Anorexia

In the mid-nineteenth century successful Western businessmen and politicians “tummy bulged.” Their relative obesity in societies in which the scourge of potential famine had only relatively recently been overcome was a sign of their high status and social success. Eating disorders were relatively rare then. They have now become much more common and are quite possibly increasing in the developed countries where there is relatively ample food. Only in countries where there is ample food can there be a cultural fashion for thinness.

Almost all women everywhere are concerned with being attractive within the terms of their cultures and in Western cultures now almost all women are self-conscious about their weight. Most believe themselves to be overweight and the diet industry is enormous.A survey of 5,000 women in the UK by Real magazine published in November 2002 has some rather depressing statistics. 91% of women were unhappy with their hips and thighs and 60% were depressed by their body image. 84% of those who were normal weight wished they were lighter. Only 3% of women were happy with their bodies. However, anorexia nervosa is a serious mental health disorder which is characterised by an exaggerated preoccupation with the appearance of the body. It can be considered a disorder of beauty in that the sufferer believes, despite all evidence to the contrary, that he or she is too fat and therefore unattractive. The anorexic wishes to be thinner. The disorder is typically characterised by a refusal to attain or maintain a normal body weight (body weight of less than 85% of the norm). There is a terror of becoming fat or gaining weight. In girls and women menstruation is not attained at an appropriate age or ceases (amenorrhoea). It has one of the highest mortality rates of all mental disorders with a long term mortality of over 10%.

The first medical case history was published in 1689 by Richard Morton. It was named in the 1868 by Sir William Gull and the name means “nervous loss of appetite” but actually loss of appetite is rare. It has more to do with control of appetite and therefore with self-control. The anorexic is preoccupied with their appearance and body image. While there are male anorexics, and the incidence of male anorexics may be increasing, most anorexics are female. She will wear baggy clothes to both hide fat, and in a curious paradox, hide the signs of emaciation from others and to stay warm. She might spend a lot of time in front of a mirror inspecting the different parts of her body particularly those which have some significance for female reproduction, sexuality, and the nurturing of children-the breasts, the hips, the thighs, the stomach and the buttocks.

Venus of Willendorf

In our ancestral past the food supply would not have been constant-there were no 24 hour supermarkets or Internet food delivery services to the door. Our ancestors were hunter-gatherers for hundreds of thousands of years and our bodies evolved in adaptation to that lifestyle and those environmental conditions in which the availability of food varied. Primitive agriculture only began about 10,000 years ago and that is a small fraction (.16%-not even one per cent-check our maths! 10,000 is only 1% of 1,000,000) of the 6,000,000 years that humans have been evolving. Anatomically modern human bodies have only been around for about 150,000 years (about 2.5% of the time). Bodies which could not cope with periods of relative scarcity and abundance did not survive to pass on their genes. It would have been adaptive in days gone by to binge eat when food was available and for as much of that food as possible to have been stored in the body.

Especially those foods which were sweet, fat, or salty tasting. Women, in particular, need to have bodies which are capable of storing up food reserves as fat in order to be able to feed their children. It would also have been¬†adaptive to develop mechanisms to be able to control the body in the absence of food and to control the appetite. In anorexia some of these evolved mechanisms have clearly gone awry. The photo is of the Venus of Willendorf, a prehistoric ‘Venus’ about 30,000 years old. The exact meanings of this and the many other ‘Venus’ figurines of prehistoric Europe has been a matter of considerable debate among archaeologists but, if it represents some kind of feminine ideal of prehistoric European hunter-gatherer societies, it is a vastly different feminine ideal than that of today’s world.

Anyone involved in treating anorexics soon becomes aware of the contradiction of potentially beautiful young girls, who while denying their actual beauty, pursue an ideal of beauty and often end up emaciated and extremely unattractive. In cultures in which food is scarce then obesity symbolizes high social rank and access to resources. When food is readily available and anyone can be fat, then to be thin can symbolize high social status. It signifies self-control. These days even 6-9 year olds in western cultures are concerned about their weight and shape. Immigrants to western societies do not themselves develop eating disorders but their daughters do. There is no single cause of anorexia but rather it is caused by a combination of factors including genetic, biological, family, individual and social/cultural. Evidence for the social/cultural causation can be seen in that here are relatively few anorexics in a culture in which most people do not get enough to eat.

Karen Carpenter

In 1983 the singer Karen Carpenter died at age of 32 from anorexia nervosa. This brought eating disorders to America’s attention. In 1987 the average model weighed 23 percent less than the average American woman and by the 1990s five million American women were suffering from eating disorders.

The fashion industry doesn’t cause eating disorders in young women. Glamorous images of thin models reflect something else which is going on. All of us have genes which seek to reproduce themselves-it is built into our psychologies. Status means access to resources like food and mating opportunities. There is an inherent psychological preference for status because, in our ancestral past, higher status meant better chances of survival as it usually meant greater access to resources and greater comforts. This, of course, is still true today in many parts of the world. In the Western world where there is a surplus of food to aspire to be thin is associated with aspiring to higher status. The tragic paradox is that the aspiration to be thin, when over exaggerated as in anorexia, carries with it a significant risk of other health problems or, in extreme cases, mortality.

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