August 29, 2013

Sloppy language

Yesterday I had one of those moments of clarity that, interestingly enough, came while reading about memory loss. My mind has been Swiss cheese lately so the topic of memory drew me in to this piece on differentiating age-related memory loss from Alzheimer's.


It struck me that this is exactly analogous to my issues with conflating disordered eating with Eating Disorders. By putting both DE and ED in the same basket and then just stringing it along a spectrum we lose sight of what I believe to be true: that we are looking at different things altogether.

Memory issues can be caused by age-related decline, brain damage, Alzheimer's, and other dementias. Understanding ANY of those issues means parsing them out. Treatments would not be expected to be the same, and part of the diagnostic process has to include parsing them.

Same with eating disorders. Although individual PEOPLE may present symptoms along a spectrum of disordered eating we should not assume that all of those people have eating disorders, nor would all people with eating disorders present with certain levels of disordered eating.

Figuring out which patients have age-related memory issues and Alzheimer's offers great hope for treating both - appropriately. We are going to need to do the same thing with eating disorders.

Language, and diagnosis, matter.

3 comments:

  1. I hate to admit this b/c I feel so "in sync" with you in other areas.... so I hate to admit that I've never followed you when it comes to distinguishing b/w DE and ED ...... until now! This is the first time I've "heard" you talk about this where I follow what you mean! And, yes, I think it has big treatment implications. And I think DE causes suffering and deserves help, but it might be different help than ED help... [btw, just reflecting, i think the reason I never understood you before was b/c I was still sick before and so I reading everything as "I just have DE and not a real ED and therefore I don't deserve treatment," which of course is not what you were saying - that was just my ED filter. I now have no doubt I had an ED. I also have no doubt that you don't mean people with DE don't deserve help to experience something better!]

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    1. PS have I mentioned how over the moon I am that you are well? What a wonderful, heroic, courageous woman you are.

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  2. L, I can't tell you how much that means to me. I know part of the reason we all tussle over this is just what you describe: a mistaken idea that we're ranking the issues and judging. For others it is a very strong identification with the suffering of both DE and ED that makes any parsing seem cruel and irrelevant.

    But part of it is intellectual. This is a difficult concept for many of us. It certainly was for me. I had the advantage of a EUREKA moment when I realized we had not just gone over a line but we were looking at something entirely different. It was the same person and the same symptoms but reframed - and this made an enormous difference in our response. Because our frame had changed we also had a LOT of practice parsing it.

    I have a strong sense that DE outside the context of mental illness will respond differently to intervention and that is good: all the body image work and self-esteem stuff and media literacy and all that are important and can do real good for all of us.

    But if we continue to treat mental illness this way we risk blaming the patients for their thoughts and feelings that are NOT rooted in experience but rather are pre-programmed to a large degree and un-amenable to external messages.

    I think most people are doing this with OCD, for example. We no longer look to the symptoms as a way to understand the patient's true will and desires. We know the person isn't really more attuned to the need for pictures to be at 90 degree angles and hands to be washed. We know the symptoms are a sign of a brain in a lock and we understand the suffering better. We don't treat OCDs by telling people they just shouldn't care so much about symetry or hygiene or whateever social value their brain has locked on.

    It is more of a sign of our disordered society around appearance and food that we conflate ED and DE than it is of those struggling with them. If we as a society were more reasonable and balanced it would be clearer when someone's symptoms were a sign of the suffering of mental illness and when it is learned or chosen behavior.

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