Shame and Our Bodies in Modern Culture

The shame many people experience about weight and body is a crushing burden. They live their lives with the unwavering belief that their body is unhealthy, unattractive and unlovable. They interact with others always feeling less valuable. These thoughts plague them every minute of every day.

In most posts in this blog, I write about body shame with respect to people with eating disorders. That feeling is central to the hold eating disorders have on a person’s life.

The shame people with eating disorders feel is often shared by others. Women and men, young and old, people of all different sizes experience enormous shame about themselves embodied by their physical being.

Recent posts highlight the fine line between an eating disorder and a body lauded by society. The external validation or vilification doesn’t always affect the internal experience people have about their body. Shame often exists no matter how the world reacts to one’s body.

To be clear, I don’t mean to compare the extreme hatred people with eating disorders can feel about their body with the more common pervasive shame. However, discussing widespread shame makes it easier to explain how common self-hatred is.

Our physical selves represent what we show to the world. Without knowledge of the other person, people can assess, judge, criticize or praise anyone’s body.

Our culture now and for many decades values thinness over almost anything. Thinness represents success and diligence, willpower and determination, financial means and the luxury of time and attention to oneself. Thinness is not the number on the scale or solely a measure of vanity. Thinness represents a moral high ground that can be the means to feel superior to others.

Anyone who perceives their body or their lives to be less than ideal can immerse their sense of failure and loss into body shame. Peers, media of all kinds, family and even doctors reinforce the idealization of thinness. Medications beckon people to inject themselves with the hope of an ideal body. Body shame is an accepted way of being in the world.

The purpose of a social construct built around shame is to keep people in line. Those in charge, supported by success and financial backing, can keep a stronger hold by propagating shame as a way to make money and exploit negative feelings about oneself for personal or corporate gain. Personal well-being does not satisfy the greed of various industries which use our collective self-reproach to induce us to spend money hoping to find a reprieve from the shame.

It’s hard to know where education can make inroads into all of our shame. Medicine has little evidence to support the connection between larger bodies and poor health. In fact, there’s more evidence that smaller bodies lead to more health issues with age. Small changes for body positivity pale in comparison with overvaluing thinness. Food, fashion, diet and exercise industries all benefit enormously from our desire to feel better by losing weight. And the newest availability of weight loss drugs adds a new wrinkle to the desire for thinness.

Perhaps the goal is to find value in ourselves in new ways. We can’t win the thinness argument, but we can agree that love, compassion, kindness and care lead to more happiness than focusing on weight and body. We can look for new ways to find joy in a world bent on profiting from our misery.

People who recover from an eating disorder go on an existential journey to find themselves and meaning in their lives. Creating new ways to cope with emotions and with life’s travails forces anyone in recovery to take a hard look at what matters. People who venture down this path often end up better equipped to handle the cultural shame so many of us endure. Escape from shame entails finding a new and different way to live, one that values things that truly matter in life.

Why are Eating Disorder Diagnoses so Fluid?

Diagnoses in psychiatry change over years and even generations to reflect the role mental illness plays in our culture. Some changes are due to a better understanding of an illness. Other times the diagnoses reflect a new social construct around a mental disorder, changes in the social structure or treatment trends that lead to increases in specific diagnoses.

Eating disorder diagnoses change over time as well. More recent trends include the misdiagnosis of depression or anxiety as an eating disorder or the expansion of the diagnoses to accommodate the larger number of treatment centers seeking to fill their beds. The ease of access of GLP-1 medications leads to more self-diagnosis of “food noise” as a different kind of eating disorder and as a way to justify taking these new drugs.

These are just examples of how diagnosis changes over time and how the concept of eating disorders remains fluid rather than a fixed concept, largely due to changing external circumstances rather than a fundamental change in the illness.

The borderline between an eating disorder and a supposedly healthy person is narrow in our culture. The drive for thinness implies that health, beauty and success are synonymous with a low weight. However, the line between these purportedly positive attributes and an illness is not always easy to define.

