Social support was probably crucial in the Pleistocene for AN recovery

I just watched a Dr. OZ show with an extremely emaciated woman who had had anorexia for most of her adult life. It is another illustration of why we need a new paradigm. Dr. OZ seemed to think she chose her illness and he moved quickly to a facile psychological interpretation—she wants to be taken care of—that blames her for the AN. He naively urged her to get well so she can see him again and perhaps he believes for him she will. If she doesn’t get well his narcissistic injury will lead him to blame her. He’s a good proxy for every person who interacts with her.

He presents her with a new therapist who says they will get to the bottom of why she doesn’t eat and then she will get better. As though she hasn’t tried to do this so many times over the last twenty years.

Oz comments that in contrast to other seriously ill people he has had on the show, she has no one in the audience rooting for her. She lost her mother to sudden cancer, which exacerbated weight loss that began trying to lose the freshman fifteen in college. Presumably 20 years ago her grieving father was counseled to keep his distance. Her husband had no way to understand AN except that she was willfully killing herself and he left. Friends, probably thinking she cared more about her figure than about getting well also left. Without a village to help her recover she became chronically ill.

I think anorexia nervosa is so deadly today because we blame victims for their plight and expect them to get well on their own. AN evolved in the context of deeply social bands and I believe the whole tribe helped their anorexic scout recover. Anorexia outside of the environment in which it evolved can be deadly. Starving rats and mice will run themselves to death in a lab cage, but in the wild their anorexic behaviors would have brought them to a better foraging area.

Evolution doesn’t have to fix what the tribe can fix. For example, when you have nursing problems you find they happen a lot. This makes one wonder why natural selection didn’t weed out these mistakes long ago. Without the La Leche League’s wise counsel my son would have been on formula and before formula he might have died. I think that when we lived in bands there was usually an informal “La Leche League” of wise old women who carried such knowledge. Like the old mare that shows their wild horse herd where to eat, drink, bed down, old women carried precious knowledge for the tribe. Foolproof nursing did not have to evolve.

By the same reasoning, if the family and tribe helped her recover, it didn’t matter if a solitary person couldn’t because there were no solitary people in the Pleistocene.

Next time: What is wrong with CBT for eating disorders.