CW: disordered eating, anorexia, family dynamics around food
By. Dorothy Jiang
I wrote a paper last April for a seminar called “The Global Burden of Mental Illness” at the Brown University School of Public Health. Throughout the semester, we were asked to focus on a mental illness and write several papers on it, ranging from its epidemiology to potential ways to close the treatment gap around it.
I chose anorexia. I have dealt with patterns of restrictive eating and negative body image since my teenage years, stemming from societal messages, familial pressures, and systemic forces, both externalized and internalized, that create within me an inherent dissatisfaction with my colored, female body. I wanted to know more about my own experiences, especially as they intersect with my racial and ethnic identity. So, when asked to address the state of my disorder in a country other than the United States, I delved into research primarily conducted in China. My parents both immigrated from northern China in the 90’s, right before I was born. Though I was born and raised in Seattle, WA, my experience growing up was different from many of my white American peers.
I am an Asian American woman, and I have lived in the US all my life.
I wanted to learn more about anorexia and disordered eating in China, also in part, to better understand the dynamics around food my parents were raised with and see how they translated into my life. My research on this topic, in my view, cannot be authoritative because it does not draw from any personal experience of living in China with an eating disorder. While I reflected upon many of my Chinese-American household experiences when writing, particularly regarding family dynamics and hierarchies around food, I do not recommend reading or using my findings as definitive insight to Chinese culture. I worry I may misrepresent the culture of my ancestry, and in doing so, betray the customs and people who I carry in my ancestral journey.
I think of myself almost at a junction, someone with a foot in each culture, belonging fully to neither; and therefore, being unable to speak fully for either.
I suppose this was my diasporic nature asking me to feed it and nurture it by exploring my unmistakably hyphenated, Chinese-American experience. But, out of the respect for academia that inevitably leads to self-denial for people of color and folks of other marginalized identities, I chose to study China. Unhyphenated, to keep it simple.
Here are 5 key findings from my research:
1) Westernization and imperialism contribute to rising rates of eating disorders in East Asia.
Traditionally, in China, outward bodily appearances have been deemphasized in comparison to inner content of character, including respect for elders, intelligence, and personality (Lai, 2000). In more recent years, however, the Eating Attitudes Test (EAT) shows that in Hong Kong, which was exposed to Western influences earlier than other parts of China due to British imperialism, 40% of adolescent girls subscribe to Western ideals of beauty that emphasize thinness (Lai, 2000).
2) Societal modernization, as pushed by urbanization and industrialization, increases eating disorder rates in women.
Across three Chinese communities, Hunan, Shenzhen, and Hong Kong, the most modernized societies experience the highest body dissatisfaction and disordered eating (Lee, 2000).
3) In Chinese culture, food is often closely and inextricably tied to family dynamics and social hierarchies; an aversion to food has much broader social and familial implications beyond a personal experience of mental illness.
Because cooking and preparing food are considered womanly duties to express care and love, eating is considered a form of filial piety (Ma, 2003).
Food distribution is under parental control and heavily reliant on family hierarchies (Ma, 2003). Male children are often given more food, while sisters are asked to give portions of their food to their brothers under the guise that boys require more sustenance to grow.
Families could interpret disordered eating as a lack of affection or respect, adding to family dysfunction. If individuals experience heavy stress from their families and want to distance themselves as much as possible, food restriction may be an obvious way to do so, given the central nature of food preparation and eating to Chinese family life (Ma, 2009).
4) Since food is so closely intertwined with family life, detaching oneself from food not only divides family members, but it also sends the message that survival and wellbeing are not contingent upon them.
This is a key relationship to target in treatment interventions, as demonstrated by a case study of a female patient in Hong Kong, whose main treatment focuses were repairing family dynamics and cognitively reframing family relationships (Chan, 2006). Even so, family dynamics are not the full picture; she still showed some resistance to recovery, finding it difficult to sacrifice body image ideals and feelings of control in order to maintain a healthy weight (Chan, 2006).
5) Symptoms of anorexia may manifest themselves differently in people from different cultures; any blanket statement about anorexia, particularly on the global stage, must be examined within cultural contexts.
In Hong Kong, patients often describe their symptoms somatically with complaints of stomach discomfort, bloating, or lack of appetite, instead of cognitively, with obsessive thoughts (Pike, 2015). This differs from the DSM view that all anorexic people have overwhelming cognitive fears of gaining weight. This could contribute greatly to the treatment gap; patients are not receiving accurate diagnoses of anorexia nervosa because of its manifestation as physical discomfort.
As I submitted my paper, and as I extracted chunks for this piece, I asked myself:
Did I use too many broad, sweeping statements about Eastern and Western? Not only that, but did I at times put them at odds with each other, as if they did not, and could not, overlap in the globalized human experience?
Take me, someone of an Eastern-Western hyphenated identity--is the gap between them so large that I fall in, invisible?
Am I, by writing this paper as someone with one foot in and one foot out, unintentionally exotifying my culture of origin, or characterizing it in a one-dimensional way?
Is this a semi-voyeuristic, semi-invasive look into a culture I can only partly claim?
These are merely a few of the many questions I now ponder. And, if I’m being honest, this line of internal questioning is all too familiar when I speak on any subject that is meant to represent more than my personal experience.
To a certain extent, I wonder if undermining myself in this way is excessive, especially since so many [cishet white male] people have drawn, and continue to draw, so many “definitive” conclusions about phenomena they have not, and will never, experience.
I need to remind myself that my doubts are as valid as my thoughts, and my disruption of the ableist, heteropatriarchy of capitalism and white supremacy is necessary, in whatever form it takes. I and those who look like me know that we are often forced to try twice as hard, think twice as hard, and be twice as good to be recognized.
Next time, I’ll be twice as nuanced.