My Self Care is Not Your Damn Business

I’ve been pissed off this week. Pissed off to the point of being incapable of doing my normal work and becoming so anxious and twitchy that I needed to call on some mindfulness skills that have gotten pretty rusty. I want you all to know this because I want you to know the consequences of trendy, uninformed, bullshit thinkpieces and their kin, the edgy Facebook status.

This week I just can’t seem to get away from people making commentary on others’ self care routines. Unsurprisingly, most of it hinges on “Tumblr self care,” that holy grail of joke fodder that is in large part created and consumed by teenagers and young adults. I want to make a note of that, because it’s important to realize that Tumblr is in large part young people struggling to understand how they exist responsibly in the world. It’s especially a lot of outcasts, introverts, and mentally ill folks who are young and trying to understand how to deal with the pain they feel while also maintaining relationships and contributing to the world.

So first and foremost, can we cut Tumblr a bit of slack? We all struggled with this same kind of thing when we were younger, so stop shitting all over today’s young people because they happen to be sorting it out online instead of in their basement. The world isn’t ending because young people are trying to figure things out.

But second, the messages that we are sending to these young people in response to their (honestly not that big of a deal) posts about self care are completely toxic. I want to start by giving you an idea of the types of messages that most people with mental illness hear on a regular basis. It’s incredibly common in the U.S. at least for the message “you are what you accomplish” to get ingrained at a pretty early age. Where I grew up, I was also often sent the message that we don’t talk about our feelings very much, we deal with them, and we move on. Once you commit to something you DO NOT back out of it or you’re a bad and flakey person. You don’t cause drama or act negatively, because no one wants to be around a drama queen and you’ll end up with no friends. Don’t be selfish, give more to other people than yourself, your life isn’t so bad, other people have it worse, why are you upset there’s nothing to be upset about get over it, I bet if you just exercised and ate healthy you’d feel fine, blahblahblah. No one is living their life in some sort of uncertainty about whether their friends like them flaking out or whether it feels really great to not be able to get out of bed. The messages of guilt and shame around emotions and mental illness start early and come often.

Unsurprisingly, people with mental illnesses also tend to be people with hyperactive senses of guilt and shame anyway. There are a few personality disorders out there that don’t have those as symptoms, but nearly every other mental illness includes guilt, shame, or self-hatred as some element of its symptoms. SO. Can we all please start from the understanding that there really isn’t an epidemic of depressed and anxious people parading around oblivious to the way their actions affect others, totally ok with the fact that they can’t deal with life? There MAY be the usual packs of teens and young adults who are still figuring out the ways their actions affect others, or how to find some balance in their lives, but that has to do with being 14-18, not with having a mental illness.

So with all of that history of serious guilt and stigma and internalized bias I get real pissed off when I see stuff like this:

“Seriously, nothing is worse than the writing and the ~comic strips about mental illness~ and the pandering videos which tell us that people with anxiety are these fragile butterflies who must be catered to at every turn. ‘Just take care of yourself,’ this rhetoric says. ‘Practice self-care! Take a bath! Cancel your plans! Don’t explain yourself! If your friends can’t give you space and be totally understanding, that means they’re not your friends!!! They’re toxic! GET THEM OUT OF YOUR LIFE. You have no obligation to keep around Toxic People. If you need to throw your phone into a river and spend two weeks locked in your room eating Ding Dongs, that’s what you need!! :3′”

There are approximately a billion things wrong with this paragraph, so I’m going to start with the most obvious one: this person doesn’t link to any evidence that these people or this advice exists. What I see when I go on Tumblr is a lot of people reminding each other that they’re valuable, that emotions aren’t bad, that it’s important to eat and sleep well, notes about taking your meds or exercising, and a few about the fact that it’s important to choose your friends carefully because some people will leave you feeling worse than you started. Some are little things, like goals to drink water or buy something that you particularly enjoy, or suggestions to try a coloring book or a bath. Some of them are about setting reasonable boundaries, and reminding people that they should take care of themselves IN ADDITION TO OTHER PEOPLE. And sometimes it’s just little reminders that things will be ok.

