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Argue that Anorexia Nervosa is a form of Cartesian Dualism i.e. Mind over Body.
Introduction: In this essay we discuss the influences of Cartesian dualism, the philosophy of dualism and how this relates to Anorexia Nervosa. The concept of staying slim is largely controlled by eating habits and this in turn leads to problems and physiological conditions of Anorexia.
Anorexia nervosa -
Anorexia nervosa is one of the better known eating disorders in which the pursuit for thinness makes a person maintain a body weight lower than normal for their age and height, and such individuals weigh 85% less than what is expected. There are severe malfunctions of menstrual periods in women and level of sex hormones in men and young girls do not menstruate at an appropriate age but anorexics also deny the dangers of low weight as they are extremely afraid of becoming fat. The disorder lies in a completely distorted perception of a body image and how one should look like. This is also guided by a severe fear of becoming overweight although most of these patients are usually highly underweight (Dawson, 2001). The fear of weight gain and feeling fat are more psychological symptoms rather than physical disorders as the anorexics report ‘feeling’ fat even if they are severely underweight (Chernin, 1994). This psychological burden and a distorted self image leads to other associated symptoms in the anorexics such as depression, irritability, withdrawal, compulsive behavior, obsessive thoughts, strange or odd eating habits, low tolerance and ineffective coping with new life phases.
Clinical research studies suggest that about one percent of female adolescents have anorexia which means one out of every hundred young women in their adolescence and between the ages of early teens to early twenties are prone to starving themselves, even to death. Although there are no conclusive figures for older women and children, anorexics are found among older women as well. Eating disorders have been found to be common in alcoholic subjects, although due to eating disorder being held as secret eating habits in most cases, it is difficult to determine the exact number of subjects who suffer from anorexia.
Anorexics have unusual eating habits characterized by taking tiny portions or skipping meals, elimination of fat intake, and remaining ill, weak or even without food most of the time. Anorexia is an illness that seems to represent the more serious emotional and psychological problems of patients as food habit changes are used as substitutes for problems of depression or anger (Dawson, 2001). The weight loss may be slowly progressive although reduction of weight can suddenly reach extreme levels as individuals may be determined to lose weight. Anorexia is characterized by the symptoms of deliberate self starvation and rapid weight loss, refusal to eat and denial of hunger, absent or irregular menstrual periods in young girls, loss of hair, constant exercising and overwork and exhaustion, sensitivity to cold and a negative self image thinking one is too fat when actually too thin (Dawson, 2001). People with severe anorexia are at risks of dying from starvation although they may think of food all the while and have a tough time concentrating in work (Rie et al, 2005).
People suffering from Anorexia may need care in hospitals and counseling to improve their self image and overcome emotional problems such as family issues or self esteem issues that lie at the root of their eating habits (Tierney, 2005). Anti-depressants are also given sometimes. Anorexia is also accompanied by other illnesses such as emotional detachment and nervousness. However people with anorexia feel comfortable with their illness and believe in their ability to lose weight unless they experience severe symptoms of physical weakness due to little or no food.
Cartesian Dualism -
Dualism is a strong philosophical position which has its roots since pre-Socratic times with the distinction of appearance and reality and took up a stronger emphasis in Descartes' mind/matter distinction. With recent studies in the philosophical position of consciousness, Cartesian Dualism is being debated with increased and renewed interest among philosophers and scientists alike. Many scientists have recently argued against dualism of any sort suggesting that the mind is nothing but a bunch of nerves or bodily structures working in a specific manner at specific times. In his Meditations, Descartes proposed a form of substance dualism also known as interactionist dualism in which he suggested that mind and matter are different categories or class of substances and Descartes proposed that these two kinds of substances can causally interact although they are distinct and separate. Descartes defined the essence of matter as characterized by extension of having spatial dimensions and being located at a specific place and time whereas the mind is characterized by thinking. Cartesian dualism is marked by the fact that the two systems - matter and mind are essentially different and that one can exist independently of the other (Baker, 1996). However the causal interaction of mind and body seems to have been essential in explaining how the two work and the interaction of mind and body has led to the problem of dualism and the classic mind body problem or how the mental can represent the physical and vice versa (Baker, 1996).
