Raising Awareness vs. Promoting and Normalizing Pathology

Newsweek recently published an article titled Out of the Shadows regarding the proliferation of so-called “pro-ana” web sites:

A Web page labeled “Ana Boot Camp” recently offered its members a seemingly irresistible proposition: a 30-day regimen designed to help them drop some serious pounds, no exercise needed. The catch was that the group’s members were to vary their daily caloric intake from 500 (less than half the daily minimum requirement for women recommended by the American College of Sports Medicine) to zero. They were supposed to track their progress, fast to make up for the days they accidentally “overate” and support each other as they worked toward their common goal of radical weight loss.

Pro-anorexia, or “pro-ana,” Web sites (with more than one using the “Ana Boot Camp” name) have for years been a controversial Internet fixture, with users sharing extreme diet tips and posting pictures of emaciated girls under headlines such as “thinspiration.” But what was unusual about the site mentioned above (which is no longer available) was where it was hosted: the ubiquitous social networking site Facebook.com. The (largely female) users who frequent pro-ana sites have typically done so anonymously, posting under pseudonyms and using pictures of fashion models to represent themselves. Now, as the groups increasingly launch pages on Facebook, linking users’ real-life profiles to their eating disorders, the heated conversation around anorexia has become more public. Many pro-ana Facebookers say the groups provide an invaluable support system to help them cope with their disease, but psychologists worry that the growth of such groups could encourage eating disorders in others.

More recently, I came across an article by John Grohol in which he seems to argue that there is a positive side to such groups:

These groups are a little disturbing, especially as you read through the postings. But no more so than the dozens of self-harm sites online, or the sites devoted to helping people be more successful in suicide. Or a dozen other topics that if you learned you could join a group that was “pro” that, you’d be saying to yourself, “Really? Wow.”

That is, after all, the nature of the Internet. It allows for people with very diverse wants and needs to find one another and hook up with one another far more easily than has ever been possible previously in human culture. The fact that some of these wants and needs are outside of the mainstream norm is not at all surprising.

So what does all of this do for people? Isn’t allowing people to discuss their pro-ana needs just plain harmful and potentially dangerous? Not necessarily:

Marcia Herrin, a Dartmouth professor who has written several books on eating disorders, finds the public nature of the discussions of anorexia on Facebook encouraging, because it shows that teens are less afraid of confronting eating disorders.

The more “out in the open” these kinds of concerns become, the more society learns and can answer the kinds of information (or mis-information) they promote. If more teens feel comfortable talking about eating disorders, then perhaps more will also feel comfortable asking for help when they notice themselves or a close friend who might be going down that road. And while in an ideal world, we’d prefer a teen or child not have to go down that road to learn for themselves, sometimes experience is the only teacher that can make a difference.

I think Grohol is confusing two very different things here.

I would argue that the answer to Grohol’s question, “Isn’t allowing people to discuss their pro-ana needs just plain harmful and potentially dangerous?”, is an emphatic “Yes!”.

There is an enormous difference hetween raising awareness about anorexia and other eating disorders and pro-ana sites, just as there is between raising awareness about suicide and pro-suicide sites.

Raising awareness draws attention to, and potentially political and financial support for research into causes and treatment of, the disorder.

Pro-ana sites not only strive to normalize the behavior but encourage their members to ignore the risks in the pursuit of extreme “thinness”, aka “thinspiration”. How is this any different from the typical antipsychiatry site that promotes the view that illnesses such as schizophrenia do not exist beyond social rejection of the symptoms that characterize the illness?

For those caught up in (or formerly caught up in) the internet pro-ana scene, I would recommend having a look at We Bite Back, a forum community for support in recovery from this sinister online virtual cult world:

This is the site that comes after the madness. Before we came along, there was no place for people to go who found support on pro-ana forums, communities and email lists who didn’t want to do the ana thing anymore. Welcome to the first web site designed specifically for post-pro-anorexics.

We represent a worldwide virtual network of people proactively seeking recovery and happiness with the same dedication that proanas apply to seeking lower goal weights.

pro-ana sites, anorexia, bulimia, recovery, awareness, pathology, normalization

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  1. WoW – really a very interesting and well documented article.

  2. I have recently begun working with youth with eating disorders and have learned about these pro-ana sites. I’m not a person who is easily upset by psychiatric issues, but these sites left me feeling physically unwell. I do think we should encourage young people to discuss their issues, but no one should be encouraging them to indulge their unhealthy habits. I understand that eating disorders, combined with being a teenager, can be frightening and isolating and knowing they are not alone can decrease anxiety, but we (and that includes people with eating disorders networking with others with the disorder) need to use community to get better. Eating disorders are treatable.

