Not even wrong

A recent editorial titled "A Western illness best forgotten" is so off-base and so incorrect, that it can't even be classified as wrong.

And because there's no real way to paraphrase such insanity, I'll let the author speak for himself:

Of course, the desire to have the state influence how satisfied or unsatisfied we are with our bodies is totalitarian, but I had assumed it was essentially harmless - Melbourne University churns out a lot of arts graduates who have studied feminist and cultural studies and these people need to be employed somewhere.

The chances of the Government succeeding in influencing how attractive we find fat or skinny people to be are of course almost nil, but if it keeps a few Labor and Greens voters happily employed, then that's fine by me.

True, some people have questioned whether it is wise for the most overweight societies in human history to be spending money making its fatties feel better about themselves.

They have wondered whether the Government may not be better off spending our money telling us that if we have a negative body image it is because we are lardarses who need to eat less and exercise more.

...In the West, anorexia is most likely to strike urban girls from middle-class families who are often high achievers. The few anorexics in Hong Kong tended to come from poor rural villages where the influence of Western culture, with its adoration of the young and skinny, was weak.

The strangest thing Dr Lee found though, was that the anorexics he saw had none of the self-delusion about their body size that Western anorexics do.

Asked to draw themselves, these anorexics correctly pictured themselves as dangerously thin, whereas Western anorexics will usually draw themselves as overweight.

The Hong Kong anorexics attributed their failure to eat to physical factors such a bloated stomach or blockages in their digestive tracts rather than a desire to be thin.

When he investigated the history of the disease, Dr Lee found that the earliest Western descriptions of the disease from the 1820s more closely matched the patients he was seeing than the textbook definition of anorexia.

In the early 19th century the disease was so rare that it wasn't until 1873 that medicine could even agree on a name for it. In that year a French doctor delivered a paper that sparked widespread interest and understanding of the existence of the disease.

The really interesting thing is what happened next. Though in the 1850s anorexia was a rare disease, by the end of the century it was commonplace. The growth was so marked that it could not be explained away as the result of doctors finally picking up on a disease that had always existed, but of which they had been previously unaware.

In other words, the widespread knowledge of the existence of the disease was responsible for spreading it.

Watters then catalogues the way in which the Western form of anorexia developed in Hong Kong after the media there highlighted a schoolgirl who died of the disease. Within a few years Hong Kong went from having almost no anorexics to being full of them.

Apparently James Campbell missed the first lesson in Epidemiology 101: correlation doesn't equal causation. He doesn't account for the fact that increased awareness of an illness can lead to increased diagnosis, not increased incidence. Maybe I'm off-base, but it seems that increasing diagnosis and treatment of an illness was a good thing.

Furthermore, most people with anorexia don't deliberately try to end up that way. They either eat less or cut out sweets or try to lose a few pounds and then they find themselves stuck in an anorexic hell. Anorexia is ego-syntonic; that means that sufferers don't see the illness as a problem, and that the outcome of the illness (weight loss) is a good thing. As the Western cultural ideals of weight loss and thinness have spread, it doesn't seem unusual that someone with an ego-syntonic illness would latch onto these as a justification for thoughts and behaviors that seem pretty bizarre. With more people dieting, you would naturally expect to have more eating disorders triggered.

I honestly believe that the body dysmorphia is a culturally mediated aspect of anorexia. Culturally-mediated doesn't mean that there's no biological basis, just that you only see these symptoms in certain cultures. Biology helps explain why not everyone in this culture has the symptoms/illness, but the body dysmorphia in anorexia does seem to be pretty consistent with modern, Western cultures (it is much less prevalent in young children with anorexia). But that in and of itself isn't anorexia. It's just one aspect of the illness.

Anorexia is NOT a Western illness. It exists in China, Ghana, and Curacao, at rates that are roughly comparable to the US and Western Europe. Say it with me in a sing-song voice now: someone didn't do his research...

Then there's the issue that if we pay attention to eating disorders, they will go away. To me, this smacks of the larger write-off that many people with eating disorders get, which is: "They're just doing this for attention! If you ignore it, they'll stop!" One must wonder, then, why people with EDs go to such extreme lengths to hide their symptoms if what they really want is attention.

BP ignored the problems in their oil well, and we all know how smashingly that one turned out. As a culture, we've tried to put blinders on to issues like teen pregnancy, homosexuality, and environmental decay, hoping that they will just "go away" and that one day, we will all laugh at how teens used to get pregnant, people were attracted to someone of the same sex, and we honestly thought the world was going to hell. If it worked, it would be convenient. But it doesn't work.

Rates of some cancers have increased over the years, and we don't blame the War on Cancer. When heart disease rates go up, we don't boycott the American Heart Association for trying to help. Anorexia isn't just biology--culture is important. But ignoring a problem to make it go away? It's a short-term solution to a long term problem.


Anonymous said...

Dr Lee's comments where earlier published in NYT here:
The Americanization of Mental Illness


James Clayton said...

This editorial is so offensive, insultingly and laughably wrong that I am honestly lost for waords.

Shame on James Campbell. Good grief.

Cathy (UK) said...

OK, so I will probably annoy some people here, but that is not my intention...

I actually rather like the heraldsun article, in many ways. We have become a world obsessed with 'body image', and the more people harp on about it, the more people become obsessed with it.

I like the comment:

"Of course, the desire to have the state influence how satisfied or unsatisfied we are with our bodies is totalitarian, but I had assumed it was essentially harmless - Melbourne University churns out a lot of arts graduates who have studied feminist and cultural studies and these people need to be employed somewhere."

IMO, EDs have very little to do with feminist and cultural studies. I am not a fan of feminist theories in general, but more especially feminist theories applied to the aetiology of EDs. EDs are not caused by our culture; they are caused by how our brains interpret and process information, in conjunction with our temperament, character and various life stresses.

Now, I don't view AN, especially the restricting type, as a body image disorder/disorder of body image; it has far more to do with asceticism than body dissatisfaction, and far more to do with dissatisfaction of the self as a whole and not just (or even) the physical body. However, our culture now interprets AN in the context of a Western 'thin-ideal' and many patients are given (what I feel is) rather pointless 'body image therapies'. AN is almost always depicted in the media by some dreadful photo of an individual staring at themself in the mirror with a disgruntled look on their face. Some people with AN (and other EDs) do have BDD (especially when professionals harp on to them about 'body image'...), but others do not.

Nevertheless, I also agree with many of the points you raise Carrie, including the important fact that correlation does not necessarily equate to causation. Neither do I feel that EDs should be ignored. However, I do feel that ED awareness sometimes 'fuels the fire' and can actually precipitate disordered eating through 'copycat' behaviour. A simple Google search reveals just how many individuals are seeking 'anorexic tips'.

This is all highly complex, and rather too difficult to explain at length as a comment on your blog, but I honestly feel that the more our society preaches about 'body image', the dangers of the 'thin ideal' (etc.) the more damage this causes and in a variety of different ways; one of these being that EDs are misunderstood, misinterpreted and wrongly treated.

Crimson Wife said...

He needs to read some of the biographies of female medieval saints if he thinks anorexia is a recent phenomenon. The culture has influenced the motivations (a desire for thinness vs. a desire for holiness) but it's clearly the same disorder.

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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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