Anorexia as an Extreme Form of Mind and Body Dualism - Case Study Example

Introduction Anorexia nervosa is an eating disorder that typically affects young women either in adolescence or young adulthood. It occurs more frequently in females as compared to males and has a higher incidence in Westernised countries. Gull (l873) and Lesque (l973) described anorexia nervosa in the latter part of the l9th Century. This disorder is characterised by abnormal eating behaviour, a morbid concern about body weight and a distorted perception of body size. According to the 1994 American Psychiatric Association (DSM-IV), the criteria for the diagnosis of anorexia nervosa includes: refusal to maintain minimal normal weight with body weight less than 85% of that expected for age and height, fear of becoming fat or gaining weight, disturbance in body weight and shape perceptions, absence of at least three normal non-drug induced consecutive menstrual cycles. The current International Classification of Diseases (ICD-10) states that though the condition occurs most commonly in adolescent girls and young women, adolescent boys and young men may also be affected rarely, as well as children approaching puberty and older women up to menopause. In extreme cases, bizarre eating patterns can lead to life-threatening medical conditions, which require hospitalisation. Anorexia is thought to be due to a complex interplay between psychological, biological, and socio-cultural causes. Mind/body Dualism Before the existence of the theory of dualism, it was considered that the mind and body were the same. This view was called monism, which proposes that behaviour is strictly a function of physical events. Typically, the physical events are associated with or are directly a function of brain activity. Boring (1950) suggested, "The chief function of the brain is thought, perhaps, or consciousness". Hence, behaviour could be considered a direct outcome primarily of brain activity. The doctrine of mind/body dualism was recognised since the time of Plato, but it was Rene Descartes (1596-1650) who reworked this concept of dualism into a form, which fitted to the times (Lowry et al., 1982). Philosophers subsequently referred this as Cartesian dualism. According to this theory, the mind and the body are two distinct entities. Descartes argues for his theory by saying that as he is a subject of conscious thought and experience, he thus, cannot be anything more than spatially extended matter. The mind cannot be material but must be non-material. This non-corporeal entity may be intimately associated with the body, but it is not itself a material entity as is the body. He further goes on to clarify how his mind and body are like. His body extends into space, is divisible and obeys the laws of physical science. In contrast, his mind is indivisible, does not extend into space and does not obey the laws of physical science. He says that he knows his mind and body in two different ways. He knows his body, just like he knows any other physical object – that is, as an object of his perceptions. This also means that this knowledge of his body is also subject to doubt, just like his other perceptions. He believes that he knows his mind, however, from ‘within’ and in a unique way. Most followers of this dualistic view hold that the purpose of the human mind (or soul) is to survive the annihilation of the body. The contrasting view, which is materialism, on the other hand, affirms that everything in our universe is composed of mass-energy, minds and bodies included (Serendip, n.d) However, having argued that the mind and body are separate, Descartes then raises the question, how does the mind and body interact? Many critics feel that this question can never be answered satisfactorily. The general argument being: how can the body, which obeys the laws of nature, affect the mind, which does not obey the laws of nature? And how could the body, as a physical thing, be affected by something, which is non-physical? Merleau-Ponty (1962) doubts Descartes by arguing that we do not relate to our body as to an external object. He says that moving some physical object is not the same as moving our body. The dominant view among academics is that of materialism or physicalism (Nash, 1999). But dualism is still a prevalent concept. In answer to his own query on the interaction of body and mind, Descartes put forward the theory of the mind-body interactionism (Lowry et al., 1982), which suggests, “both mental events and physical events exist and that causal interaction can and does occur between them”(Nash, 1999. p.374.) As Descartes says: It is not sufficient that the soul be lodged in the human body like a pilot in his ship, unless perhaps for the movement of its members. Rather, it needs to be joined and united with it more closely, in order that, in addition to any such motor-function, it may have sensations and appetites and thus constitute a true man ( Lowry et al., 1982:8). For example, physical events (like a blow to the body) can cause a mental event (pain) and a mental event (like fear) can cause a physical event (like shivering). Mind/body Dualism and Anorexia In Western countries, the mind/body dualism concept, where the body is seen as a separate entity from the mind, is widely prevalent. Bordo (1993) feels that eating disorders like anorexia, which are common in Western society, derive from the mind/body dualism concept and that anorexia nervosa