They still don't get it

As much as I love keeping up to date on ED news and research, I sometimes cringe when I click on a link.  Is the author of this news story going to screw it up?  Will they have done their homework?  Much of the time, the stories are a mixed bag--some bits are okay, some could use a bit of tweaking.

Every once in a while, though, someone knocks it out of the park.  With these two stories, though, the authors didn't do so in a good way.  It was awful.  I don't know whether I blame the journalist more, or I blame the people they interviewed.  Or both.

So for the first one:

Is Victoria's Secret Peddling Eating Disorder Porn?

No, Victoria's Secret is peddling overpriced unmentionables.  They're also peddling sex and clothes that make your partner want to do you.  They're peddling an image.  They're peddling an image of a sexualized, idealized women with huge boobs and a tiny waist.

It's very common for people with eating disorders to compare themselves to these idealized images and find themselves wanting.  It's also very common to try and lose a few pounds or get breast implants.  All of which are a waste of time and money and form a tremendous drain on society.  But really?

Eating disorders existed long before women with gigantic breasts and push-up bras paraded around on national television. In the Middle Ages, women with eating disorders compared themselves to holy women and other saints.  Those were the idealized images of what a woman could be, if she tried hard enough.  Part of that trying involved fasting for religious purposes. 

Today, some people with eating disorders fast for cosmetic purposes, or to be better at a sport or it just sort of happens.  It could very well be that women in the Middle Ages had a variety of reasons that motivated their behaviors.  They probably did.  The world may very well be a better place if Victoria's Secret disappeared. It would definitely be a better place if we stopped promoting only one body type as beautiful or sexy.  But whether there would be fewer eating disorders?  I'm not entirely convinced. 

These images, and our society's obsession with food and fat, are the cultural backdrop against which eating disorders occur.  We use and co-opt this language to help explain what we're going through.  Although exactly what motivates an eating disorder is far from irrelevant, motivation doesn't always explain causation.

Which brings me to the second article.

Butler Hospital Physician Too Familiar With Eating Disorders

Based on this doctor's quotes, however, I might advise a little more familiarity before saying such things as this:

Qualls said the disease usually arises from a person’s unhappiness with their appearance.

The media play a role in the equation, he said, providing a model of the body that may not be realistic or healthful for people to strive to imitate.

...Diseases such as compulsive purging or not eating tend to occur during transitions in life, he said. Among them: girls going from eighth grade to high school, “which is a triggering event because all of the sudden boys become more important,” he said. “The next change is when they go into college. Once they experience [a disorder], they are at risk of this recurring at any point for the rest of their lives.”


In case this isn't obvious by now: my eating disorder had nothing--nothing--to do with wanting to look good or attract men.  Nothing.  I thought that eating better, exercising more, and yes, maybe losing 5 pounds would help me feel less depressed.  After a while, I knew I looked atrocious.  I thought nothing about sex and dating.  I knew that the ED was destroying my health and appearance, and yet I couldn't stop.

The concept of "re-education" sounds very Soviet, and maybe it is, but I kind of want to have an intensive training program for these journalists and especially these doctors before they are allowed to even see another ED patient.

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Holly said...

it's seemed odd to me that anorexia mirabilis is classified differently. I guess because it makes the supposed motive too central. thoughts?

I think you're missing a word here; just an alert.
:It would definitely be a better place if we only promoted one body type as beautiful or sexy.:

Carrie Arnold said...

Thanks, Holly. Comment is now fixed. :)

It's been a while since I read "Holy Anorexia" so I hope this isn't too error laden. I see what Rudolph Bell called anorexia mirabilis and what today is called anorexia nervosa as the same illness. Different motivations, yes, but the same illness. If you consider AN (and EDs) to be largely cultural issues, then yes, I would see how you might classify them differently.

But people with OCD weren't obsessed with germs hundreds of years ago--they didn't even know that bacteria and viruses existed. Yet these different obsessions and compulsions don't make the OCD of the Middle Ages different than the OCD of today.

It's the same with anorexia.

Lisa said...

