In the book, Crazy Like Us,by Ethan Watters, four different psychological disorders are explored.
However, for the purpose of this paper, the focus will be on anorexia. Anorexia can be described as “an intense fear of being fat and arestriction of food intake” (Shacter, Gilbert, and Wegner, 2011, p. 330). It is commonly seen of anorexia in females, but there are also caseswhere males have been reported to have anorexia. In most cases, femaleswho are diagnosed with anorexia, think of themselves as fat when in actualitythe female individual is extremely thin.
Body image is an issuethat many females struggle with, especially with advertisements showcasing whatsociety thinks the perfect woman should look like. This mindset ofthinking that you have to be thin to be beautiful is often the cause ofanorexia. Anorexia affects your appetite and hunger, usually reducingone’s desire to eat. As a result, leptin (the appetite suppressinghormone) levels are decreased, and ghrelin (the appetite stimulating hormone)levels are increased (Shacter, Gilbert, and Wegner, 2011, p. 330). Whilesociety and culture might play a role in the manifestation of anorexia, it ishypothesized that males with anorexia might have developed the disorder becauseof “prenatal exposure to female hormones” (Shacter, Gilbert, and Wegner, 2011,p. 330). Doctor Sing Lee is a renowned scientist in China who works at thePrince of Wales Hospital and researches eating disorders, such as anorexia.
Interestingly, Lee was “the first scholar to document anorexia in Chinesewomen” (Watters, 2011, p. 12). Chinese women seemed to have differentsymptoms than a typical anorexic patient.
While anorexia was well-knownin other countries around the world, China and Hong Kong had no information onthis particular disorder. Lee discovered that anorexia was not a commondisorder in Hong Kong. Stemming from his research, he published a paperin the British Journal of Psychiatry called “Anorexia Nervosa in Hong Kong: Whynot more in Chinese?”; anorexia can be described as “an intense fear of beingfat and a restriction of food intake” (Watters, 2011, p. 14).
Lee’s first patient, Jiao, suffered fromanorexia. Jiao was the only living child left in her family, as her twoolder brothers passed away at a young age. Her father was often away onbusiness, as he was the sole provider for her family. However, when herfather was home, he often verbally expressed his disapproval or irritation ofJiao and her mother. It was discovered that Jiao’s anorexia began fouryears prior to her hospital visit, as a result of her boyfriend leaving her. She could not cope with being alone.
Jiao made excuses for herdecreased eating habits such as having stomach pains. Doctors and herparents urged her to eat. According to hospital records, when Jiao wasseen by Lee, she had an unhealthy body weight of 48 pounds, and her skeletonwas visible through her skin. Along with her physical appearance, she waspale and cold and had a low blood pressure and heart rate. During theinteractions between Lee and Jiao, Lee realized that her symptoms didn’t matchthe standards for anorexia set by The Diagnostic and Statistical Manual ofMental Disorders. Jiao understood that she was malnourished andunderweight. Jiao stated that she never was self-conscious about theamount of food she consumed. Jiao just did not feel hungry at times,which would lead to her not eating anything throughout the day (Watters, 2011,p.
16). Jiao followed Lee’s suggestion and admittedherself to the hospital. After observing Jiao, Lee realized that thereason why Jiao was not responding to treatment could be due to culturalreasons.
He enlisted a Chinese herbalist. The herbalist created aconcoction that was supposed to heal her damaged liver and repair herheartbreak, but Jiao rejected the drink. Another specialist also tried tointroduce a new form of treatment; however, Jiao still refused to participate. As a result, the specialist quit and said that Jiao is untreatable,because she was “not willing to recover” (Watters, 2011, p. 20).
Jiao wasdisgruntled with how her treatment was progressing, so she made the consciousdecision to leave the hospital. Unfortunately, she was readmitted twoweeks later and in even worse conditions. Jiao seemed to have a change ofheart and more positive outlook on life, as she started to eat in smallincrements.
Two days later, Jiao died from organ failure. Lee decided to perform his own experiment. He began to limit his daily food intake and exercise more intensively inorder to better understand how his patients felt physically andpsychologically.
Lee soon made extreme dieting apart of his dailyroutine, even stating that it was refreshing. While he did not want torevert back to his old eating habits, Lee forced himself to adapt. Theexperiment caused Lee to lose “12 percent of his body weight” (Watters, 2011,p. 24).
