Saturday, 18 April 2015

Skinny Minnies

I've blogged in the past about eating disorders, both my own experiences and my thoughts as a doctor. I don't claim to be an expert at all, but from a combination of personal experiences, talking to friends and acquaintances who have had similar difficulties and encountering many patients with eating disorders at work, I've built up my own ideas about eating disorders and have also tried to read around the area to expand my understanding.

I make no apology for the fact that the forthcoming post may be a bit angry and ranty. I'm cross, and it was my annoyance and crossness which lead me to write. On reading it, I also appear to have used an awful lot of brackets. For that, you can have a bit of an apology I suppose (but only a bit).

A few days ago, I was casually scrolling through my timeline on a well-known social media site, when I saw a post which an acquaintance of mine had apparently showed some kind of appreciation for. The headline was "These 12 Anorexic Girls Look Stunning After Beating Their Condition". This annoys me for several reasons. Firstly, "desperately sick people look much better when they aren't ill anymore" is stating the obvious and is yet another reflection of (modern? Or has humankind always been so inclined?) society's obsession with appearance. Secondly, and more importantly, it demonstrates and perpetuates a deep and serious misunderstanding of what eating disorders are. Pictures of terribly sick, skeletally thin young women next to pictures of them looking healthier with captions like "no woman should ever be as thin as she was in the first picture, she looks much better with some weight on her" show just how flawed a perception many people have of eating disorders. I also find the use of the term "beating" to describe recovering from an illness unhelpful, but I'll elaborate on that in a separate post.

Would people write an article entitled "This Girl Who Had Cancer Looks Great Now She's Off Chemo"? How about "Man With End-Stage Liver Disease Looks Gorgeous Post Transplant"? Or "Check Out How Fit These Ladies Are Now They're No Longer In ICU With Overwhelming Sepsis"? I like to think not, unless the people in question were celebrities, in which case no doubt the first thing we're supposed to noticed when someone's been incredibly ill is whether their weight has changed or if they've got the energy to still do their hair nicely. But I digress.

What upset me most about this articles was that it perpetuates the myth that eating disorders are solely about how people look. The premise of the article appears to be "overly skinny is not hot". Now, whilst I have no problem with promoting a range of body shapes as attractive (although frankly I do wish we could all shut up about appearance), the suggestion that people (not just girls - they affect both genders and all ages) with eating disorders are driven purely by a desire to be as thin as possible is just wrong. Eating disorders are complex. Patients with eating disorders are diverse. Trying to suggest that all eating disorders occur because a person wants to be skinny is as wrong and as damaging as suggesting that all cancers are caused by excessive alcohol intake - both illnesses occur due to a variety of factors. In some cases, one of those factors may be a desire for thinness/excessive alcohol consumption, but this is only one of a number of elements which co-exist and allow the disease to develop. In some patients, this factor will be completely absent.

Now feels like a good opportunity to link to a post my lovely friend Jo wrote about her experiences of an eating disorder. Another helpful post is this one, from the website of Mind - a mental health charity. Their website has some useful information on eating disorders which may help anyone who either has an eating disorder or is supporting a friend or family member with one. As all these links stress, eating disorders are often about control and dealing with difficult situations and not just a vain desire to look thin.

This blog is explicitly about eating disorders, but more generally it's about the lack of parity of esteem between "physical" and "mental" health conditions. I use the inverted commas because personally I believe the terms create a false dichotomy. Physical conditions may well be worsened by emotions - we all know people who get more migraines when the pressure piles up, and there's now evidence that adverse events during childhood may play a role in the development of diabetes. The way our feelings and emotions affect our health is something we are only just beginning to understand. In the meantime, if we could all aim to be a bit more understanding and not jump to conclusions about people just because they have a particular diagnosis, the world may well be a brighter place. And if you're writing a headline about a "mental" illness, think about how it would look if you replaced it with a "physical" one. If it sounds voyeuristic, shocking or offensive, chances are you're best not using it.

P.S. I googled  "These 12 Girls With Cancer Look Stunning After Beating Their Condition". Surprisingly, noone's written that article.