Iatrogenic twist on anorexia?
Anorexia subcultures are flourishing online, to the perennial surprise of the media. The current fascination with group anorexia is a significant shift from the last generation of After School Specials and eating disorder memoirs.
In the old days, anorexia was depicted as a solitary pursuit of perfection. Now, popular culture is fascinated by so-called "pro-ana" communities, blogs and livejournals where self-identified anorexics and aspirants talk shop.
Human interest writers have been wringing their hands about this phenomenon every few months for a year or two. Every time, they make it sound like a new discovery. Web hosts make a big show of canning the latest crop of "pro-ana" boards, the girls set their diaries to "friends only" and regroup.
Here's a new addition to the "subcultural anorexia" genre:
'Ana' devotees starve themselves
CHICAGO — They call her "Ana." She is a role model to some, a goddess to others — the subject of drawings, prayers and even a creed.
She tells them what to eat and mocks them when they don't lose weight. And yet, while she is a very real presence in the lives of many of her followers, she exists only in their minds.
Ana is short for anorexia, and — to the alarm of experts — many who suffer from the potentially fatal eating disorder are part of an underground movement that promotes self-starvation and, in some cases, has an almost cult-like appeal. [Rutland Herald]
This article is especially disturbing because it takes the personification of the eating disorder so seriously. It's almost as if anorexia is being recast as a delusional or dissociative disorder. Patients are talking about "voices in their heads" or setting up the eating disorder as an object veneration. As the name suggests, the many in the so-called "pro-ana movement" are also very serious about the personification angle.
My question is whether eating disorder counselors have inadvertently spawned the personification craze. It used to be standard to encourage eating disorder patients to imagine their eating disorder as a person, to name it, to describe its attributes, to represent it in art therapy, etc. The intent was probably to encourage the patient to separate herself from her disease. The therapists wanted the patients to say "That's just the disease talking, that's not what I really think/want/feel."
Maybe the meme is getting out of control.
For others, Ana is a person — a voice that directs their every move when it comes to food and exercise.
"She's someone who's perfect. It's different for everyone — but for me, she's someone who looks totally opposite to the way I do," says Kasey Brixius, a 19-year-old college student from Hot Springs, S.D.
To Brixius — athletic with brown hair and brown eyes — Ana is a wispy, blue-eyed blonde.
"I know I could never be that," she says, "but she keeps telling me that if I work hard enough, I CAN be that."
Dr. Mae Sokol often treats young patients in her Omaha, Neb., practice who personify their eating disorder beyond just Ana. To them, bulimia is "Mia." And an eating disorder often becomes "Ed."
"A lot of times they're lonely and they don't have a lot of friends. So Ana or Mia become their friend. Or Ed becomes their boyfriend," says Sokol, who is director of the eating disorders program run by Children's Hospital and Creighton University.
In the end, treatment can include writing "goodbye" letters to Ana, Mia and Ed in order to gain control over them.
Maybe the therapeutic trope meshed too well with the trend towards online communities. It's easier to organize a cult than a club.
It would be ironic if eating disorder therapy was inadvertently reconstructing anorexia as a form of frank insanity. I don't think anorexia patients are any crazier than they ever were. It would be a real disservice to inadvertently encourage these quasi-mystical delusions in the name of therapy.