Often, in writing about eating disorders, you will come across references to how some consider these disorders to be “culture bound.” If you start to unpack what researchers and clinicians are referring to, you might come to the conclusion that “culture bound” means specific to one particular culture or society, for example, modern Western society.
By extension, you might then think that the more “Western” a culture is, the more likely that there will be eating disorders present. You might have seen this logic reproduced in such works as: “Western Media is the Root of all Evil” (note: title does not refer to an actual study/article… I hope).
The way the popular press has taken up the culture boundedness of eating disorders does not always represent the way that it is described in research articles (I know, you’re shocked–not). Generally, and quite predictably, the “culture bound” nature of eating disorders is much more complex than a matter of a transporting cultural values (and thus eating disorders) from one society to another.
So let’s go back. Way back to 1994, when Anne E. Becker published a chapter entitled “Nurturing and Negligence: Working on Others’ Bodies in Fiji.” Or perhaps we could return to 2002, when her article “Eating Behaviors and Attitudes Following Prolonged Television Exposure Among Ethnic Fijian Adolescent Girls” appeared in the British Journal of Psychiatry. These studies were foundational to an exploration of the “culture bound” nature of eating disorders, and so might help scaffold this exploration.
THE STUDY
In her work on television and body image in Fiji, Becker looked at how young women in Fiji negotiated their identity development during a time at which their cultural surround was in flux. Frequently, in reiterations of Becker’s work, interpreters draw upon her findings that indicated an increase in body dissatisfaction, weight/shape preoccupation, and disordered eating behaviours when television was introduced to the island. Some use these findings to make a case for the “Western-media-is-at-the-root-of-all-ills” argument.
Is Western media at the root of all ills? Well, it rarely helps anyone feel good about themselves. But is there more to the picture? One of Becker’s more interesting (in my opinion) findings relates to the ways in which her participants negotiated their identities not only amidst a changing visual landscape, but alongside major shifts in Fiji’s political economy.
This is perhaps best described in a 2004 article, wherein Becker reports on following up with 30 young girls in Fiji three years after television was introduced. In this lengthy article, Becker touches on everything from the types of television programs introduced and the associated aesthetic ideals they portray to the changing economic landscape of Fiji.
Notably, the introduction of television was not the only major change happening in Fiji at the time; the very nature of work was ongoing a major shift from a relatively narrow set of job opportunities (e.g., domestic labour, plantation work) to a wage-based economy where people are encouraged to buy things and accumulate wealth.
Becker introduces a few important nuances as she describes how young girls’ shaped their identities in this time of flux.
Firstly, young girls did emulate and work toward a thin ideal, but mainly commented on the influence of marketing and advertisements, rather than television programs themselves, in shifting their attitudes about body work. Additionally, the work to be like the characters in the programs themselves was about more than just appearance, for example being a woman who occupies a similar place in the world to a man (as exemplified in Xena the Warrior Princess, for example).
Much of this role modeling was tied into concerns about the world of work; this could be tied into weight and shape concern when girls saw attractive characters achieving success. Notably, this pursuit (i.e., an individualistic concern for social and economic advancement) did not fit with traditional Fijian values (as Becker described them, noting that “competition and achievement are not traditionally sanctioned values among ethnic Fijians” (p. 545).
Instead of working on their bodies to be attractive, participants made comments about how body-work, and the resulting thin form they might achieve, made them appear less lazy and more successful. For example, a participant said:
It makes me feel good because I am thin and I can do every work in the family at home, unlike fat people who are always getting lazy and feel like relaxing all the time. (S-48)
Here, we start to see that problematic and unfortunately often-heard equating of morality, productivity, and body size.
Links to disordered eating were somewhat less clear than links to the desire to engage in body work more generally; Fijian girls negotiated between an understanding of dieting, appetite loss, and weight loss as negative (as per traditional Fijian values) and the use of disordered strategies to emulate the “successful” women on the screen.
