The Social Contagion of Eating Disorders

The canon of Western philosophy can be summed up in one sentence: in the end we are all alone. From that first self-aware moment, the first realization we all are going to die, this truism seeps into the zeitgeist of our humanity to become the one balm to ease our panic. But how true is it really now? With the unlimited ways of staying in touch, can anyone feel alone in this day and age? The existential crisis of modern life pits the alone hypothesis against our growing interconnectivity. It all leaves me hopelessly confused. What I do know is that the study of human social systems and group dynamics makes the isolated philosopher a dated creature. The age-old academic stance on the human condition needs an update.

I'm aware that this is clearly a big leap for a psychiatrist. But when it comes to understanding how eating disorders have spread like wildfire, the logic of this post will become clear.

The first point of business is to reconcile the isolated individual with the breadth of humanity. Until recently, any one person's world remained fixed and small. No one could easily travel or keep in touch with the world around them. A life was led in a small geographical area amongst family, friends and neighbors. The larger scope of humankind was a heady concept, an abstraction in need of a theoretical framework. Instead, the nature of pre-industrialized civilization led inward. Living a relatively isolated life, the intellectual focus was on our individual existence and the inherent loneliness of experiencing the world behind the filter of the mind. The juxtaposition between the unique human gift of self-awareness and the universal prison of our own minds occupied the best and brightest minds for centuries. The result is a compendium of philosophical transcendental and religious treatises that solve nothing and ignore a basic, equally important fact of being human.

We have conquered the world through sheer mass and numbers. Our consciousness and self-awareness distinguish us from other animals, but let's not fool ourselves. The sophistication of our individual minds is only as powerful as the community, society or nation we belong to. The lone peacock may spread its plume to attract a mate, but no one cares unless the peacock clan survives. The brain development and capability of humans matter only because the complex social forces--no different from the lion or elephant herds--shaped history as it did. The philosophical truism, enlightening as it is, missed the forest for the trees. To ignore the magnitude of social forces in our own daily lives is akin to the blind spot in anorexia: you can't survive without food.

The social forces behind the eating disorder epidemic are incontrovertible. No one in this country can ignore the mass media pressure for thinness and weight loss. For each eating disorder recovery forum, there is a website schooling the budding anorexic in how to lose weight faster, or the bulimic in purging tips. Even mainstream eating disorder programs, clearly intent on promoting recovery, have to clamp down on underground education for the new generation of anorexics and bulimics. An ambivalent group of patients without clear guidance is as likely to egg each other into illness as into recovery. And the conflicting, powerful forces proceed unabated.

But recognizing the social forces at work in the proliferation of eating disorders only scratches the surface. It is the precious few who still read and follow any guidance from philosophers. We may be trapped in the human condition but are too distracted by the interconnected world to care anymore. In the modern era, it's hard to find a spare minute to reflect on our individual fate. Each moment is steeped in the enormity of the broad scope of humanity and reinforces our small place in that vibrant mass of life. The overarching mantra of the modern era has left behind internal reflection and instead revolves around the philosophy of food and weight. The combination of willpower with the right number on the scale equals salvation. The burden is off the lone philosopher charged with explicating our suffering. Now philosophy 101 is taught in the mass media and celebrated in pop culture. The slow, inevitable reach of distorted food thoughts can feel like our modern-day consumption. Just instead of the image of the philosopher coughing incessantly and wasting away, we all starve, and suffer the consequences.

The obvious examples of the disordered eating contagion abound, but one less obvious choice is the severe calorie restriction movement. I remember vividly the blinding media coverage of the starving rats in the mid-1980's. In a quick summary, rats fed half the normal rodent diet lived significantly longer than their unstarved brethren. In an interesting turn of events, starvation as an elixir of youth and longevity was too tempting an offer for an already deprived society to refuse. No one seemed to feel sorry for the poor, listless creatures. Instead, everyone marveled at the extraordinary discovery. The lure of a guaranteed century of life, no matter how miserable, hungry and food-obsessed it might be, was like a carrot to a bunny. And carrots, along with other vegetables and fruit, are the mainstay of a calorie restrictor's diet. How else to survive on such a paltry sustenance? The steps from lab discovery to philosophical movement to an eating disorder aren't hard to follow. We have all seen it before from Weight Watchers and Atkins to Bariatric surgery.

The real concern is that antibiotics might have eliminated consumption but it's much less obvious what will make us eat again. Stay tuned for the next post.

