More on leading questions

Cathy posed the following in the VERY interesting comments section of my recent post on Leading Questions:

"It IS a good discussion point Laura... Another thing that I would be interested to hear a debate around is the following question:

If there was not so much emphasis on the theory that the psychopathology of Eating Disorders, and especially Anorexia Nervosa, develop as a consequence of body dissatisfaction or 'body image' disturbance, would we even attribute the behaviours of an individual with Anorexia Nervosa to a disorder of body image?

The reason I ask this (and would be interested to hear others' responses, is that I wonder whether any child who develops AN really understands why? I didn't know why I felt compelled to restrict food and over-exercise in a very rigid manner as an 11 year old. Interestingly no-one suggested body dissatisfaction to me or body image disturbance when I was an anorexic child. It was not until I was in my late 20s that anyone ever suggested that I had AN because I didn't like my body. To me, AN was just another obsessive-compulsive behaviour, like my previous OCD behaviours.

So the main question is:

Do clinicians, the media etc. put an idea into a child's mind (who aleady has AN) that their AN is a disorder of 'body image' - such that they believe this to be true?

How would you feel about raising this as a new discussion point"

For my part, I think mental illness takes the form of the sociocultural backdrop of the time. AN presented as an ascetic and religious thinking in earlier history, as Freudian in another, and now predominantly in a fat-phobic way. The core illness, though, strikes me as remarkably stable: avoiding normal consumption. I believe the core illness is nutrition avoidant and that malnourishment is a far more comfortable state for certain people. An altered consciousness that is mistaken for a choice and not understood as a very dangerous state. We get that with drugs, but not with malnourishment - by which I mean both anorexia and bulimia and probably all eating disorders.

And yes, I do think the fat phobia of these disorders is partially "suggested" and absolutely maintained by a rather narrow modern idea of eating disorder pathology.



  1. i think this makes a lot of sense.
    mental illness has always taken on the back-drop of the culture during it's time.
    But what i don't understand about this, or what this explanation would fail to answer, is why, in my personal experience, i had the thought/feeling of wanting to lose weight/being fat FIRST-- LONG BEFORE I developed an eating disorder. how does that fit in?

  2. The Americanization of Mental Illness -
    By Ethan Watters ‘‘Crazy Like Us: The Globalization of the American Psyche’’

    A very interesting article on how our interpretations and understanding of mental illnesses change according to cultural settings.

  3. Rose,

    Here's a way to look at this. Not all thoughts about weight loss are driven my pre-wired mental illness. That idea is TOTALLY out there around us. I doubt many women get through life without ever thinking "do I look fat in this?" But not all people are wired to eat less and have that idea lock in like a vise.

    By analogy, think of someone who is raised to wash the dishes before going to bed. Normal, right? But if that person inadvertently triggers an OCD by, say, having too little Vitamin X in their diet and their zeal for cleanliness becomes a life-swallowing obsession we don't think that that earlier interest in clean and order CAUSED the OCD or that the person can just stop needing to clean obsessively by deconstructing their childhood cleaning habits. We understand that something has gone awry in the brain and seized on an earlier value in that person's life.

    That's the way I think of it.

  4. i re-read the post and i understand it now. it's a hard topic to wrap my mind around, though, i'll be honest.
    it actually makes a lot of sense and could really HELP support the way in which therapy or nutrition therapy is often conducted with eating disordered individuals (ie telling the patient that feeling "fat" is just a 'codeword' for some other, bad, unidentifiable feeling). this theory would then play rather well into the way in which a lot of the most successful therapy (that i've seen) is conducted.

  5. I believe that anorexia is not a mental illness, and I am treating my 13yo daughter with this "theory" in mind. Because I believe it's a hard-wired, biological disease, I believe professional psychobabble is dangerous precisely because its all suggestive.

    After my daughter took the EDE-Q survey for family based therapy followup, I found her in her room rubbing her belly (never saw this before) of the questions was about a desire for a flat stomach...hmmm....Yes, adults put ideas into kids' heads--isn't that our job! As always, it doesn't matter how one gets to the point that the disease interrupts their life. What matters most is the immediate, aggressive treatment with food, not talk therapy.

    My daughter, who has anorexia, will always need scheduled eating and higher calories than non-disordered eaters. How is this any different than a child with diabetes or asthma who has to manage their disease with medication and lifestyle changes. Why is the treatment of this disease in the field of psychiatry, which is so outdated?

    I'm treating anorexia as a medical disease with a prescription of high calorie foods within a structured, strategic plan.

    I am consciously choosing not to allow the psychological aspect of the disease to affect my daughter's life--my daughter does not see a therapist (and hopefully, will never need to). I want to avoid the "professional patient" syndrome that affects most who get caught in the traditional therapy factory.

    My treatment takes the takes the weird blame and guilt and "identity" out and focuses on management of the disease. As this is unchartered territory, we'll see how this works -- so far, my daughter is recovering beautifully!

  6. Anonymous, I think we may be using the term "mental illness" in a different way because I actually agree with what you are saying. "Mental illness" means brain disorder - in this case symptoms that seem to be dependent on malnourishment.

    I don't mean a mental problem caused by circumstances or outside influences.

  7. Laura,
    Yes, we agree. My rant was just a rant, not about anything that was said. I'm just mad about these psycho-surveys--the professionals who approve use of these surveys seem to be saying to kids "hey, you're messed up, let's find out how bad." Professionals using these surveys obviously believe that people with AN *all* consciously restrict--all the questions are about how "conscious" are you about your "freeky habits." Okay, I'm exaggerating for effect.

    If the professionals came from the place that "food is medicine," the questions would be about food and support from family and management of disease. Heck, wouldn't it be great if they were "positively" leading questions using healthy habits and healthy relationships.

    But, this discrepency about the word "mental illness" highlights the need to better define why AN is not a mental illness by defining mental illness, which I can't really do now that I'm forced to! (Funny.)

    In general (and this week), I believe AN is a communication problem between the brain (insula, probably) and the stomach and other organs & systems that tell a person to fuel up. Manage with scheduled meals and voila -- problem solved! Sounds so easy, huh? Well, sorta and sorta not.

  8. Laura, could I put another query out there along a similiar line? - this time regarding honesty when answering our children's questions. I know everyone's gut reaction will be that you need to answer your children's questions openly and honestly. But if we've already agreed that there may be something to this topic of planting ideas in their heads, then is it possible for parents to add to this problem by being too honest? - especially with those children we may already fear to be genetically predisposed to this (and especially if we are ansering questions about our own eating issues). This isn't something I've thought about before (my own children are still too young), so I would be really interested in hearing other people's thoughts on the topic.

  9. In the you-tube video: "Dana the 8 year old anorexic" the narrator says it's "body-image!"

    The little girl clearly articulates how she lost weight. When she's asked why she developed anorexia, she says that the adults couldn't figure it out.

    So it was just assumed that she has body image problems because she stopped eating.

    When I developed AN, it wasn't about body image. It was more about the high/buzz you feel when you don't eat. This is worded perfectly: "that malnourishment is a far more comfortable state for certain people"

    I even developed an ulcer because the feeling of satiety felt so wrong.

    The video is on you-tube. Do a search: "Dana, The 8 Year Old Anorexic Part 1/5"


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