Friday, February 29, 2008

Anorexia Nervosa: a cult?

I have long recognised that Anorexia Nervosa is really only a symptom, like a headache, for which there is no “one-size-fits-all” cure.
In my book The Cockroach Catcher, I wrote:
“……It is probably too late as so many doctors and psychiatrists are brought up on empirical diagnosis that sheds little light on the sufferings of the individual. The more powerful the diagnosis is, the easier it is to ignore the person as an individual and not to take into account his life history that may have a strong bearing on his treatment…….In psychiatry, attempted suicide is not in itself a diagnosis and that is simple enough.
When we come to Anorexia Nervosa, psychiatrists are suddenly blinded. It is what I call a powerful diagnosis because it overshadows everything else…….”
In that Chapter, I went on to describe two girls, both severely anorectic. One suffered severe sexual abuse, and the other experienced the traumatic witnessing of her father’s death.
That is not to say that there is always underlying trauma.
Minuchin’s concept of the psychosomatic family (enmeshment, rigidity, over-protectiveness, and lack of conflict resolution) was both insightful and ground breaking at the time. However, it seems to be no longer fashionable or politically correct in the modern day no-blame culture. I do not have any argument with the no-blame approach, but it would not hurt psychiatrists to understand cases from Minuchin’s point of view without making a song and dance about it.
Sometimes modern parents give their children too much right and freedom for self determination.
In the chapter “SARS and Knowledge” of my book, I compared the freedom to starve oneself to that of not wearing a mask during the SARS outbreak in the endemic zones:
“…… If a child can be made to wear an uncomfortable mask, why can parents not make a child eat?...”
In matters concerning life or death, shouldn’t zero tolerance really be a no-brainer?

No doubt the promotion of zero size models by the fashion industry has managed to exert undue influence on some gullible teenagers and created a “cult” following. Have you not noticed how frightened some of the anorectics are of even the slightest touch of fat? How they panic when banned from exercising! There always seems to be a little voice in their head asking them to disobey their parents, nurses, psychiatrists and anyone who tells them that their belief is wrong. Like any cult rescue, someone needs to take over and the one taking over will take over the wrath of the new Anorexia god.
“It is not me who wants to eat, it is them.”
All those trying to help are on the “other side”
Yet, given time, there will be recovery for cult victims, at least for some.



2 comments:

Laura Collins said...

I'm not sure I can agree to the level of volitionality with anorexia.

There may be a cult, but isn't it the illness that makes one seek it out?

Anorexia isn't just the far range of vanity - it is as involuntary as schizophrenia once it has taken hold - and it takes hold with just a simple short diet for those with a genetic predisposition.

Am Ang Zhang said...

I am glad you raised the question of volitionality. I probably need to emphasize that I use the word “cult” for one good reason. My understanding is that no one voluntarily joins a cult. It is the cult’s brainwashing technique that induces unsuspecting followers to join and even to die.

Genetic predisposition has been used in medicine for as long as I can remember to explain why some people get ill and some people do not. I can only quote J. D. Bernal: ““There are two futures, the future of desire and the future of fate, and man's reason has never learnt to separate them.”