In recent years philosophers of mind have tried to suggest that this mind-body problem or the explanatory gap would not be closed as brain and conscious experience are essentially different categories with brain being a physical object and mind being a mental category. There are some physicalists who believe mind can be completely specified according to brain mechanisms whereas others believe that the mind matter explanatory gap can never be successfully explained. Amidst these speculations, it is interesting to study the possibilities of explaining anorexia nervosa in terms of Cartesian dualism.
Anorexia Nervosa and Cartesian Dualism
Anorexia Nervosa is characterized by the extreme sense of negative self image and a desire to be thin beyond normal weight levels. It is almost a psychological obsession and is characterized by extreme concerns with weight even if one is thin. The physical features of anorexia are specified by:
- loss of weight
- extreme thinness
- weakness and physical fatigue
- menstrual disruption in women or sexual dysfunction in men (Dawson, 2001)
- The mental or psychological features of anorexia are characterized by -
- depression
- increased anxiety on matters of body weight
- obsessive compulsive thoughts about physical appearance and eating habits
- nervousness
- irritability
The physical and psychological symptoms in anorexia nervosa seem to be related and can suggest a mind-body interaction. As according to Cartesian dualism mind and matter are separate and distinct categories or substances although the mental category interacts with the physical and causally affect each other (Baker, 1996). In anorexia this is manifested by the fact that depression and nervousness lead to low intake of food and irregular food habits which in turn lead to loss of weight, irritability and anxiety. Thus the physical seems to cause the mental problems of depression and anxiety which in turn seems to trigger physical symptoms of weakness and loss of weight even starvation to fatal possibilities.
In anorexia, Cartesian Dualism of mind and body is revealed as the mental symptoms of depression and anxiety or irritability though essentially separate from the physical symptoms are actually caused by and in turn cause physical symptoms of loss of weight, thinness, sexual dysfunctions and starvation, even death. Anorexia reveals and reinforces Cartesian mind matter dualism as the mental and physical although being separate with distinct symptoms of problems show that they are different categories or substances yet they seem to causally interact as the mind causes the physical symptoms and the body causes the psychological symptoms as shown by anorexics.
In our discussion we provide several studies to prove our point that anorexia nervosa is one of the primary eating disorders that does seem to justify Cartesian dualism and is a form of Cartesian dualism or the fact that mind and matter are separate entities yet causally interact. Studies on anorexia prove the various symptoms that seem to justify mind-matter interaction so that the mind affects the body and vice versa.
Bornholt et al (2005) suggest close relations between the cognitive and affective self evaluations in case of adolescent girls in the context of diverse experiences of their body. The authors studied 141 adolescent girls as their subject including overweight and underweight schoolgirls as also young girls hospitalized with anorexia nervosa. The girls were questioned with brief inventories on self concepts about the body, movement, appearance and feelings about the body. According to the results of the study, measurement models using inventories confirmed the discreet and related self concepts about the body such as movement and appearance, guilt, worry, anger, disgust. The results indicated that self concept and feelings were not correlated with body weight although girls with anorexia are more sensitive to self image and self concept than low weight schoolgirls. According to the study, relationship between self concepts and feelings about the body vary with context. The study indicated that self concepts and feelings were incongruent for anorexic girls with acute experiences who are prone to making repeated self evaluations of their bodies. The study focused on the fact that self evaluations by adolescent girls may not reflect actual body weight and may just be exaggerated which reflects personal and psychological rather than actual physical perceptions of the body. Associations between thoughts and feelings about the body seem to vary with diverse experiences of the body. Bornholt et al concluded that the indicators of self concepts and feelings about the body seem to be vital in the design of prevention, intervention and monitoring as well as evaluation programmes for girls in clinical and educational settings.
