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 a
restriction of food intake” (Shacter, Gilbert, and Wegner, 2011, p. 330).
It is commonly seen of anorexia in females, but there are also cases
where males have been reported to have anorexia. In most cases, females
who are diagnosed with anorexia, think of themselves as fat when in actuality
the female individual is extremely thin. Body image is an issue
that many females struggle with, especially with advertisements showcasing what
society thinks the perfect woman should look like. This mindset of
thinking that you have to be thin to be beautiful is often the cause of
anorexia. Anorexia affects your appetite and hunger, usually reducing
one’s desire to eat. As a result, leptin (the appetite suppressing
hormone) levels are decreased, and ghrelin (the appetite stimulating hormone)
levels are increased (Shacter, Gilbert, and Wegner, 2011, p. 330). While
society and culture might play a role in the manifestation of anorexia, it is
hypothesized that males with anorexia might have developed the disorder because
of “prenatal exposure to female hormones” (Shacter, Gilbert, and Wegner, 2011,
Doctor Sing Lee is a renowned scientist in China who works at the
Prince of Wales Hospital and researches eating disorders, such as anorexia.
Interestingly, Lee was “the first scholar to document anorexia in Chinese
women” (Watters, 2011, p. 12). Chinese women seemed to have different
symptoms than a typical anorexic patient. While anorexia was well-known
in other countries around the world, China and Hong Kong had no information on
this particular disorder. Lee discovered that anorexia was not a common
disorder in Hong Kong. Stemming from his research, he published a paper
in the British Journal of Psychiatry called “Anorexia Nervosa in Hong Kong: Why
not more in Chinese?”; anorexia can be described as “an intense fear of being
fat and a restriction of food intake” (Watters, 2011, p. 14).
Lee’s first patient, Jiao, suffered from
anorexia. Jiao was the only living child left in her family, as her two
older brothers passed away at a young age. Her father was often away on
business, as he was the sole provider for her family. However, when her
father was home, he often verbally expressed his disapproval or irritation of
Jiao and her mother. It was discovered that Jiao’s anorexia began four
years prior to her hospital visit, as a result of her boyfriend leaving her.
She could not cope with being alone. Jiao made excuses for her
decreased eating habits such as having stomach pains. Doctors and her
parents urged her to eat. According to hospital records, when Jiao was
seen by Lee, she had an unhealthy body weight of 48 pounds, and her skeleton
was visible through her skin. Along with her physical appearance, she was
pale and cold and had a low blood pressure and heart rate. During the
interactions between Lee and Jiao, Lee realized that her symptoms didn’t match
the standards for anorexia set by The Diagnostic and Statistical Manual of
Mental Disorders. Jiao understood that she was malnourished and
underweight. Jiao stated that she never was self-conscious about the
amount 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,
Jiao followed Lee’s suggestion and admitted
herself to the hospital. After observing Jiao, Lee realized that the
reason why Jiao was not responding to treatment could be due to cultural
reasons. He enlisted a Chinese herbalist. The herbalist created a
concoction that was supposed to heal her damaged liver and repair her
heartbreak, but Jiao rejected the drink. Another specialist also tried to
introduce 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 was
disgruntled with how her treatment was progressing, so she made the conscious
decision to leave the hospital. Unfortunately, she was readmitted two
weeks later and in even worse conditions. Jiao seemed to have a change of
heart and more positive outlook on life, as she started to eat in small
increments. 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 in
order to better understand how his patients felt physically and
psychologically. Lee soon made extreme dieting apart of his daily
routine, even stating that it was refreshing. While he did not want to
revert back to his old eating habits, Lee forced himself to adapt. The
experiment caused Lee to lose “12 percent of his body weight” (Watters, 2011,
More research studies were conducted on the
atypical symptoms presented by many anorexic women. Hysteria seemed to be
a common symptom in addition to starvation. According to a French journalist,
“The illness of our age 1881 is hysteria” (Watters, 2011, p. 29). In
1873, anorexia was formally named anorexia nervosa. As this disorder
became more recognizable, more women began diagnosing themselves as anorexic
off of a based list of corresponding symptoms. Due to new discoveries,
Lee determined that his past patients might not have felt that their starvation
stemmed from a fear of being fat because it was not common in China (Watters,
2011, 36). His curiosity about the differences between eastern and
western cases of anorexia also increased.
One teenager, Charlene, passed away from
anorexia nervosa. The cause of her death led to a familiarity of this
disorder. Before the disorder took over her life, Charlene was the
perfect daughter and an excellent student. Nevertheless, her lack of
nutrition led to her losing weight, as well as a complete difference of
personality. She started to distance herself from others. Others
noticed the sudden change and tried to encourage her to eat more. Her
school faculty knew of her disorder, but her parents did not. On her way
home from school, Charlene collapsed and died. Her death made the news,
jumpstarting the spread of awareness. Schools were now required to offer
counseling and educate their students on eating disorders (Watters, 2011, 44).
After Charlene’s death, the number of
patients that Lee saw increased drastically. Lee was still trying to
support his theory that the symptoms of Chinese women with anorexia are
different from the medically published symptoms. However, patients
started to report symptoms that aligned with the The Diagnostic and
Statistical Manual of Mental Disorders. This was concerning to Lee,
as he did not know if his patients were just conforming and identifying with
anorexia from its distinguished signs. Lee discovered that half of his
patients were unaware of their starvation while the others were “manifesting
the disorder that reflected the system pool at the time” (Watters, 2011, 52).
A famous painting, Les Demoiselles d’Avignon, created by Picasso
became the center of Melanie Katzman (a feminist) and Lee’s paper. They
wrote about how the painting was a representation of “women suffering from
eating disorders in general and anorexia nervosa in particular.
