Giving Voice to Ana

As part of my initiation into the eating disorder online community, I thought I should probably take at least a quick look at one of the largest sources of internet ED chat: so-called pro-ana websites.

For me, the initial sensation was a little like the time a couple of months ago that a neighbour told me he wanted to show me something on his computer (alarm bells, anyone?), I all-too-innocently agreed, still did not have the good sense to pull out when I saw thirty pdfs on his desktop labeled “Hitler 1”, “Hitler 2”, “Hitler 3” etc., and finally was subjected to a two-minute “Obama is Hitler reincarnate” slideshow (yes, it turns out that the proverbial guy downstairs was one of the ACTUAL guys who helped inspire America’s latest epidemic). Anyway, to get back to my point… the “thinspiration” offered on many pro-ana sites echoes sentiments I have heard from countless patients. However, it is somehow unnerving to read this stuff in the privacy of your own living room, delivered up with that strange combination of broadcast authority, voyeurism and intimacy that only the internet can bring.

What I found most interesting about the pro-ana websites I looked at was the very public articulation of the “anorexic voice”. Many patients experience anorexia as a voice inside them which berates them for their selfishness, greed and laziness, and guides them towards the behaviors associated with anorexia (dieting, exercise, self-negation, obsessive pursuit of perfection etc.) as an antidote to these characteristics. However, typically the voice operates only in the private universe of the sufferer’s brain -articulated in the real-world its inconsistencies and flawed logic risk exposure. In fact, in many treatment approaches, having patients articulate their anorexic thoughts so that they can be assessed and challenged is an important aspect of therapy, and one that many patients who remain ambivalent about recovery fear.

However, through pro-Ana websites the domain of the “anorexic voice” has extended out from the minds of individual sufferers to find recognition and motivation in each others’ illnesses. Within the “safety” of the pro-ana online community, giving public voice to the internal anorexic voice no longer challenges the illness, it validates it. Firstly, it tells sufferers that other people share their thoughts, therefore lending support to the notion that they represent some external truth "e.g. anorexia is not an illness but a conscious decision and a lifestyle". Secondly, it encourages comparison and competition (e.g. "You think you're thin? Well, look at these pictures and see what you think then.") Given that perfectionism is a common personality characteristic among sufferers, the competition to be the "perfect anorexic" is dangerous indeed.

It is perhaps one of anorexia’s most perplexing qualities that it is frequently experienced as an independent entity which has taken control of the sufferer and which is intent on its own survival. To say simply that anorexia is egosyntonic, that is to say consistent with the sufferer’s self-perception or ideal self-image, does not fully describe the extent to which the disorder can appear to have a “mind of its own”, and to make calculated decisions to ensure its own fortification by strengthening its hold over the sufferer. Pro-ana websites provide a dangerous weapon in anorexia’s armory. Until recently each sufferer’s anorexic voice existed largely in isolation, trapped inside her head. However, by amplifying that voice and turning it into a community of mutually sustaining voices, pro-ana websites have changed its quality –giving the voice of the illness a new-found presence outside individual sufferers and in that other, alternative reality represented by cyberspace.

How do people who use pro-ana websites feel about influencing each other in this way? Certainly the sites come with plenty of disclaimers (e.g. “You can’t decide to become anorexic by reading a webite”, “Pro-ana websites do not support anorexia, but people living with it”). The repackaging of the illness as a lifestyle endorsed by the sites has important implications for how sufferers view anorexia. In the past anorectics usually met each other in a treatment setting, where necessarily anorexia was defined as a problem and an illness. By and large patients saw the illness for what it was in each other, if not in themselves: “Everyone else here is sick and deserves help, but the things my voice tells me are true; I’m an imposter and don’t need help”. This meant that supporting other people’s illness was something of a taboo. However, at the point when anorexia is presented as a lifestyle (rather than illness), and legitimized by so many other people who share the same values (rather than symptoms), this for some pro-ana website users is no longer the case.

Clearly, pro-ana websites are a toxic influence on people who are at risk for anorexia or currently suffering from the illness. However, given that they do exist and aren’t likely to disappear any time soon, maybe eating disorder clinicians and researchers might use them to their benefit. Pro-ana websites provide very striking examples of the “anorexic voice” and how it seeks to manipulate sufferers. Moreover, and like the illness itself, they provide some sufferers with a sense of belonging, direction and purpose they are not finding elsewhere in their lives. Qualitative analysis of pro-ana websites might help to identify and better understand anorexic patients’ needs. Finding constructive, healthful ways to fulfill them is a treatment priority.