You know what I see nowhere? Ignore your friends and don’t tell them what’s up. You’re better off alone. I see the exact opposite of that. I see people trying to connect with each other. So the first issue I have is that this is responding to a problem that doesn’t exist. I also fail to see how people writing or taking a bath hurts ANYONE. The way people seem to equate “doing things for yourself” with “being selfish” is a serious problem and contributes to the ongoing struggle many people have with taking any time or resources for themselves. As you can see in many of the linked examples, people talk repeatedly about having a hard time with giving themselves time and care. That’s WHY the dialogue at the moment is so one-sided. We don’t need any more reminders that we should think of other people too. Those are already everywhere (as discussed above). So these messages exist to combat the current climate, and so don’t feel the need to pussy foot around things or talk about how you also need to take care of other people. People who only look at messages like “it’s ok to cut someone out of your life if you need to,” are ignoring all the messages that say “only bad people give up on their friends.” Do you see the fear in this article? It’s completely tinged with the terror that all the ways of dealing with mental illness are bad and wrong. We don’t need more of that. We don’t need more thinkpieces telling us that we’d better watch out or our mental illness will sneak up and make us jerks (and it will be our own fault).

Most of us have already had friends disappear on us, or been told we’re selfish and self-absorbed, or that we’re manipulative and abusive, even when we’re trying so hard to be ok. We don’t need more reminders to watch our backs, or keep from getting too selfish in our self care.

And beyond the people guilting us for just engaging in self care, I’ve seen the start of battles between people who like different types of self care. In particular, I see a lot of people who prefer more “active” or “accomplishment” type forms of self care looking down on self care that’s a little more basic. Most people with a mental illness know that they should get out of bed, take a shower, eat well, exercise, clean their apartment, call their friends, etc. That’s why there’s so much effort to validate the other kinds of self care: it’s ok to hide under the blankets sometimes. It’s ok to wear pajamas to go see your friends. It’s ok to spend a little extra on that latte if it means you’ll have the energy and emotional wherewithal to get to work today. None of this says “you should probably always do these things because they’re really productive.” It says they’re ok to do sometimes.

As someone who really does thrive on self care that is very sensory and very basic (footie pajamas, a mocha, my cat, a chewy necklace), I can guarantee that I don’t do these things to replace my basic life skills, nor do I use them to focus on myself over other people. I often end up feeling childish and incompetent. I need reminders from my friends that I’m not hurting anyone, and that there’s nothing inherently great about looking dignified. I certainly don’t need someone to tell me that I’m trite and my mental illness isn’t “real” or “gritty” enough because I use “cute” coping skills. I’ll use whatever damn well makes me feel better, even if it’s riding a unicycle while playing the kazoo. I don’t care how it looks, and the reality of mental illness is that when it hurts that bad you don’t care if you look stupid, you just need it to stop.

The hierarchy of “productive” self care over “useless” self care and the anxiety about being good to friends is not just thoroughly unhelpful in general, it also screws over people who happen to have physical disabilities or who can’t afford a gym membership and good food or people with chronic pain. It creates more stigma against people who can’t easily leave the house, or who might have days that are unexpectedly painful. There is no good reason to tell people that they should stop using coping skills that are working and that don’t hurt anyone.

Now what is true is that sometimes people with depression or anxiety do become self absorbed because their own pain overwhelms their ability to look at much else. This however, has little to do with someone’s self care routines and more to do with the actual illness: when you cannot physically get out of bed, you are generally not at your best as a friend. But the solution to this problem is to increase the number of coping skills and self care options available, not to increase the guilt and shame. The more blame we place on self-care, the more we miss that it’s actually helping improve the situation. I know that I am a better friend when I let myself cancel sometimes and show up when I will actually be a decent person to be around, when I take some time for myself so that I can listen and support my friends. I am a better person and a kinder human being when I treat my depression. That treatment includes self care, everything from the tiniest fidget to the expensive massage, and the showers and cooking and sleeping and cleaning in between.