More research studies were conducted on theatypical symptoms presented by many anorexic women. Hysteria seemed to bea common symptom in addition to starvation. According to a French journalist,”The illness of our age 1881 is hysteria” (Watters, 2011, p.
29). In1873, anorexia was formally named anorexia nervosa. As this disorderbecame more recognizable, more women began diagnosing themselves as anorexicoff of a based list of corresponding symptoms. Due to new discoveries,Lee determined that his past patients might not have felt that their starvationstemmed from a fear of being fat because it was not common in China (Watters,2011, 36). His curiosity about the differences between eastern andwestern cases of anorexia also increased.
One teenager, Charlene, passed away fromanorexia nervosa. The cause of her death led to a familiarity of thisdisorder. Before the disorder took over her life, Charlene was theperfect daughter and an excellent student.
Nevertheless, her lack ofnutrition led to her losing weight, as well as a complete difference ofpersonality. She started to distance herself from others. Othersnoticed the sudden change and tried to encourage her to eat more. Herschool faculty knew of her disorder, but her parents did not.
On her wayhome from school, Charlene collapsed and died. Her death made the news,jumpstarting the spread of awareness. Schools were now required to offercounseling and educate their students on eating disorders (Watters, 2011, 44). After Charlene’s death, the number ofpatients that Lee saw increased drastically. Lee was still trying tosupport his theory that the symptoms of Chinese women with anorexia aredifferent from the medically published symptoms. However, patientsstarted to report symptoms that aligned with the The Diagnostic andStatistical Manual of Mental Disorders. This was concerning to Lee,as he did not know if his patients were just conforming and identifying withanorexia from its distinguished signs. Lee discovered that half of hispatients were unaware of their starvation while the others were “manifestingthe disorder that reflected the system pool at the time” (Watters, 2011, 52).
A famous painting, Les Demoiselles d’Avignon, created by Picassobecame the center of Melanie Katzman (a feminist) and Lee’s paper. Theywrote about how the painting was a representation of “women suffering fromeating disorders in general and anorexia nervosa in particular. Lee met with one of his old patients namedLing. Ling did not have the happiest life.
Her father sexuallyassaulted her at a young age, not to mention, he was also a raging alcoholic. Ling developed insomnia, halted menstrual cycles, and had to have herappendix removed. Her motivation for everything ceased,she dropped out ofschool and attempted to commit suicide.
The first specialist that Linghad a consultation with was a gynecologist. Her mother had hopes of fixingLing’s menstrual cycles, so that one day she could get married and have afamily. Lee diagnosed Ling with anorexia; however, Ling was in denial. When Ling was checked into the hospital, she encountered others with thesame condition as her, as there was now a wing dedicated to anorexia (Watters,2011, 56). As of right now, “there is no effective drug treatment foranorexia” (Watters, 201, 57).
The only way to treat a patient withanorexia is to provide motivation and a support system. In hopes of finding an effective treatmentfor anorexia, research is being conducted not only in the United States, butalso in other countries. One experiment done explored the possibility of”repeated doses of intranasal oxytocin enhancing treatment outcomes in anorexia(“Intranasal oxytocin in…”, 2017, paragraph 1). The hormone, oxytocin, isvery important in this experiment. Oxytocin is a hormone that regulatessocial behaviors, as well as food consumption and anxiety or stress levels(“Intranasal oxytocin in…”,2017, paragraph 6). This study included femaleparticipants, ranging from the age of sixteen to sixty.
Combined, theaverage body mass index score was 16.6 (“Intranasal oxytocin in…”, 2017,paragraph 32). All forty-one of the patients were from an eating disorderfacility in Greenwich, Australia. There were two groups of participants inthis study: one who got the intranasal oxytocin and one who got a placebo.
Both the intranasal oxytocin and placebo “sprays were commerciallyproduced by Stenlake Compounding Chemist in Sydney (“Intranasal oxytocin in…”,2017, paragraph 17). Every dose of treatment contained 9 internationalunits of the chosen drug. The use of the sprays was monitored by nursesin the facility. On the first day, 18 international units wereadministered to the patient. After that, in the morning, the patientsdosed themselves with the 9 international units of the drug or placebo. However, during the afternoon, they were instructed to take 18international units (“Intranasal oxytocin in…”, 2017, paragraph 18).
