The biology of blame

Dr. Keel, her blog post The Biology of Blame, Part II, nails it with one perfect sentence:

"The problem with biological determinism is not biology, it is the determinism."


  1. When I asked a reresentative of one of the largest residential ED treatment centers in the US why it doesn't tell parents anything about the role of genes and biology in the development of EDs, instead focusing almost entirely on socio-cultural and interpersonal emotional issues, she said it is because the center was afraid patients and their parents would give up hope of recovery if they believed genetics makes people inevitably predetermined to develop an ED. This statement shocked me, because it reflects a serious misunderstanding of genetics and biology. There are a multitude of illnesses that are --at their core --genetic and biological in nature, and are fully treatable. I happen to think EDs are among them. I think part of the problem is that large treatment centers in the US tend to be operated by people whose education and training are in fields like marriage and family therapy, counseling, and social work. Many, unfortunately, have not been very well trained in modern science, and are even hostile to it. I feel this limits their ability to understand the illness and develop effective treatment models. It's one reason I think better care is available at university-based medical centers, where there are people who have a better understanding of biological sciences.

  2. To add to that, I think the lack of public knowledge about science is part of the reason so many misconceptions remain in the media. Most reporters have NO science background- even those who cover the "health" beat. Psychologists and social workers will have basic biology and statistics (among other courses), but again, the neuroscience likely isn't being taught.

    Frankly, both my parents and I found it a relief when we learned about the biology of AN.

  3. Biology may reduce the stigma of blame for patients and feel like a relief to families wondering what went wrong ... but I sense that society will take the biology of eating disorders with the same grain of salt it accepts obesity as a thyroid issue.

    A few people might have a thyroid issue, which is treatable, but there are a lot of heavy folks out there struggling with weight-related health problems ... and our culture still stereotypes and judges them. And it is still true that most obese people are in that position because of lifestyle choices. The natural conclusion about eating disorders is that they also are about errant lifestyle choices (which, to some degree, they are ... at least perpetuated).

    It will take a long time to make it to a mainstream understanding ... something akin to autism and epilepsy.

    Part of the problem is that these research docs who are doing the work aren't out there in the public eye, nor are they publishing in Redbook. You don't pick up medical journals at the check-out in the grocery, and many presentations (in grand rounds, for example) don't come with a press release or make it past an obscure Australian web site.

    It's true that many health beat reporters don't have a science background (I worked 13 years as a newspaper reporter and editor) ... they learn from their sources. But the sources have to make themselves available, speak in plain language and offer clarity and patience vs. highbrow self-promotion/importance and jargon/journal-speak. If the news desk doesn't "get it" or understand why it's interesting or important ... then it will never make it past the assignment editor and to readers.

    The ED research crew is a small band of brothers (and sisters) who tend to hold their own little huddles to the exclusion of everybody else who isn't making a concerted effort to hear what they're seeing and saying. Maybe they just don't know we're interested; maybe there is an interest in keeping emerging information close to the chest for academic, business or other reasons.

    Sometimes, we ... and people like you ... need to ask them the questions the public and patients need/want answers for ... and spread the word. Then, maybe they will be heard, and patients will begin to benefit.


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