Pro-Ana, pro-mia and eating disorders

**PLEASE NOTE: This may be triggering for some people although no numbers or specific known triggers are discussed.**

**PLEASE NOTE 2: These are not my final opinions but rather ponderings of the past week, ideas to think about and discuss**

I've been thinking a lot lately about what a lot of what people would consider to be the "pro-ana" community. Now from what I'm aware of there are two basic sides to this community, there is the community that has an eating disorder (EDNOS, Anorexia Nervosa or Bulimia Nervosa typically) and are supporting each other whether they're in recovery or not, there is no real blame or shame, just support and understanding. There is some encouragement of supporting eating disorder behaviours, but its not fueled by hatred. Then there is the other side of the "Pro-ana/mia" community that is a lot more harsh, sharing a lot of tricks and tips and stuff. I do wonder though, at what point is being supportive and helping buying into an illness and at what point does NOT supporting and helping cause stigmatisation and more isolated and thus LESS able to access help and recovery. And also another question is, who's responsibliity is it to do what and when? Should we always push for recovery? Is that really our role? If we encourage someone to diet (that we know has an eating disorder or an eating disorder history) and something happens to them, are we partly to blame?

I'm asking a lot of these questions as they've come up for me lately with some people I've met. They're awesome, loving, caring, generous people. They certainly are not people setting out to hurt others or to encourage someone's demise, yet I know from the outside at least, that many of them would be labelled and frowned upon for what they "supposedly" encourage in the behaviour of others. But its not that simple. Like by listening to someone, by teaching them a "trick" that "trick" can also mean that that person eats when they otherwise wouldn't! So it's not that simple I don't think. I also think, I don't have answers.

This is what I think I know...

Everyone should have a chance of recovery. Everyone should have access to services that are appropriate to their needs to assist them in recovery if that is the path they choose. Not everyone wants to recover and other than life saving measures, I don't think forcing a recovery mindset necessarily helps, I strongly suspect, it just causes that person to shut down and not talk and not get help - ever (at least, not until they're ready and choosing to recovery). I think eating disorders are a horrible, deadly illness and they do take lives. I don't think that the encouragement of behaviours that lead to death are positive, but I don't think that it is simple to judge what is and isn't supporting various behaviours. I think even in the pro-ana/pro-mia community that there is a lot of good that happens by warning away from unhealthy weight loss issues, that a lot of cautionary tales are told. I also think its all a very fine line.

Most of all, I think that if we label and stigmatise these people that its not going to help anyone. I think mental illness is not straight forward or easy. I know that some of my friends are not ready to recover and others are in recovery but also need to lose weight for various reasons. I have been thinking a lot about all this because with a history of an eating disorder but needing to lose some weight (which is being encouraged by some members of my treatment team) that for people to just shut me down and not help me because of my history is very unhelpful and those friends that have stepped up and accepted this as an issue and are willing to help me, that its much easier to be honest with them and get the help and support I need and therefore it's actually easier to take control and let the eating disorder have less control.

I know that it's a very slippery slope and so like I said, its a fine line. What works and is appropriate for one person, is NOT going to be appropriate for another person. Some people simply cannot engage in ANY form of dieting behaviours (even if that "dieting" behaviour is meant to be a lifestyle change not just a short term fix) and that needs to be recognised. I think that its better to do weight loss (if it is genuinely required) with the help of a treatment team if available. I think that if one is engaging with people that have a pro-ana/pro-mia mindset that its important to monitor yourself and be careful with whom you are friendly.

I don't have answers but I know there are a lot of people out there that expect that the system should automatically treat everybody on a recovery model. The expectation that everybody wants to get well and that if they don't, that if they're treated for long enough that it will change (sometimes it might, sometimes it won't). I think that there is this idea that if we talk about alternatives to working with people not ready to recovery from eating disorders, that we will feel that we're responsible for the outcomes of their health, that we're encouraging them to continue in unhelpful behaviours. There is also the expectation that if there was enough treatment available then thigns would improve, and sure, in part, I think that's reasonable, but I also think a lot of people are forced into treatment and they're not ready, hence the revolving door problem of eating disorder treatment.

I know a lot of this is controversial. But when I worked at in the Needle and Syringe Program that was very controversial. We were giving free needles and disposal stuff to addicts (and sometimes people with medications). Lots of people assume that its encouraging drug use. That is never how I saw it. For us, it was always an opportunity to help that person keep their health as best as possible. If that meant I gave them a tip on how to inject properly, so be it. It also meant they often felt more comfortable speaking to us when they wanted to get clean. Drug use is just as hazardous as eating disorders and can have some incredibly long term consequences, just like eating disorders. The NSP approach looks are harm minimisation, so reducing the level of harm that might be caused from the drug taking behaviour, we could give advice and support and help to people ready to hear it and help keep other users healthier while they weren't. I think there is a place for this in eating disorders. It's mostly just figuring out how to engage with that idea in a manner that reduces harm, not increases it.

Again, I know its controversial, I know the line for each person is going to be different. But lets not isolate and stigmatise a community even further. Lets work on ways that we can help each other to get better, step by step.