The Context of Eating Disorder Diagnosis and Treatment

The overlap between culture and psychiatry is profound and always has been since the inception of the field. The dearth of scientific information to diagnose and treat mental illness combined with societal bias mean that psychiatry relies heavily on social values and cultural norms to determine treatment. Although other fields of medicine change from social impact, none do so more than psychiatry.

The definition of mental well being changes through generations. Success can mean many things: professional success, completing an education, a steady job with a family, a thin enough body, the ability to study or work 12 hours per day for weeks and months and years, or spiritual awakening. And the ideal mental state to attain many of these goals is extremely different.

Accordingly, dysfunctional mental states change drastically as social norms change. Odd or unusual behavior that is seen as mental illness now may have been adaptive in smaller, isolated villages centuries ago. A slow and steady temperament may be beneficial in some communities and seem as a sign of a learning disorder in others. Inattention that is a hindrance in school can be more creative and inspirational in times of societal distress. A thinner body may be ideal in certain towns and a sign of illness in a different community even in the same state.

As these norms change, psychiatry changes as well. Without a clear way to diagnose and treat illness, mental health professionals need to consider the world each patient lives in when thinking about diagnosis. What is considered an eating disorder now may not have been twenty years ago.

The point of this blog post is not to discount psychiatry and mental illness at all. However, we all need to be sure not to conflate psychiatry with clearcut science. The scientific data about the safety and utility of medications or research into best practices when treating eating disorders are sound. The philosophical and moral values about how to proceed in recovery is not only dependent on the person’s medical and psychological state but also on their background and community. Our individual mental health demands context in order to be defined correctly.