By Laura Collins Lyster-Mensh, F.E.A.S.T. Executive Director
I was amused to see the headline of a recent article, “Rethinking Anorexia: biology may be more important than culture.
I was also frustrated.
You see, that’s not a new headline or idea. In fact, the breathless “discovery” that eating disorders “may” have a biological basis has been a reliable shocker headline at least every year for over 15 years since I started watching the topic. Papers are published, articles are written, books come out, minds and practices and language changes… but the public — and much of the treatment world — continues to consider it a news flash. It doesn’t stick.
A tweet this weekend expressed it well when they said:
This article may surprise you if you think, like most people, that eating disorders are purely cultural. It is clear they are not. This is not to say they are purely biological, either. Have a read.
Isn’t it weird that we keep having to gently justify the biological? Isn’t it strange that biology is seen as somehow the opposite of cultural, still?
The writer of that Science Magazine piece asked me why this idea of biological origins was still so shocking and so little believed. I heard in a podcast episode about the piece that she asked a lot of people that question. She published part of my answer in the article:
“There are still these myths out there—that these are chosen illnesses and parents somehow failed to prevent, or caused, or exacerbated the problem.” (Lyster-Mensh)
What’s hardest on me, in these conversations, is the sense that people think there is winning and losing at stake here: that if eating disorders are not based in culture and nurture then we’ll stop caring about our toxic culture and bad parenting, or that any talk about culture is inherently parent-blaming or patient-blaming.
Here’s how we all win this tug of war. Let’s drop the rope.
Culture and biology are not either-or: they are interconnected. To understand eating disorders and all mental illnesses we’re going to have to do the difficult work of seeing how the brain interacts with environment: a biological process. We’re also going to have to stop seeing discussion of biology as promoting the brain as a machine that operates on its own without the influence of the world outside the body.
Eating disorders are like all mental illnesses: they are “real” and they are going on in a biological brain that is interacting with experience and learning. But the patterns of OCD and schizophrenia and eating disorders are not chosen or given or willful or imposed. Culture doesn’t cause mental illness, but it very much affects it. Culture can also play a role in identifying, healing, and treating mental illness. Or NOT treating it, which is actually what we’re doing when we fail to see these disorders as “real.”
To progress, we need to have some conversations we keep starting without finishing, and stop being shocked by evidence that patients are not choosing their suffering.
This conversation is going to be difficult. It will require holding complex and unfamiliar ideas simultaneously. It will require a higher level of science literacy. It will require listening to people who say absurd things with goodwill, and others who are correct for the wrong reasons: really listening to why these ideas matter to us. We will have to convince people who feel victimized and traumatized to trust institutions and ideas that have harmed them. We will have to stop trying to “win” and we will have to work harder at listening.
To start, those who feel that a biological basis for mental illnesses threatens their view of the illness need to hear this: no one is saying environment and experience and, yes, parenting, do not matter.
For my part, I am saying these things matter in a different way than you may assume I’m saying. I have listened to the cultural arguments and can recite them chapter and verse. What we need now is to be heard for what we’re really saying, and to have that conversation with mutual respect. I have been having these conversations for over 15 years and only a handful of times have I felt the people on the other side of the conversation had dropped the rope enough to hear. Those conversations — you know who you are — have been fruitful and helped me immensely. I learn, and I have to listen to do that. We don’t have to agree — that will take time and changing of minds — but we really need everyone to be speaking the same language and be able to understand one another’s point of view. Part of that language is biology, neurobiology, genetics, and nutrition.
These articles have to stop being news, and have to stop being shocking.