A lot of ED news still confuses me a lot. I still feel like...the research is all over the place. :) I do really love your postings though. They are so informative.
btw- can you email me your email address because I made my blog private and i'd love to stay in touch.


chartreuse said...

I wonder. Yours and other ED blogs (Laura Collins's, in particular) devote a lot of time to the claim that the eating disorders have nothing to do with media, culture, etc. I would agree in the case on the type of 'classical' AN that you and Laura's daughter have had. An AN that is characterized by low weights, body dysmorphia, pre-existing anxiety disorders, etc.

(I wonder if the greater prevalence of dieting in our culture does lead to more individuals with a predisposition for AN ending up with weights low enough that their ED gets 'triggered', but that's a different issue.)

But when it comes to eating disorders more characterized by binging and purging behaviors, I am less sure. Individuals with these disorders have a completely different personality profile than those with AN (eg. greater premorbid mood lability than premorbid anxiety), the course is different, and I'm not so sure that the claim that the media/culture has nothing to do with it holds up. I think we need to be careful about using the term "eating disorder" as shorthand for AN, a disorder which in at least some ways is more clear cut in its initiation, maintenance, and treatment, than for other eating disorders.

hm said...

"Qualls said the disease usually arises from a person’s unhappiness with their appearance." Yeah- I guess when I was 7 or so, and discovered that starving felt so incredibly soothing, REALLY I was wishing I was sexy like a Victoria's Secret model. That's how it must've started. Gosh, I wish he was MY doctor- he'd have me fixed in no time.

Libby said...

I may add a real comment after I finish banging my head against the wall.

I think that in some cases it may appear that magazines and Hollywood and Vickies and all "cause" eating disorders ONLY because they do promote a certain type of body as perfection. That in itself may lead to more dieting. And THAT may trigger an ED in a person with that predisposition. But I do believe that once the ED has taken hold, it ceases to be about anything commercial.

But all of that is way different than OMG I looked at Glamour two months in a row and now I have an eating disorder! Ummm... no.

Sorry for the incoherence. Banging one's head against hard objects jiggles the brain.

K-pedia said...

Ugh, I know, we had an online discussion in my social and behavioral health class (grad school, no less), in which everyone decided that the media was to blame for EDs. This trivializes ED sufferers, making them look like spoiled, vain little children, and this outlook also minimizes the true suffering that comes with these mental illnesses. I spent about 2 hours debunking myths like these to my classmate who wants to do nutrition interventions for ED sufferers.

I think the key to understanding ED motivation is this: ED sufferers interpret cultural messages as being directly applicable to them, not just a cultural standard as a whole. I described to my classmate the desire to feel "perfect" ... in our culture today, for women, perfect = thin. But, like Carrie said, this philosophy was translated in a religious setting, as well, during previous days.

Did we decide to ban religion? No. Then why should we ban media images (to prevent ED)? They may fan the fire, but they don't light the flame.

Even though MILLIONS of people in this nation suffer from EDs, people still don't seem to have a clue about them. I'm starting to think that it's going to be my burden in life to have to educate these glib, unthinking people in my public health profession about the real risks of EDs. *headdesk

K-pedia said...


I agree with your sentiment. As a BN sufferer, I have found it hard to relate to a lot of the AN material ... they are, in reality, very different as far as motivation and execution are concerned, and I think you bring up a valid point. Many people associate ED specifically with AN, but BN has its own special set of issues that need to be addressed. I would agree that I was heavily influenced by culture, but it didn't CAUSE my eating disorder.

Angela Elain Gambrel said...

I also found the more I became enmeshed in anorexia, the less interested I was in sex and any kind of relationship with my husband. And part of me knew I didn't look attractive; it wasn't about being thin in the sense of thinking the thinner I was, the better I looked. I always say that my size was (is?) the outward manifestation of how I deal with my inner pain, depression, anxieties and OCD. If I wanted to be thin and attractive, I would have never started starving myself, because I personally feel anorexia has aged me. But I do think media influences, such as promoting anorexic-looking models, does send a lot of negative images to women in general and the younger generation in particular. Whether it is a trigger is anybody's guess, although I think you have to have a propensity toward eating disorders to develop one.