  3. (I apologize for the length of my response)
    First of all, I must say that I do not promote, nor condone eating disorder behaviors. I have lived with anorexia for the last 20 of my (almost) 30 years, and I know first-hand the hell it puts a person through. I have been outpatient for 13 of those years, had a brief stay in-hospital for emergency surgery and organ failure, and spent 6 mo. inpatient at a residential facility. And to this day, every day is still a fight. Did I choose this lifestyle? No. But I don’t always choose to fight against it. That I do know.

    What upsets me most about these “pro-ana” groups is not what is shared amongst the members, but it is the reaction against it. The very first “so-called” pro-ana group began on Yahoo! Groups over 10 years ago. And it started because a number of members on a certain recovery board were asked to leave because we talked too much about our eating disorders. We didn’t share “tips” or “tricks” or what-not. We shared our common struggles and fears and anxieties about foods and weight and dr. appointments and parents who cared TOO much and kept watch, and parents who cared too little and simply turned their heads. We talked about our ED’s because it was part of our lives, part of our “normal”.

    We broke from the recovery board and created our own private group, and the girls in the group were from around the world, not just here in the US. It wasn’t pro-recovery or pro-ana. It was pro-support, no matter if the goal was losing a few more pounds or going into inpatient treatment, we were there for one another. If someone did go IP, the rest of us made sure to send cards and letters and encouragement.

    To this day, we still keep in contact. Many of us have healed or mostly healed from our eating disorders, some of us still fight it every day, and some of us only face it during the most stressful times, when going back to losing weight feels safe.

    The U.K. edition of Cosmo magazine did an article on our group several years ago. To this day, I still have the original transcripts of the questions/answers I had sent (along with a couple others who were interviewed), but what was published was very much edited and skewed to fit the reporters/magazine’s agenda for the article. And it was in this article that our group was labeled as being “pro-ana” as in “promoting anorexia”. When actually, the term originally meant simply that we were “for anorexia”, meaning we were not yet active in the recovery process. Most of us were still trying to figure out where we were and how we got there, let alone figuring out how to get back out again.

    After this article was published, claiming we offered “tips and tricks” on how to “be” anorexic, and included a link to the group site and our website, our membership requests for the group and website hits skyrocketed. The number of so-called “pro-ana” websites and groups increased on a daily basis. Anyone who really does have an eating disorder knows it’s more than simply dieting for a few weeks. You can not “give” someone an eating disorder, nor can you “teach” them how. It doesn’t work that way. It’s not an illness you can catch. And you don’t get to pick and choose which parts of the disorder you want. You can’t have the weight loss and maintain your health. Can’t have the thinness and maintain your sanity. Someone can show me how to shoot up with drugs, and what to use and how to take it, blah blah blah, they can “teach” me the methods of the addiction. But this does not mean that I automatically will become addicted. Same way with an eating disorder.

    Rather than point fingers at those who of us who visit these sites and placing blame at us for creating/causing “this sinister online virtual cult world:” (direct quote)[and quite creative at that– I haven’t heard it stated in exactly those terms before. That’s a new one! Congrats!] I’d suggest you learn from those of us who have lived it, rather than learning simply from those who have only observed it. Because there is a world of difference between the two perspectives.

    If eating disorders were taken seriously, and not seen as something we do intentionally or for attention; if we were given the same considerations in treatment options as those who’s addiction is alcohol or drugs rather than starvation and weight loss, maybe we wouldn’t have to hide away in the corners of the WWW to find justification for our own existence. If ED’s weren’t such a taboo subject and weren’t glamorized in the media, then maybe we could actually find support in “real life”, in our own communities.

    Basically, it breaks down to this mindset: “if the doctors/therapists/teachers/parents/peers/friends/family/coaches/insurance companies etc. don’t think I have a problem, then I don’t. If they don’t think I need help, I must not need it. If they don’t think I am worth spending the time or effort on, then I must not deserve it. And if I don’t deserve to get better, then the faster I lose the weight, the faster I’ll disappear. The less room I’ll take up in the world and the better off I’ll be. The better off everyone else will be. ”

    And if someone else knows exactly what I think and exactly what I feel, and we share a common need for disappearance, it makes it a bit more tolerable if you share the spiral down with someone who understands it.
    I’m not justifying it, simply trying to explain it.

  4. You too are confusing raising awareness with promoting pathology (see my comments above in the original blog post). Would you make the same “pro” comments about pro-suicide sites?

  5. What a great article! I do see what it means that these days it so much easier to lalk about issues of depression, anorexia and such. It’s scary thinking that you can get online and dicuss these things with another person that has the problem. There is a chance of encouraging each other. On the other hand, talk about it and encourage each other to get help. It can go either way.

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