Cross Cultural Eating Disorders

It’s commonly held knowledge that eating disorders are a Western phenomenon. They came about because of beauty standards, small models, and photoshopping. They’re on the rise! Panic! It’s an epidemic!

Only this isn’t necessarily supported by a hard look at the data. One of the problems with assessing whether or not eating disorders exist in other cultures is that the diagnostics for the disorders were developed in the US and Western Europe, leading to a focus on the presentations that we tend to see in those places. As an example, one of the diagnostic criteria for anorexia is “Intense fear of gaining weight or becoming fat, even though you’re underweight.” While this is the motivation for many people to refuse food, it is not true of everyone who displays many of the symptoms of anorexia, and may simply have different motivation.

There are a few different sources of data that contradict the idea that eating disorders are culturally bound or that they are caused by Western beauty ideals. We can look at history or we can look to minorities or other countries that may not have been wholly influenced by Western concepts.

Historically, we have strong evidence that people have been choosing to starve themselves for hundreds of years. The book Fasting Saints and Anorexic Girls traces the history of self starvation from the earliest records through to the first recognition of eating disorders as psychiatric conditions. While the book suggests that these are distinct phenomena because in the past few people have practiced self starvation due to a fear of fatness, behaviorally it shows many parallels.

One particular group of individuals that have similar behaviors to modern patients with eating disorders are religious fasters. These tended to be young women who had little control over their lives in many ways and who chose to abstain from food for extreme periods of time in order to be morally better by ignoring their bodies and focusing on their spirits.

The book includes some quotes from people who chose to restrict their food intake in times past, and concerns about morality, space, selfhood, and perfection come up again and again, just as they do in current conversations about eating disorders. Many of the experiences are couched in religious terms, but the underlying fears (“I am not good enough”, “there is something wrong with my body”, “I need to be better”, “I don’t want this life”) could just as easily be pulled from a study of eating disordered patients today.

Individuals throughout history have chosen to abstain from food, often falling into something like depression and priding themselves on their ability to go without for long periods of time. Their motivations have changed as their social milieu has changed, going from religious, to entertainment, to aesthetic. However many of the sentiments that these individuals express ring similar across time and space.

“It’s like I never knew what self-respect was all about until now. The thinner I get, the better I feel . . . I’m proud of my stoic, Spartan existence. It reminds me of the lives of the saints and martyrs I used to read about when I was a child . . . This has become the most important thing I’ve ever done.” This kind of quote could easily be from a religious faster or a modern individual with anorexia.

Over at Science of Eating Disorders, Tetyana posits “Religious and spiritual reasons are not the only factors that could be contributing to AN in non-Western countries (or Western countries before the ‘thin ideal’). Personally, it would seem to be, that anorexics in those times, would just attribute their desire for weight loss to those reasons much like today it is often attributes to a fear of being fat. But, both of those could just be post hoc rationalizations on the part of the sufferer, to make sense of their otherwise perplexing desire to restrict their intake and lose weight. That’s my feeling.”

I’ve written elsewhere about how restricting food made me feel powerful, godly. I often imagined that my body was not subject to the same requirements that others were. Only the weak needed food, but I decided my morality, my meaning, and my body for myself.

“Comparable to the ascetic practices in the history of Christianity are the fasting practices in the Chinese Daoist tradition (Eskildsen, 1998). These practices sought to transform the body as a means of gaining immortality…  The history of Chinese thought thus suggests that, in certain traditions at least, the emaciated body has been highly valued and pursued in a manner highly reminiscent of Western observances.”

But in addition to historical examples, we can also look at current cases of eating disorders in non-Western countries. It’s a common trope that these are rare, and when they do appear they are evidence of growing Western influence in the country. The problem with that assumption is that many individuals who might be diagnosed with an eating disorder but lack fatphobia are not given the diagnosis. The unthinking assertion that the rise of eating disorders correlates to increased Western influence doesn’t look at the lived experiences of individuals in non-Western countries.

Again, from Science of Eating Disorders:

“For example, one study found that in British Asian girls, dietary restraint was correlated with traditional (rather than Western) values (Hill & Bhatti, 1995). This finding was supported in a study by Mumford and colleagues (1991) who essentially found the same correlation. On a Caribbean Island, with little Western media, Hoek et al (1998) found that the prevalence of AN was comparable to Western countries and a study by Apter et al (1994) showed that a group of village Muslim women (with minimal exposure to Western values) had eating pathology scores that were indistinguishable from patients with AN.”

