Ambivalence is a great word to describe how many eating disorder patients feel about recovery. Many people that follow my Science of Eating Disorders tumblr run thinspo blogs. But, they follow me, and many probably follow fyoured, which offers pro-recovery advice. Many people might want to recover someday, but they feel they can’t let go of the behaviours now. They are not denying their illness, or that recovery will happen, or that it really IS a disorder, but, right now, recovery is just not an option.
Bear with me for a moment. Suspend your judgements and gut-reactions to “proana/mia.”
Eating disorders are highly stigmatized. Most people don’t understand them. Physicians, nurses, and healthcare staff are often no better than the public. Treatment itself can have negative consequences. In a recent study, “more than half of all nurses and residents (58.2%) thought that ED patients were responsible for their disease “always” or “in most cases.”"
This stigma, hostility, and ignorance leads people to form on-line communities where they can openly discuss their experiences and connect with others. This is not unique to anorexia, mental health, or health in general.
But problems occur when the discussions that on-line users seek to have because they cannot have them in real life become so censored and policed that open and honest discussions cease. Ambivalence is no longer tolerated (and it isn’t on many/most pro-recovery communities).
Hence the need for an alternative. A place where people can openly discuss their struggles. But just as media portrayals of eating disorders are often very problematic, media portrayals of pro-ana/mia are often, unsurprisingly, one-sided and misleading.
Thankfully, researchers have began trying to understand why these communities exist, what purposes they serve, and what really goes on inside.
In one particularly illuminating study by Brotsky & Giles (2007), one researcher (Brotsky) went undercover into 12 pro-ana websites, participating in 23 separate groups, and posed as ‘SB’ (a female in her 20′s with anorexia nervosa and a pro-ana sympathizer) in order to understand the “kind of psychological support offered by such websites” and the “beliefs of community members towards eating disorders and the processes of of treatment and recovery.”
I’ll summarize some key points of this paper. As you read through this post, remember that this is ONE study and these are the experiences of ONE researcher.
1. WHAT ATTITUDES DO PRO-ANA COMMUNITIES HAVE TOWARD RECOVERY?
Many individuals believe that pro-anorexia communities are, by definition, anti-recovery. So, are they?
When SB announced that she was about to go into inpatient treatment for her eating disorder, the responses were “overwhelmingly encouraging, supportive, and hopeful”:
That’s a big step your taking. I don’t know about anyone else, but I’m proud of you. Good luck!
I’m here for ya no matter what!! Best wishes!
I hope everything goes well and you’re able to beat this. *Hugs* I’ll be sending support waves to you!
well you’ve been here listening to me go on and on and you related to me and kept talking. I’ve never ever had that. Someone who understood why i need it. Now you want to recover and you may need someone to hear you, when no one else is there. […] you have given it, and i appreciate it so much.
“Not one word of dissent” was uttered at SB’s decision to seek treatment. On that note, Borzekowsky et al (2006), in a review of 180 pro-ana websites, found that 38% included recovery-oriented advice and information, and 21% featured specific sections dedicated to recovery.
2. DO PRO-ANA GROUPS THINK ANOREXIA NERVOSA IS A LIFESTYLE? A CHOICE?
On this, SB found that little consistency between groups, websites, or even individuals within one sub-community.
It is disease, and disorder. But it is not a lifestyle. Whoever claims an Eating Disorder as a lifestyle, agh! It makes me want to cry.
Sorry, but you DO CHOOSE to continue having an ED. And yes, I CHOSE to stick my fingers down my throat when I became bulimic. I didn’t catch any anorexic/bulimia virus. Take some personal responsibility people.
It is true that seeking treatment is a choice, but engaging in behaviours isn’t really a choice. The game is rigged in favour of “choosing” symptoms: they become compulsive, offering a powerful (of course, maladaptive) anxiety reducing and numbing tools to deal with moods and emotions. It is not a choice in the sense that picking the shirt you’ll wear today is a choice. Either way, you’ll be okay. Not so with eating disorders, choose one and you might be faced with an onslaught of anxiety and self-hatred, which is difficult to deal with when you don’t have adequate support (it is difficult even when you do!).
3. ARE PRO-ANA COMMUNITIES REALLY PRO-ANOREXIA?
While the authors carefully selected communities that were NOT focused on recovery and DID use terms like “pro-ana,” SB found that many sub-groups and communities were not at all friendly to ‘ana’:
The following is an excerpt from a chat:
“SB: that’s why i am trying to make conversation […] come on guys
# 305: Nobody wants to talk about ‘ana’ with you, fucktwat.
# 315: THIS ISNT A FUCKING PRO-ANA SITE!! WE DONT DO STATS HERE we come here for SUPPORT
SB: why the hostility
# 315: go to a pro ana site and talk about how fucking grand it is to be anorexic
SB: this is also not a recovery site
# 305: It’s not a recovery site, but it’s not a pro-ana site. This chat sure as fuck isn’t a pro-ana chat.”
When pro-recovery sites become so stifled with rules and any mention of symptoms (outside of saying “I used symptoms”) is censored to protect others who might be triggered, some people who joined the communities in order to be open and honest about things they cannot be honest about in real life will choose to seek support elsewhere. It doesn’t mean they are “pro” eating disorders.