I know that this has gotten long and ranty, but there is nothing that ruins my day faster than people saying that there are right and wrong ways for me, in my own life, to deal with my mental health, and then heaping guilt on me for not doing what they think is right. There’s a reason the dialogue around mental illness has turned to (perhaps too much) validation and love: it’s because those things work a whole lot better than shitting on someone. There is no reason to continue perpetuating stigma against mental illness under the guise of being “edgy” or “real.” Stop.

Medicalizing Difference: A Study in Oppressive Language

I was perusing the asexual blogosphere the other day and ran across this fairly disturbing post that looked at an abnormal psych paper. This paper was proposing a potential new diagnosis to be added to the DSM, which they term “Nonsexual Personality Disorder”. While this is the first I’ve heard of someone literally terming asexuality as a disease, it is not uncommon for people to medicalize it or treat it as something which needs to be fixed.

I’ve spent a fair amount of time with DSM definitions and looked at a lot of problems with the ways we currently define mental illness, but even one glance at what this person proposes as the definition of Nonsexual Personality Disorder tells me that this is a horrible definition for many reasons. At its root, it says that this is different from normal and thus it’s bad without actually taking into consideration whether or not the difference is harmful to anyone. This is the same thing that happens to people who are gay, people who are extremely sexual or kinky, or all sorts of things that constitute “different”, generally from the privileged and well off majority.

Looking closely at the definition, we can pull apart what’s wrong with it and see how medical language is often used to oppress difference. This particular case is a doozy as it manages to pack in all kinds of oppressive tendencies that happen to many different people, so this should be fun.

Let’s start at the beginning shall we?

“A.  A marked inability to experience sexual attraction, beginning in early adulthood and indicated by 5 or more:”

As far as I’m aware there is no other diagnosis in the DSM that hinges exclusively on the lack of one experience. Oftentimes an inability to feel certain things are part of a diagnosis, but rarely are they the whole diagnosis because the whole point of the diagnoses in the DSM is to have a way to treat something that is causing harm or lack of functioning in someone’s life. There is no need for sexuality to be able to live a happy and fulfilled life and this whole diagnosis rests on the idea that if you do not have sexuality in your life then there is something empty or unhappy about your life.

Moving on:

“Inability to interpret sexual signals”

Now there are all kinds of symptoms listed in the DSM that people who are not mentally ill have but that only become signs of mental illness when they move into a realm where they seriously inhibit someone’s functioning or lead to high distress. Now I can imagine how you might get into some awkward situations if you can’t interpret sexual signals, but overall it doesn’t seem like the sort of thing that should be medicalized: it’s pretty damn normal and unless the other party involved also has some difficulties with reading emotions it should just mean that you don’t get into sexual situations. Oh no. How horrible.

Another way this sort of symptom was used in the past was in medicalizing lesbians. If you can’t interpret or don’t respond to a romantic overture, there’s something wrong with you. If you can’t follow the scripts that have been laid down, there’s something wrong with you, something that needs to be treated. In reality, it may simply be that you follow your own script or no script at all and that’s totally ok.

“Uncomfortable in intimate situations with a partner”

So I have a serious problem with this particular criterion because this whole disorder is circulated around an inability to feel sexual attraction. That implies that the intimate situation here is sexual. That’s a whole lot of assuming that the only intimate situations you’d ever be in would be sexual. There are all sorts of intimacies and personally I think it’s a bit gross to eliminate them all because SEX. There are also many, many people who are uncomfortable in sexual situations with partners for a variety of reasons and this criteria doesn’t touch on ANY of them (including abuse, PTSD, different priorities, etc). It also doesn’t specify frequency of discomfort, which seems important as probably everyone has felt uncomfortable in intimate situations at one point or another.