As a follow up, the patients were asked aseries of questions to check their progress. They had to rate theirconcerns on a scale from zero to six. This type of scale is called aneating disorder evaluation, which bases the questions on “eating concern,restraint, weight concern, shape concern, and overall global measure”(“Intranasal oxytocin in…”, 2017, paragraph 19). Other tests wereconducted to assess the severity of the patient’s’ disorder. Thisexperiment was conducted to find out the effects of oxytocin on stress, theSpielberger State-Trait Anxiety Inventory Short Form was also given to thepatients. Regarding the physiological aspects of the experiment, bloodand saliva samples were taken for analysis. One of the hormones that wasextracted from the saliva was known as cortisol (“Intranasal oxytocin in…”,2017, paragraph 23). Moreover, the oxytocin levels were assessed usingthe 96-well commercial oxytocin enzyme-linked immunosorbent assay (“Intranasaloxytocin in.
..”, 2017, paragraph 24). Concerning the results, there were no malreported side effects of the intranasal drug after the thirty-nine-day period. Some of the minor symptoms include headaches, nausea, urination andconstipation issues, and breathlessness. Regarding anxiety, there was onepatient who reported that her anxiety did not improve, rather it increased(“Intranasal oxytocin in…”, 2017, paragraph 31). On a positive note,there seemed to be an increase in weight for the participants and their eatingdisorder evaluations were on average lower than when the experiment began(“Intranasal oxytocin in.
.., 2017, paragraph 44). The results of theexperiment prove that intranasal oxytocin doses improve one’s aversion toeating after a period of time, basically reducing the stress associated withthe notion of eating. Because the main issue with anorexia is that theaffected individuals lose their appetite due to their fears, this issignificant. While this research experiment seemed to be successful, theprocedure needs excess trials with a bigger sample size (“Intranasal oxytocinin…”, 2017, paragraph 56).
Another trial in France was being conductedon how ghrelin affects appetite in anorexia patients. The hormone,ghrelin, increases hunger, “administrations of ghrelin may represent the firstchoice for pharmacotherapy of anorexia” (“Ghrelin treatment prevents…”, 2016,paragraph 3). It was discovered that IgG protects the protein hormone,ghrelin, from denaturing. With the IgG protected, the hormone can be moreeffective. Based on this discovery, it is hypothesized that both ghrelinand IgG together will have a better outcome and effect than if ghrelin was usedindependently (“Ghrelin treatment prevents.
..”, 2016, paragraph 5). Instead of using humans as test subjects,the experiment was tested on mice. Ghrelin and IgG were injected into thebloodstreams of both obese and lean mice. Throughout the trial, the micehad access to water and had a running wheel provided inside of their cages.
However, the amount of food provided was limited and controlled. After a meal, scientists measured the amount of food that the miceconsumed (“Ghrelin treatment prevents…”, 2016, paragraph 7).
Half themice were restricted to small amounts of food, almost to the point ofstarvation. Reasoning behind small portions was to simulate anorexicconditions. One way to measure the amount of ghrelin in the blood was toseparate the plasma from the blood. The IgG levels combined with theghrelin were calculated by the enzyme-linked immunosorbent assay (ELISA). In addition, purification of the plasma helped to preserve the IgGsample, which was measured using the Nanodrop (“Ghrelin treatment prevents..
.”,2016, paragraph 10). The hypothesis was incorrect, as thecombined use of ghrelin and IgG did increase appetite more than the use ofghrelin alone. While ghrelin is used to increase hunger, it is also usedto increase physical activity. The mice had “a reduction of physical activityassociated with feeding, yet it had increased physical activity after feedings”(“Ghrelin treatment prevents…
“, 2016, paragraph 30). This could be thereason why there was no significant weight loss difference in the mice. On the positive side, the IgG lengthened the life of the ghrelin in theplasma, prolonging hunger. Still, further studies are needed to uncoverthe full effect of ghrelin in anorexic patients. Comparing the two research studies, boththe intranasal oxytocin and ghrelin experiments focused on the use of hormonesas treatment, concentrating on increasing the desire to eat.
Instead oftrying to fix the hunger issue, it seems more logical to unearth the motivationbehind the self-starvation and the psychological reasons. Without theproper determination to eat, one could still suppress the hunger if they settheir mind to it and let their fear of fatness drive their actions. The United States, Australia, and France arewilling to find a treatment for this common and terrible disorder, and thesecountries understand that this seriously affects not only the patient, but alsotheir loved ones.