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Every society has a way of torturing its women, whether bybinding their feet or by sticking them into whalebone corsets.What contemporary American culture has come up with is designerjeans."
Anorexia nervosa (AN) is an eating disorder most commonly affecting adolescent women. The diagnostic criteria for anorexia is defined by the Diagnostic and Statistical manual of the American Psychiatric Association 4th ed (DSM-IV) as excessive dieting or exercise leading to extreme weight loss for age, height and gender, a refusal to gain weight, disturbance in body shape perception and amenorrhea. The underlying cause of AN is believed to be psychopathological, with recent biomedical research emphasizing a biological perspective, where a specific gene, molecule or brain region is sought out to contribute to the biological basis of AN. Subsequently there is much effort put into the development and licensing of potential 'anti-anorexic' pharmaceutical drugs. However, the general lack of success of effective drugs for treating AN points to more than a simple biological cause to AN. It has been suggested (Bordo) that the psychopathologies behind AN are a set of particularly symptoms that arise from within a cultural framework, namely the Western culture. In essence, AN may be labeled a psychiatric disorder that manifested as a result of the influence of Western ideals of beauty and body types. Western society's young adolescent women are particularly vulnerable to these portrayals of body types and thus show the highest incidence of AN. Furthermore, in recent years AN has become a transcultural disorder, affecting cultures influenced by Western culture or currently undergoing Westernization such as the Chinese, Japanese, Fijians and African Americans, where AN had once been unheard of. Yet, it has been argued that AN cannot be seen strictly as a Western culture-bound syndrome as there have been more and more reports of eating disorders bearing symptomatic resemblance to AN afflicting women in non-Western cultures and even certain groups of people within Western cultures. The distinguishing characteristic of these variations of AN is their cause, which is highly individualized, varying from personal distress to traditional and religious reasons. Importantly, these variations do not relate to a distorted perception of the body nor an irrational fear of gaining weight, suggesting that the current definition for AN is limited and assumes that AN is a universal experience. Thus, although AN is considered a psychiatric disorder, it cannot be viewed solely from a biological or psychological perspective, but rather from within a transcultural context, one which encompasses the influences of Western culture on perceptions of the body as well as the specific, individualized reasons that arise from within other cultures.
Paragraph 1: The Western Culture of Thinness
Anorexia is considered a Western culture-bound phenomenon as a result of the current sociopolitical demands placed upon women in regards to the ideals of beauty, body shapes, and feminism, as well as the typical eating behaviours found in most families and the surplus of available food. The term culture-bound denotes a restriction of a phenomenon within a particular cultural group due to specific social, political, culture and psychological factors from within that culture. It has been shown that most American women are preoccupied with their weight. Subsequently, anorexia has been presented as an extreme to the nation-wide preoccupation with weight and body image (Banks). Historically, the concept of the ideal female body was fluid, changing with the political and economic climate, which affected cultural values and thus attitudes toward female bodies. During the colonial era, the struggle to survive in a harsh environment favoured strong, fertile, able-bodied women who were capable of assisting with chores as well as bearing many children to increase family size. Times changed in the 19th century, however, with the introduction of a more comfortable life-style, the fraility of women and the invention of the corset. Women who appeared vulnerable, thin and frail were considered to have the ideal lady-like attributes that were desirable. This trend changed in the 20th century when the waifish look became popular, where women balked at long dresses and subservience to men in favour of short hair, pants and an androgynous, thin, waifish look that represented their freedom. Since then, there has been a cultural trend towards thinness, with famous models such as Twiggy becoming household idols, culminating in today's nation-wide obsession with 'weight-watching,' 'calorie-counting' and 'dieting.' It is the mass media portrayal of the ideal thin female body as attractive, desirable and healthy that has further perpetuated the 'culture of thinness.' The main targets of these cultural 'fads' are teenage and adolescent women, who also have the highest incidence of anorexia. Recently, the incidence of AN has increased in pre-teen and teenage girls, as they are often the main target audience for a variety of media, which present unrealistic expectations of their body shapes. Dysfunctional dynamics within a family have also been attributed for this trend of increasing AN incidence in younger girls. Fashion magazines often depict thin women to be desirable and healthy, television ads promote the latest technological invention that helps a woman lose weight and the Internet offers countless websites with tips on 'eating healthy,' keeping off the 'fat,' appetite suppressants and '0 calorie' dietary supplements. Particularly notable are the 'pro-anorexia' websites that proclaim AN to be a lifestyle choice, offer advice on weight management, effective dieting strategies and community support encouraging AN. This bombardment of social and cultural expectations to be thin in order to be attractive has predominated Western culture since the 19th century. The advent of mass media has exacerbated these expectations, resulting in the increase of incidence of AN as well as other eating disorders, particularly in young girls and women. Thus the psychiatric problems behind anorexia may be described as a set of particular symptoms that arise from within a cultural framework - the Western culture of thinness.