Generally discomfort at a situation is only diagnosable when you need to be able to function in that situation in order to have a complete and fulfilled life. I think there are many people out there who could attest that sex is not necessary for a complete and fulfilled life with intimate relationships, which makes this criterion really bizarre. There’s really nothing wrong about having discomfort or preferences against some stuff, and saying that we all need to be comfortable in the same settings is really a set up to oppress some people. Yes, being uncomfortable in all social settings or all settings outside of the house might be something that really interferes with your life, but sexual situations are specific, private, intimate, and unnecessary for day to day functioning.

If you’re really not interested in something and another person tries to get you to do it, it is 100% reasonable to feel uncomfortable. Generally we only want to label something as mental illness if the emotions or reactions are far outside of reasonable or logical.

“Avoidance of situations in which sexual activity may occur”

Um…so if you’re a priest you have symptoms of mental illness? If you choose to be celibate? Lots of people can make it through their lives without sexual activity. In other news, not feeling sexual attraction does not imply that you have to avoid sex. Unrelated! Crazy! Throwing these symptoms together is just illustrating a complete misunderstanding of what it’s like to be asexual.

“Lack of attraction to the opposite or same sex”

This is extremely sloppily written. What kind of attraction? What about non-binary people? Do friend urges count? If they don’t then we’re really looking at something far more akin to antisocial personality disorder. I think it’s implied that those are not the kinds of attraction that the author is thinking of but rather sexual attraction. What is wrong with not feeling sexual attraction if there’s nothing about it that hurts you or anyone else? It’s not like a lack of empathy that leads you to undertake cruel behaviors, it simply leads you to seek out different relationships for yourself. I’m really failing to see the problem.

At its heart this criterion says there’s one way to be human and that’s a sexual way, not because asexual people say they’re unhappy but because the author can’t imagine a different way. Why is this any less discriminatory than making it an illness to have a lack of attraction to the opposite sex?

“Complete lack of sexual thoughts”

My biggest problem with this is that I don’t think it exists unless you’ve got a hormonal imbalance, which is not related to mental illness but simple physical health. There are absolutely people that don’t feel sexual thoughts towards anyone or who rarely have sexual thoughts, but our bodies are filled with hormones that give us certain reactions and that doesn’t stop happening just because of your orientation. As an analogy, if a gay man is given a blowjob by a woman, oftentimes his body will react even if he doesn’t feel an attraction or particularly want the blowjob. It is possible to orgasm during rape. Our bodies react to things.

The other problem is that things like age can also play a role here. Hormones change with age, and some people’s testosterone and other happy sexy hormones just go down as they age. And then they stop thinking sexual things. It’s actually super normal and healthy. So why the compulsory sexuality?

“Touch aversion”

Ok so this is one of the criteria that I think has a little bit of merit in that there is a fair amount of research that shows that human contact is really good for your mental health. People who get hugs or hold hands or what have you tend to be happier. But there is also a lot of evidence that people simply exist on a spectrum of sensory sensitivity and for those who are extremely sensitive touch can be overwhelming. That’s a simple fact about the way their bodies process touch. Perhaps it has something to do with a medical condition (physical), but probably it’s just like different pain thresholds. We have them and for people with high pain thresholds it’s kind of a nuisance but you adapt.

I am one of those people who is fairly touch averse. I am not a hugging type person. I am not a kissing type person. I generally like my space. I cannot cuddle through the night (except with a cat). But that doesn’t mean that there aren’t times that I feel incredibly comforted by touch with someone I trust and care about. It doesn’t mean that I’m broken, just that I need touch in a different way. It really hasn’t been a big deal in a lot of my relationships except that I yell “STOP TICKLING ME!” fairly often when the other person is not intending to tickle me at all. People get their boundaries, move on.

“Inability to experience romantic relationships”

This is unrelated to sexual attraction. Sex and romance are not the same. Romantic relationships are possible without sex. Not feeling romance is also not a super big deal. Someone needs to read asexuality 101. I really have no more ways to say “it is possible to have a fulfilled and happy way full of great relationships without sex and romance”. These symptoms are basically saying “I prioritize romance so much that the only way I could imagine not having it is if I was crazy”.

