I saw on the news recently a piece describing a rise in the number of people over 40 developing eating disorders. I was initially skeptical – to me it seems unlikely that in the last few years older people have suddenly started suffering with eating disorders. I think it’s more likely that people of all age groups have always suffered from them, but our diagnostic criteria has changed in the last few years. 50 years ago we didn’t even have a name for most eating disorders, so is it really surprising that we’ve now found out that older people can develop them too? It seems to me that the marked increase in the over 40s developing eating disorders can be attributed to more thorough diagnosis of these disorders.
Diagnosis is about putting people’s symptoms into categories, each of which has different possible treatment options. But the lines between these categories are blurred when it comes to mental illness, including eating disorders. When my grandad was reaching the end of his life (long after the age of 40, I should point out) he started refusing to eat. He went into hospital and his behaviour was attributed as a decision by him to stop fighting to stay alive. The family accepted it and let him pass peacefully at home. Which I’m sure is what he wanted. If a 16 year old was admitted to hospital because they weren’t eating, doctors would undoubtedly make every effort to help them manage their mental illness and start eating again (which would probably be what they wanted). However the young person and the old person may both have been suffering from the same condition. Without knowing what caused it, which thoughts and electrical signals in the brain led to their behaviour, we can’t possibly know.
I’m not trying to say that my grandad had anorexia – he probably didn’t even fit the diagnostic criteria. I simply believe that my example shows just how subjective psychiatric diagnosis can be. Two people could have very similar symptoms but receive completely different treatment; this surely is partly because every patient has different personal circumstances which are likely to lead to assumptions about what’s wrong with them. Some might argue that this is unfair and wrong, and that my grandad had just as much right to recover from his refusal to eat as a teenager would. This argument seems logical and ethical. But I think assumptions doctors make, consciously or unconsciously, can lead to giving people a more appropriate treatment for their situation – such as letting my grandad fade away instead of treating him for an eating disorder, which I believe was the right decision, as I’m sure would many others. Of course there are many sides to every debate, particularly when mental health is involved, but perhaps we should be more inclined to use some assumptions to help us rather than be offended by them.