The kinds of shifts in aesthetic ideals are only the tip of the iceberg, as it were, in terms of the broader shifts at play. Shifts in preferences for thin bodies are here tied to shifts in working on one’s own body as opposed to caring for others’ bodies (e.g., through feeding and other practices).
To boil it down even further, Becker argues (quite convincingly) that body shaping and disordered eating might hold a different meaning in different social contexts. We can’t untie the girls’ desire to change their bodies from the political economic landscape of the time, in which competition was increasing, consumerism was becoming more important, and girls might feel caught in between traditional and emerging styles of being.
What does it mean for our understanding of eating disorders as culture-bound?
So, why unearth what might be considered a relic of a study to explore and critique it? I would argue that one of the important offerings from this study has too often been missed (and in fact might have benefitted from even more unpacking in Becker’s work).
Becker comments on how young girls in Fiji may not have strong role models to guide them through a society in transition, and so might turn to television programs to navigate the challenging terrain of a shift to competitive, consumeristic, individualistic modes of work. In so doing, they might conflate appearance with success.
However, I would say that she leaves undertheorized how these young girls might experience the caught-in-between-ness of traditional and emerging social landscapes. Might this conflict, rather than the explicit modeling of bodies on television-presented ideals, be at least partly at the root of disordered eating behaviours and dissatisfaction with bodies?
For all of her consideration of the need to explore the broader socio-political landscape, Becker leaves relatively untouched the idea that there could be intervening “cultural” variables which lead to distress–in other words, it might not be a linear trajectory from economy-at-change to seeking role models in the media to linking bodies to success.
Further, not being Fijian herself, it might be hard to say what kind of a grasp Becker had on the “traditional values” espoused by Fijian individuals. Though she spoke to Fijians about culture and likely immersed herself in this culture from a researcher and experiential perspective, it is possible that she is to a certain extent projecting a Western perspective on Fijian values (e.g. assuming collectivity in non-Western societies). She might also have more explored in more intricate detail the kinds of cross-currents at play: what about resistance about the capitalist economy of accumulation and consumption? Who is resisting, and how, and what role does this have in shaping sense of self and relation to body?
So, in short, there is more to be gleaned from Becker’s work than media-causes-eating-disorders, of course. The other elements of her work help us to look beyond this simplistic assumption and unearth the rootedness of body work in broader political, social, and economic milieu. There is more work to be done to unpack what counts as “culture,” still to come (in the third part of this series).
In the next post, I’ll provide another perspective on culture boundedness, in which Keel & Klump suggest that bulimia is culture bound, while anorexia is not. Stay tuned to find out why!
References
Becker, A. (2004). Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity during Rapid Social Change Culture, Medicine and Psychiatry, 28 (4), 533-559 DOI: 10.1007/s11013-004-1067-5
I share your concern about not falling into the trap of reducing cultural and socioeconomic factors to things like television exposure. My feeling is that researchers often focus on these things because they want to “stay empirical”, and empiricism is often understood in quite narrow, quantitative terms. They want to be able to isolate factors, measure and quantify, run the appropriate tests based on externally validated questionnaires, etc. And while this need to remain bounded by what we call “empirical data” is justified and important, I have this uncomfortable impression that some aspects of these discussions can’t be fully explored, adequately addressed, or even in some way “resolved” by this kind of empirical inquiry.
The way I see it, culture, economy, and mental health are related in very deep, intricate ways. Understanding what these aspects actually are (as you mention, it’s not easy to define culture…) and how they related to each other also requires the use of language and tools that this sort of empirical research can’t provide. I hate to say that, believe me. I feel immensely uncomfortable about things I can’t approach on a very narrow quantitative basis, or about aspects of reality that can neither be isolated nor subjected to tests and trials. I have been trained all my professional life to measure and quantify. However, the more I read about EDs, the more clear it becomes that by wanting to “stay empirical” in that very narrow sense (I do believe “empirical” is more than just what I’ve been describing), we actually run the risk of being inaccurate (or even unscientific).