Psychiatrists try to define an eating disorder diagnosis based on the number on the scale, a certain amount of disordered behavior or the overall level of disordered thoughts about food and weight. However, many people who seem to fall into the socially admirable category don’t seem all that different from the people who are deemed sick.

Often the difference is context. Does the person have family who assess the situation as an illness or an achievement? What is the opinion of the pediatrician or primary care doctor who does the first assessment? What is the role of that person in their family of origin? The answers to these questions can determine the outcome: either a functional person with disordered thoughts and behaviors or extended stays in eating disorder treatment. The difference is not diagnosis but context. Few mental illnesses rely on external circumstances as the crux of the issue.

With current trends leaning towards extreme thinness again, there is much more acceptance of thinness as the goal rather than a sign of being sick. Because so many people are underweight due to the GLP-1’s, it is harder to differentiate the unwell versus the well. Without other markers for achievement, weight has become the default indicator of wellness again. There is no medical justification that people losing weight are healthier, but all cultural trends overvalue size and health, so anyone losing weight receives accolades across the board.

Eating disorder diagnosis is as much a cultural construct as it is a psychiatric disorder. There are many people who clearly have eating disorders and struggle to get well. The clearest diagnoses involve addictive-like behavior around food, intractable intrusive thoughts, trauma and often primary medical illness like MCAS. However, the number of people who don’t fit these categories but also dilute the severity and understanding about eating disorders is vast.

In trying to be clearer about diagnosis, the term eating disorder ought to reflect the cause of the illness, the severity of the symptoms and the types of experiences more specifically. These changes involve further research into possible underlying causes and incorporating changing trends around food and weight.

Vigilance and Persistence are the Needed Traits to Get Better From an Eating Disorder

Eating disorder treatment is hard because the process is long and slow and because one needs a lot of resiliency to handle the ups and downs. It’s so important not to let the harder times transform into hopelessness and instead to remember that continuing down the path of recovery leads to getting well.

The eating disorder thoughts and urges become very ingrained. All mental and physical actions around food are somewhat subconscious since we are all biologically-driven beings who the need food to survive. This fact remains embedded into our most basic essence. Even if these actions are disordered, our minds are designed to repeat food patterns over time.

Changing those patterns involves a different type of vigilance. One needs to be aware of the smallest subconscious thought that might lead to eating disorder behaviors. People in recovery often say things like: “I’ll just do this one more time” or “I’ll start tomorrow” or “nothing will happen to me if I don’t change in the next few days.”

Even though everyone in recovery recognizes these thoughts are false, the lure and comfort of continuing a known path is strong and hard to resist.

Getting better means having consistent and regular accountability combined with contact with someone who helps recognize the insidious thoughts and choose a different action.

The central tenet of this part of recovery is vigilance. Only by being vigilant each and every day can a person in recovery make long lasting changes to the subconscious eating disorder thoughts.

The second part of recovery is managing the daily ups and downs of getting better. Everyone has stretches of time when thoughts and actions start to fall into place and lead to recovery-oriented steps. Similarly, everyone has periods that feel like going back to square one.

Neither extreme is the truth. These widely different experiences reflect the challenges of recovery. The process of getting well is not linear at all. For a long middle period of recovery, people know and understand the nature of the eating disorder, how the thoughts work and ways to counter the disorder mental and physical actions. Yet they still get stuck routinely in old patterns and become increasing frustrated and, at times, hopeless.

The second tenet of recovery is persistence. Changing ingrained patterns is a lot harder than acquiring new information and understanding. These well-worn patterns of eating will only transform with persistence to translate the knowledge about recovery into action and eventually into ingrained, subconscious behaviors. With enough work over time, this change will happen.

Vigilance and persistence underlie success in getting better from an eating disorder. The combination of these two traits with the focus on recovery each day leads to truly getting well.