Being normal

One of the most lively conversations during my medical sociology class tends to come when we talk about eating disorders. This comes as part of a series of discussions about the sick role and definitions of health and deviance. My students really get into thinking about social pressures to conform, media influences on body image, and the idea that eating disorders can be much more than expression of a desire to be thin; we talk about eating disorders as a kind of model for deviant behavior that becomes symbolic of will, control, and independence as much as anything.

Today’s Times has an article on race and eating disorders that raises some intersting ideas that intersect with some of that discussion. The general idea of the piece is that African American women in particular 1) have unknown rates of eating disorders, but 2) are believed to be underdiagnosed and 3) are treated at much lower rates than white women. Research discussed in the piece suggests that “young black women were as likely as white women to report binge eating,” and “black women were as likely as white women to report binge eating or vomiting and were more likely to report fasting and the abuse of laxatives or diuretics than their white peers.”

So while there’s some evidence of similar rates of eating disorders, there’s nothing to suggest that treatment is equal: 28% of white women reported receiving treatment or therapy, while only 5% of black women do so. The research discussed has an admittedly small sample size, but it corresponds with plenty of other work, such as Sing Lee’s1 review of cross-national prevalance of eating disorders and cultural barriers to diagnosis and treatment.

The Times article suggests that issues of resources may prevent many black women from seeking treatment, and that culture plays a role in the belief that they may be unaffected by eating disorders: A researcher interviewed in the article comments that, “experts traditionally had thought that “anorexia and bulimia didn’t happen to black, Asian or Hispanic women, that they were somehow immune.” In her own article, Lee demolishes the idea that eating disorders are bound to particular (Western) cultures by re-explaining them as being about much more than simple fear of being overweight (which is usually included as part of the diagnosis).

What the Times article doesn’t quite do is put this situation of underdiagnosis and treatment into context: It fits perfectly with what we know about other medical concerns in underserved populations. There’s a gender factor at work here as well as a racial one, such that the most readily-treated subject of medical care—the model for baselines of normal and abnormal—is still largely based on white men. Just as eating disorders are less likely to be diagnosed in black women, heart disease was undiagnosed in women generally for decades. And what might have been diagnosed as anxiety in male patients was frequently determined to be hysteria in female patients. The Times article, then, is a nice and detailed depiction of just one of the ways in which social characteristics affect treatment and diagnosis at multiple points in the process, from definition to clinical findings to patient perceptions of their own dis-ease.

1 Sing Lee, “Reconsidering the Status of Anorexia Nervosa as a Western Culture-Bound Syndrome.” Pp 21-34 in Social Science & Medicine vol 42, no 1 (1996).