Why Should You Care About Eating Disorders?

Why should you care about eating disorders? If you haven’t struggled with an eating disorder, don’t know know anyone who has, or don’t work with them, the conversation around advocacy and awareness may seem far removed from you. However, while eating disorders may not affect you in the same way if you are not as close to the issue, there is still a place in this conversation for you, reasons you might want to care, and a role to play. This is because the seemingly specific issue of eating disorders are part of much broader conversations we need to be having in our society around issues like mental health, reflection on our collective cultural values, and how hard life can be sometimes.

Mental Health for all

Mental health is something that affects us all. We may not all suffer from mental illness to be sure, but we ALL have mental health that needs taking care of. This seems like a straightforward sentiment, but a few simple comparisons between how we prioritize physical vs. mental health can quickly demonstrate how far we still have to go for the idea of mental health to be normalized.

Think of an annual physical check-up, this is a fairly expected thing (in an ideal healthcare system with a sufficient general practitioner to patient ratio…) The idea of a mental health check-up on the other hand sounds strange to us, but why should it?

What is “health” anyway? How do we define it? The World Health Organization has been defining it as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” since 1946. This is a broad definition, but it highlights the fact that there has been some understanding for some time that health is a broad and relative concept. Still, while this definition may be generally accepted and has been added to over the years, it is much harder to see this ideal of health and wellness being upheld in the current reality of many public and private healthcare systems. We are still struggling to provide holistic healthcare to people in our current system and there are negative consequences on patient and societal outcomes because of this.

Here’s John Green to tell you all about it:

Another example that illustrates the stark contrast we have between the attention we pay to physical health as compared to mental health can be seen in healthcare insurance and benefits coverage. Many workplace health insurance plans with extended coverage may cover things like podiatry, naturopathic medicine, and massage therapy, but are less likely to cover therapy or similar mental health treatment options. This is the case even in high stress jobs with high rates of burnout (e.g. healthcare professions, first responders, etc). Of course it comes back to legitimate questions of priorities and funding, etc. but it is something important to think about.

While we certainly have a ways to go there has been progress in our understanding of health and in the way we view and treat illnesses (physical or mental). In Canada alone there have been several influential reports developed through the years (such as the Lalonde report in the 1972, and the following Ottawa and Toronto Charters in the 1980s and early mid 2000s respectively.) In expanding our views of health we have begun to expand our views of healthcare and how we treat people in the healthcare system. Through the years we have shifted away from placing all emphasis on the biomedical model (which focuses on the physical processes of a disease, such as pathology, biochemistry, etc., but does not take into account the role of social factors or individual subjectivity.) Broader understandings of health (mental, psychological, social, and spiritual), the determinants of health beyond the individual (and thus the individual’s sole responsibility), ways of treating illness/disease, and the importance of health promotion have become more accepted and better utilized in healthcare. However, the biomedical model (and the subsequent focus on physical disease or infirmity) is still quite dominant in Western culture and medicine.

There are still steps for us to take and progress for us to make in our understanding of health: what constitutes health and how we best support people’s health in practice and policy. Mental health is still a conversation many of us are uncomfortable with. We think of it as weakness, we don’t accept emotional health as important, we imagine it is just a matter of willpower or simple choice to overcome depression, anxiety, or substance use. The truth of the matter is that it’s much more complicated and our mental health needs just as much tending to as any other aspect of our lives.

Cultural Values - Diet Culture, individualism, and gender roles

Not everyone struggles with an eating disorder, but I would argue that the majority of people will struggle with their relationship with food, exercise, health, and their body image in their lifetime. What is normalized in our culture is a disordered relationship with food and our bodies and because it’s normalized people don’t necessarily learn to question it.

The moralization of food (labeling foods as good or bad), struggles with body image, and the focus on thinness as the ideal (a mark of self-control, success, beauty, and happiness) - these are things that most people can relate to. It has become normal for people to spend their lives yo-yo dieting, hating themselves, and restricting their choices simply because they do not feel they can enjoy life until they are thin. This might currently be the norm, but it doesn’t have to be and people like Christy Harrison RD (FoodPsych podcast presenter) are putting their efforts into changing the current culture we have around food and our bodies.

Beyond our culture’s current obsession with thinness, Western society is a culture that highly values individualism and choice. There is nothing inherently wrong with valuing these things of course, there are just consequences we can observe in our society.

The focus on individualism and autonomy of choice lends itself to a society where we tend to lay blame on people for the limitations they encounter in life. It is a very right-wing political perspective, that we all start out equal and where we end up in life is a matter of the grit we possess as individuals. That’s a lovely idea, but it severely neglects social, political, and historical inequalities that we are not past (yet). We do not all start out on an equal playing field and the idea that any achievement is in our power is grossly inadequate. This is where we see things like poverty, substance use, and other mental health issues blamed on the individual and their choices, but it is not as simple as choice and we are not as free to make entirely uninfluenced choices as we might like to believe.