There’s no denying that we’ve made a huge progress in the way we talk about and understand mental illnesses. I feel there’s a huge gap between what psychiatrists wrote in the 1940s and what clinicians and researchers write today. The field has become legitimately more scientific and culture-neutral in a way. That said, cultural and socioeconomic factors still play a major role in how we define, classify and understand mental illness, including EDs. These factors influence not only where we draw the line between ED and non-ED, but also the way we interpret and use some very specific diagnostic features (like the weight criterion in AN, which is often talked about in terms that are manifestly culture and social-bound). How weird is it to think that when it comes to mental illness, we often read in handbooks and papers that one important criterion to distinguish health from ill is one’s ability to “function”? It seems to me that the ability to function often means in this context being able to “function” in a capitalist economy with a job market that is often marked by structural violence (like the ever-present threat of job loss, etc).
Finally, I really hope this doesn’t sound as a general discussion about “natural vs social sciences”! I really don’t mean it this way, and I don’t believe this division makes sense in many cases.
You write: “culture, economy, and mental health are related in very deep, intricate ways”
YES, absolutely. This. I would say, however, that it isn’t that empirical research can’t provide these tools, more so that it makes research far messier and complex than some are willing to contend with (and I think you’re getting at that in the above as well, but I just wanted to highlight that because I think that it is all too easy to get caught up in a can’t spiral where we do ourselves a disservice by not even trying). I totally agree that a commitment to empiricism can actually make us miss things that would actually add to our understanding. I think that people sometimes forget that the scientific method (and thus the need to quantify everything) is also grounded in a historical legacy. Choices infuse research at every stage, whether these are conscious or whether one is “following what has always been done.” Looking at the history of science and philosophy is really interesting for what it reveals about the ways in which, as you say, culture, [political[ economy and health are interrelated. This also impacts what counts as evidence, what counts as science, and how these can be leveraged to, in turn, impact systems of power and privilege. A complex nexus of ill defined and incompletely understood factors indeed.
When you say that the field of mental health has become more scientific and culture-neutral, are you meaning this in a positive sense? I’m unsure if I would say that culture neutrality is a good thing; I think there is a fine dance between acknowledging and singling out cultural difference. Of course we don’t want to lump people into categories and treat them according to their “culture” (which would be a gross oversimplification of their intersecting identities along gender, race, class, etc. lines), but nor do we want to apply a one-size-fits-all approach in the hopes that it will categorically apply to all, as there are those very real social determinants of health which so profoundly impact how people navigate their social worlds including but not limited to healthcare settings.
I definitely agree that progress has been made, and that it is interesting to look at how cultural and socioeconomic factors impact definitions, classifications, and understandings of mental illnesses. Mapping the changes in the DSM is an absolutely fascinating (and time/headspace consuming) exercise in observing how political, social and economic interests have come to change the very way in which we delineate “well” and “not well,” “functionality” and “non-functionality.” In one of my upcoming posts in this series I’ll write about the problematics of importing categorization schema onto different sociohistorical and “cultural” contexts in what is presently a bit of a ramble but I will edit into more clarity (hopefully)…
I don’t think your comment read into natural vs. social sciences at all; I think you are nuancing those divisions and exploring their intersections and how they shape experience and what is read from experience.
I agree with all your comments, which are very illuminating! I also think “culture-neutral” can be harmful, just like you describe.
I should also have added that I think Anne Becker’s studies are fascinating, extremely sophisticated, and very insightful. Some time ago I read a study co-authored by her where she and her colleagues resorted to careful ethnographic work, used latent profile analysis to assign Fijian schoolgirls to two different classes (BN-like and herbal purgative use), and assessed aspects like cultural orientation in very meticulous ways. And they were thoughtful and insightful enough to note that “a second limitation is that our selection of LPA indicators and validators—although informed by extensive ethnographic work with this population—necessarily reflect our Western conceptual models of disordered eating and related distress” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291029/?report=reader).