Faer et al (2005) studied the relationship between female intrasexual competition and eating disorders and suggested a psychological and physical link. The need for mates seems to motivate bulimia whereas a need for social status has been closely related to anorexia nervosa. In this study described by Faer et al, 202 undergraduate women participated and completed surveys measuring Female competition for mates scale, the Female competition for status scale, the General Competitiveness Scale, the Eating Disorders Inventory (EDI), and additional measures specific to Anorexia. The internal consistencies of the measures were computed and adequate measurement reliability was also found. the resulting model pointed to the fact that female intrasexual competition or ISC for mates and status were driving factors that contributed to general competitiveness, perfectionism, body dissatisfaction, drive for thinness, and both Bulimia and Anorexia or related eating disorders. The results of the study supported a causal relationship between female competition for status and anorexia with an indirect causal effect being through an idea of perfectionism related to general body image. The psychological components of attractiveness, or potential of finding a mate, social status, and a positive body image seem to drive eating habits and lead to exaggerated concerns on weight, shape and eating habits. the importance of body image in determining attributes of an ideal partner has been suggested and status, body image and eating habits have been found to be correlated yet body dissatisfaction was found to be negatively related to psychological perceptions of status and one's positive self image.
Honey and Halse (2005) discuss the responses of parents to their daughters suffering from anorexia nervosa. The findings of the study showing parental reactions to anorexia suggest that parents try to influence their daughters by searching for help and providing practical support in terms of advice. They also help in avoiding confrontation, complying with special requirements, providing emotional support, persuading and explaining the dangers of excessive diet control or unusual eating patterns. Parental actions are geared towards the perception of anorexia and its control and the way anorexia is perceived - whether as an eating disorder, an illness or mystery, a personal choice or psychological problem. Understanding parental perceptions and their approaches to the problem has been pointed as essential to the development of collaborative partnerships between clinicians and parents for treatment of anorexics.
The mind body connection in anorexia nervosa has been exemplified in a study by Boyd et al (2005) who point out that that there are many gastrointestinal symptoms that occur without any evidence of gastrointestinal disease and are found in patients with eating disorders. The study as given by Boyd and colleagues described the prevalence and types of functional gastrointestinal disorders or FGIDs in patients suffering from anorexia nervosa (AN), and other types of eating disorders. It also aimed at determining the relationships between psychological features, eating disorders, attitudes and behaviors as well as the type of functional gastrointestinal diseases found in anorexics. In the study 101 female patients admitted to an eating disorder and completed a modular questionnaire and other validated self reported questionnaires that detailed history of illness, psychological features and eating and exercise behavior. 98% of the sample fulfilled criteria for any one specific functional gastrointestinal disorder and these included irritable bowel syndrome, functional heartburn, functional constipation, abdominal bloating, functional dysphagia and functional anorectal pain disorder and as many as 52% of the sample had three coexistent FGIDs. Psychological variables of somatization, neuroticism, state and trait anxiety were found to be associated with age and binge eating and coexistent functional gastrointestinal disorders although the body mass index and other disordered eating patterns were not considered as predictors of anorexia nervosa. The authors concluded that in patients with eating disorders, specific psychological traits can predict gastrointestinal disorders and the presence of multiple FGIDs. The role of psychological variables as important contributors to gastrointestinal complications as well as eating disorders are given and show conclusively a form of Cartesian dualism in the fact that the mental and the physical are intricately related and psychological variables are related to disorder eating patterns and consequently gives rise to psychological symptoms of weakness, sexual dysfunction, pain, gastrointestinal disorders and anorexia nervosa leading to emaciation and progressive weakening of the body.