“Social isolation”

Where did this come from?? Especially because later in the definition it specifies that you would be capable of holding down close personal relationships of a nonsexual or romantic nature, so it contradicts itself. Not dating is not the same as social isolation. Saying that it is is basically telling everyone there’s one way to have a family or be around other people and if you don’t do it that way you’re sick.

“Inability to become sexually aroused”

This is seriously not on par with nor related to a lack of sexual attraction. The symptoms that they give as evidence of “lack of sexual attraction” for the most part have nothing to do with sexual attraction. The ability to become aroused is 100% biological: does your body respond to certain stimuli. Attraction has to do with feelings towards someone. If you can’t become sexually aroused at all and you have a problem with it, it’s probably a question for your medical doctor not your psychologist. But of course none of these symptoms can be the result of something medical as per criterion b.

“It would manifest as something similar to schizoid PD, in which the individual is rather socially detached. However, unlike schizoid PD, this person would take enjoyment in other types of close relationships, such as with family or platonic friends. Additionally, they would not exhibit flattened affect, excepting in sexual situations. In this dimension, this individual does not possess the skills to understand or interpret social cues. A person may develop this due to either a predisposition to a schizotypal-like PD, lack or disregulation of hormones, or a lack of physical contact in childhood.”

So basically nothing would be wrong with this person except that they don’t want to have sex. Oh no! How horrible! Their life must be empty! The basic take home message is that if someone is not feeling a desire for sex then they must be unhappy or wrong. This is a pretty common feeling among a lot of people: if you’re not having or wanting sex, there must be something wrong with you and you should probably fix it. But simply having different desires, priorities, ways of relating, or ways of expressing intimacy doesn’t mean anything about your ability to live a good life. Throughout history psychology and medicine have turned difference into illness so that they have a legitimate way of trying to eradicate it. You’re a woman who likes sex a lot? Medicate. You’re gay? Stamp it out, it’s a disease. You’re a kinkster? Better see your doc.

Many of the symptoms presented above boil down to “you don’t feel the way that I’m used to people feeling”, or tie together something painful but unrelated with the different way of feeling. Many of them point at things that are often a sign of illness (lack of sex drive) and say that they are ALWAYS a sign of illness. Together, these allow a doctor to say that difference is actually a problem because it causes unhappiness. In reality the unhappiness is more likely caused by stigma and oppression.

So if you’re thinking about introducing a new medical definition let’s think about whether the symptoms are actually causing pain in someone’s life rather than just are something that doesn’t make sense to you, shall we?

 

More About Skeptech: Individual and Societal Responsibilities

So at the conference this weekend we spent a fair amount of time talking about censorship because hey, we were talking about the internet and censorship had to come up at some point or other. Zach Weinersmith (edited because I fucked up Zach’s last name. Sorry) of SMBC gave a talk about comics as a natural experiment in censorship and argued that we should have no censorship (except maybe yelling fire in a crowded theater) particularly of art, because art needs to reflect life, and the best art reflects ALL of life, not just the pretty parts.

We also talked some about Reddit and the r/jailbait fiasco. Some people argued that the subreddit never should have been shut down, because protecting free speech is more important and we should be able to talk about illegal activities if we so choose. Should we be able to shut down the r/trees (edited because apparently the subreddit about marijuana is called r/trees. Way to confused me guys) thread simply because marijuana is illegal?

These are all really important concerns, and I am most certainly a free speech advocate. However I tend to think that our morality should be more about harm than about rights. I don’t think we should do away with the concept of rights entirely because it’s incredibly important for the safety of minorities, but in general when you have to invoke a “right” to justify a harm, you’re doing something wrong. Something that was rarely brought up in these discussions was at what cost do we allow completely unrestrained free speech. Because there certainly are harms. Zack Weinerstein made the argument that with this unrestrained free speech, we now have the most tolerant generation in history, so it’s no big deal that certain parts of the internet are steaming cesspits of hate. But that completely overlooks the damage that that hate directly does to the people who have to witness it. We may be “more tolerant” of women, but if a woman gets harassed every time she logs on to her favorite website, that is a harm.

