Last week, a NSW coroner made an extraordinary finding. Extraordinary because it’s hard to believe such a finding has never been made before. Extraordinary because – at the request of the family – it was made public prior to the release of the entire report. And extraordinary because, despite the specificity of aspects of the statement, the media has failed to understand the implications of the finding, and has slipped into its usual easy ‘blame-game’ space when discussing this illness.
Last week, a NSW coroner directly linked a suicide to anorexia nervosa. But just as importantly – even more importantly really – he described this disease as ‘complex’. I don’t expect anything much to come of this. I was initially pleased that it got any media coverage at all. But that quickly turned to dismay as commentator after commentator trotted out the tired old line about ‘unrealistic media depictions of the female form’ as a ‘cause’ of anorexia.
As a society we have no difficulty accepting supposedly ‘physical’ illnesses as complex entities. No one believes that low exposure to vitamin D in childhood ‘causes’ MS. Or that a virus ‘causes’ type I diabetes; nor high salt ingestion hypertension. There is an inherent acceptance that these are complex chronic illnesses that require a coalescing of multiple factors in order to develop.
Why then are we constantly bombarded with the fallacy that a disease as complex, severe and all encompassing as anorexia nervosa can be attributed to a simple, single cause? And a cause that ignores the obvious physiological aspects at play when this disease first manifests clinically, and during relapses. Are we still, as a society, so scared of psychological illnesses that we feel obliged to take a reductionist viewpoint? We do everyone who lives with this – and other mental illnesses – a huge disservice by perpetuating the concept of simple causality, and seeking a scapegoat.
This disease is a perfect storm of physical, psychological, emotional and cognitive factors. Among those women, men, girls and boys for whom societal expectations of a particular body shape have been at play during the prodromal phase, it becomes of little consequence once the illness has taken hold.
So, I applaud the insight of Coroner Mark Douglass, and can only hope it is the beginning of something positive for the understanding of a disease with a fatality rate so heartbreakingly high we would never tolerate it for a physical illness.
Disclosure: I have had anorexia for over 20 years.