Anorexia Nervosa (AN) is an eating disorder characterised by self-starvation. Accounts of AN typically frame the disorder in individualistic terms: e.g., genetic predisposition, perceptual disturbances of body size and shape, experiential bodily disturbances. Without disputing the role these factors may play in developing AN, we instead draw attention to the way disordered eating practices in AN are actively supported by others. Specifically, we consider how Pro-Anorexia (ProAna) websites—which provide support and solidarity, tips, motivational content, a sense of community, and understanding (...) to individuals with AN—help drive and maintain AN practices. We use C. Thi Nguyen’s work on epistemic “echo chambers”, along with Maria Lugones’ work on “worlds” and “ease”, to explore the dynamics of these processes. Adopting this broader temporal and intersubjective perspective, we argue, not only helps to further illuminate the experiential character of AN but also has important clinical and therapeutic significance. (shrink)

This is a preprint draft. Please cite published version (DOI: 10.1111/mila.12385). The aim of this paper is to provide a novel analysis of anorexia nervosa (AN) in the context of the sense of agency literature. I first show that two accounts of anorexia nervosa that we ought to take seriously— i.e., the first personal reports of those who have experienced it firsthand as well as the research that seeks to explain anorexic behavior from an empirical perspective— appear to be thoroughly (...) in tension with one another in their descriptions of anorexic actions. Rather than proceeding at this point by way of disregarding anorexic testimony as meaningless or insincere, I instead offer a positive account of the sense of agency in anorexia nervosa that renders these two depictions compatible. The resultant picture of anorexic behavior is one that accommodates current empirical findings while also providing valuable insight into how it is that anorexics can sincerely report feeling fully in control over their food restriction. (shrink)

Concerns over medical paternalism are especially salient when there exists a conflict of values between patient and clinician. This is particularly relevant for psychiatry, the field of medicine for which the phenomenon of conflicting values is most present and for which the specter of medical paternalism looms large. Few cases are as glaring as that of anorexia nervosa (AN), a disorder that is considered to be egosyntonic (meaning its symptoms are reflectively endorsed by the patient) and maintained by the presence (...) of pathological values. One might think, given this, that an approach to medicine that foregrounds the role of values in clinical encounters would be particularly well suited to address the problem of medical paternalism in treating AN. As it happens, this is precisely the goal of values-based medicine, an approach to medicine that prioritizes the integration of patients’ unique values into the aims of treatment and that has been touted as being particularly applicable to psychiatric conditions such as AN. Although this strategy may initially appear promising, in this paper I will argue that the directive to incorporate patient values (as dictated by values-based medicine) cannot do the work of mitigating medical paternalism in the treatment of egosyntonic disorders such as AN. Rather than chalking this up as a failure due to AN being a particularly challenging case, I will instead conclude that the failure of values-based medicine in this context cuts to the heart of the limitations of rectifying medical paternalism within psychiatry as it currently exists. (shrink)

Loneliness is a near-universal experience. It is particularly common for individuals with (so-called) psychopathological conditions or disorders. In this paper, we explore the experiential character of loneliness, with a specific emphasis on how social goods are experienced as absent in ways that involve a diminished sense of agency and recognition. We explore the role and experience of loneliness in three case studies: depression, anorexia nervosa, and autism. We demonstrate that even though experiences of loneliness might be common to many psychopathologies, (...) these experiences nevertheless have distinctive profiles. Specifically, we suggest that: (i) loneliness is often a core characteristic of depressive experience; (ii) loneliness can drive, and even cement, disordered eating practices and anorectic identity in anorexia nervosa; iii) loneliness is neither a core characteristic of autism nor a driver but is rather commonly experienced as stemming from social worlds, environments, and norms that fail to accommodate autistic bodies and their distinctive forms of life. We aim to do justice to the pervasiveness of loneliness in many — if not all — psychopathologies, while also highlighting the need to attend to psychopathology-specific experiences of loneliness, agency, and (non-)recognition. (shrink)