Many of the patients quoted in this article don’t talk about a strong desire for thinness or weight loss, but point to their bodies as the site for other struggles in their lives, particularly around control and selfhood.

“… food restriction arose from a sense of powerlessness in the family context, it is possible that the patient experienced her emaciation as egosyntonic, with her low body weight consonant with the goal of not wanting “to ‘give in’ to her family, especially her mother, who forced her to eat even when she was not in a mood to.”

Again, these individuals exhibit many of the same behaviors as individuals diagnosed with eating disorders in the Western world, but don’t show the obsession with thinness or fatphobia that we assume is an essential part of an eating disorder.

An eating disorder is a coping mechanism that allows an individual to survive extremely difficult situations or feelings. Physically, it has effects that make it easier to live through strong emotions: it numbs out painful things, it leaves you sleepy and sedated, and it also provides a kind of high that makes you feel accomplished and safe. These are biological results. They are the same no matter where you are or when you’re living. And they are effective at helping someone survive a difficult situation no matter what kind of difficult situation that is: it could be not living up to religious expectations or not fitting into a beauty ideal.

And so I am continually dismayed at ridiculous articles like this that seem to think eating disorders are not only limited to the West, but also limited to young, naive, shallow teen girls who can’t figure out how to do basic things like feed themselves. Diagnosis, demographics, and etiology are complex and confusing. If you don’t know a little something about mental health, don’t write about it.

I Hate People Who Take the Elevator

A friend of mine made an off handed comment the other day. “I’m sick of lazy people taking the elevator!” To say that I was taken aback would be an understatement. I pushed him a bit, and he simply said he hated that everyone did it, that it was an engrained social structure, that obesity was an epidemic, and that it was a waste of energy.

I think it’s time to review both fatphobia and ableism 101, as well as how they’re intertwined. The first thing to note about something like whether other people take the elevator or not is that it’s none of your damned business because you know nothing about this random other person and their behavior isn’t hurting you (we’ll get to questions of obesity soon). There is nothing morally wrong about not wanting to be active right this instant. And in many cases, someone might be incapable of taking the stairs: some people have invisible diseases, and your assumption that everyone should take the stairs is part of the underlying cultural norm that other people’s bodies belong to us and they all have to be able and thin or they are doing something wrong. They are causing harm.

There are a lot of things wrong with the assumption that you should be able to tell someone else what to do with their body or that it’s any of your business what someone else does with their body, whether that’s how/when they have sex or their choice of diet and exercise. The moment we start deciding what the correct way for another person to treat their body is, the moment we’ve decided to try to take away their basic autonomy.  Everyone has the right to decide what to eat, how to move, where to go, and when you assume that their actions are fair game for your shame and criticism because you don’t like what someone else is doing, you’re implying that someone else’s body is public property. And that’s just really uncool.

There is nothing wrong with being fat. Spoiler alert: it is entirely possible to be healthy, happy, and active while being fat. The Health at Every Size movement has a great deal of information on this, but suffice it to say that genetics plays a huge role in your size, and that body composition makes a large difference. The “obesity epidemic” is based on the BMI scale, which does not take body composition into account at all and reduces many complex health problems down to “you’re a fatty, lose some weight,”. As this article points out, fat people often have to fight for the right to be able to eat food. Relatedly, they also often have to fight for the right to be inactive or rest. Any time we see an overweight person sitting down or watching TV or taking the elevator, we assume they’re lazy. We don’t do that with thin people, even though there’s not any law that says the thin person is more active than the fat person.

We tend to only accept a fat person as a “good fatty” if we see that they only eat salad or take the stairs every time. Fat people are by default considered unhealthy and lazy until they have proven that they do all the correct healthy behaviors and are still fat. Many people assume that if a fat person is engaging in any “unhealthy” behaviors, those behaviors are what has caused them to be fat (and thus a drain on society because all fat people are the worst ya know). Never mind that some people are fat because of disabilities.  Never mind that you literally have no idea whether or not that individual just came from the gym or not. Never mind that you have literally no evidence that taking the elevator is what caused this person to be overweight or whether or not this overweight person is unhealthy. Never mind that some people physically can’t take the stairs, even if they look able bodied.

