Tuesday, December 12, 2006

Searching for an identity: Overestimating the importance of societal values in diagnosing eating disorders in young black women - Carolyn Masinick

Until the 1980’s eating disorders were not recognized as a major public health problem. With the death of Karen Carpenter in 1983, the prevalence and devastating effects of anorexia nervosa became front-page news. More communities began receiving accurate information about eating disorders such as anorexia nervosa, bulimia, and compulsive overeating. Consequently, there was an increase in the numbers of diagnoses, which tended to be only among young, white middle to upper class women. For that reason eating disorders have traditionally been considered a condition affecting only white women.

Although eating disorders are one of the most treatable diseases effecting Americans, they can cause many serious health problems including hair loss, decrease in protein in the blood, ulcers, hernias and in severe cases, congestive heart failure. Despite the increased awareness about eating disorders affecting white woman, there is still much unknown about the causes and effects of the disease in black woman. This lack of knowledge stems from the false belief among many health professionals that black woman are invulnerable to eating disorders.

The three main arguments that are often used to explain the decreased risk of eating disorders among black women include the following cultural norms in the black community: black women‘s tendency to promote a more positive attitude toward larger body images, the propensity to have strong familial support along with high self-esteem, and the lessened emphasis on physical attractiveness within their culture. Unfortunately it is not always these cultural level factors that are most important in determining risk factors for eating disorders; health professionals should be more concerned with individual risk factors. The individual’s acceptance of white American’s standards of beauty, the effects of mainstream advertising on the individual, as well as the individual’s level of self-esteem should all be considered important individual level risk factors when health professionals diagnose eating disorders.

Health professionals continue to diagnose eating disorders daily among young white women; however, when a young black woman comes in with an eating disorder it is often misdiagnosed. In her article entitled “The Diagnosis of Eating Disorders in Women of Color”, Jennifer Daniels states “many mental health professionals have unconsciously bought into the notion of eating disorders as a "white girls disease" and diagnosing a women of color with a eating disorder simply doesn’t cross their minds” (Daniels, 2006). Assuming that a black woman unwaveringly approves of her black culture, including the general acceptance of larger body size in her culture can be a costly mistake among health professionals. Health professionals must take into account the social norms that are facing these black women everyday and influencing their behavior and body images.

Essence magazine featured an article on the subject of eating disorders in black women, providing possible insight into this cultural difference between black and white Americans and body image. According to this article, "The Black-American culture traditionally accepts more fat on women than the White culture, but when Black middle-class women become integrated into White culture while they are trying to get ahead, they become more at risk of developing Eating Disorders” (Cultural Roles: Shades of Grey, 2006). Black women may become more at risk for eating disorders because they begin to dismiss their cultural ties and thoughts to try to fit-in with the modern mainstream standards of beauty and ideals that surround them. They may have perceptions of what is normal in the society and strive fit the social norm. If young black women see white women in their social group who are striving to meet the unrealistic goal of extreme thinness, they are more likely to attempt to achieve this goal as well.

Furthermore, according to the social norms theory, “…behavior is influenced by incorrect perceptions of how other members of our social groups think and act” (Berkowitz, 2004). These incorrect perceptions of behavior at the societal level often come from the mainstream white American culture that surrounds young middle class black women. Modern day society finds that social groups are no longer defined by race. And unfortunately, the mainstream American culture often touts the ideal woman as being severely underweight and places much value on physical beauty. Consequently, all black women may no longer accept the stereotypical cultural level factors of black American culture. Although, historically speaking, the black culture has been accepting of a larger body image for black women, this stereotype may no longer be true. As young black women become more integrated into mainstream white American culture, their values and beauty standards will begin to move toward the social norm.

Another cultural level factor in which health professionals are placing too much emphasis is the black cultures lessened importance on physical beauty. In modern mainstream white culture flawless beauty is a value that is highlighted all the time. As young black women struggle to find acceptance in the mainstream culture, they will often accept this unachievable view of beauty and perfection. In a study to explore and examine the factors that influence women's perceptions of their bodies, Alyson Spurgas stated that the “Results indicate that participants have struggled to achieve positive perceptions of their bodies as adults, tend to feel that women of all races and ethnicities are increasingly held to a similar standard of beauty (i.e., thin and White), and believe that images of the female body depicted in the media have significant effects on the way women perceive their own bodies” (Spurgas, 2005). Just as white women are exposed to the blonde, flawless, stick thin models that are plastered on billboards and spilled throughout the pages on magazines, black women see the praise that is given to these women when they fit the thin, flawless model stereotype. In the media, women are commended for being a size zero and covering up, perhaps airbrushing, all of their flaws. The media is in fact encouraging all women in the community to associate with the dominant culture’s values of attractiveness and pure beauty and to strive to reach these unrealistic goals of perfection.

Additionally, often it is thought that black women do not respond to media messages picturing white women. But as the media incorporates more black models into their advertisements, the effect of these messages on young black women is increasing. In her article on mass media effects on black women, Cynthia Frisby states, “although African-American women are not affected by images of Caucasian women, they experience body dissatisfaction when viewing media images of African-American women… who exemplified societal ideals of thinness and attractiveness” (Frisby, 2003).

Thus, beauty is being hailed as a tangible object for women of all races and backgrounds. So health professionals must change their view on young black women’s level of vulnerability to the media’s messages; they must begin to realize that some black women relate to the advertisements promises of freedom, independence, autonomy and acceptance. As the advertising theory emphasizes, the most important aspect of an advertisement is the promise that it makes and how that promise appeals to the most basic and compelling core values. As these advertisements appeal to some black women by using these basic core values of autonomy and acceptance, black women begin to question and often disvalue the traditional black culture thoughts of beauty.