Individuals suffering from depression consistently report experiencing a lack of connectedness with others. David Karp (2017, 73), in his memoir and study of depression, has gone so far to describe depression as “an illness of isolation, a disease of disconnectedness”. It has become common, in phenomenological circles, to attribute this social impairment to the depressed individual experiencing their body as corporealized, acting as a barrier between them and the world around them (Fuchs 2005, 2016). In this paper, I offer an (...) alternative view of the experience of social disconnectedness in depression, suggesting that rather than necessarily experiencing their body as object-like, the depressed individual’s bodily is saturated with experiences of lethargy, tiredness, heaviness, sadness, hopelessness and so on, to the exclusion of being able to bodily connect to others. I suggest that depression does not involve a complete social impairment but a specific impairment of affective forms of interpersonal experience. (shrink)

Body dissatisfaction has long been considered an integral component of and driving force behind anorexia nervosa. In this paper, I characterise body dissatisfaction in terms of problematic beliefs about body size and the value of thinness. I suggest two methods for understanding these beliefs. Regarding body size beliefs, I suggest focusing on certain forms of misleading phenomenal evidence that sufferers of anorexia nervosa are exposed to. Regarding beliefs about the value of thinness, I suggest focusing on the benefits of such (...) beliefs. (shrink)

This article challenges the consensus that silences about mental disorders are there to be broken. While silence in mental disorders can be painful, even deadly, the consensus rests on an oversimplified understanding of silence. Drawing upon accounts from depression and bipolar memoirs, this article names and analyses some salient experiences of silence in mood disorders. It does so with two goals in mind. The first is to show that mood disorders may involve several different kinds of lived experiences of silence. (...) This is important because even though silence is considered a promising objective symptom of depression, little has been written about lived experiences of silence in disorders that involve depression. The second is to argue against the fetishisation of breaking silence and the concomitant understandings of silence as an externally imposed and inherently negative phenomenon. This is important because some silences are not experienced as external and are even felt to be valuable, meaning that efforts to break them may be counterproductive. (shrink)

Self-illness ambiguity is a difficulty to distinguish the ‘self’ or ‘who one is’ from one's mental disorder or diagnosis. Although self-illness ambiguity in a psychiatric context is often deemed to be a negative phenomenon, it may occasionally have a positive role too. This paper investigates whether and in what sense self-illness ambiguity could have a positive role in the process of recovery and self-development in some psychiatric contexts by focusing on a specific case of mental disorder – anorexia nervosa.

The experience of embodiment is a central theme in phenomenological philosophy and has recently received increasing attention also within psychological science. In the present paper we argue (1) that the experience of embodiment represents a fundamental synthesis of having a body (the body as an object) and being a body (the body as felt “from within”); (2) that this synthesis is basic to an individual’s experience of self-identity; (3) that each individual, as an existential task, has to develop their specific (...) version of the embodiment synthesis; (4) that these syntheses can be more or less harmonious or disharmonious, and that disharmonious syntheses are associated with psychological distress and psychopathology. Different phenomenological accounts of possible variants of disharmonious embodiment, as found in the literature on eating disorders, are discussed and compared. Finally, some research implications and clinical implications are discussed. (shrink)

Body dissatisfaction has long been considered an integral component of and driving force behind anorexia nervosa. In this paper, I characterise body dissatisfaction in terms of problematic beliefs about body size and the value of thinness. I suggest two methods for understanding these beliefs. Regarding body size beliefs, I suggest focusing on certain forms of misleading phenomenal evidence that sufferers of anorexia nervosa are exposed to. Regarding beliefs about the value of thinness, I suggest focusing on the benefits of such (...) beliefs. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders classifies “anorexia nervosa” as a mental disorder, yet individuals with anorexia often characterize it as an identity. The author describes the identity of being an anorectic and compares it with what it takes to have anorexia in the diagnostic sense. This furthers the existing scholarship on anorexia and identity, most notably by revealing a disconnect between being an anorectic and having anorexia: Some individuals inhabit the identity of being an anorectic but do (...) not have anorexia because they do not have a significantly low body weight. The author explores whether expanding the diagnostic criteria for anorexia would be beneficial for anorectics by examining the implications of classifying the identitive phenomenon of being an anorectic in terms of a medical concept of mental disorder. In the short term, the answer depends on whether being an anorectic calls for interventions that require a diagnosis. Either way, it would be beneficial to develop nonmedical frameworks for understanding anorexia that facilitate interventions that do not require a diagnosis. Understanding being an anorectic as an identity lays the scaffolding for a nonmedical way of conceptualizing anorexia that illuminates innovative approaches to assisting anorectics. (shrink)