It’s none of your damned business what anyone does with their body, what food they eat, and how they exercise. Bodies are complicated, and unless you’re someone’s doctor or intimately close to them, you don’t know even close to enough to make a judgment about whether or not they’re lazy. A lot of this is straight out concern trolling, and there’s good evidence that it’s not really about health in the fact that I don’t see any of these concern trolls telling me that they have a right to tell me to eat more and deal with my eating disorder because insurance! Public health! You need to be able to work! They’re not concerned with the state of my health and body because I am thin and able bodied and sometimes I rock climb and swing dance for hours. You cannot read someone’s health off of their body.

Maybe taking the elevator is an engrained social structure, and maybe we could do more to promote exercise. But any fat person or depressed person or sick person can tell you that they’ve heard it. They’ve heard it a thousand times. One more piece of shame is not going to help (it may actually make people fatter). There are more positive and more helpful ways to promote movement. I take the elevator because the stairs take longer and are boring. I’d rather exercise in a more fun fashion. So maybe that “just take the stairs” approach is alienating some people, and is actually an excuse to complain about fat, lazy people.

Yes, maybe it is more energy efficient to take the stairs. But we all make trade offs in our lives in terms of values and priorities, and how we treat our bodies is incredibly personal. If it’s so important to you, then take the stairs yourself, but stop haranguing others when you have no idea what their lives are like.

 

The Body As Evidence

I’ve written before about the frustrations of having a mental illness that leaves visual signs on my body, and that it can often feel as if my body is betraying me with its scars or its size. I’ve recently noticed what appears to be a corollary to this and it’s something that gets under my skin (pun intended). For those of us who have mental disorders that result in a physical change, our bodies are used far more often than our own words or mental state to gauge whether we’re ok or not.

This is something that has been criticized for some time now. We’ve heard that “you can’t see whether someone has an eating disorder by their size”. Many people are still convinced that size and weight loss are the indicators of eating disorders. Others are certain that depressed people probably look like vagabonds and don’t wash or take care of themselves. I would hope that we all have enough evidence by now that people of every shape and size can have a mental illness and most of the time it’s utterly invisible.

But there’s another layer of looking at bodies as evidence for mental illness, and this one is more subtle and more insidious. This is the one that comes when someone knows that you have a mental illness and really wants to know how you’re doing. So they pick apart your physical appearance for signs: are there dark circles under your eyes? Have you lost weight? Gained weight? Is there a scar or a cut that indicates symptom usage?

Now of course if you’re nervous or worried for someone it makes sense to try to find evidence of how they’re doing. Where this turns into a problem is when bodies are used as evidence against the person whose body it is. Often, when someone with a mental illness says that they’re doing ok, their body is scrutinized to see if they’re right or not. The individual can’t be trusted to know their own mental state or to truthfully express it to others.

In many ways, I think this plays into the idea that people with mental illness are manipulative or disconnected from reality. For most people, if they said that they were feeling ok, or doing better, or their mood was up, they would be trusted unless there was some glaring evidence to the contrary (muttering, monosyllables, glowering face). Particularly with physical illness, if someone has an injury but says that they feel fine, most people take them at their word. We’ve all experienced having a particularly nasty looking scratch that doesn’t actually hurt and reassuring others that we’re fine. For the most part, they trust us to know whether we’re in pain or not. Even with illness, if someone has some symptoms but reassure us that they’re feeling much better, we smile and tell them we’re happy for that.

Obviously all of us use our common sense to determine whether we think someone is lying to us about their internal conditions, but for some reason those with mental illness are held to a far higher bar than others. Any evidence of symptoms is often construed as evidence that our  mood cannot and is not ok, or that things are going downwards. Particularly for things like purging or self-harm, there is a guttural response of disgust and fear to the symptoms that means outsiders are often convinced that it’s impossible for an individual to be doing ok and still engaging in those behaviors (never ever nuh uh). That means any evidence of symptom use is held up as evidence that things are not ok and if the individual says they are it is a lie.

