The Body Modification Paradox
Eating Disorder Education (vol 3), March, 2008
(posted with kind permission from the publisher)

Chris Kraatz, Ph.D.

        I recall watching with interest the scene in Lauren Greenfield’s film Thin when two of the residents who had obtained day-passes went to a tattoo shop.  The fact that they were interested in getting tattooed was no big deal to me, I have a lot of tattoos myself.  It was more the
necessity of hiding the tattoos that caught my attention.  Despite the fact that they were having the National Eating Disorders Association logo tattooed on them as a symbol of their newly begun recoveries, the rules of their residential program indicated that getting tattooed was not allowed.
        My tattoos bear an important relation to my recovery.  At the time I began to consider this form of body modification, I had come to a point where my recovery was of a longer duration than my eating disordered years had been.  This was a significant turning point for me, and I
wanted to do something physical, tangible, and visible that would capture this moment of transformation in my own life.  So, I got a few tattoos (which I designed myself).  Although I realize that expressions of personal transformation can vary widely from one person to another
and that tattooing might not be appropriate or appealing for some people, it was right for me and it didn’t in any way present problems for my personal recovery.  That’s why I could appreciate the sentiments of the people in the movie.
        Even so, I must acknowledge that the prohibiting of tattoos and other forms of body modification during the course of one’s eating disorder treatment and recovery is not without justification in eating disorders orthodoxy.  The thinking goes something like this: Since eating
disorders have an exceptional co-morbidity with issues of exaggerated dissatisfaction with one’s body, the modification of one’s body can often serve to reinforce this dissatisfaction and even thwart one’s attempts at recovery.  The modifications which are discouraged or even
proscribed under these auspices include not only tattoos and piercings, but also plastic surgeries that are done for reasons that are cosmetic rather than medical (lifts, tucks, augmentations, reductions, implants, liposuctions, etc.).
        There is a sense in which the orthodox view seems compelling in this regard.  After all, those of us who struggle with eating disorders often experience the concurrent struggle of body dysmorphia.  In my own experience, I’m not at all sure that I could disentangle my eating
disorders from my skewed and uncomfortable perceptions of my own body.  While we may not strictly identify an eating disorder with body dysmorphia, our experiences as eating disordered people tend to show us that it would be naïve to suppose that these conditions are separate
and distinct from one another.  So it makes sense to suggest that indulging in various forms of body modification could contribute to the elusive nature of recovery.
        Eating disorders and body dysmorphia often proceed according to the following self destructive algorithm: satisfaction with oneself varies according to one’s ability to manipulate and control one’s physical properties and attributes.  To the extent that we engage in forms of body modification (so the orthodox thinking goes) we simply reinforce our destructive and unhealthy behaviors, forever chasing an ideal image that cannot be obtained and thereby making our own satisfaction impossible.  This is, of course, one possible interpretation of what I refer to as the body modification paradox; that this formula for achieving satisfaction actually makes satisfaction impossible.
        As far as dealing with the fact of wide spread body dissatisfaction is concerned, one might well inquire as to what sorts of alternatives there are to body modification.  If changing some of the features of one’s body won’t produce satisfaction with one’s body, then what will? Fortunately, there is some complex and sophisticated genetic research being conducted that is designed specifically to deal with this issue. Research teams at the University of Pittsburgh and the University of North Carolina are currently receiving significant funds from the National Institute of Mental Health (approximately $2 million annually) to identify the contributing genetic components for anorexia and bulimia.  In the fall of 2005, some initial findings from these research efforts were published in the online edition of the American Journal of Medical Genetics Part B, and indicated that researchers had identified six core traits that appear to be linked to genes associated with anorexia and bulimia.
