn et al. (1991), the
purpose of their study was to estimate the prevalence of eating disorders in the entire diabetic and non-
diabetic population, but men were only included in the diabetic sample. By only studying women in the
non-diabetic sample, the non-diabetic population is not fairly represented. The absence of males in the
control group may have influenced the results.
LIMITS
A few of the studies were limited by problems with their samples. In “Eating Disorders and
Maladaptive Dietary Insulin Management among Youths with Childhood-onset Insulin-dependent
Diabetes Mellitus” the number of subjects found to have eating problems was too small to detect
differences on different variables between those with and without eating problems. This limited the
authors’ ability to suggest what factors cause eating problems among IDDM patients. According to Rydall
et al. (1997), a drawback of their study was that they lost participants that had highly or moderately
disordered eating at baseline. The information provided by these subjects could have contributed greatly
to the results. The loss of participants is a drawback in any study.
The experimenters could have avoided other limits of these studies. In the Pollock et al. (1995)
study the authors did not focus on “all manifestations of diabetes-specific eating problems”, and they may
have underestimated the rate of these difficulties (p. 297). Unlike Fairburn et al. and Rydall et al., they
did not acknowledge the eating problems that may be caused by the diabetes.
In the Rydall et al. article the authors could have avoided some of the limits of the study. First of
all, according to Rydall et al. (1997), eating behavior was only assessed twice over a four to five year
period. This is a big gap of time to allow when measuring eating disorders among young women. Many
changes may have occurred in these girls’ lives in between assessments that the authors’ did not take
into consideration. By the time of follow-up more of the subjects had reached the age of higher risk for
eating disturbances, and this alone may have influenced the results. Another limit was that, according to
Rydall et al. (1997), the self-report measure (a questionnaire) had “limited established reliability” (p.
1853). An important part of every study is to use an instrument with high reliability and validity. If such
instruments are not used, little faith can be put in the results.
Conclusion
This critical review examined four studies on IDDM patients and the prevalence of eating
disorders and insulin misuse among them. Special concern seems warranted among diabetics, because,
according to Irvin (1997), “ diabetes can be a natural jumping off place for an eating disorder and a
perfect mask for the disorder once it starts” (p. 28). Fairburn et al., Rydall et al., and Affenito et al. all
agreed that eating disorders occur at a great rate among IDDM patients. Pollock et al. concluded that
eating problems and disorders were not very common among IDDM patients. All of the studies found a
high occurrence of insulin misuse among diabetic subjects with eating problems. Arguments can be
made against and in defense of the findings of these studies. Despite a few strong elements in a few of
the studies, each study had at least one weakness of bias, contradiction, or limits of the study.