Let Freedom Ring

Life, liberty and happiness are three fundamental rights borne out of the creation of this country. The meanings of liberty to a society over almost three hundred years fluctuate wildly. Initially as an escape for the oppressed and the pioneers, America stamped its reputation as the land of the free. In later years, immigration and the lure of the American dream bespoke the reality that all classes could aspire to success and wealth. The hypocrisy of a long history of slavery and oppression of women finally amounted to the civil rights and feminist movements and culminated recently in a hotly contested primary between an African American man and a woman. In one sense, freedom clearly still reigns.

But to the individual, the fundamental American right is much less clear. Class distinction, based largely on socioeconomic and racial differences, is growing. The disparity between the rich and the poor has widened exponentially. Educational opportunities for the lower classes have all but disappeared. Perhaps for the first time, this country is divided into the haves and the have-nots. We all may be grateful for the individual freedom to speak our minds and for our human rights, neither to be taken for granted, but too many people are trapped, their freedom not even an afterthought. Either the fortunate buckle under the pressure to be in the haves or the less fortunate wallow in the despair of never having. One pressure is usually applied by knowing, desperate parents hoping to push their children towards success, the second by hopeless, desperate parents who know of no escape. The freedom of the individual, one pillar of American life, is more a relic of the past. 

Children can sense the futility of a predetermined life. Even the wealthy, a class known to produce children with eating disorders, suffer this fate. A child with means, who knows she will always get what she wants, has nothing to drive her, nothing to prove. The unusual child with preternatural internal motivation might find her way, but the bulk of these children of means live the lives set by their parents and find identity through other means, a scenario that can easily produce an eating disorder. The message is clear. Your life is set by your place in birth and the freedom to move within society largely relegated to distant memory.

There is a glimmer of hope: the philanthropy aimed at improving a broken education system; the technology opening new avenues in staid industries; the growing backlash against the food industry; and a president who represents hope and change. These all foreshadow a piece of society interested in bringing freedom back in future generations but with little sense of how to do so.

What is so often overlooked is that personal freedom doesn't exist in a vacuum. American idealism grew out of a loosely structured but firm Constitution open to interpretation but upheld as the truth. Different legal schools of thought vary widely, some may be controversial, but all point to this document as the American bible. It is a miracle that an entire nation can accept a political compromise as a guide to good living almost 250 years later. And that bible makes clear that freedom is a high priority.

But freedom in and of itself is not what works; freedom within a clear-cut structure is the lesson to be learned. The American dream grew not only in a land of endless opportunity but in a land of endless rules. Granted, those rules largely proclaimed individual freedoms, but a national proclamation of freedom is much more than good intentions. Instead, the message reads like good parenting advice: follow the basic rules, then you can do whatever you like.

Backed by American history, this philosophy works. The freedom of the individual, the wild successes of the high-minded entrepreneur, the social-minded activist and the idealistic politician have in turn molded the innovation, individuality and liberty grounding this country. As the rules break down so goes individual freedom. Class and money now open unlimited opportunity while the growing masses see no way out except the mind-numbing path of materialism and commercialism. The nascent but obdurate class system may just cut off individual freedom at its knees. The new generation is getting the hint. Good grades, extracurricular passions and an entree into elite education don't replace the wide open American life. Individual liberty trumps the class system, even if you're on top. The young deeply feel a sense that they are missing something. The momentary high of an eating disordered identity is like a new generation getting stoned together. It's an adolescent solution to an insoluble problem. But on an individual level, letting freedom ring can open the door back to opportunity. With generations of experience with individual liberty, the land of the free, it isn't like this society needs to remake the world. Going back to basics will suffice, and hopefully make it easier for everyone to eat again.

Just the other day, I was asking a colleague a question about my child, just to surmise what the future might bring. She sensed my trepidation, even anxiety, and quickly interpreted it in her own way: what might happen to my child? Could this snowball into a life of failure? But her way of assuaging my fear was all too telling. She said, "I have known children like your daughter who have gone to Brown, some even to Princeton and Harvard." And then life is set, all worries forgotten? The path is clear? Life's satisfaction as simple as an Ivy league degree? All I could think was that we have surely lost our way. There is nothing sacred to grasp onto when the future is unclear. That philosophy will be the ruin of this country. Contrary to current popular belief, peace of mind comes in a moment when all is not lost, when opportunity lies ahead and when, above all, freedom to aspire, to dream and to live fully remains within our grasp.

The next post will switch to a new topic: the role of social contagion in the spread eating disorders and disordered eating.

Beware of our Good Fortune

Many people in this country are fortunate enough to spend their days searching for happiness, rather than eking out survival. History points to aristocracies with such luxury but never the better part of an entire society. Not until the advent of clean water, abundant food and antibiotics have the lower classes been able to take daily survival for granted. Although we can agree that hunger and poverty still ravage many, at least here that is no longer the norm.

