The stereotype's new clothes

Stereotypes about eating disorders hurt, maim, and kill.

Ask the family who thought their daughter was "too young" to have anorexia.
Or the family who thought their daughter couldn't be anorexic because she came from a "loving home."
Or the guy who wasn't diagnosed.
Or the African-American woman whose food concerns weren't taken seriously.
Or the mother who was discharged early from treatment- and then died.

Early diagnosis and treatment, as well as continued support for full recovery, is crucial. And if our blinders are on, we won't see everyone who needs our help and support.

A lot has been said about the new book "Going Hungry," by Kate Taylor, about how it "shatters stereotypes" about eating disorders. Why? It includes stories by women over the age of 30, women who aren't rich and white, and even by two men.

All of this is good, very good. However, my appreciation for the "good" ends there. Why? Because it still rejects a lot of the current science and goes back to the anorexia-is-about-control* or about-such-and-such, when I'm not sure that's the case.

Anorexia isn't about wanting to fit in. Can weight loss bring you attention and make you "feel" like you fit in? Yes. Can it make recovery harder? Yes. But that's not to say this is what an eating disorder is "about." And it is not about "Disappearing in order to be seen." It sure as hell feels that way, but there's something a lot more primal going on, something way deep down in your insula, in your hippocampus, in your synapses.

In the NY Times, reviewer Gina Bellafonte writes:

The happy family is, of course, rarely the anorexic’s breeding ground. Anorexia is considered a disease of control, but it is also, notably, a disease of differentiation as the anorexic tries to occupy a separate and autonomous emotional space, as if the act of shrinking will ease the fit.

Yet another harmful stereotype. Because no one, really, has a happy and perfect smiling family. My family didn't go to pot until after I got sick (and quite possibly, because of it). If you have a family member with a deadly illness, is happiness even called for? Hope, yes. Happiness? Not as much.

Says Kate Taylor (editor of the anthology) in an interview with the New York Sun about the genetic influences on eating disorders:

I think the research so far is very preliminary and doesn't show much — certainly not as much as some popular articles have suggested. Clearly, genes are a significant contributing factor, just as they are for depression, obsessive-compulsive disorder, and other mental illnesses. But whether there is a specific gene for anorexia — frankly, I doubt it.

Well, the last part is correct. It's highly unlikely anorexia--really almost any illness--is going to be controlled by one gene. Because genes don't cause disease. They just make proteins. But the research isn't preliminary, either. Is it as good as we would like? No, but if a family member has an ED, you are twelve times more likely to develop an eating disorder. Which is quite a ways from "preliminary" if you ask me.

Anorexia and bulimia have a cultural context, no doubt. But they're not a cultural illness. Which is another harmful stereotype, and certainly contributes to men and minorities being overlooked.

Taylor also referred to Hilde Bruch as founding the "modern" perspective on anorexia. If modern was the 1970s, then maybe. But the twenty-first century perspective belongs to other people, using science and compassion to break down those stereotypes that continue to be built.

I've read the book, and the essays are well-written, but they're not particularly novel. Maybe the book isn't particularly meant for people with eating disorders- I don't know. But I didn't walk away with a better understanding of eating disorders. And despite all of my reading and researching (which borders on the compulsive at times- shocker, I know), I don't know everything.

It was the same stereotypes (parents, control, society), just dressed in new clothes.

*I have conflicting thoughts on the "about control" part, but that's fodder for another post.

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4 comments:

Cammy said...

I had mixed feelings about the book as well. I was looking forward to it (pre-ordered it on Amazon), but ultimately felt a little let down. I found it slightly triggering and, like you said, less progressive and diverse than I thought it would be. No doubt the people show great strength in sharing their stories, and the writing is excellent, but I do wish that some more examples of post-recovery life had been included, partial recovery or just achieving subclinical status seemed to be the climax for a lot of the authors. That is an issue that's important to address, but I think showing a wider spectrum of outcomes would have made the book more well-rounded.

Jane said...

"my reading and researching (which borders on the compulsive at times- shocker, I know)"

LOL.

Seems that part of the problem is people like Taylor don't really get how genes work. It more complicated than we used to think and many people gave up on learning about them after drawing little blue eye/brown eye charts in junior high.

Researchers, including your homeboy, don't think there's an AN gene. The bottom right of this page links to a nice powerpoint presentation. The 8th slide says quite directly that's not likely to be the case.
http://eatingdisorders.ucsd.edu/BrainImagingParticipants.html

Everybody wants to be in control and when things get chaotic it makes sense that the impulse would be dialed way up. I'm inclined to think that arguing what EDs are about isn't likely to get us anywhere. Why not focus on getting people truly back in control of their lives?

IrishUp said...

I think these issues arise when we conflate what being sick with a disease - and recovering - "mean" to us with what are the pathophysiologic processes that make us sick, and how do/did we get better. A cancer patient may be 100% sure that it was Karma, or the Devil, or the stress from their job that made them sick. Heck, any of those might actually be true! BUT none of those things changes the fact that cancers form when normal biological processes go awry. Two totally different things.
IMO, the anthology we need is one that combines diverse experiences of sufferers and their recovery with the wealth of information accumulating about ED pathophysiology and remission.

Crimson Wife said...

I've been reading biographies of the saints recently and have been struck by how many of them seem to fit the modern definition of having an ED: St. Teresa of Avila, St. Catherine of Siena, St. Veronica, and a number of others (mostly women). Back in their day, their self-starvation and/or purging behaviors were seen as a sign of holiness :-(

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote



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