Considering the fact that anorexia does seem to show close relations of the mental and the physical, Davies et al (2005) illustrate how cognitive remediation therapy (CRT) can be used as part of a treatment program for acute anorexia nervosa or AN. Cognitive remediation therapy uses mental activities and cognitive theoretical approaches to stimulate mental activities and improve thinking skills and information processing systems as part of a treatment programme for acute anorexia nervosa or AN whereas other forms of therapy such as cognitive behavioral therapy or CBT may be to complex and intense for the patient to engage in any form of therapeutic method. Davies et al hypothesize that CRT is an effective tool in improving flexibility of thinking in conditions of anorexia as the rigid understanding of one's body image is replaced by more flexible approaches to self image. Rigidity has been found to be one of the main factors in maintaining anorexia nervosa. The fact that cognitive remediation is an effective treatment method for anorexia again points to the important contribution of mental or psychological perceptions of body image and how the mental is important in controlling the physical conditions of the body as seen in anorexia in keeping with the causal emphasis of Cartesian dualism.
Apart from the treatment methods of cognitive remediation, Ro et al (2005) draw up a report on the 2 year outcome of chronically ill adult eating disorder patients and investigates whether a specialized inpatient treatment may be more effective in influencing the course of the illness and also searches for prognostic factors. For the purposes of the study, 72 patients were treated with 5 month specialized group treatment programme for chronically ill adults with eating disorders and 90% of the patients were also available for follow up assessment. The results indicated that 46 patients out of 72 improved at the 2 year follow up and 17 did not meet the diagnostic criteria for eating disorder. The symptoms reductions for patients were found to be larger and more significant during the inpatient period compared to the periods of waiting and follow up. Yet there were no predictors of treatment outcomes found and patients with avoidant personality disorder showed a higher level of distress at all times although improved as good as the others. The authors report that during the follow up period, there were substantial reductions in eating disorder symptoms and also in the general psychiatric symptoms of the anorexic patients. They concluded in the study that most improvement of anorexics occurs during inpatient treatment and this sort of treatment may just be very effective for patients with chronic eating disorders. The emphasis in inpatient treatment seems to be related to psychiatric conditions of the patients and mental distress as seen in patients with eating disorders. The links between psychiatric symptoms and eating disorders reemphasize the need to establish a relationship between the mental and the physical realm as argued in Cartesian dualism and all the studies above reiterate the fact that the mind and the body are closely related and this relation is easily manifested in eating disorders and related physical complications.
Malson (1997) discusses why anorexia could be categorized as a medical pathology and how the concept is based on not just the perception of anorexia as a physical illness but also a social understanding of self image issues and the problem is also seen as socially situated in the conceptions of gender, subjectivity, and control. Young women are most affected by anorexia and issues of subjectivity and control are important here. The women themselves control their diet, eating habits and lifestyle according to their subjective perception of body image and their own understanding of how they look and how they should look in terms of body shape and image. The subjective perception of body is related to issues of controlled or limited diet, physical weakness and rapid weight loss leading to almost a frail physical disposition and starvation. The links between the mental conditions of subjectivity and control and physical conditions of the body suggest that anorexia is far beyond a mere physical condition and have deeper psychological causes and implications.
Conclusion:
Anorexia nervosa can be studied within a broader social context using the implications of such concepts as beauty, social attractiveness and a woman's ability to find suitable mates. As we have seen in some studies discussed above, anorexia can be a social phenomenon in which more and more women perceive that being thin can make them more attractive to potential suitors and in society at large (Faer et al, 2005). This may be an entirely distorted perception of personal attractiveness and yet suggests the social dimension of anorexia shaping up individual preferences. Social pressures of being thin may trigger an unconscious need to be thin and in this pursuit of a social sense and ideal of beauty, anorexia sets in when controlling one's body image becomes more of an obsession rather than a healthy practice (Toro et al, 2005; Chernin, 1994). Anorexia is thus a distortion or an exaggeration of a socially triggered practice that brings in physical or psychological problems to young suggestible men and women.
In this study we used research and clinical evidence to prove the importance of Cartesian dualism or mind body interaction in providing a suitable explanation for the occurrence of anorexia nervosa in young men and women.
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