        While these preliminary results by themselves are of limited use, their ultimate value and utility lies in the prospect of what these researchers refer to as “gene therapy.”  Presumably, gene therapy that is designed to treat eating disorders could proceed in either of two directions; prospective parents could rely on genetic testing in order to select against the genes responsible for eating disorders, or eating disordered people who already (obviously) have such genes could
(perhaps in the more distant future) have their genes “fixed” in some way.  By whatever means gene therapy proceeds, it necessarily involves some kind of manipulation of genetic code.
        This raises an interesting question that these research teams seem not to have considered in any explicit fashion: isn’t the manipulation of the human genome a form of body modification?  I suppose it could be said that in a strictly literal way any medical procedure could be construed as a body modification of some sort, and so we might do well to consider distinguishing between altering one’s body for medical reasons and alterations that are done for some other purpose.  After all, if  “body modification” refers to any and all changes to one’s body, then the term is meaningless because it no longer picks out a distinct group of actions…  So, let us proceed with the understanding that “body modification” applies when the changes imposed on one’s body
serve no medical purpose.
        Very well then, is it the case that gene therapy as an eating disorder or body dysmorphia treatment involves a change to one’s body for strictly medical purposes?  This seems quite unlikely.  I say this because the accepted reason that eating disorders and body dysmorphia
constitute “mental disorders” to begin with is that they proceed from wholly unwarranted dissatisfactions - I may be convinced by my own image in the mirror that my body has a defect of some kind, but this is an illusion - in reality there is no defect.  Hence, my behaviors that are oriented towards correcting my perceived defects are inappropriate.  But if there is no physical defect to begin with (as it seems there can‘t be if we are to be understood as “disordered“), then any treatment which proceeds by making changes to one’s body cannot be making those changes for a medical purpose.
        Herein lies a more subtle and yet much deeper form of the body modification paradox.  If those of us with eating disorders and/or body dysmorphic disorder really do have bodily defects, then our dissatisfactions with our bodies are in some sense justified.  If, on the other hand, those of us with eating disorders and/or body dysmorphic disorder really do not have bodily defects, then treatments which proceed by making changes to our bodies are de facto inappropriate - since they do not address any existing physical problem, they do not have any medical purpose.
        The NIMH funded research teams at Pittsburgh and UNC are therefore committed to two inconsistent propositions:  (1) Eating disorders and body dysmorphia constitute mental illnesses
(at least in part) because they involve the perception of physical defects when in fact there are
none, and (2) eating disorders and body dysmorphia are (at least in part) attributable to physical (genetic) defects.
        The only feasible manner in which to resolve this inconsistency (and indeed the implicit assumption on which this research is based) is the supposition that those of us with eating disorders and/or body dysmorphia have simply misidentified our defects, focusing too much on
our more superficial imperfections while missing entirely our more deeply embedded genetic malformations.  Is this the kind of recovery oriented thinking that will be of service to us?  How should we eating disordered and body dysmorphic people respond to the suggestion that we
are more deeply flawed than we could have imagined - that our very genetic code is defective?
        We might do well to remind ourselves that the human genome has been in it’s present form for a very long time, while eating disorders and body dysmorphia are fairly recent artifacts of Western European culture. Even the research team at Pittsburgh reflects some awareness of this
simple fact that our cultural practices, not our genes, are responsible for widespread disordered eating:

[E]ven if an individual was at high genetic risk (i.e., possessed several of these relevant genes), she might never develop anorexia nervosa if she did not live in a culture such as ours which emphasizes dieting and thinness. *

There we have it - even our most expert orthodox opinion cannot escape the observation that we need cultural therapy more than we need gene therapy.

As far as I’m concerned, gene therapy is a body modification that is too extreme for me,
I’d rather get another tattoo…

Chris Kraatz
Indianapolis, Indiana
ckraatz@iupui.edu
http://www.iupui.edu/~philosop/ckraatz.htm


* “Brave New World: The Role of Genetics in the Prevention and Treatment of Eating Disorders”
     by Craig Johnson, PhD and Cindy Bulik, PhD.
     http://www.wpic.pitt.edu/research/pfanbn/genetics.html