While the comfortable aristocrats focused on education, breeding and power, with a few directed to ascertain the meaning of life, the bulging middle class now has ample security, and practically a national obligation, to pursue happiness as a birthright. As a national phenomenon, happiness can mean many things: professional success, financial security, family, but many if not most people are still perplexed by this newfound freedom. In addition, outside forces can manipulate the extra leisure time and lack of direction to turn happiness into entertainment or materialism and precipitate a descent into a deeply felt meaninglessness, something easily mistaken as depression. The residual memory of a parent or even grandparent who struggled to survive can temper the fall into complacency, but at some point, in some generation, a child far removed from these fears will think we all do have it easy. Who can ignore how available everything is in this country? With that safety net in place, any child taking in the surroundings will know life is good. In fact, any child will believe we can control anything we want. Living well is most clear at the mundane miracle of your local supermarket: everything is available all the time. Just pick what you'd like.

It just feels like we haven't wrapped our minds around the idea that we all have it so good. There are countries in the world with illness and lifespan data unchanged from a century ago. To think that we all now expect to live twice as long as our forbears, and with good health to boot, is an astounding shift in a moment in time. Entertainment, capitalism and the food industry may fill our time and minds. Many smart people devise ways for us to while away our luxurious lives comfortably, if mindlessly. But I'm not sure who is truly thinking about our well-being. What in the world should we be doing with ourselves?

The answer seems to lie in future generations. It is unnerving to see small children, barely out of diapers, nonchalantly using a computer (more adeptly than their grandparents no doubt), turning on the TV or unlocking screen after screen on Angry Birds. It's just as disconcerting to see these same children shamelessly manipulate their parents in public, and succeed. Without the pressure or instinct that comes with the struggle to survive, young children can live with their enthusiasm and drive to pursue pleasure unbound. With only parents' willpower between them and the proverbial candy, children are overwhelmingly successful in their endeavors. Honestly, when do these kids not get what they want?

However, the freedom to get anything you want isn't equal to the freedom to be whoever you want to be. Parents raised in a world of security have since learned that adulthood doesn't come with guarantees and place the onus of vicarious success onto the next generation. Increasingly desperate parents, now egged on by sanctioned professional opinions, think they have found the answer: flood children with endless encouragement. What happens when the comments like "good job" and "you're so smart" are a dime a dozen to a growing child? Success, accomplishment and praise become the only way to understand the world; pleasing parents the sole purpose. Although survival may be a birthright, academic, professional and personal success are not. Just because the middle class can take food (even organic, pesticide-free), shelter (one room per kid) and clothes (the latest fashion, of course) for granted doesn't mean success comes along with it. Some people work hard their whole lives and don't get far. Others just get lucky.

So children are very much expected to fill the void. They live as scheduled a life as their parents. Their future goals are lined up long before they can even tell time: the right schools, the right people, the family expectations. What's so scary about letting those children run free? What's going to happen if they fritter away some time in the afternoon after school? The obvious answer is that they will fall behind. In the endless rat race, each kid always has to be caught up or even ahead. If you're left behind, you'll be lost forever. But in the lost freedom to think and explore, to wonder and question, lies true answers. Who can better figure out what to do with all the extra time? Imagination is the essence of childhood. The answer may lie in creative play.

I don't mean to say one generation of children left to run free will magically solve the pointlessness of our miraculous longevity. Parents clamping down on childhood to absorb their own doubts, failures and excess healthy years isn't helping either. The rampant disordered eating and eating disorders certainly can attest to that. The complacency, if anything, heralds the slow descent of a nation from its most glorious moments. If parents attend to their own failures and frustrations, children can be left to focus on their struggles and be free to learn both how to succeed and how to fail. And hopefully to learn to have compassion for the uncertainty of life ahead, no matter how long and healthy it might be. The general idea is that a more realistic, freer experience of childhood allows the child to gradually see the human condition for what it is and not become trapped in an artificial world they are supposed to save. Undoubtedly, placing the weight of the world on young shoulders collapses the true order of the world. The young need to contribute but also need to be free to forge new, uncharted paths ahead. They are much more likely to find ways to constructively fill all this extra time. The undue, poorly timed pressure leads instead to childlike solutions, like eating disorders.

There is no question that a laissez-faire approach to rearing children can feel anachronistic, like a proto-hippie backlash. Freedom needs to mean something else. Children crave structure and order, in large part to have rules to break. So if the rise in disordered eating stems from a desire for order, why would freedom lower this need? Look for the next post.