Ana, Mia, and the Health Imperative: Do We Have to Eat for Our Health?

A long while back, after I’d just stumbled into the pro-Ana and pro-Mia communities (not as a member), which I had no clue about before I started blogging about fitness and health, I wrote “Why the Thigh Gap Makes Me Sad.”  When I re-visited that article later, “Revisiting the Thigh Gap: Thin Body Shaming Isn’t Okay Either,” I remarked that it contained some thin-body shaming. Based on what I’ve learned over the year and a half or so of blogging on these things, I said a lot of thing I wouldn’t say (or would say quite differently) now.

A couple of days ago Sam sent me a news story from the National Post that is essentially a commentary on pro-Ana and pro-Mia websites and on-line communities.  It’s entitled: “‘Anorexia is a lifestyle, not a disease: an investigation into the harrowing on-line forums promoting extreme dieting.”

The author opens with a bit about a woman named Jade,

Jade calls herself an “ana veteran.” Her aim is to provide “tips, tricks and information” for others who, like her, are in the grip of an eating disorder. Her readers, she says, are “girls who are desperate in their anorexia and willing to do anything to lose weight. They are sick, but they don’t see it as an illness. I’ve been anorexic for 10 years and I know this is the way I want to live.”

Instead of urging her readers to stop starving themselves, Jade helps – often encourages – them to embrace their eating disorder. “I eat three meals a day but make sure I never take in more than 50 calories,” she writes in one post. Another boasts: “I’ve reached a point where I can go without food for three or four days. You can do it too, but it will take discipline and hard work.”

Moving into commentary now, the author says:

Her attitude is chilling but far from unique. Jade is part of a growing international group of “pro-ana” (pro-anorexia) and “pro-mia” (pro-bulimia) bloggers, who perceive their illness as a “lifestyle.” Though sites like this have been around for years, hers is one of a worrying new generation of online communities that have turned anorexia and bulimia into an aspirational state.

The attitude is a bit chilling, I agree. But as an onlooker, my thoughts about this issue have evolved quite a bit over time. One thing that comes up regularly on this blog is a rejection of the idea that health is an imperative. There is no requirement to be healthy, to choose healthy options, to pursue healthy goals.

If there were such an imperative, that would support all sorts of interventions that most of us think cross the line by violating people’s autonomy and right to make their own choices.  Is forcing someone with anorexia to eat any different from forcing someone who is extremely obese to diet or mandating a committed smoker to quit or even forcing a thin couch potato living on junk food to make healthier choices?

It’s not clear to me that it is.  This is not to say that health is not a good. I think, in fact, that good health is an objectively valuable thing to have and to aim for.  It’s an important part of a good life and contributes something fundamental and basic to human flourishing (I’ve been teaching Aristotle lately!).

And still, it’s not something to be forced on people.

I get, too, that anorexia and bulimia, both of which are promoted in these on-line communities, are considered to be illnesses.  Considering them as illnesses, the people who have them are actually ill and in need of help.  But we allow other people with illnesses get to make their own choices.  If I’m diagnosed with cancer, it’s up to me whether to pursue treatment, not up to anyone else.  And if I chose not to, surely there would be support for my decision and people would respect it.

But with eating disorders it’s quite the opposite. Few anorexics or bulimics will find support from family or friends.  From the article:

Dr. Helen Sharpe, a professor at the Institute of Psychiatry, King’s College London, has conducted research into pro-ana and pro-mia websites. They are, she says, “incredibly common,” and though they don’t cause eating disorders, they can perpetuate them. “What do they give people that they can’t get elsewhere?” she asks. “Eating disorders can be extremely isolating conditions, and so finding a community of other people who think like you can be a powerful draw.”

This idea of community, of anorexics and bulimics wanting to “belong” to a virtual family, is played out across the websites. On the world’s largest pro-ana forum, which has 65,000 users and 1.5 million posts, many topics are available exclusively to members, with layers of access granted the longer they stay with the site.

A couple of comments. As Sharpe says, these communities do not cause eating disorders even if they promote the idea.  I’ve lurked on some of the message boards a bit and seen that when someone comes on looking for advice about how to “become anorexic” she (usually she) is certain to get flamed.  She is urged to get out and to get a grip. Members explain to her that it’s an illness.

So even within the idea of anorexia as a lifestyle, there’s an implicit often unstated assumption at work: that it’s only a “lifestyle” for those who are already afflicted with an illness. There is a further assumption that it’s a difficult and painful lifestyle. No wonder they are seeking mutual support.

The shocking element for an onlooker is the type of support–it’s a lot of support to maintain and sustain the condition in a stealth way, so as to minimize interventions and comments from friends and family members.

But perhaps, like addicts or alcoholics whose chances of successful recovery are low if they’re forced, much better if they choose it, pro-ana and pro-mia support communities can nudge people into the direction of choosing something different and seeking help and healing:

Not all online discussion of eating disorders is negative, either. There are a host of websites that are more constructive than destructive. These ones, suggests Susan Ringwood from Beat, may hold the key to encouraging sufferers to have more positive discourse.

Ruby, a 32-year-old from the West Country, runs one such blog. She has lived the “half-life” of anorexia since she was 16. With her doctors’ permission, she writes to me from inside a psychiatric unit, where she is seeking treatment after decades of concealing her illness. “It’s a daily battle,” she explains. “There is a tug-of-war going on in my head. Recovery or eating disorder. Life or death. Fight or give up.”

Though she shares some characteristics with other sufferers who write online, Ruby’s blog is different from a pro-ana website. There is no claim that anorexia is a lifestyle, no “10 thin commandments,” no telling others off for eating.

Instead, there are sections entitled “myths”, “the facts” and “treatment”. Her writing is stark and honest; her acceptance that she has a mental illness clear. Most importantly, she urges her followers to seek help. “I don’t think pro-ana girls realise how dangerous their behaviour is,” she says.

There are signs, too, that writing has spurred Ruby on towards real-life recovery – a result that, experts say, might encourage others. “It’s a sad truth that my virtual life is more active than my real life,” she writes in a recent post.

I guess what I’m saying is that the issue is much more complicated than I thought it was when I first encountered it.  The article in the National Post would have had me nodding along a year ago. But today, I’m more cautious.  I still feel as if there is a reason to feel sad when people choose to pursue a life that restricts their range of choices and, by all accounts, promotes an excessive focus on one thing (much as an addict or alcoholic is focused on one thing).

But I don’t think that people can be forced to pursue healthy options even if they’re ill.  And that’s because health is a value, not an imperative.  And yes, watching people make choices that we perceive to be harmful, to support their illnesses, is a difficult thing to do. But the bottom line is, no one has to eat for their health.