Whether anorexic patients should be able to refuse treatment when this refusal potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of “terminal anorexia” suggests criteria when a move to palliative care or even physician-assisted suicide might be justified. The author argues that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is (...) in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision-making capacity. It should therefore be rejected. (shrink)

Existing phenomenological accounts of anorexia nervosa suggest that various forms of bodily alienation and distorted bodily self-consciousness are common among subjects with this condition. Subjects often experience a sense of distance or estrangement from their body and its needs and demands. What is more, first-person reports and existing qualitative research reveal struggles with authenticity and a search for identity. Is there a connection between the two? I argue that to gain a fuller understanding of anorexia nervosa, how it is experienced (...) by subjects, and why many of them express concerns about authenticity, we need to look more closely at their experiences of bodily alienation and the ways in which they encounter a diminished sense of bodily ownership. After presenting a general overview of the various sorts of bodily alienation that appear to be characteristic of anorexia nervosa, I outline three conceptions of authenticity and introduce some empirical evidence indicating that many subjects with this condition have concerns about identity and authenticity. Then, I examine how different sorts of bodily alienation have the potential to compromise authenticity at various stages of the disorder. Throughout, I draw from several first-person accounts of anorexia nervosa to illustrate and support my claims. (shrink)

This paper delves into the complex and conflicting relationship between the body-subject and body-object, as well as the self and the other, within the context of anorexia nervosa. Within the field of phenomenology of medicine and health, the emphasis tends to be on the dimension of the lived body, with limited attention given to the physical dimension of the body. Recognizing the work of scholars who have acknowledged this oversight and made progress in addressing it, this paper aims to further (...) unify the two bodily dimensions of the lived body and the physical body by drawing primarily on Husserl’s phenomenology of constitution and intersubjectivity. The central argument put forth is that in the case of anorexia nervosa, confronted with the inherent split between these dimensions and the conflicting relationship between the self and other, it is crucial to adhere to the constitutive principle of irreducibility of subjectivity. Moreover, there is a need to promote the constitutive interplay between the two dimensions and accentuate the constitutive dialectic structure of the self and other. Through these insights, the paper offers potential avenues for understanding and addressing the lived experiences of individuals battling anorexia nervosa. (shrink)

Anorexia Nervosa (AN) is widely considered to be a bodily disorder accompanied by unrealistic perceptions about one’s own body. Some researchers thus have wondered whether deficits in interoception, a conscious or non-conscious sense of one’s own body, could be a primary cause of AN. In this paper, we make the case that rather than interoception being a primary cause, deficits in interoception may occur as by-products of emotions that arise upstream in the pathogenesis of AN and interact with feelings of (...) a loss of self-control. We consider interoception, emotion, and self-control as a dynamical triad involved in the explanation of AN, with emotions as the central aspect of their interactions. We begin with a critical analysis of recent empirical literature on AN and differentiate three types of interoceptive processes. We then consider the role of self-control in AN. We go on to evaluate recent empirical and philosophical work on the role of emotions in AN and assess their importance in both interoception and self-control dynamics. We develop a testable integrative model that we believe best captures how self-control, emotional and interoceptive processes causally interact in the pathogenesis of AN. In this model, AN behaviors are not caused by interoceptive abnormalities, but rather interact with changes in emotional regulation and feelings of loss of self-control, subsequently leading to interoceptive deficits downstream. To capture a later stage in the pathogenesis of AN, we show how AN behaviors are maintained as a result of feedback among components in the model. We briefly explain future plans to further complement the model using a semi-structured interview to probe patient perspectives in AN. To develop a more valid understanding of AN, this model will have to be integrated into pluralistic approaches that include patient perspectives. (shrink)