In diagnosing and treating eating disorders, we need to make sure to remain aware of how our Western culture can influence the way we think.
I’ve been reading “Crazy Like Us: The Globalization of the American Psyche,” by Ethan Watters, which highlights how the “American way” of understanding mental health has been exported around the world to other cultures. In Western society, we tend to present the symptoms associated with mental illness as universal, when in fact there are important cultural variations in the way mental illness is experienced and expressed. Treating the symptoms as universal often leads to less-informed treatment or care.
One of Watters’ chapters centers on anorexia and how one psychiatrist and researcher, Dr. Sing Lee, has traced the course of anorexia in China since the 1980s. In the ‘80s, the cases of anorexia that the UK-trained Dr. Lee saw were relatively rare and missing what we think of as the central feature of AN: a preoccupation with shape and weight. Instead, Dr. Lee’s patients described a lack of hunger and a pain somewhere in their body (often the stomach) that was preventing them from eating, even though the clients could recognize that they were desperately underweight and actually wanted to gain weight.
In 1994, things in China began to shift after a young woman collapsed in public and died shortly thereafter from complications from anorexia. Chinese media coverage included segments from Western clinicians about the signs of AN and how to recognize them, and teachers and doctors were provided with a similar explanation for what “causes” AN and how to treat it. Accordingly, there was a corresponding increase in the number of cases of AN and these new clients increasingly reported a preoccupation with shape and weight, to the point that it is now a frequent symptom of the illness in China.
As individuals living in a Western culture, people receiving treatments for eating disorders in America do not have the experience of another culture’s understanding of eating disorders shaping their lived experience. But the symptoms do tell us something about how Americans understand and experience distress and their bodies. This has implications for us as clinicians.
So my reading provoked some important questions:
- If symptoms are in part shaped by culture, how can I help my clients work towards and stay in recovery when our culture (and New York’s in particular!) is suffused with such a preoccupation with thinness, “clean eating” and extreme fitness?
- How do we navigate these realities in a culture that also encourages over-consumption of both food and alcohol?
- How can we help shape the culture within a treatment center such that it encourages our clients to focus on health rather than facilitate more illness?
Please come back for future blogs as I will share some thoughts in response to these questions.