Maree Burns in Eating Like An Ox says “In cultures where identities are read off the surface of the body, one’s physical state is understood to represent both moral and mental health”. There are intersections here with numerous other oppressions: fatphobia, racism, sexism, slut-shaming, ableism (as well as many others I’m sure I’m forgetting at this moment). The problem with assuming that a body is an identity is that no one can ever convince you you are wrong because they must be lying. There is an odd tension in American culture in which we partially dismiss the importance of bodies (we assert that focusing on looks is shallow, we eat horribly and don’t take care of ourselves, we shame people for having sex, and we typically subscribe to a Cartesian dualism that suggests our mind is our self while our body is just a nice carrying case), but at the same time we are convinced that we can read identity and selfhood off of bodies. Fat people can’t control themselves, people with disabilities are lazy, people of color are Other (scary or dangerous).

We don’t see bodies as selves, but we see them as books on which selves are written, clearly and unequivocally. The tension between the fact that we don’t see our bodies as our selves and the fact that we think our selves are clearly reflected in our bodies can make self-identity a serious challenge, but it also serves to undermine the self that an individual might seek to portray or express to others through means that are not the body. And this of course always impacts those who are already oppressed because we are more easily assumed liars.

My body cannot tell you things about my self, my well-being, or my identity. I may have scars, but I am ok. Someday I will openly wear my scars and smile and laugh and be a walking advertisement for the fact that mental health is not visible. Until then, I will just repeat over and over: I’m ok.

Intersectionality: Mental Illness and Fatphobia

Ok so this should be my last super subversive post for a while because I need to have some time to learn how to deal with comments and disagreement (yay learning adulthood)!

 

But since this is a followup to one of my recent posts I figured I should post it now rather than later. I recently posted about fatphobia and thin privilege, and I got a few comments from people who said that I “just didn’t get it” because I straight out said “I have a hard time accepting my privilege”. Now I’m still slightly confused as to what this means. If anyone can parse it out, I would be forever grateful. I was under the impression that when you’re trying to accept that you’re privileged sometimes it can be difficult to accept but that as long as you keep reminding yourself of your privilege and listening to those people who are oppressed and trying to get better, then you’re being an okish ally.

 

However when someone tries to call me out on something, even if I can’t quite tell what it is, I do try to think about it. And so I spent some more time with my experience of weight, my experience of thin privilege, and I came to a realization, which is that I think the intersection of eating disorders and thin privilege is one of the most confusing ones there might be in the social justice world, because it is the only one that I can think of in which someone may understand that a certain privilege exists, but refuse to believe that they are part of the privileged group.

 

I objectively am thin. If I look at my BMI, it is on the low side of average. It has dipped into underweight a few times, and is always hovering around there. If I look at my clothing sizes, I am thin. If I ask my friends, family, or even strangers, they will tell me I’m thin. By all objective measures I fit into the group of privileged people who benefits from their size based upon the attitudes of society.

 

However despite these facts, I cannot believe that I am thin. My brain reminds me every day that I’m not. No matter how many times I look in the mirror I cannot see myself as thin. I try over and over again to remind myself that yes, I experience privilege from something I cannot believe is true of myself. I cannot think of another form of privilege where this happens: is it ever the case where a white individual firmly believes they’re black? I wonder if any trans* individuals can speak to this. It seems like a unique situation to me. How can accept my privilege when I don’t believe I am thin? How can I be a good ally when I don’t see myself accurately, when my perception of reality is so distorted? How can I fight against oppression when I’m too busy fighting against myself to even accept reality? I think that as an ally being open about our hangups makes us better allies. It means that people can call us out a bit easier and help us when we need it and ask. It means that we’re not lying just to say the right words. So I want to be open when I have a hard time getting past my privilege so that we can more thoroughly understand what helps entrench that privilege.

 

This next section I want to be very careful about. I absolutely do not want to co-opt any experiences of the fat community or reduce their experiences in any way. I am trying to be honest about my experiences though. So in addition to having a hard time accepting my own privilege because I have a hard time accepting my thinness, I believe that I have also experienced some forms of fatphobia. These have never been forms that come from society. They are not external. They come exclusively from my own mind. It reminds me every day that I am fat, and that when I am fat it means I am lazy and worthless and useless. I am reminded that the most important thing in my life is to lose weight. I am told that none of my accomplishments mean anything unless I am thin. I am told that everyone is staring at me when I go out, and that I should be ashamed. I’m told people only like me despite my body. I am told that I shouldn’t wear revealing clothes because my body is too disgusting to be seen. I’m even sometimes told that I should hurt or starve myself because I take up too much space.