and bulimia are “logical (if extreme), manifestations of anxieties and fantasies fostered by our culture” (p15) that looks up to the slender, fit body as a “mastery over bodily desires” (p15). Our society views slimmer people as more attractive, active or successful and fat people as lazy and lacking motivation. Those who are anorexic aim to gain ultimate control, and depriving oneself of food makes one a master of their own body, which creates a sense of purity and perfection. According to Bordo (1993) conditions like anorexia "develop out of the practice of femininity itself" (p180). The female is defined by society as a passive, primitive object, while the male is seen as an active, conscious, striving subject. Bordo (1988) describes anorexia as having three converging axes of continuity: The dualist axis, which involves experiencing the body as alien, as the enemy, and as a threat to control; the control axis, which allows subjugation of out-of-control hunger and the gender/power axis, which interprets the body as excess and creates anorexia as a subconscious protest against femininitys restrictions. Malson (1998) says that although anorectics seemingly are in control of food and body weight, they feel as a failure in all other aspects of life. Dualism provides the mind/self dissociation from the ‘bad body.’ However, when this dualism is not there, Malson says that “the self too becomes negative: hatred of the body becomes hatred of oneself”(p160). Garry & Pearsall (1996) say that anorectic women experience hunger as an alien invader with its own course and without any normal self-regulatory mechanisms. The body is experienced as alien and the soul as being trapped in this alien jail. They quote an anorectic woman as saying “I feel caught in my body” and “I am a prisoner in my body”(p 396). According to Garrett (1998) dualism implies domination and submission. Anorectics make an attempt to control the body with the mind. Garret feels that recovery from anorexia is a spiritual experience (which may not be necessarily a religious one), reconnecting the self with body, nature and society. Numerous biological and psychological causes have been proposed for the development of anorexia. Gunter&Wykes (2005) say that the “Two approaches encapsulate the separate sides of the mind/body dualism that seems to lie at the heart of understanding the condition”(Gunter & Wykes, 2005:23). Gromark (1999) sees anorexia as an example of unhealthy personhood, which is similar to canonical accounts of personhood with their stress on disembodiedness, unity, autonomy, transparent self-awareness, and rationality. Weiss (1999) raises a question as to how we can account for “distorted” body images as in the anorexic. Weiss feels “The answer cannot be reduced to the contradictions between her own body image and the perceptions of others”(p 99) nor can it be answered by social pressure. According to Weiss, the body image distortion “stem from its excessive coherence”(p 9). This coherence, according to Weiss, can only be maintained by the anorexic through their “disidentification with and repudiation of her own multiple body images”(p 9). Hangos (2001) considers the cognitive thought patterns in eating disorders, which includes catastrophising, inappropriate comparing and perfectionism. These have implications in the sexual life and mating of anorectics. Catastrophising is a cognitive symptom where one assesses their bodily state as being in an emergency condition. Hangos quotes Bordo that anorectics employ the inference that “If I make my body suffer, then I will purify my soul (my true self).” (p 261), which is a characteristic mind-body split in eating disorders. Inappropriate comparing is a cognitive symptom where there is an error in assessing “one’s mate value by comparison to some rivals”(p 262). The ‘rivals’ being other females who might compete for the mate. This may lead the anorexic to choose a mate with low value or decide to delay mating. Hangos says: Perfectionism is a cognitive symptom of error in assessing one’s mate value by framing one’s attractiveness and desirability as a deficiency according to a perfectionist standard, which could lead to an unacceptably low self-perceived mate value. (Hangos 2001:263) Socio-cultural Factors According to Brownell and Fairburn (1995) there is an inverse relationship between socio-economic status and weight. Women belonging to the upper socio-economic status are thinner than those in the lower socio-economic status. Also, there seem to be fewer black women with eating disorders. It has generally been considered that African American women are not afflicted by eating disorders because of the greater acceptance in their culture of fuller female figures. Black women have different concepts of what is beautiful than White women, and they have more realistic expectations of what men desire in terms of their body size (Lisa, 1998). Also in the media, a greater proportion of positive Black female body images are depicted (Demarest & Allen 2000). However, studies show that as Black women imbibe more values from the predominant White culture, they feel a greater pressure to diet and start exhibiting abnormal eating behaviour (Henriques et al, 1996). Bordo (1997) feels that a person’s experience of their body is never purely ‘natural’ but always mediated by culture. Bordo says, “Interpreting anorexia requires, not technical or professional expertise, but awareness of