Another aspect of our current culture we can critically analyze and discover flaws within, is the way in which we view gender roles and the effect this has on people. In our society we have certain expectations of men and women and we tend to divide gender along these binary lines (i.e. we historically divide gender into the categories of male or female). We uphold certain expectations for these gender roles and expect members to appear and act in ways our culture has deemed appropriate; some of these expectations have led to things such as “toxic masculinity” which is what I would like to focus on in this entry as it lends itself to poor emotional intelligence, objectification of women, and other issues that may not (on the surface of things) seem relevant to the conversation of eating disorders in any way, but do have an important effect. It is important to note that toxic masculinity is not an insult to all that is masculine, it is merely an examination of certain fixed, stereotypical masculine features that are harmful to all genders (including men).

“In contemporary American and European culture, hegemonic [or “toxic”] masculinity serves as the standard upon which the "real man" is defined… Contemporary hegemonic masculinity is built on two legs, domination of women and a hierarchy of inter-male dominance. It is also shaped to a significant extent by the stigmatization of homosexuality. Hegemonic masculinity is the [stereotypical] notion of masculinity that shapes the socialization and aspirations of young males. Today’s hegemonic masculinity in the United States of America and Europe includes a high degree of ruthless competition, an inability to express emotions other than anger, an unwillingness to admit weakness or dependency, devaluation of women and all feminine attributes in men, homophobia, and so forth (Kupers, 2005).

How is any of this relevant to eating disorders? There are several important threads I want to pull out of this conversation:

1. The devaluation of women, the normalization of sexualized violence, and the objectification of women contributes to women’s lack of control over their own bodies and lives (whether directly experienced in terms of specific trauma or indirectly experienced through the constant objectification of women’s bodies as sexual objects). This idea of domination and stereotypical masculine representations also impacts male body image with men being expected to occupy physically domineering bodies. A lot of male eating disorder issues with body image, while similar in some ways to female issues, differ in terms of body image. There is much more focus on being “strong,” muscular, and being athletically inclined.

2. The disregard of the importance of emotions (especially for men). In Western society, emotional health and intelligence is not something we pay much attention to, especially for males. The idea is that we are supposed to be “in control” of our emotions and/or push them down when they surface. This lends itself to extremely poor insight, poor emotional health, and poor coping mechanisms when it comes to experiencing and processing our emotions. We can pretend they’re not there, but that does little to address the issues that emotions serve to signal us about. This is a common theme in eating disorders, this extreme discomfort in experiencing and appropriately dealing with emotions. The avoidance of emotions is a key reason people engage in eating disordered behaviours (and other behaviours aimed at escaping uncomfortable emotions). In our society is not seen as acceptable to talk about difficult emotions and this is especially true for men. The documentary “The Mask You Live In” is an excellent exploration of the harmful ways we expect boys and men to deal with their emotions, act in our culture, and how this influences poor mental health.

It is important to know there are different ways to think about things. Cultural values and norms are constantly in flux and we can see that in the way these have shifted over the centuries. It is within our power as consumers and citizens to continue to change the values and norms our culture holds.

About Food But Not About Food, About Weight But Not About Weight

People often confuse the idea that eating disorders are about food and about weight and these disorders are concerned with these things, but not solely. Food, weight, and an obsession with thinness is only part of a very complex picture. At their core, eating disorders are coping methods. People focus on food and weight and things they can control to deal with numerous other issues. These other issues may include co-morbid mental health issues (such as depression, anxiety disorders, personality disorders, etc.), histories of trauma, or other, more common life experiences (such as bullying, societal pressures, and day-to-day life stresses.)

The thing is, an eating disorder is an escape, it provides a means to avoid the responsibilities of the real world, an escape from the stresses we all experience in a capitalist society focused on production and consumption, the stresses of a day-to-day life and our lack of control over many aspects of it, as well as the existential dread that many experience wondering what our purpose is, what the meaning of life is, etc. Not everyone who experiences stress, a co-morbid mental health condition, trauma, or the pressure to be thin (that our society is currently obsessed with) will go on to develop an eating disorder. It takes the right combination or genetic and environmental influences to result in an eating disorder, but the point I want to emphasize here is that these conditions are not so unrelatable, they reflect the very human need for every single one of us to learn to cope with life and the hardship it can bring. Some of us learn healthy coping mechanisms, some of us learn to cope through other means such as substance use, workaholism, smoking, avoidance, gambling, etc. But the core of it is that everyone seeks relief and strives to cope in some way, the means are just different.

So while an eating disorder is a very specific experience, there are aspects of this issue that apply to us all. This conversation around eating disorders is also a conversation about the state of our world as it currently is, our collective cultural values, the importance of mental health, and the hardship that is life sometimes. It is a conversation about compassion that we are all a part of and that we all need to be having together.

- S. Ritchey

Shaely RitcheyComment