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In defense of biology, part 2

Posted Dec 24 2010 12:03am
I got some wonderful replies to yesterday post In Defense of Biology .  I was responding to one of these comments, when I realized that what I was saying was a post in and of itself.  So I moved it to an actual post.

First of all, here's the comment
We're on a slippery slope, as patients, when considering the role of biology and the disease process. On the one hand, acknowledging a biological root to a disorder allows us to let go of some guilty, feeling (appropriately) that something else contributed to this condition or caused it.

On the other hand, it seems we often view biology as simply medical, that someone medical will need to fix for us, taking away our responsibility to also help ourselves.

The more the medical community seems to learn about most diseases, the more it appears they are more complex than we originally believed, combining genetic predisposition, an environmental trigger and then support of the disease process.

It's the middle paragraph that intrigued me the most.  I'm not entirely sure I see how viewing eating disorders as biological and/or medical takes away our responsibility to help ourselves.  Yes, newer treatments like Family-Based Treatment do take away the sufferer's responsibility to feed themselves.  But the goal of FBT is ultimately to give these responsibilities back.

Part of treating a broken ankle is resting the injury and putting any weight on the ankle.  It's temporarily relieving the ankle of its responsibility to help you walk, yes.  It's also a medical treatment.  But the point of using crutches for months is to let your ankle heal so that you can walk properly again.

One of the most frequent reasons I've heard against understanding the neurobiology of eating disorders (besides the fact that our culture equates biological with "I'm screwed, so why bother.") is that it makes people into passive, helpless victims.  But is that really true, or is that just a faulty assumption on our part?  I bet if you asked, say, a breast cancer survivor, you would hear that a cell in her breast couldn't stop dividing, but then she got treatment.  That treatment isn't entirely passive.  She had to show up.  She had to get her mammogram or do her self-exam.  She had to have the scans and the biopsies and the surgery and the chemo.  All very medical things.  None of which relieved her of responsibility for managing her illness.

It did say that she couldn't stop that cell from dividing.  She couldn't ask the cell if it had issues with its mother, and hope that if she gave the cell some control, it would stop dividing.  No, the cell was going to keep dividing and keep making that tumor bigger because that's just what cancer cells do.  With an eating disorder, the life-threatening behaviors aren't going to go away on their own.  After a while, biology takes over, and ain't nobody messes with Mother Nature.  The sufferer needs help and support to be able to stop.  Viewing this as a medical issue doesn't mean the patient is helpless. Nor does the medical view discount the fact that things that happened during this woman's life may have increased the chance she ultimately got cancer.

Doctors never viewed my broken ankle as anything more than a broken ankle.  They did realize that osteoporosis had ravaged my bones.  They did ask questions like "You broke your ankle doing what?" (I slipped on a patch of black ice in front of my apartment.  I still get panic attacks when I have to walk on ice).  But the surgery to repair the break and the rehab and all were essentially medical.

Other than occasional soreness and swelling and two nasty scars, my ankle is fine.

People use the word medicalization like it's some sort of cuss word.  And yes, medicalizing things (such as grief) can be unnecessary and rather harmful and counterproductive.  A grieving person doesn't need a pill.  They need neighbors to bring them casseroles, friends to listen to them cry, and time to heal.  There are lots of examples of making normal things medical conditions--I won't deny it.

But we medicalize cancer.  We medicalize tuberculosis and diabetes and Alzheimer's disease.  I'm not entirely sure I understand how mental illness in general and eating disorders in particular are different.  I, for one, am glad the medicalized broken ankles so I didn't have some BO-laden guy laying his hands all over me and telling me the Lord Commanded It!  I'm glad they no longer think of epilepsy and seizures as being the mark of the devil and instead give you EEGs, medication, and one of those little alert bracelets. 

If someone offered me a pill that would make my eating disorder go away, you better fucking believe I would take it.  I don't need to spill my guts to a therapist for $100 each week to create meaning to an illness.  I go to therapy because it's the only thing I've got.  Creating something metaphysical out of an illness doesn't create a cure.  Honestly, giving meaning to my suffering and illness is nice, but really?  Cancer patients don't need to do it in order to get better. Nor do diabetics.  Nor do people with schizophrenia.

I don't know--maybe I'm just bitter.  I would love to be able to take a pill for my eating disorder.  That might make me lazy or unwilling to do the hard work of recovery.  Maybe that is true.  But it would be nice nonetheless.
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