Medicalization of Anorexia

Medicalization

Medicalization can be defined as the process of treating a human social condition as a medical condition. It is a concept that has been around for many years, originating in 1973 by Ivan Illich. He was the first to associate every day life patterns as medical conditions. For example, Illich described the low level of tolerance to sadness as a medical condition that we now diagnose as depression. Similarly, and within the same time frame, Foucault (1976) stressed that a doctor's duties include the ability to differentiate what is considered normal and what is pathological [1].

What is Anorexia?

Anorexia, or anorexia nervosa, is an emotional eating disorder whereby an individual refuses to intake food due to an obsessive urge to lose weight [2]. Simply put, it is the tendency of self-starvation. This condition is extremely dangerous for one's health, resulting in malnutrition, vulnerability to infections, osteoporosis, dehydration, and potentially death. In fact, anorexia nervosa has the highest death rate of all psychiatric disorders, some resulting from a higher risk of suicide . Those suffering from the anorexia have an extremely low body weight compared to their height and body type. They often accomplish this low body weight with abnormal eating patterns and minimal consumption. However, they often believe they are much heavier than they appear due to a skewed obsession with a thin figure.

Types of Anorexia

There are two major common types of anorexia: Binge/Purge and Restrictive [3]. Both exhibit the same symptoms including fear of gaining weight and abnormal consumption patterns.

Binge/Purge Type

This type of anorexia revolves around the individual purging after eating. Typically, the patient will intake a large portion of food after long periods of not eating, which initially boosts their mood from the sugar. Purging is often done via vomiting, excessive exercise, or laxative abuse. These methods attempt to override the individual's guilt of consuming food, which follows shortly after the boost in mood, and ensures no weight is gained. Once the guilt is in full-force, they binge again to feel better, re-entering the dangerous cycle [4].

Restrictive Type

Restrictive anorexia requires extreme self-discipline from the patient, as the individual restricts his/herself from calorie intake. They refuse to eat food in quantity, food of fat or sugar, and food of high calories. This minimal form of consumption acts as a starvation method to significantly reduce body weight past the normal threshold. Those with restrictive anorexia (and anorexia in general) typically suffer from a low self-esteem and low self-worth. The patient feels as if everything is out of their control, that is, except what they eat. However, once the obsession becomes irreversible, the control becomes that of the disorder, not the individual [5].

Perspectives on Causes of Anorexia

Anorexia nervosa is subject to many different perspectives, including biological, psychological, and socio-cultural. Below are two major themes of beliefs surrounding the underlying causes of anorexia.

Contemporary & Medical

The medical perspective of anorexia originally stemmed from Gull (1868, 1874), who defined anorexia as a result of hysterical tendencies. While that definition is outdated, the idea that anorexia is a self-inflicted condition is still a prominent psychiatric perspective. In 1992, Fleming and Szmukler released a study that described anorexia patients as responsible for developing their condition. It is believed that the patients are to blame for maintaining their condition through actions like purging and restriction. This highlights the need for therapeutic and psychological treatment, given the individual's personal desire to starve.

Cultural & Feminist

There are many literature pieces that outline society and culture as a large causal factor of anorexia. This is a social constructionist view, as it places emphasis on social norms as a blaming factor of some human conditions. This perspective attempts to object the contemporary view of anorexia as being self-inflicted, and rather focuses on the pressures of Western socio-cultural norms. Giddens (1991) turns to developed societies as a major cause of anorexia, as trends such as dieting and body management have become increasingly popular. He recognizes the higher expectations of females to be physically attractive, thus encouraging women to pursue unhealthy eating habits.

Similarly, feminist groups despise the medical perspectives of anorexia, and instead advocate in favour of gender inequalities triggering the condition. Feminists believe women share the same difficulties caused by gaps in gender equality, an example of this being the resulting eating disorder. Bordo (2003) explains the role of the media as a large contributor to anorexia, as females are often portrayed as glamourized and thin. This equates to societies norms of how a woman should appear, which influences women to achieve this body image to communicate self-worth and status.

Treatment

Treatment has been found to be most effective when implemented early on. However, due to difference in sexuality, culture, religion, beliefs, ethnicity, gender, and age, many anorexia patients are not reported. A study in 2006 found individuals of colour were less likely to be diagnosed and therefore treated. Some religions discourage the reporting of anorexia due to the shame of being identified as mentally ill. Similarly, there are some cultures, for example Muslim, that encourage abnormal eating habits such as fasting. Individuals, namely men, who identify as gay or bisexual are a lot more likely to admit to binge/purge anorexia. Nonetheless, once a patient is diagnosed, there are three components to treatment: medical, nutritional, and therapy [6].

Medical

Many of the symptoms of anorexia nervosa include serious health issues that need to be tended to. These include, but are not limited to, malnutrition, an imbalance of electrolytes, amenorrhea, and unstable heart rhythms [7].

Nutritional

Once health issues have been addressed, the patient will need treatment to reverse the physical affects of their anorexia. This includes the restoration of weight, a well-monitored meal plan, as well as extensive communication regarding healthy consumption patterns [8].

Therapy

As aforementioned, anorexia can stem from a individual's lack of self-worth and self-esteem, thus treatment must also target personal psychology. The root cause of the condition must be healed for full recovery, which can be done by addressing internal problems and focusing on better coping strategies [9].

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353591/
2. Illich I. Limits to Medicine – Medical Nemesis: The Expropriation of Health. London: Marion Boyars Publisher Ltd; 1973.
3. Foucault M. Crisis de un modelo en la medicina?. Revista centroamericana de Ciencias de la Salud. 1976;3:202–19.
4. https://www.eatingdisorderhope.com/information/anorexia
5. Misra, M., Shulman, D., & Weiss, A. (2013). anorexia. The Journal of Clinical Endocrinology & Metabolism, 98(5), 35A-36A. 10.1210/jcem.98.5.zeg35a
6. http://eprints.nottingham.ac.uk/28065/1/606295.pdf
7. http://www.seedeatingdisorders.org.uk/page/what-is-anorexia-binge-eating
8. http://www.seedeatingdisorders.org.uk/page/what-is-anorexia
9. Hepworth, Julie. The Social Construction of Anorexia Nervosa. SAGE Publications Ltd, 1999.
10. https://www.eatingdisorderhope.com/blog/intersectionality-ed-treatment
11. https://www.medicinenet.com/amenorrhea/article.htm