 

Is it possible to be oppressed by one’s own brain? Probably not. Obviously there is a HUGE (hugehugehuge) qualitative difference between this and true fatphobia because I cannot systematically oppress myself. Again, I 100% understand that this is NOT the same as the experiences of fat individuals and that it is NOT bad in the same ways and that it is NOT oppressive in the same ways. However it certainly leaves me feeling confused about how I could have privilege for something that I’m also firmly ridiculed for. It is distinctly a mind-fuck that the same thing which causes other people to give me privilege is also the thing which causes me to hate myself and compromise my health.

 

And I believe that this is one of the most important things that we need to be aware of as allies and as privileged individuals: WE DO NOT GIVE OURSELVES PRIVILEGE. The thing that gives us privilege is not INHERENTLY giving us privilege. It is only the reaction of others that gives us privilege. It could be anything in the world, but society has chosen things like whiteness and maleness and able-bodiedness and thinness. My brain may hate whatever piece of me has privilege. I could despise being white, and still have white privilege. I KNOW these things. And I know that I always have to be aware of them. I know that while my experiences differ hugely from those of the average thin person because of the intersectionality between my mental illness and my thinness, that doesn’t change the attitudes of society and I need to continually fight against those attitudes.

 

But I also want to be open about the fact that I’m actively fighting those battles in my own head. Each of us has to do our best to eradicate the bad beliefs we hold. When I admit that I struggle with my own privilege, that is what I’m doing. I’m saying that I have had some fatphobic or thin privileged beliefs that went unquestioned for a long time, and now I’m trying to challenge them and remove them. And it’s a struggle. Is this a bad thing? I don’t think so. I think it’s the work of every person who wants to fight oppression. And it’s hard. I’d rather be open about the work I’m trying to do so that others can see it’s possible than hide it so as to be a “better ally”. But maybe it does do more harm than good. Thoughts? Maybe I don’t get it. Maybe I am doing something really wrong by publicly admitting to these struggles. What do you think?

 

PS-the reason I post so many pics of myself is a.I talk a lot about me and b.I’m nervous bout copyright issues.

Thin Privilege and Fat Phobia

I spend a fair amount of time on tumblr, which means that I spend a fair amount of time hearing about thin privilege. At first I was kind of annoyed by this concept (as I think every privileged person is at each new iteration of their privilege), but I have come to understand that there are elements of being overweight that I will never understand, never experience, and that are difficult. I understand that it can affect your job prospects, and that it can affect the way that doctors treat you and diagnose you. I understand that there are difficulties being a fat person that a thin person will never experience.

But there is still something that rubs me the wrong way about many of the examples of thin privilege that people have provided to me. Partially this is because I have an eating disorder, and so it is INCREDIBLY difficult for me to view my size as a privilege, because it has come at the expense of my health, well-being, mental stability, and many of my relationships. But beyond that, many of the examples of “thin privilege” or “fatphobia” that I hear being thrown around seem to me simply to be examples of sexism. For example, many fat women have said that thin women can eat whatever they want without being judged for it. This is patently untrue, as I have been judged for eating anything that appears low-calorie, or as if I’m watching my weight as a thin woman. The problem seems to be that people feel they deserve any say over what women eat because they deserve a say in women’s health or beauty or appearance. I have rarely heard men complain about this same thing, and I have certainly seen thin women judged on their food choices, just like fat women.

I also have heard many fat people say that they have been denied medical treatment because of their size, and told that all they have to do is lose weight. Well even when I was underweight, even when I was severely damaging my health and really truly ill, doctors never looked any further because my size appeared “healthy”. Those standards of weight and size negatively affect everyone involved. They may come down more harshly on those who are fat, but many of those same problems can be traced back to expectations of women’s bodies. In one study, new healthcare professionals even professed more bias and judgment towards individuals with anorexia than they did towards individuals who were overweight or had diabetes. Each is considered a disease in its own way.

Now there absolutely are examples of fatphobia and thin privilege. The attempts to charge more to overweight individuals to fly, or the constant labeling of the “obesity epidemic” spring readily to mind. But I think that many of the problems that overweight individuals face overlap heavily with sexism and general expectations of women’s bodies, and that we should be willing to accept that some of these problems cut all ways and harm EVERYONE. 

(The featured image is me at one of my lowest weights. Lucky me, I got light-headedness and heart palpitations! Remembering that time it’s hard to view my weight as a privilege, but I’m doing my best)