the many layers of cultural signification that are crystallized in the disorder” (Bordo 1993:67). However, dismissing or limiting the role of medical models as implied by Bordo could be dangerous, since it is to medicine that we should look upon and not culture when treating eating disorders. The craze for thinness derives from deeply embedded cultural standards that require women to be decorative (Bordo, 1993) and exemplify popular notions of femininity (Seid, R 1994). Bordo notes that in the Western culture "the obese and anorectic are disturbing partly because they embody resistance to cultural norms" (Bordo 1993: 203). Bordo also argues that the preoccupation with slimness in Western culture represents a rejection of femininity. Any excess amount of weight is taken to mean that the woman is lazy or careless regarding her body. Regarding this, Bordo comments: Our bodily ideals have become firmer and more contained (we worship not merely slimness but flablessness), any softness or bulge comes to be seen as unsightly-as disgusting, disorderly fat, which must be eliminated" (Bordo 1993: 57). Chernin (1983) also looks at the cultural pressures on women to achieve and maintain a single, attractive, socially approved body-shape. Gromark (1999) argues, that canonical Western philosophical notions like rationality, mind, body and personhood are embedded in contemporary Western culture. Gromark also feels that the Western society has a long tradition of measuring a woman’s worth by her physical appearance, and that contemporary ideals of slimness can be said to be based in a deeply embedded philosophical contempt for the body and in an association between women and bodies. In general, it can be said that the demographic distribution of eating disorders shows a pattern: they are more prevalent in relatively rich Western countries, and affect young White women, who are usually from middle-class backgrounds. It seems to impact differently on different minority ethnic groups. However, the exact role of sociocultural influences, which include country of residence, race, ethnicity, and acculturation in the development of anorexia nervosa as opposed to subclinical eating disturbance and body dissatisfaction, is as yet unclear (Wildes, Emery, & Simons, 2001). Social anxiety has been considered as a factor related to eating disorders, and shame is a primary symptom of social phobia and of social anxiety in general. One study (Grabhorn R, et al., 2005) focused on shame and social anxiety in anorexia and bulimia, as compared to other clinical disorders. The results showed that patients with anorexia and bulimia nervosa have higher scores in internalised global shame when compared with patients having anxiety disorders and depressions. This indicates that both shame and social anxiety are important factors in the development of these disorders. Bordo (1993) feels that the Western media conveys an impression that only slim people are attractive or morally worthy. Various advertisements in both the print and electronic media on health food, exercise machines, diet plans etc are targeted specifically on womens desire to control their weight and play on their sensitivity. Gordon notes that anorexia is widely publicised, glamorised, and to some extent romanticised by popular media (2000: 3). Hesse-Biber (1997) comments that it is the slim figure, which has come to represent health and beauty. This concept is increasingly being promoted by the beauty industry, pharmaceutical industry, and the food industry. This ‘Cult of Thinness’ has only served to generate tremendous profits for these industries. Tracing the concept of ideal beauty or figure in history, Hesse-Biber (1997) says “Since the 1960s, the ideal body type for women has become steadily more slimmer and less curvaceous than in the 1950s” (p.4). According to Holcombe (2004), in the 1800s, a plump body was considered as a beautiful body, but the Industrial Revolution and the rise of consumerism changed that concept. In the past 20 years, thinness appears to be coming to the forefront of beauty standards among women (McComb & Clopton 2002). Hesse-Biber also traces the mind/body dualism in Western culture, which places women in the role of the body, and men in the role of the mind, and makes a discovery that the Cult’s message is spreading to pre-teens, men and to ethnic and social classes that were previously untouched. Hesse-Biber gives intimate portrayals of young women suffering from anorexia who engage in eating habits that are not only self-destructive, but also similar to the obsessions and ritualistic behaviours found among members of cults. Increased exposure to Western media also seems to have influenced women in third-world countries. Eating disorders have been described in South Asian women (Littlewood R, 1995) and seem to be not just an incorporation of contemporary Western ideals of female morphology, “but a reassertion of an instrumental strategy of self-renunciation in situations of experienced constraint” (Littlewood R, 1995.) Although anorexia nervosa was first described in the West and felt to be rare or absent in Eastern cultures, in the past two decades, the occurrence of anorexia has increased worldwide. This could be attributed to changes in cultural norms, concepts of feminine beauty and an increasing inflow of Western values (Iancu I, et al., 1994). It was Ritenbaugh who defined conditions like eating disorders as a Western culture-bound syndrome (CBS). Lee (1996) reconsiders this concept and argues that anorexia nervosa, in its ‘culturally reconstructed fat phobic form’ is not restricted to Western countries and feels that it is found in many rapidly urbanising parts of the world, due to ‘the globalisation of fat phobia and diffusion of biomedical technology.’ Mother/daughter Relationship In addition to sociocultural factors, Chernin (1985) attempts to present a psychoanalytical model, and in particular, stresses on the mother/daughter relationship theory. Stresses and expectations put upon a daughter by her mother can lead to eating disorders. Young women, reject their mothers as role models, and indeed, the female identity itself in an obsession with becoming thin (Chernin, 1985). Chernin argues that the cause of anorexia can be traced back to the inadequate rite of passage from girlhood to motherhood. Chernin writes: For a woman to develop into her full womanhood, she must surmount the guilt that arises from her fantasy of having damaged the mother through the force of her oral aggression and rage (Chernin 1985:120). Chernin (1985) also sees eating disorders as an effective way for women to stop making a transition into the world. A woman separates herself from society and the pressures it puts upon her and feels that eating disorders can be viewed as the most widespread form of alienation from our own bodies. Other Causes Gordon (2000) feels that events that trigger eating disorders in adolescents can be any event that challenges their sense of independence and power, for example, a first relationship, loss of a friendship, loss of a family member, etc., rather than the typical stereotypical life altering events such as sexual or physical abuse. Lawrence M (2002) suggests that anorectic women have an intrusive object instated in their minds, which need not be the result of actual intrusions in external reality. Further, the psychopathology underlying certain cases of anorexia leads to a failure in symbolisation. According to Bruch (1978) anorexia is a reaction to the confusion of role demands women confront and the ambivalence about ones gender. Malson (1998) looks beyond the notion that societal norms of thinness and media influences are the root cause of anorexia and other eating disorders. Instead, she focuses on the meaning and construction of gender and body. Malson (1998) makes a strong argument for the uniqueness of thinness/anorexia for women, but however, does not discuss how this gendered construction may be affecting men/boys differently and increasingly in present society. Other risk factors for the development of anorexia nervosa are a family history of eating disorders, early childhood eating or digestive problems, body dissatisfaction, low self-esteem and a premorbid personality pattern of compliance, perfectionism, and dependence (Polivy & Herman, 2002) Evolutionary psychology is a relatively new discipline, which studies human behaviour from an evolutionary viewpoint. During human evolution it would not have been wise to always eat everything that is available, but rather, it would have been important to effectively ration during lean times and eat more during abundant periods. Thus, the capacity to starve would have been important for survival.  In addition, Crawford (n.d) feels that a million years ago, sexual harassment and fasting could have indirectly contributed to the reproductive success of some of our ancestors. Anorexia could have been one mechanism for adjusting womens reproduction to current and future reproductive conditions. The survival chances of women could have increased by being able to postpone reproduction in difficult times Rusca  (2003) provides an existentialist approach to anorexia nervosa. According to Rusca, in anorexia nervosa, the self attempts to refuse itself and invents another self, leading to a dissolution of the link between the self and the body. Conclusion Anorexia is a complex eating disorder with an interplay of various factors like biological, psychological and sociocultural factors. The mind/body dualism doctrine, which existed from the time of Plato was reconstructed by Descartes into what came to be popularly called as Cartesian dualism. Although this concept had its fair share of critics, this view is still prevalent with philosophers. One explanation for anorexia could be based on this mind-body split, which is commonly seen in anorectics. Anorectics make an attempt to control the body with the mind and some have a very detached view about hunger and eating, wilfully starving in order to “purify their souls.” The highly materialistic Western society has distorted views on slimness and beauty. The beauty, pharmaceutical and fashion industries have managed to portray through the media, false notions of feminity. Various subtle messages in our society remind us constantly that we are beautiful only if we fit into a certain definition of the word.  This pressure often results in heavy dieting or disordered eating.  However, the notion that eating disorders are confined to the Western world, no longer holds true. Anorexia is also being seen in developing countries and can no longer be considered as a Western culture-bound syndrome. ************************************************************************************************** References Becker, A (1995). Body, Self and Society: The View from Fiji. 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