When young black women begin to accept the mainstream white American culture’s definition of beauty and thinness suggests that the media might have a stronger effect on them then previously suspected. As stated on the About Face Organization’s website, “The more a person is pressured to emulate the mainstream image, the more the desire to be thin is adopted, and with it an increased risk for the development of body image dissatisfaction and eating disorders” (Cultural Roles: Shades of Grey, 2006). Since black women do not have control over the color of their skin, they may be more likely to try to fit in to mainstream culture by changing something that the media deems important and that they do have control over: their weight and their eating habits. As the advertisements and the media begin to integrate more black women models in their message about the importance of physical beauty and thinness, it is likely that more young black women are going to be accepting these values in order to fit in with mainstream culture. Health professionals should begin to reject traditional thinking that all black women are invulnerable to the messages in the media about thinness and beauty and be willing to accept these mainstream values in women of all races. Realizing that all women are vulnerable to these messages of thinness and perfection might help health professionals begin to correctly diagnose eating disorders in young black women.

As eating disorders are beginning to be diagnosed in more diverse groups of people, other than white women, it has been noted that one common trait in the development of all eating disorders among all races is low-self esteem. Self-esteem issues do not discriminate between races. If any woman feels as though she is not accepted in a certain group, her esteem for herself will be low. The development of a positive self-image is an ongoing struggle for most young black women. Unlike many woman of other races, they face historically negative racial stereotypes, influences from their familial network as well as their social network and influences from mainstream American culture that make it increasingly difficult for them to create a positive self image and feel as though they belong. Most black cultures stress the importance of a strong social and familial support network; unfortunately, having a strong social network does not constitute high self-esteem. Assuming these cultural level stereotypes protect all young black women from issues of low self-esteem and eating disorders “fails to take into account the reality of within-group individual differences and the complexities associated with developing a self-image within an oppressive and racist society”(Daniels, 2006).

Furthermore, Maslow’s hierarchy of needs model, in part, can explain this increasing incidence of low self-esteem among young black women. Maslow states that all people have “the desire for strength, for achievement, for adequacy, for confidence in the face of the world, and for independence and freedom” (Maslow, 1943). All humans have a need for a stable, firmly based, high level of self-respect, and respect from others. Maslow goes on to state, “thwarting of these needs produces feelings of inferiority, of weakness and of helplessness. These feelings in turn give rise to either basic discouragement or else compensatory or neurotic trends” (Maslow, 1943). Some black women are already trying to counteract the historically negative racial stereotypes, so their search for self-esteem is often harder and longer than for white women who do not have to overcome such barriers. In order to make themselves feel in control of their situation in society, they may be likely take control over their body image and body weight and risk the development of an eating disorder.

Moreover, as black women are trying to fight these cultural level stereotypes of acceptance of a larger body image, of a strong familial support network, and of a lesser emphasis on physical beauty they will often come up short and experience a lessened self-esteem. Daniels states, “Culture influences self-esteem and aids in the maintenance of an eating disorder yet does not solely account for the development of an eating disorder” (Daniels, 2006). Thus, young black women are just as susceptible or perhaps more susceptible to have problems regarding low self-esteem than white women. This problem of low self-esteem along with an unsatisfied attitude toward one’s body image is one of the required individual level risk factors for developing an eating disorder. Because of they are classified as having a strong social support network within their own race, young black women are often disregarded when it comes to diagnosing self-esteem issues. Additionally, if low self-esteem problems are not diagnosed properly health professionals will continue to under diagnose and misdiagnose eating disorders in black women.

As young black women are facing more and more pressure to become mainstreamed in today’s society, often times their level of identity with their own black culture is diminished and replaced with some expectations of the mainstream culture. As this happens it is important to realize that these changes in culture can cause confusion and if not handled properly can cause mental health problems such as an improper self-image and low self-esteem.

In a world where mainstream culture has a significant effect on young black women one must stop overestimating the importance of the historic societal level factors associated with the black culture that are assumed to safeguard all black women from developing eating disorders. Public health professionals should be concerned with the health and well-being of all individuals and assess their risk for eating disorders on an individual basis. Too often cultural values are considered to protect an individual from certain diseases. Cultural stereotypes should never be used as an excuse to not screen an individual for a serious disease.

With such a treatable disease, such as eating disorders, health professionals need to begin to offer help to all individuals, not just those white women who come forward proclaiming that they have an eating disorder. Such improvements in identifying and diagnosing this public health problem should be the first step so that accurate care can be provided to all individuals.

Berkowitz, Alan. “The Social Norms Approach: Theory, Research, and Annotated Bibliography”. 2004. http://www.alanberkowitz.com/articles/social_norms.pdf

“Cultural Roles: Shades of Grey”. Something Fishy: Website on Eating Disorders. 2006.

Daniels, Jennifer. “The diagnosis of Eating Disorders in Women of Color”. Something Fishy, 2006. http://www.something-fishy.org/cultural/roles_jd.php

Frisby, Cynthia. “Mass Media Damaging African-American Women's Body Esteem, MU Journalism Studies Find”. 8 September 2003. http://journalism.missouri.edu/news/2003/09-08-frisby.html

Maslow, A.H. A theory of Human Motivation. Psychological Review, 50, 370-396, 1943. http://psychclassics.yorku.ca/Maslow/motivation.htm

Spurgas, Alyson Kay. “Body Image and Cultural Background”. Sociological Inquiry 75 (3), 297-316. 2005.


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