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June 01, 2005

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.


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It's a cross between the whole new age/paganism/witchcraft cultures, the deeply ritual and/or religious nature of self starvation and people not getting metaphor that's led to this. That it will weird out and scare expoerts and parents is just an added bonus.

And it's either not yet a cult (lacking the centralised organisation and leadership that is a mark of all cult/religions) or is the possibly the world's first Peer2Peer cult, which is both kinda cool and just plain weird at the same time.


And it's either not yet a cult (lacking the centralised organisation and leadership that is a mark of all cult/religions) or is the possibly the world's first Peer2Peer cult, which is both kinda cool and just plain weird at the same time.

I think certain "experts" are getting confused about the boundaries between metaphor and literal descriptions of experience. It's one thing to ask patients to imagine what a voice in their head might say, if they had one. Or to act as if some of their thoughts belonged to someone else.

People are suggestible. If clinicians get carried away with the "voices in the head" trope, it won't be long before patients start having those depersonalizing experiences. That's not a step towards mental health, IMO.

"It's almost as if anorexia is being recast as a delusional or dissociative disorder."

Whaddya mean, "recast"? Hasn't it always been treated as a distorted perception? This is how I've always understood it, though my understanding is limited. Maybe I've seen too many pop representations of a skeleton looking in the mirror and seeing a whale.

You used my favorite word. Iatrogenic. Of course, as a hypchondriac, maybe I'm projecting.

Thin... slavery to a media ideal that's not realistic.

Some how I wish the Greek ideal would come back in vogue... you know healthy physically fit bodies integrated with a well trained mind, and yes even an appreciation of their own spirituality too.

Dissociation is not the same as distorted body image (although the two can go together). It's one thing to have a distorted body image, it's quite another to literally hear voices telling you to starve yourself. It's good to have some detachment from your own thought processes. Normally that's called "introspection" or "insight."

Dissociation happens when people regard their own thoughts (or sometimes parts of their own bodies) as being somehow alien. MPD is an extreme example. Some psychiatrists think that it's a learned coping mechanism that children acquire to deal with very stressful situations.

It just doesn't sound helpful to encourage patients to ignore their own agency. Beyond a certain point, encouraging patients to dissociate themselves from their self-destructive thoughts and behaviors is bad. If you regard your own impulses as coming from somewhere else, even some "other part" of yourself, you undercut your own ability to stop making those choices.

I think you may have identified what is really driving these 'pro-ana' communities, Lindsay. The combination of dissociating the negative thoughts and behaviours to an external source, and the world wide reach of the internet, is just assisting the survival and propagation of eating disorders.

Another point of interest (to me, at least) is the cyclical nature the media frenzy surrounding eating disorders. As you pointed out, the media seems to jump on this story every couple of years, highlighting a new wave of too thin celebrities, and causing panicky parents the world over. Just last weekend, I watched a story on the CBC profiling an anorexic girl in Ontario, and I thought to myself 'here we go, again!'

While I certainly don't condemn the media for bringing the public's attention to these and other types of mental disorders, the coverage is often shoddy. To really understand what's going on, more information is usually needed, and the average reader/viewer isn't going to bother to figure it out on their own.

You raise a very good point and psychiatrists have talked about this since the time of Frued. Some mental illnesses have somatic basis like Borderline Personality Disoders as an example.

Others seems to have been popularized in the public mind like Dementia Praecox or the Hysterical disorders were at the time of old sigmund was doing his work. There are lots of arguments about this as to whether it was misdiagnosis or even a valid diagnosis in the first place, as well as it became popular to have it.

I'm not being dismissive of the current disorder at all so don't anyone get their hackles up. I know how serious these disorders can be.

Magaret Talbot had a great article a few years ago critiquing Marianne Williamson, who apparently is a major proponent of this "personalizing the disease" stuff. It seems creepy even by New Age standards...

I believe that anorexia is a big "fuck you" to anyone who might love the anorexic. It's also such an attention getter. The anorexic is the one in the family-dynamic who gets the most attention. I think it's somewhat sociopathic, and I don't have a lot of sympathy for the sufferers. I do think it's about controll, attention, and power, and it's very perverse. As for a cult of anorexics, or a community, it could never work, since they also suffer from narcissism. In fact I think anorexia is a by-product of narcissism.

This "ana" thing has been around for a while. One of those websties that makes fun of crackpot websites, "Insolitology" did a long article on "ana" websites called "Disappearing Teenage Girls". I also saw a re-run of some law and order type program (Judging Amy? I can't remember - don't watch these things often enough to tell them from each other) that used the story line of one of these website owners causing another girl to die from anorexia. It is really creepy and cult-like, and I would assume it does initiate from some sort of need for control, but one that has gotten really warped.

It's hard to feel sorry for them.

"I do think it's about controll, attention, and power, and it's very perverse... In fact I think anorexia is a by-product of narcissism." - Scott Lemieux

I disagree with those statements. Whilist the pro-ana and cosmopolitan culture deffinetly do portray an image of narcissism, someone who is truley suffering is a far cry from narcissistic. I believe it comes down to the girl who's inner image is not what she sees in the mirror, like a person wanting a sex change. They hate their bodies, and it isn't a contest aggainst anyone but themselves. It has to be about controll, because having the ability to stop from eating when everyfiber says 'FOOD NOW,' it takes alot of controll to say no to that. Then there is alot of suffering, denial, and other pains that go along with it. When one can't stop, even when they want to, society shouldn't snub their cry for help. There is a diffrence between the person perfectionist, and the social perfectionist.

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