Also, I don’t know if that makes sense, but there seems to be an inherent difficulty in measuring people’s behaviors and subjective experiences, even in our own culture (let alone in other cultures)! Some time ago I was going through one of these questionnaires (I guess it was the CEBQ), and I was struck by some of the questions. The parents are supposed to answer things like “if allowed to, my child would eat too much”, “my child has a big appetite”, and “my child eats more when she’s happy”. The questionnaire is sound, has been properly validated, and is the result of careful work, but I can see how it can still be terribly imprecise and unreliable in many cases.
it must be a very big challenge for researchers to carry out good empirical research about these topics. It must be both exciting and nightmarish. But judging from some of the great studies published in the last decades, I don’t doubt for a second that it is possible and worth pursuing! 🙂
Wow, that IS encouraging (re: the note that the conceptualization follows Western models). This sort of attunement to the broader sociocultural, political & economic aspects is why I think it is a shame that Becker’s Fiji studies get reduced to TV=ED. A disservice to careful and in-depth work!
Yes, the difficulty of putting a number to experience is something I grapple with. On the one hand, I recognize the utility in being able to create questionnaires that make it easier to compare scores across studies and categorize behaviours and cognitions in a way that makes developing some recourse possible. On the other, many of the behaviours and cognitions being measured are far from static. This difficulty of capturing dynamicism is one of my main concerns about measures of body image in particular, which is such a contingent and fluctuating concept- I wrote a post about another way of seeing body image, actually, partly out of that kind of frustration.
Thanks for the comments!
You write, “they might conflate appearance with success” — but it is not entirely conflating, is it. I mean, there is some truth to this.
What kind of role models is Becker envisioning? I’m also quite unclear on that part.
Have there been other studies of the effects of transitioning to a wage-based economy? The issue with looking at other cultures/communities is that there are so many other factors at play (for example, I’m thinking about Canada’s First Nations communities). I wonder if this page I found by a quick Google search has anything interesting: http://www.phac-aspc.gc.ca/publicat/human-humain06/15-eng.php. It seems to (see “negative factors” under “Factors Affecting Children and Youth”).
True, and funny you should write that because I initially had a bracketed sentence after that sentence saying “leaving aside for a moment the research that indicates that conventionally attractive people may be more hireable and have other social benefits” but I took it out in an effort to be less wordy. So yes, you’re right, as unfortunate as that is.
What kind of role models? Well, she talks about girls modelling on Xena, warrior princess, but I’m not 100% clear on her stance on Xena as feminist/good role model or problematic model.
Do you mean effects in terms of eating disorders or effects more generally? Back in the day when I did international development work, I remember reading about the effects of economic transitions and could unearth some of the papers I read about it if you’re interested. I looked for ones related to eating disorders and came up short on articles specifically/exclusively looking at that, but it comes into play more in the third part of this series looking at Mexico/US contexts…
Ah I see — you should’ve included it!
Re: Xena: Yeah, I don’t get it. Is it because she’s strong? Or because she is in the wild? Or…? She’s very attractive and her body is an unrealistic attainment for most, though she’s not runway-model thin.
Okay, I’ll wait for the third series. I suppose I’m more interested not in the thin models/commercials –> eating disorders, but in typical capitalist/neoliberal rhetoric of every man, woman, and child for themselves –> anxiety –> eating disorders, which relates, I feel, more to the idea of viewing “body work” as something to strive for in and of itself.
I think because she’s a “strong independent woman,” but yeah… come to think of it, the kind of “strong independent woman” imperative might be undergirded by the everyone for themselves rhetoric, but I think I might be reading too far into Xena, there.
I hope I do justice to at least some of that capitalist/neoliberal rhetoric in what’s to come… it’s hard to find many articles that *directly* speak to that but I feel it lurks around the edges of some “cultural” work.