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Will the Real Authentic Voices Please Stand up and Be Heard

Giving anorexia nervosa an "authentic" voice.

What is the authentic voice when it comes to anorexia?

Anorexia and the authentic self

"Anorexia Nervosa and the Language of Authenticity" is a recent report conducted by Tony Hope, Jacinta Tan, Anne Stewart and Ray Fitzpatrick and published by the Hastings Center (Nov-Dec 2011, Vol 41., Pp 23-29.). In this report, the concept of authenticity is explored thoughtfully through interviews with 29 young women suffering from anorexia. The goal of the report was to examine the concept of "living authentically" and determining the "authentic voice" as it relates to anorexia.

The study states, "There is a long history to the idea that authenticity is relevant to how we should live, and that the point of our lives is to be true to ourselves—true, that is, to our authentic selves." While reading this, the question came to mind, "Who is the authentic self when someone has anorexia?" One issue the authors' address is the capacity (competency) of someone who has anorexia to act autonomously when it comes to decision making, particularly around refusal of treatment. Is the authentic or inauthentic voice guiding the person toward treatment refusal?

Ethical issues abound when it comes to whether or not it's ok to impose treatment when someone with anorexia is refusing it, despite the clear and apparent medical need. And indeed, the report revealed that many in the study experience anorexia as their "in-authentic self" - separate from their true, "authentic self." One participant even noted, "It feels like there's two of you inside - like there's another half of you, which is my anorexia, and then there's the real [person], the real me, the logic part of me, and it's a constant battle between the two."

So the study begs the question: which voice is really the authentic one. Is it the unhealthy voice telling the person not to eat, or the voice of self-reproach, which according to the authors still does not speak to authenticity? Yet, if we view eating disorders as a vehicle to express behaviorally what cannot be expressed emotionally and verbally, then maybe the anorexia can in part also represent a voice of authenticity.

What sometimes gets split off from the individual, which in turn can perpetuate an eating disorder, are deep feelings of anger, shame, competitiveness and guilt. These are normal emotions that we all experience in our lives; they are part of an authentic human being. Is the authentic self therefore only the one who is strong, competent, and filled only with positive emotions? Does this not then support the idea that authenticity is about feeling and being good, or perfect?

Perhaps the anorexia is also a way to allow the authentic self to live, too. Some could argue that having an eating disorder is a way to express and experience feelings that the person cannot allow in an otherwise healthy way. But because the very nature of eating disorders are self-destructive,they also act to punish the person for having these negative feelings. It's a case of one hand slapping the other.

The authors end with some recommendations for treatment practices which include a discussion with patients about their struggle with authenticity - i.e. fears that treatment will take away their authentic self and that recovery is about helping patients discover and live authentically.

An important element was also the understanding on the part of the authors as to why listening to patients, and the need for patients with anorexia to feel understood, is a cornerstone for establishing trust - a key factor in enabling recovery. Indeed, authentic recovery is about integrating and accepting all aspects of yourself without engaging in behavior that is self-defeating or self-destructive.

Positive regard for one's self is an authentic voice. Yet positive regard also includes the integration of those deep, dark emotions and negative qualities that make us all human. Authenticity, in my mind, means living a life that is true to you, and this includes integrating all sides of you. Therefore, this also means the side that is split off in the eating disorder is still part of the individual, and should also be regarded as an authentic voice that needs to be heard.