Futhermore, there have been an increasing number of reports of AN in non-Western populations, challenging the notion that AN is a Western culture-bound syndrome. This trend is attributed to the exposure of non-Western cultures to Western culture via mass media (Nasser, 1994). One study has shown that Hispanic and African American girls exhibit AN, influenced by their exposure to Western media, suggesting that AN is a psychiatric disorder that transcends cultural and socioeconomic boundaries. It was originally believed that the mentioned group of people were 'protected' by modern Western influences, due to their tradition of embracing larger, full-bodied women. Yet, a study conducted by Becker found that the Fijians' conception of the female body has been heavily influenced by the Western culture of thinness. There were no reports of eating disorders in the Fijian population until 1995, when an international television station was broadcasted for the first time, depicting Western media. Three years later, reports of dissatisifation with body image, attempts to control weight such as dieting and self-induced vomiting were seen, suggesting that these Fijian women were influenced by the Western cultural ideals of the perfect body and perhaps could not distinguish between the reality television presented and true reality. Despite a tradition of favourably viewing full-bodied women, a few years exposure to Western cultural and perceptions of beauty have significantly impacted the Fijians. Similarly, a study conducted by Nasser on the prevalence of AN in teenage Egyptian girls in Cairo indicated that despite traditional Egyptian values of larger, fertile women, accessibility to Western conceptions of the ideal body type through mass media has culturally assimilated young Egyptian women. These findings highlight a phenomenon known as global culture, where the world is connected via media, allowing cultural values to be readily accessible by other cultures across the globe. Such a phenomenon points to the significance of treating AN as not only originating from Western cultures, but a disorder that transcends cultural boundaries.
As well, studies have indicated that assimilation of immigrants into the Western culture and adaptation to the expected norms and values on body image and conceptions of beauty has contributed to the increase in incidence of AN in non-Western groups. In contrast, other studies have shown that those who live by their own culture whilst living in a Western culture compared to those who have acculturized show an increased incidence of AN. The concurrent existence of two cultures results in a 'culture clash,' which has been theorized to contribute to greater internal conflict with regards to self-identity and thus higher predisposition to anxiety about self-image and increase in incidence of AN. Mumford and Whitehouse have shown that Asian girls in the United Kingdom that have not acculturated are less satisified with their body image and subsequently more susceptible to eating disorders, such as AN. These findings interestingly point to the influence of a non-Western culture not as protective, but exacerbative of eating disorders. Another report by Bryant-Waugh and Lask confirm this theory of culture clash by reporting specific AN cases in more traditional Asian children living in the UK. They claim that the more traditional the family dynamics are and imposed traditional cultural values, the higher the risk of sociocultural conflict.
It has been argued that the values portrayed by Western culture, specifically the link between slim, thin body shapes to attractiveness and health, symbolize socioeconomic progression, social status, social acceptance as well as self-control, liberation and self-discipline to less developed nations as well as nations currently undergoing Westernization. There is a preoccupation with the Western culture in these nations as it is believed that adopting their values and beliefs will allow them to identify with socioeconomic progression, higher social status and social acceptance. Streigel-Moore points out that African American groups within the United States have shown increasing incidence of AN, stemming from a desire to participate in the 'white world,' despite traditional values of fuller-figured women.
Paragraph 3: Simpson. Kleinman.
The prevailing biomedical definition of anorexia as a psychiatric disorder characterized by fat phobia and distorted perspective on body image has been argued to itself be a cultural construction within the confines of the Western culture. This suggests a need to adopt a culturally-sensitive definition of AN. Fat-phobia is the defining symptom in AN, but there have been accounts of those with an eating disorder very similar to AN, except for the obvious lack of fat-phobia. Simpson argues that the belief that Western culture influences the conceptions of body image of other cultural groups suggests cultural homogeneity and that culture is the sole factor in AN. She presents reports of Chinese women suffering from AN who do not report fat-phobia. Rather, they attribute chronic epigastric bloating and a loss of appetite to their disinclination to eat. In another case, a woman refuses to eat after being separated from her boyfriend, citing abdominal discomforts and a disinterest in food. These psychosomatic symptoms are a result of somatization (Kleinman), where the illness symptoms of AN manifests from social problems, rather than dissatisfaction of body shape and a desire to lose weight. Psychosomatic symptoms are commonly reported in the Chinese population and contribute to the etiology of AN, although they are not included in the DSM-IV criteria for AN. Furthermore, some women from conservative religious fundamentalist backgrounds have been cited to abstain from food, as a result of their beliefs about food, the body, femininity and spirituality. This points to the idea that AN is not a universal experience. AN is not simply defined by Western cultural values and explaining it within a culture-bound context establishes a limited perspective of the disorder that does not take into account the personal factors that contribute to AN. Thus, AN must be understood within a holistic framework that includes the influence of local biologies in
Conclusions: Definitions of anorexia must encompass individual reasons for anorexia and not assume fat phobia. Diagnoses must be more culturally sensitive and take into account the cultural context of anorexia. Local biologies influence how anorexia arises as a psychological disease.