Was Gandhi suffering from Anorexia Nervosa?

Valmont

Yes, this is a serious question. Insofar as Gandhi (or Bobby Sands or any hunger striker for that matter) engaged in self-starvation to the detriment of his health, should this not tell us he was mentally ill with Anorexia? I'm curious in picking apart the criteria used to classify who has a mental illness and who doesn't.

littleblackDRS

No. Gandhi was a pacifist. He engaged in peaceful protesting. He spent most of his life on hunger strike. This doesn't mean he was mentally ill. He wasn't doing it to self harm. He was doing it because it worked.

dar100

Valmont wrote: »

Yes, this is a serious question. Insofar as Gandhi (or Bobby Sands or any hunger striker for that matter) engaged in self-starvation to the detriment of his health, should this not tell us he was mentally ill with Anorexia? I'm curious in picking apart the criteria used to classify who has a mental illness and who doesn't.

Interesting points Valmont, I had a whole post wrote out stating they where different, but after reading it back I realized I was contradicting myself in my view.

IMO, hunger strikers are acting out of a sense of injustice and have such strongly held beliefs and values that they are willing to make the ultimate sacrifice, the main point here, is that it's intentional, planned and thought out with the long term consequences in mind. In a strange way this can be viewed as adaptive

I don't know a huge amount about Anorexia, but I don't imagine that the person sets out to intentional hurt themselves, rather the progression of the illness manifests to a point where it is out of control and deadly.

I believe that the hunger striker has it within their power to change this behaviour, by changing their intention, whereas someone with Anorexia, will need long term interventions

Valmont

littleblackDRS wrote: »

No. Gandhi was a pacifist. He engaged in peaceful protesting. He spent most of his life on hunger strike. This doesn't mean he was mentally ill. He wasn't doing it to self harm. He was doing it because it worked.

If a teenage girl starved herself to get thinner would you conclude she didn't have anorexia because it worked? Also Gandhi -- by starving himself deliberately -- was eo ipso self-harming. So where can we find the one crucial factor according to which a teenage girl who starves herself to look thin (or for any other reason) is suffering from anorexia and Gandhi is not?

littleblackDRS

Valmont wrote: »

If a teenage girl starved herself to get thinner would you conclude she didn't have anorexia because it worked? Also Gandhi -- by starving himself deliberately -- was eo ipso self-harming. So where can we find the one crucial factor according to which a teenage girl who starves herself to look thin (or for any other reason) is suffering from anorexia and Gandhi is not?

Ok, so that is really not what I am saying. I think people throw the word anorexia around. It's not just a matter of starving yourself. It's a mental illness. You wouldn't do it with any other illness.

My point was it wasn't self harm for the sake of self harm. It was politically motivated.

Valmont

littleblackDRS wrote: »

Ok, so that is really not what I am saying. I think people throw the word anorexia around. It's not just a matter of starving yourself. It's a mental illness. You wouldn't do it with any other illness.

My point was it wasn't self harm for the sake of self harm. It was politically motivated.

If a teenage girl diagnosed as anorexic admitted to her psychologist that she was self-starving as a protest against the war in Iraq would you then say she had been mis-diagnosed?

I suppose I'm starting to think that our reasons for classing A as mentally ill but not B aren't nearly as objective as we'd like to think. In fact if Gandhi was self-starving as a means of encouraging space aliens to liberate India from British rule he would still be politically motivated but we would be saying he had schizophrenia with co-morbid anorexia not that he was an inspirational leader.

JuliusCaesar

Anorexics don't generally want to die. They want to be less fat. They see themselves as fat, even if everyone else sees them as skin-and-bones. Their perception of themselves (each person) is no longer in accord with reality. You can argue about whether it's a delusion or a fixed idea, but the starvation is to stop them putting on fat, which is 'ugly' and would indicate that they are 'bad' or 'unworthy' or such like. I have seen them picking at the skin on their stomach (about as much as I'd find if I pinched the back of my hand) saying: Look at this fat! It's disgusting!

