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Anorexia from the outside in

Posted Aug 31 2012 1:15pm

Despite the fact that I've been blogging less (okay, a LOT less), I still think about eating disorders. Not just in terms of my own recovery, but also in more philosophical and general neuropsychological terms. I was listening to an audiobook by VS Ramachandran the other day, and he was talking about theory of mind. This got me thinking about how people without EDs (and even people with EDs) try to understand another person's disorder.

Theory of mind is the technical neurological term for trying to figure out what someone else is thinking.  Quoth Wikipedia
Theory of mind is the ability to attribute mental states—beliefs, intents, desires, pretending, knowledge, etc.—to oneself and others and to understand that others have beliefs, desires, and intentions that are different from one's own.

If you see someone reaching for a glass of water, you assume that they're thirsty. After all, that's generally why you reach for a glass of water: you're thirsty. Water is something to drink. Ta-da! You don't have to be thirsty to understand that someone else might be.

Crucial to understanding someone else's motivations is understanding our own. We know what thirst is, we know that water makes thirst go away, we know we have to bring the glass of water to our lips and swallow.

So what does this all have to do with anorexia? Most of the research related to eating disorders and theory of mind has been with regards to any potential deficits in this area in sufferers. One 2004  study  didn't find any problems with theory of mind in a group of 20 anorexia patients; a separate 2010  study  found that AN women did have difficulty identifying others' emotions, which is one aspect of theory of mind. Bulimia patients were more attuned to others' negative emotions, according to  research  published earlier this year.

All of this is good to know, but it still doesn't tell us how other people understand what it's like to actually have an eating disorder. I don't know whether or not this research has been done, or even how you would go about measuring it if you did. But crucial to understanding anyone's experiences of anything is theory of mind.

Imagine this: someone at work has stopped bringing their usual PB&J sandwich to work and has started bringing salads. They talk of wanting to lose weight. To the average person, it looks like your co-worker is on a diet. Like so many others, your co-worker wants to be thin. Unlike most people, however, this "diet" doesn't stop after just a few pounds. Your co-worker still talks of wanting to lose weight, no matter that they don't have any weight left to lose. Then you learn that it's anorexia.

The only way a non-ED person has of understanding anorexia is from their own experiences. Most people have been on a diet. They've grabbed flesh in the mirror and strained their necks to see if these jeans do, in fact, make their butt look fat. Anorexia looks a bit more extreme, but most people have never found a plate of spaghetti more horrifying than a plate of snakes. This diet mentality is all people know, the only frame of reference.

It's dangerous on several levels: 1) people think they know what it's like to have an ED because they juice fasted for a few days and 2) EDs seem to be about wanting to be thin. Of course, many ED behaviors are the dogged pursuit of weight loss, but weight loss isn't really the motivating factor. It's a fear of fatness, a fear of losing control, an ineffable fear that defies being put into words.

This is also, to some extent, how people with eating disorders try to explain the craziness in their minds to other people. Dieting is readily available, easily understandable cultural currency. Any woman I ran into could understand exactly what I meant when I mentioned my worries about what I was eating. We were motivated by different things, but it made sense for me to be worried about my eating and exercise habits. Everyone else was. I couldn't describe what the rest of my anxiety was about, and food seemed like as good of a scapegoat as any.

Chime in: What do YOU think? Have people had difficulties understanding your ED? Has anything helped others gain a better idea of what it was like?
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