Lee met with one of his old patients named
Ling. Ling did not have the happiest life. Her father sexually
assaulted her at a young age, not to mention, he was also a raging alcoholic.
Ling developed insomnia, halted menstrual cycles, and had to have her
appendix removed. Her motivation for everything ceased,she dropped out of
school and attempted to commit suicide. The first specialist that Ling
had a consultation with was a gynecologist. Her mother had hopes of fixing
Ling’s menstrual cycles, so that one day she could get married and have a
family. Lee diagnosed Ling with anorexia; however, Ling was in denial.
When Ling was checked into the hospital, she encountered others with the
same 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 for
anorexia” (Watters, 201, 57). The only way to treat a patient with
anorexia is to provide motivation and a support system.
In hopes of finding an effective treatment
for anorexia, research is being conducted not only in the United States, but
also 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, is
very important in this experiment. Oxytocin is a hormone that regulates
social behaviors, as well as food consumption and anxiety or stress levels
(“Intranasal oxytocin in…”,2017, paragraph 6). This study included female
participants, ranging from the age of sixteen to sixty. Combined, the
average body mass index score was 16.6 (“Intranasal oxytocin in…”, 2017,
paragraph 32). All forty-one of the patients were from an eating disorder
facility in Greenwich, Australia.
There were two groups of participants in
this study: one who got the intranasal oxytocin and one who got a placebo.
Both the intranasal oxytocin and placebo “sprays were commercially
produced by Stenlake Compounding Chemist in Sydney (“Intranasal oxytocin in…”,
2017, paragraph 17). Every dose of treatment contained 9 international
units of the chosen drug. The use of the sprays was monitored by nurses
in the facility. On the first day, 18 international units were
administered to the patient. After that, in the morning, the patients
dosed themselves with the 9 international units of the drug or placebo.
However, during the afternoon, they were instructed to take 18
international units (“Intranasal oxytocin in…”, 2017, paragraph 18).
As a follow up, the patients were asked a
series of questions to check their progress. They had to rate their
concerns on a scale from zero to six. This type of scale is called an
eating 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 were
conducted to assess the severity of the patient’s’ disorder. This
experiment was conducted to find out the effects of oxytocin on stress, the
Spielberger State-Trait Anxiety Inventory Short Form was also given to the
patients. Regarding the physiological aspects of the experiment, blood
and saliva samples were taken for analysis. One of the hormones that was
extracted from the saliva was known as cortisol (“Intranasal oxytocin in…”,
2017, paragraph 23). Moreover, the oxytocin levels were assessed using
the 96-well commercial oxytocin enzyme-linked immunosorbent assay (“Intranasal
oxytocin in…”, 2017, paragraph 24).
Concerning the results, there were no mal
reported side effects of the intranasal drug after the thirty-nine-day period.
Some of the minor symptoms include headaches, nausea, urination and
constipation issues, and breathlessness. Regarding anxiety, there was one
patient 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 eating
disorder evaluations were on average lower than when the experiment began
(“Intranasal oxytocin in…, 2017, paragraph 44). The results of the
experiment prove that intranasal oxytocin doses improve one’s aversion to
eating after a period of time, basically reducing the stress associated with
the notion of eating. Because the main issue with anorexia is that the
affected individuals lose their appetite due to their fears, this is
significant. While this research experiment seemed to be successful, the
procedure needs excess trials with a bigger sample size (“Intranasal oxytocin
in…”, 2017, paragraph 56).
Another trial in France was being conducted
on how ghrelin affects appetite in anorexia patients. The hormone,
ghrelin, increases hunger, “administrations of ghrelin may represent the first
choice 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 more
effective. Based on this discovery, it is hypothesized that both ghrelin
and IgG together will have a better outcome and effect than if ghrelin was used
independently (“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 the
bloodstreams of both obese and lean mice. Throughout the trial, the mice
had 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 mice
consumed (“Ghrelin treatment prevents…”, 2016, paragraph 7). Half the
mice were restricted to small amounts of food, almost to the point of
starvation. Reasoning behind small portions was to simulate anorexic
conditions. One way to measure the amount of ghrelin in the blood was to
separate the plasma from the blood. The IgG levels combined with the
ghrelin were calculated by the enzyme-linked immunosorbent assay (ELISA).
In addition, purification of the plasma helped to preserve the IgG
sample, which was measured using the Nanodrop (“Ghrelin treatment prevents…”,
2016, paragraph 10).
The hypothesis was incorrect, as the
combined use of ghrelin and IgG did increase appetite more than the use of
ghrelin alone. While ghrelin is used to increase hunger, it is also used
to increase physical activity. The mice had “a reduction of physical activity
associated with feeding, yet it had increased physical activity after feedings”
(“Ghrelin treatment prevents…”, 2016, paragraph 30). This could be the
reason why there was no significant weight loss difference in the mice.
On the positive side, the IgG lengthened the life of the ghrelin in the
plasma, prolonging hunger. Still, further studies are needed to uncover
the full effect of ghrelin in anorexic patients.
Comparing the two research studies, both
the intranasal oxytocin and ghrelin experiments focused on the use of hormones
as treatment, concentrating on increasing the desire to eat. Instead of
trying to fix the hunger issue, it seems more logical to unearth the motivation
behind the self-starvation and the psychological reasons. Without the
proper determination to eat, one could still suppress the hunger if they set
their mind to it and let their fear of fatness drive their actions. The United States, Australia, and France are
willing to find a treatment for this common and terrible disorder, and these
countries understand that this seriously affects not only the patient, but also
their loved ones.