Don't think Ghandi was operating under the same kind of misperception.

littleblackDRS

'Self Starvation' and 'anorexia' are not interchangeable. Self starvation is only one aspect of anorexia. To diagnose anorexia, eight areas are assessed: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness and 8) Maturity Fears.

You can't just deduce "he's starving himself = he's anorexic"

littleblackDRS

Another thing to add, Anorexia is characterised by shame. They don't want to get fat, they're terrified of getting fat, and their perception of themselves is completely distorted. But they don't draw attention to the fact that they're not eating. They deny there is a problem, and they hide the fact that they're not eating. A bit different to Gandhi's "PAY ATTENTION TO ME, I'M STARVING MYSELF".

littleblackDRS

One more thing, I don't disagree with saying that people starving themselves aren't causing themselves harm, and I'd even agree that there could be an underlying mental disorder. But you can't just go around diagnosing people. It's a mental illness, not a label. You wouldn't go around diagnosing people with meningitis or cancer.

Valmont

Gandhi self-starved to improve the status of the Indian people and he was not classified as mentally ill. A teenage girl self-starves to achieve a particular body shape and is classified (or labelled) as mentally ill. Our only criterion here is a subjective assessment of each individual's reasons for engaging in the defining behaviour of anorexia nervosa: self-starvation.

For clinical psychologists and psychiatrists who like to assume the mantle of scientific objectivity as do their real-doctor counterparts with their reliance on pathological evidence the implications are profound: mental illness is based on normative valuations and authoritative decree, nothing more. For example, the eight areas which are assessed are not based on any objective measures or pathological evidence, they have simply been plucked out of thin air. I could add several more without any evidence whatsoever as long as I had the backing of my profession. This is obviously the mechanism behind the rapidly expanding list of psychiatric illnesses.

To take this back to my original question which was what are the criteria by which we classify some people as mentally ill but others healthy then the answer has to be whatever the heck the psychologists or psychiatrists feel they can get away with. Take a willful and misbehaving child for example; five years ago they needed discipline or strong parenting etc. Now, with the publication of the DSM-V they are -- by decree -- sick and disordered and in need of treatment. This is true of all mental illnesses; absent any pathological evidence (in which case they would not be mental illnesses but neurological illnesses and handed over to the real doctors) they are simply invented, not discovered.

As somebody who became interested in psychology by the promise of science, this arbitrariness cloaked as objective medicine is worrying.

littleblackDRS

So what is your question, if you don't think mental illnesses are real? You seem to be glossing over the fact that psychology and psychiatry are incredibly new sciences, so obviously they are rapidly expanding.
Mental illness are harder to diagnose than physical illnesses, obviously. If you're cut, you bleed, if you're sick, you vomit, but your brain doesn't have this.
So mental illnesses are diagnosed by assessing the CRITERIA, if it fits that particular set of symptoms, then that's what we'll call it, if it doesn't, we wont. The same way medicine started.
You can self starving and still not be classed as anorexic, ever heard of a NOS eating disorder?

Valmont

littleblackDRS wrote:

Mental illness are harder to diagnose than physical illnesses, obviously.

A diagnosis is nothing more than the name of a disease. The diagnosis of pneumonia names the inflammation of the alveoli of the lungs. This diagnosis may or may or not be correct depending on the results of pathological tests. Mental illness is the easiest thing to diagnose in the world as it only involves attaching a label to an arbitratily defined syndrome such as eating disorder NOS or oppositional defiant disorder. In mental illness the disease is the diagnosis; in real illness the diagnosis is the name of a putative physical-chemical lesion of the body.

littleblackDRS wrote:

So mental illnesses are diagnosed by assessing the CRITERIA, if it fits that particular set of symptoms, then that's what we'll call it, if it doesn't, we wont. The same way medicine started.

