Academic journal article Ethical Human Psychology and Psychiatry

A Disorder of a Vulnerable Self: Anorexia Nervosa Patients' Understanding of Disorder and Self in the Context of fMRI Brain Scanning

Academic journal article Ethical Human Psychology and Psychiatry

A Disorder of a Vulnerable Self: Anorexia Nervosa Patients' Understanding of Disorder and Self in the Context of fMRI Brain Scanning

Article excerpt

In this article, we aim to explore patient perspectives regarding the etiology of anorexia nervosa (AN) in the context of participating in brain research for AN. This is a qualitative study using semistructured interviews with 12 young AN patients. Data were analyzed according to thematic analysis method. This study shows that patients' language used to express their understanding of the etiology of AN was characterized by psychological terms such as personality, self-esteem, control, and coping rather than neuroscientific terms.

Participants held a complex understanding of the causes of AN, acknowledging a brain-mind relationship. However, participants expressed the hope that brain sciences could contribute to identify an objective, physical proof for AN, that would validate their illness, increase understanding, and reduce blame. The study suggests that prevailing biological explanations promoted by brain research did not encourage simplistic perspectives on causation among patients. Instead, patients viewed biological-based theories and brain science as a means of validating their illness.

Keywords: anorexia nervosa; fMRI; brain-based narratives; stigma; reductionism

Anorexia nervosa (AN) is defined by the Diagnostic and Statistic Manual of Mental Disorders (DSM) as a psychiatric disorder characterized by an inability to maintain normal weight, intense fear of gaining weight, and an overevaluation of the importance of body and shape on self-worth (American Psychiatric Association [APA], 2000). Etiological models proposed to understand the development and maintenance of AN have undergone different trends (Schmidt, 2003). Currently, there is consensus that the disorder is complex, attributable to the interplay of biological, social, and psychological factors. Recent advances in neurotechnologies and brain sciences, however, have rapidly shifted attention to the biological aspects of the illness (Schmidt, 2003), and especially to the brain. The increased use of neurotechnologies, like brain scanning, has generated hopes for successful brain mapping, finding markers, and possibly early identification and intervention during the presymptomatic stage of the illness (Racine, Bar-Ilan, & Illes, 2010). Especially functional magnetic resonance imaging (fMRI), which measures blood flow and level of oxygenation in certain brain regions activated by different tasks effectuated in the scanner, is increasingly being used as a principal research method. However, there are no identified valid brain markers for AN, and fMRI is not yet widely used for determining diagnosis or designing treatment, but mostly for research purposes. Nonetheless, the influence of fMRI should not be seen strictly related to diagnosis and treatment, but also at the level of how technology shapes patients' understanding of self and illness (Buchman, Borgelt, Whiteley, & Illes, 2012).

Indeed, the increased use of neurotechnologies has been critically viewed as symptomatic of an epistemological culture in which the role of neurotechnologies becomes decisive in defining mental disorders as brain disorders (McLaren, 2011). Moreover, this is seen as part of a broader trend of neurologization of the person (Singh, 2013) where personhood is reduced to "neurochemical self" (Rose, 2003). However, the assumed changes that neuroscience would bring to concepts as self and mental disorders have been shown not to be absolute or normative (Kaposy, 2010). A growing body of literature shows that theoretical concepts such as the neurochemical self have limited empirical evidence and that neurobiological explanations do not have a totalizing or reductionistic effect on the individuals' subjectivity, for example, sufferers' understanding of the illness and understanding of themselves (Pickersgill, Cunningham-Burley, & Martin, 2011; Singh, 2013).

Not only exposure to brain-based theories of causation but also patients' exposure to neurotechnologies, such as brain scans, has been hypothesized to have an effect on selfand disorder-understanding, and possibly lead to neurorealism and neuroreductionism. …

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