4. WHY CAN’T USERS REACH OUT TO FAMILY OR FRIENDS?
Here are just some examples of why:
first thing my mom said to me when she got back was, wow shorty, look how big youve gotten >.<
i only weigh about 115 and the last time i went home my dad looked at me and said “you haven’t been working out” […] my dad called me a little piggy in front of 3 friends last year when we went out to eat grrr
SUMMARY & DISCUSSION OF FINDINGS
The notion of support was highly prevalent across the community. Even where the “pro-ana” label and its associated ideas were explicitly rejected by site users, the purpose of the community was still perceived as support above all else. However the form that support takes on pro-ana sites is somewhat elusive. SB’s persona was very warmly responded to on some sites, and harshly abused on others, although the basic tenets of the sub-communities’ beliefs did not appear radically different. Making the right first impression seemed to be the only serious predictor of the way that different sub-communities would react.
These communities can be very supportive, but like many anonymous communities on-line, they can also be very snarky and mean. Like elsewhere on the internet, and in real life, much of the discourse depends on a few key, popular individuals. It is the same in a high-school classroom, or a focus group. And like elsewhere, first-impressions matter. It is just amplified on-line due to the nature of the discussions (often very emotional), the individuals involved (often isolated, emotionally unstable, and generally unhappy), and the anonymity component.
On the idea that pro-ana lures others, Brotsky & Giles point out that:
… the rather severe formal ‘application’ procedure set up by some sites would seem to foster a degree of suspicion towards outsiders and intruders demonized routinely within the community as “fakes” and “wannabes”).
What about all the tips on how to purge, starve, and deceive others? (As if one can’t figure this out on their own, my eating disorder developed without ever going on any pro-anorexia sites, and it continued without it, too.)
Ultimately, it seems that the support on offer on pro-ana websites is—for all the scare stories about “purging tips” and users egging one another on with their latest BMIs—little more than sympathetic companionship in a safe, anonymous and largely sympathetic environment. The ferocity of the verbal assaults on SB when trying to muscle into a closed community suggests that these virtual social networks engender a high degree of loyalty and exclusivity that resembles that of tight-knit offline friendship groups, counter-cultural knots of teens sheltering in the corner of the schoolyard from the more conventional “popular” students.
Finally, Brostky & Giles conclude with the following:
Our belief is that it is difficult to claim that pro-ana sites encourage non-eating disordered people to become eating disordered, and so their direct effect on “vulnerable” individuals may have been overstated. The most potentially problematic aspect of the sites, however, is that they offer their users something of a social mirage: the sense of support, connection, and social interactions that they lack in their offline environment.
These connections might be real, helpful, and exist off-line, but they are generally not the same as having strong friend or family support.
Instead of censoring and banning, which doesn’t work (more in later posts), we should be doing more to educate individuals about how to help those with eating disorders. We should raise awareness, amongst the public and clinicians, about the complex etiology of eating disorders. We need to foster a supportive community in real life, and that means working toward ending wide-spread ignorance and stigma about eating disorders.
These communities will continue to exist as long as the public, but particularly friends, family members, and clinicians, continue to be hostile, judgemental, and often wilfully ignorant about eating disorders.
I am just getting started on this topic (so please keep this in mind in the comments). In future posts, I’ll discuss (1) the demographics of individuals who visit pro-ana/mia sites, (2) delve into the content of the sites, (3) discuss how bloggers and users feel about pro-ana/mia, (4) talk about the impact (and implications) of banning pro-ana/mia websites and content, and (5) talk about the negative aspects of pro-ana/mia sites. (Not necessarily in this order.)
Special thanks to:
Dr. Antonio Casilli for recommending this paper. Dr. Casilli is the Scientific Director of the ANAMIA project, “a French National Research Agency (ANR) study focussing on online pro-ED websites and their social determinants”. I highly recommend visiting their website at anamia.fr/en/.
AnaGirlEmpath for answering some of my questions on Twitter. I would also urge readers who want to understand a bit more about the history of pro-anorexia to watch AnaGirlEmpath’s 15 minute video on the topic. It is very informative and very interesting. She also has a few videos on ana-mia research (I have not watched other videos yet, so I’m not endorsing anything, so let’s keep that in mind, I’m just sharing.)