And in addition to that, what do we really mean by “more tolerant”? A lot of these websites normalize horrific behavior by arguing that they are tolerant. They say that cat-calling a woman is no big deal, that African-Americans are just practicing reverse racism, that slurs are simply free speech, but that they think everyone should be equal. This is lip service to tolerance. But if we can actively see online through their writings for all the world to see that they treat other people like shit, clearly they aren’t tolerant. And they normalize that behavior.

For some reason, this conference seemed to focus entirely on personal responsibility in terms of free speech. You might be exposed to any number of things, but it’s your job as a responsible human being to not be influenced by any of it if you don’t want to be (apparently). But here’s the thing: societies have responsibilities too. As skeptics, we should know by now that NO ONE is immune to the influences of society. All of us internalize the messages that get sent to us, no matter how hard we try to resist (hello eating disorder that reeks of internalized misogyny. How are you today? Oh you’re all my fault because I should have just made a better personal decision? Thanks). It has been well-documented how easy it is to influence people. And when you’re constantly bombarded with certain images and certain messages, there’s only so much personal choice that you have. That limits the amount of personal responsibility you can have.

Media has to be responsible for the messages it sends. Now I don’t necessarily think this should lead to government censorship of unpleasant topics. As a lot of people said, ignoring things doesn’t make them go away, and often bringing them out into the open can help us deal with them. I’m honestly less worried about some of the unpleasant topics and far more worried about some of the glamorized topics. Take for example binge drinking. We see binge drinking all the time on TV held up as fun and awesome and hilarious and completely normal. If someone has a predisposition for alcoholism, can we hold them completely responsible if they fall into the trap of alcoholism when they are seeing how great alcohol is all the time? Do we have to take some responsibility as a society for the pain caused that individual and their family? I think we do.

Society has some responsibility to try to create media that isn’t damaging. It should be free to discuss any topic it so chooses, but I think it’s entirely possible to legislate ADDITIONAL information be available about any topic that could be triggering or influencing in a negative way: for example if a TV show depicts rape, we could require that it includes a short discussion of the characters involved and why they acted in a negative way to deconstruct the negative actions they made. And as individuals, I think that we are entirely allowed to exert pressure on media to stop perpetuating shitty stereotypes and harmful messages. We are 100% obligated to be as careful as possible about the media we consume (tell TV networks when their shows are sexist, tell advertisers when they’re perpetuating rape culture).

We cannot always be critical consumers, even when we want to be. Oftentimes we’re lacking in the choices to be ethical about the way we consume media. If I want to watch a movie that is free of sexism and racism, I would be hard-pressed to find one. We need to exert some pressure on media to provide us with more options. Weinerstein suggested that when censorship is taken away, then more types of art flourish. I do agree with that, but I think that we also need to be active in promoting different types of art and different perspectives. We need to vote with our money, and I think as a society we need to discuss larger fixes to the problems of sexism and racism in media and on the internet. If an individual has only ever been exposed through the internet to individuals who say that a woman might owe you sex if you buy her dinner, are they entirely to blame if they rape someone? No. They have some responsibility, but not all of it. We are products of our society.

There is serious harm in unmitigated free speech. I don’t know what the solution is, but ignoring the fact that there are places on the internet that actively normalize hate crimes, sexism, racism, rape, cissexism, and homophobia is not helpful to anyone. We DO have an interest in trying to keep people safe from each other and safe from internalizing negative and destructive messages. I think that people who host websites and people who host other people on their websites need to be clear about what they will and will not accept: you OWN that space, and you can easily say that you will not tolerate bigotry. People do that in meatspace all the time. Why is it unacceptable online? You can get your own damn website and spew hatred. But we will minimize the damage that you can do.

