What I learn by listening: Anorexia

No one seems to know what causes anorexia, but Prof. Jeremy Wolfe podcasts his course, Psychology 101, from MIT, on iTunesU, and gives a chilling account of the pattern that most people who fall in this category come from. Anorexia, of course, is the disease that will find someone absolutely attesting that everything is fine when s/he is wasting away with shrinking vital organs, sometimes resulting in death.

First, anorexia apparently only occurs in countries where both "food is plentiful" and "thinness is glorified", in fact where we simultaneously obsess over both thinness and food. For about forty years, this was associated with white, middle class western culture. but it recently has spread to other ethnic groups and, more recently, to Japan and China.

Second, it typically occurs among females, specifically young, post-menapausal females who usually are "always doing things right". They are self-disciplined, take care of themselves, do their homework, and generally, follow the rules.

Third, and this was the shocker, they come from families that are achievement-oriented, somewhat overprotective and "enmeshed" in the lives of each other. Prof. Wolfe gives the example of his own extended enmeshed family. When they try to go out to eat it takes 30 minutes to decide where. Shortly into the debate someone will say "Granny doesn't like that place", but it isn't Granny who is speaking up. It is the type of family where everyone tries to speak for everyone and is intolerant of individuals "acting out" anger. If there is an issue, the family tries to smooth it out, quietly, as a unit.

He throws in additional complicating cultural factors, such as the "myth of the superwoman" and how, with self-control, you should be able to fix anything in your life.

The implication seems to be that the young woman desperately wants to control something and she finds that, through self-discipline, she can reduce her eating intake which she equates to self-control, beauty and thinness, all good things. In fact, as an added benefit, the less she eats, the more she finds that she also controls everyone else around her, as they, of course, tear their hair out trying to get her to change while she remains oblivious to the danger she poses to herself.

Few things work all of the time as a cure for anorexia. In the hospital, control over treats such as letting friends visit, sometimes provides enough incentive to get the person to eat. That doesn't always work, however, when they return to the free environment. Counseling the family, as a disorder of the family where the daughter is the treated as the designated victim, also sometimes works, although it must be difficult to reach such an understanding. Most people, however, do eventually recover.

Bulima, on the other hand, occurs largely among the unattached, people who really want to fit in. This often includes a lot of social eating and drinking. It also includes wanting to fit into those tight jeans to fit in socially as well. Unlike anorexics, they feel ashamed and want to diet. But while dieting they feel the hunger and binge, followed by rounds of vomiting and more bingeing. It is as if the brain is saying you are not getting enough nutrition, so "go eat more". Group therapy for bulimics, meeting other people with the same problems, helps remove some of the shame and isolation and is usually quite effective.

What I found so chilling about the description of anorexia is, that, at first glance, how everybody seems to be doing "right" things. He uses this example, however, as a demonstration of how subtlely mental illness can take hold.

The disease must come as a great and terrible surprise to the individuals and families that it strikes. I have never previously ever heard or read anything that I thought might help people deal with the situation. Perhaps this can help a little.