It can’t just be me

I just started a rotation on the adolescent wards, and about half of our patients have eating disorders. They are all girls, and they range in age from 12 to 17 years old.

Every day, they have group therapy meetings in the recreation room at about noon. They file by our work area in flannel pants and pony tails, wearing shirts from cross-country teams and field hockey teams and basketball teams, slapping their slippers on the floor. They are all somewhere between 60 and 80% of their ideal body weight for height.

As they walk by, I think to myself, “Man, they are so pretty.” And I am not proud.

At first, I thought, it can’t just be me. Something has to be reponsible for making these women want to be thin, and it’s probably the same thing that’s squeezed my feminist brain into finding pointy chins and saucer eyes attractive. Right?

Well, not really. During a group session with our patients the other day, I began to understand that although societal norms might initiate dieting and body image problems in people with eating disorders, it’s compulsion and control that make them continue in the long term. After the thighs are gone and the belly is flat, it’s about seeing the scale needle continue to move downward; demonstrating how much control you really have; putting one over on your stupid parents; proving yourself a winner at something. Yes, the girls in our program do think they’re fat–but that’s not where it ends.

Where does it end? As one girl said, “There is no lower limit that would make me happy.”

Yes, women in all forms of graphic media have gotten thinner, on average, over the last 100 years. But it’s hard to demonstrate unequivocally that eating disorders have become more prevalent over that time. (See citations 6-17 in this paper.) One could (and I do) conclude that there’s a disease process at work in these patients that we do not provoke or mitigate with culture.

By these calculations, I’m the only one in the doctor-patient relationship whose viewpoint is much influenced by the thinness of the ladies in the magazines.

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5 Comments on “It can’t just be me”

  1. EGM Says:

    My unnamed academic institution du jour has a pathetically small inpatient EDO program compared to yours. I just finished my last day on adolescent (and, oh, man, do I need a DRINK! but that’s not the point.) We only had two EDO kids in that month. But, what I learned, and, like you said: it’s physiologic. If you starve rats you can induce anorexia. Crazy, huh? People start cutting calories because of society and end up in a twisted spiral that is so strong, it… lands girls at 5 ft 6, 80 lbs with a heart rate of 34. (And yes, nurses, I KNOW her heart rate is 34! It’s a part of her illness. She’s bradycardic. Thank you. You can stop paging me. At 3am. And 4am. And 7am. And… you get the idea)
    Enjoy the pajama parade. And the diarrhea kids!

  2. EGM Says:

    oh yeah, and it’s not just you. They’re all cute and tiny with their stick, straight pony tails (I’ll forever have hair-envy) and little pajama pants that I haven’t fit in to since I was 12 years old. And that’s when it all clicks: that girl walking by is 18 and looks like she’s 12. That’s not cute. I was envying the look of a girl who is very, very ill.
    I’m right there with yah.

  3. LF Says:

    I think you are right. I do think culture might play a role but I think it’s less about looks and more about control. In my very limited time at Choa this fall, I encountered a few EDO children (very young I might add) and one of them was male. It’s not hip to be thin and scrawny as a male and his parents and doctors were bewildered.

  4. K2 Says:

    Anorexia is not just psychological; it is also a physiological addiction. As they starve themselves, these girls (sometimes boys) get an endorphine high as a reaction. They become psychologically twisted by society and physiologically addicted based on chemicals in their body. It really is disturbing how we have to fight this on both fronts. I see this in the schools sometimes, but it really isn’t foremost in the mind of the average school psychologist. And, you’d think it would be as we are on the frontline.

  5. girlMD Says:

    you are right. it is about control. but if you think about it a little more, i think you’ll find that culture has a lot to do with girls feeling out of control. if you’re really curious, i’d read “wasted” by marya hornbacher and “unbearable weight” by susan bordo. the former is more of a first-hand account, the latter more of a cultural critique from a feminist perspective.
    oh, you’re wrong about them being influenced by the thin ladies in magazines…they just think those women are fat. some of the pro-ana web sites are simply shocking…it’s those women that your girls aspire to be like.
    girlMD


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