Jen said...

My disease was anorexia with bulimia subtype. For me the whole issue was linked to fitting in, being less than, striving to be perfect in an imperfect world. I also believe there needs to be a genetic predisposition as well as something to do with the body's lacking a balance nutrients to work right. Something goes out of whack.

When my disease kicked in I was 15 and living overseas. No televison. Definitely movies. I had my Seventeen Magazine.

But, I again had to make new friends, etc., etc., etc. The stress caused by all of this made me feel inadequate and very alone and different somehow. It was so much work! I think the same could be true for anyone who moves to a new neighborhood or even to a new classroom in school.

No one showed me how to initiate my descent into anorexia/bulimia as happened with my loved one. It was a solution. Once in the pattern I could not get out. I think as I got older, I realized I wanted to look good and feel good just for me in that mirror but it took a lot of work to get back up and there.

I came to learn that health yielded the kind of beauty I wanted. I think our culture is hypocritical about what beauty really is. I like Holly's proposal - this world would indeed be a better place if we only promoted one body type as beautiful or sexy. That would be healthy and appearing to care in all aspects for one's self.

Julie O'Toole, MD, MPH said...

Once again, the discrepancy in understanding as reflected in the articles you quote harkens back to a poor understanding of the difference between disordered eating (a behavior or series of behaviors easily influenced by social norms and expectations) and eating disorders (highly heritable brain disorders).

Keep up the great commentary, Carrie

Julie O'Toole
Kartini Clinic

Carrie Arnold said...

Oooh, I got a visit from one of my favorite ED people. So glad you came to visit, Dr. O'Toole.

Thanks everyone for your comments. I'm glad to know I'm not the only one who is irritated by these articles.

Sarah said...

Keep thse coming. The dialogue is challenging. I appreciate all your work.

Sarah said...

Good stuff Carrie. My head hurts as well.

Vanessa said...

*hides* I'm not a music nerd...really.

In choir I sing next to a tenor (amazingly nice guy.) Ironically I heard him discussing eating disorders with another member one day and he was commenting that it was a byproduct of our culture, of people wanting to be thin. I cringed but stayed quiet.

This same tenor often misses pitches and it's not just singing a note that doesn't belong it's being a tad sharp but usually flat. He's one of the loudest in the group (aren't they always?.)

As we were rehearsing for our christmas concert yesterday and I was fighting to hold my pitch against his semblance of a pitch(again cringing and staying quiet)my thoughts turned to views on eating disorders. He has one view (pitch) and I have mine. We clash, horribly. I'm not saying his view is always wrong nor mine always right but it's dissonance just the same. Unresolved dissonance. A term I fear will always apply to those who believe they understand eating disorders (as a cultural byproduct) and those who desperately uphold and fight to maintain, the correct pitch.

Kat said...

"Rudolph Bell called anorexia mirabilis and what today is called anorexia nervosa as the same illness. Different motivations, yes, but the same illness."
I'm not even sure if there are different motivations, just handy reasons to explain our starving as less pathalogical. If I lived in a religious ascetic climate, I'd spin my ED as holy. If I was less in the bio/neuro/genetic camp (and had less pride!) these days I might claim I'd been influenced by the media.
As for the Qualls guy, I'm not exactly shocked but certainly saddened that even someone working in the field of EDs is so out of touch. Arrrgh.

Missy said...

Thank you..once again and forever.

Your word still stick with me "It's visceral ... not visual"
I have a feeling that many anorexics (like myself) are almost scared of the images they see in the Victoria Secret Catalogs.

I admit I have leafed through one to try and gain inspiration that it is OKAY to have curves..flesh.etc.

Then I realize there are plenty of better places to look. (0:


Crimson Wife said...

I do think cultural pressure to look a certain way played into my developing BN rather than one of the other compulsive behavior disorders prevalent in my family. I don't think it's a coincidence that I wound up abusing food while male relatives abused alcohol or narcotics.

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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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