Our bodies cannot be contained

A good friend of mine went to her annual physical last spring.  When she was weighed, it was evident that she had lost nearly 10 pounds since her last visit the year before.  My friend is petite and sinewy, and had always had slender build as long as I have known her.  She has also always been a generally healthy eater, opting for veggie options over red meat and consuming smaller portions because she doesn't like feeling 'full' or getting that heavy, stuffed sensation after eating a large meal.  Instead, she grazes throughout the day whenever she feels hungry.  Most notably, as far as I know, she has never passed up dessert.  (I have seen this woman not buy a $10 t-shirt that will stay in her wardrobe for years because it is "too much money" and then plunk down $8 on a piece of specialty cake and gleefully savor it for the ten minutes it's on her plate.)

In the past year, however, she had taken up regular walking, occasional jogging, and hip-hop and belly dancing classes.  She had also been working longer hours, and was perhaps experiencing more stress than the year before.  Whatever the reason, dropping ten pounds meant something different for her than many people - she was now nearly 100 pounds.  And, according to where her weight and height fit in a standardized chart the doctor referred to, my friend was a disordered eater.  The doctor's tone was was stern and accusing.  "You have a problem," the doctor (a woman) said.  "You need to get help."

My friend talks about this experience with a considerable sense of trauma.  No matter her protests to the contrary, the doctor was certain she had "a problem."  My friend did not know herself to have an eating disorder, as she has never starved herself or thrown up food she has consumed.  She doesn't have any preoccupations about being fat, and has never asked me anything along the lines of "do I look big in this?"  or "does my stomach bulge in this shirt?"  But her statistics were speaking for her, and the doctor chose to believe those instead of her proclamations. 

"What could I do?" she said to me when she relayed this story.  "I fit the profile."  She is white, middle class, and a young woman in her early 20s.  These are the people we think of when we hear "eating disorder," and they are the people who are usually treated for such a disorder, even though eating disorders are not inherently white or middle-class issues.  The doctor presumed she must have been in denial about her disorder.  Likely she has been lied to before.  I wonder, also, whether the doctor has leveled other wrongful accusations in the past...perhaps she feels as though she can't afford not to.

So my friend was assigned to a nutritionist, who prescribed larger portion sizes as the antidote to her weight loss.  Within a few months, most of the weight had returned.  Overall, she has been glad to have had the opportunity to see a nutritionist, something many of us would likely benefit from, but still feels pained by the experience with her doctor, to the point of not knowing if she will return to her practice.  She was embarrassed about returning to a doctor who was certain she "needed help" and facing someone who was convinced that she had "a problem," but she was also wary of trusting of a doctor who did not listen or respect her self-narrative.  Sometimes we need a doctor to doubt us, to read between the lines, in order to help us.  But what happens when need a doctor to believe what we are saying is true?  Or at least, for the sake of our dignity, treat us as if we are the experts of our own lives?

I share this because we cannot forget that to standardize something does not mean we have accounted for every possibility of the human experience.  We are far more diverse and varied than any standardized system can accommodate.  This is especially poignant considering the interpretations of "disordered eating."  Authority intervention, as Hatse and Honey (2005) indicate, is often predicated on a subjective idea of what "normal" eating is.  To be diagnosed as having an eating disorder is not always the same as actually having disordered eating, as my friend experienced firsthand. 

In their study of anorexia, Hatse and Honey face the difficulty of setting a sampling frame given the standards of objectivity forced upon subjective opinions and experiences.  They note that "diagnoses [of anorexia] were often inconsistent and changeable," and subject to revision at the doctors' will.  "To brand a girl anorexic without consent was to deny her selfhood," Hatse and Honey write, but they were not able to accommodate for the "complex spectrum" of disordered eating experiences because of the institutional pressures of doctors and the ethics board.

As one ethics officer says, rather shockingly, "The girls are anorexic.  The fact that some girls don't agree with their diagnosis doesn't mean they're not anorexic."  Hatse and Honey later explain how ethic committees, like medical science, "grew out of a positivist tradition," where a "universal, rational subject" is presumed.  To trust the diagnoses implicitly was to "privilege clinical diagnoses over girls' views," but was a necessary precondition for achieving access to doctors' patients under standardized ethical circumstances.

In defining their research population, Hatse and Honey face a paradox - once defined, they "erased the particular and individual differences among potential participants," thereby missing a core tenet of research ethics: "respect for persons."  Although Hatse and Honey push for greater collaboration with both the ethics board and the doctors, they argue that a more collaborative approach should be possible and a greater eye for diversity should be accommodated by medical and ethical practices.  Unlike many other researchers, Hatse and Honey do not view the ethics board as an impediment to their study, but a means of ensuring a necessary protection of their studied population.  The problem is when the necessary steps to getting the ethics board's stamp of approval means sacrificing a more holistic, humane, and authentically ethical treatment of their participants.
 
As researchers, we must navigate bureaucratic and positivist standards when we know they will limit our ability to account for variable experiences.  No doubt, such standards are forced to reconcile their failure to say much about anything when faced with outliers who are really a lot like everybody else, in that they are not at all like anyone else.  Because when we set limits and standards and ranges, we constantly find that humanity leaks through the cracks.  Our bodies simply cannot be contained.  Our charge as researchers is not to recapture them and squish them back inside, but to witness, document, and account for their liberation, thereby, perhaps, finding our own.