I am so frustrated with the idea that individuals exist in a vacuum and that “personal responsibility” trumps all social issues. NO. Individuals should be held responsible for their actions, but their actions should be taken in context so that we know what led to the problem. If we simply keep pointing to bad behavior and saying “don’t do that” we’re just trying to take care of symptoms, not the etiology of the bad behavior. We are all a part of systems, and our whole systems are broken right now.

How Do We Talk About Eating Disorders?

I’m currently working on a post for Teen Skepchick about eating disorders in a cross cultural perspective. At the moment, I’m just in the research stage of this post, so I’m reading a lot about the research that’s been done about cross cultural eating disorders and about the differences in symptoms, causes, and etiology of eating disorders in different cultures.

And I have to say that I am deeply upset by the way we talk about eating disorders. I am particularly upset because I’ve been reading academic articles, pieces by graduate students studying psychology, and other articles that are surveys of the literature on eating disorders. These should be held to the best standards we have. Unfortunately, no matter where I look (except for in very particular blogs written by people with eating disorders, particularly Science of Eating Disorders), I hear the same things over and over and over again:

“When we expose our girls to thin models and beauty ideals they develop eating disorders”

“Girls of African American descent aren’t likely to get an eating disorder because their culture values voluptuous bodies”

“Eating disorders only crop up in other countries as they become infiltrated by Western beauty ideals”

I am SO sick of the conversation around eating disorders being dominated by conversations about models and images of women in the media and the desire to be thinner. It cannot be that difficult for people to understand this, but I’ll say it again: an eating disorder is a mental illness. It is not a diet. It is not even an extreme diet. It is not a desire to lose weight. It is a coping mechanism to deal with difficult things in your life that you can’t cope with otherwise.

There is VERY little evidence that eating disorders are caused by skinny models. What there IS evidence of is that eating disorders are caused by low self-esteem, family disruption, trauma, other mental illnesses (depression, anxiety, OCD, BPD, bipolar, and addiction are common), abuse, or other difficult situations that you need a way out of. It is such a cliche by now that eating disorders aren’t about food, but I cannot stress it enough: eating disorders aren’t about food! They aren’t about looking pretty or beautiful. I have YET to meet someone with an eating disorder who says they just want to be pretty. I hear them say that they’re depressed, that they can’t cope, that they’re lonely, that they don’t feel acceptable when they’ve eaten, that they feel out of control around food, or that they use food to numb out emotions and manage other parts of their lives.

It is not helpful to keep refocusing the conversation on how someone’s body looks and the beauty ideals. This continues to reinforce them as what’s important, and it focuses the issues on the body again, instead of addressing whatever mental stress has occurred. It simplifies the matter to a point that is unhelpful, and makes treatment and self-understanding very difficult because it doesn’t allow us to reach the real etiology of the disease. It even reinforces those negative suggestions that a woman’s worth is in the beauty standards she does or does not strive to live up to.

Instead of these things, it would be far more helpful to talk about the sexism that makes women feel inadequate no matter what they do, or the bad family systems that don’t allow for good communication or healthy emotions, or the abusive relationships that many women are in, or the trauma and depression of daily life, or the failure of our mental health system to provide us with good coping techniques for when we do start to feel over our heads. If we want to talk about cross cultural eating disorders, maybe we should talk about the different family roles that exist, the different expectations of women in different cultures, the common mental illnesses in those cultures, the differences in guilt and shame in different culture (these feelings are huge in eating disorders), and the relationship that these cultures have to food as symbolic, relational, or positive.

Eating disorders are mental illnesses. They are not an attempt to be skinny. They are not a reaction to the media. They are not the desire to look like a model. They are serious. They are life-threatening. They are painful. They come with depression, constant mental stress, trauma, self-hatred, difficulty with relationships, isolation, loneliness, feelings of guilt and inadequacy, and all sorts of things that ARE NOT simply reactions to the media, but are about how we relate to ourselves and how we relate to others. Can we please start talking about them in terms of the mental situation of the individual suffering, because that is what makes something a mental illness?