Yes, that is how pre-scientific medicine began in 400 BC with Hippocrates. Scientific medicine -- a field which clinical psychologists and psychiatrists like to claim membership of -- began in 1858 with the publication of Virchow's Cellular Pathology which defined disease as a physical-chemical lesion of the body. Virchow's work understandably placed a premium on the objective discovery of the various infections and malfunctions of the human body and was premised on viewing it as a machine. We don't have to dig very deep to see that the mental health movement, rather than being 'an exciting new science' is simply a throwback to the pre-scientific gnostic concept of disease as being of the person rather than of the body.

littleblackDRS wrote: »

So what is your question, if you don't think mental illnesses are real? You seem to be glossing over the fact that psychology and psychiatry are incredibly new sciences, so obviously they are rapidly expanding.

Of course they are rapidly expanding; all they have to do is slap a 'diagnosis' on an agreed upon set of behaviours and hey presto, a new disease. That this is not how scientific medicine proceeds where diseases are discovered instead of invented points to the true scientific character of the mental health movement. And possibly explains why we can't get a consistent explanation as to why Gandhi wasn't an anorexic!

JuliusCaesar

I don't think we ever claimed to be a hard science.


Psychologists often don't operate or treat people according to a diagnosis - we treat according to the formulation. The number of variables involved in mental illness is huge: the person's biological and genetic heritage, their experiences in life, the events in their lives, the interaction between all of these with their perceptions. Most of these will never be known. The formulation is an attempt to put some of these together for that individual and see how the symptoms arose, and how their attempts to deal with events maintain those symptoms. Pychologists use different methods of formulation, some psychodynamic, some CBT, etc.


'Anorexia' just means a loss of appetite and can be a symptom of physical disease too. Anorexia nervosa is something else. I won't argue diagnoses with you as I don't use them in treatment. I believe the DSM/ICD is a map of an imaginary world. I think we all recognise that. But it's what psychiatrists have come up with and strive to keep improving and refining. They try to become scientific. Do you think they/we should give the whole thing up as a bad job and just go home?




But if you want to argue diagnoses, why don't you take it to the psychiatrists in the Health Forum?

Valmont

JuliusCaesar wrote: »

Do you think they/we should give the whole thing up as a bad job and just go home?

Definitely not but I think the profession is misrepresenting itself with the prefix 'clinical' (considering you don't even use diagnoses yourself). I spoke to a CBT therapist last week funnily enough who said the same thing to me. He said the diagnosis was irrelevant towards helping the individual with certain issues they wanted help with.

JuliusCaesar wrote:

But if you want to argue diagnoses, why don't you take it to the psychiatrists in the Health Forum?

I think that would be the place for it but I often wish more people on the psychology side of things would put a bit more of a fight up against what is increasingly becoming the bio-bio-bio way of looking at personal and social problems.

JuliusCaesar

Valmont wrote: »

I think the profession is misrepresenting itself with the prefix 'clinical' (considering you don't even use diagnoses yourself).

How are we representing ourselves? What does the word 'clinical' mean to you?

Valmont wrote: »

I often wish more people on the psychology side of things would put a bit more of a fight up against what is increasingly becoming the bio-bio-bio way of looking at personal and social problems.

But in the world in which I work, in mental health, all members of the multidisciplinary team bring a different perspective and that should enrich the treatment for the patient. The biopsychosocial model is the one that is most espoused these days: see Vision for Change, or any other policy document.

See here, and also here, and countless other training and clinical blogs/courses/ etc. Probably more here, the UK and Australia, going by the odd conference I attend.

The US may be more diagnosis driven due to the insurance companies requiring diagnosis for the person to be reimbursed their treatment costs.

Where is the biological model predominant and predominating?

dtpc191991

No, Anorexia results from the psycological belief that one is over weight no matter how thin or malnourished they are. They usually in chronic cases are in complete denial about the true state of their physical health.

Ghandi did what he did out of a sense of injustice and as a way to rebel against the system. Once the causes of Ghandi and other hunger strikers were realised they would happily eat again without any need for proffesional psychological help.