Sometimes I get discouraged by what appears to me to be the excruciating slowness with which new ideas enter the mainstream of medical and psychological teaching and practice. In the same way that many of us dress in the style that was favored in our youth, many of us do not move far from what we were taught in college or professional school, even when the science has whipped past those teachings with the speed of light. Some professionals even spend their entire lives and careers defending outdated ideas and concepts or trying to beat them into a shape that poorly fits the new information, rather than just relinquishing them.
Why are we so reluctant to change, grow and learn?
Despite the avalanche of new information from the world of genetics, neurobiology and animal science, I still find websites which quote from Hilde Bruch (1980), citing anorexia nervosa as a “misuse of the eating function to deal with problems in living” and/or claiming that “there can be no dispute that the media affects the proliferation of such eating disorders as bulimia and anorexia.” No dispute? Really? Or the question thrown out there for sufferers, which really makes me grind my teeth: “what need does anorexia meet in your life?”
So I woke up thinking about the history of ideas and wondering how long it has taken new ideas to take hold in the past. I went to the Web, of course.
A brief survey of such “new” and “radical” ideas as heliocentrism (the notion that the earth revolves around the sun and not vice-versa), the sphericity of the Earth (i.e. that the earth is not flat) and the evolution of man and other animals via natural selection, reveals the uphill battle faced by those with new ideas.
Famously, Galileo was tried by the Inquisition for postulating that the Earth revolved around the sun (heliocentrism), principally because this concept contradicted a literal reading of the Scriptures, and secondarily because he had offended leading Church officials by the way he wrote about them.
And Charles Darwin? Wikipedia tells us that, long after Darwin actually wrote his treatise on the origin of species (including humans) “in the 1920s and 1930s a modern evolutionary synthesis connected natural selection, mutation theory, and Mendelian inheritance into a unified theory that applied generally to any branch of biology.” This was further supported by the discovery in the 1950’s of the double helix structure of DNA, which provided a physical basis for the inheritance of physical traits described by the humble monk Gregor Mendel. The concept of natural selection was then supported by many, many papers written up to the current time in the fields of archaeology, paleontology and molecular biology.
The Origin of Species by Charles Darwin was published in 1859, and yet for some people reading this, acceptance of the concept of natural selection/evolution will still be considered controversial and even false, for religious reasons.
From 1859 to 2014?! Now that’s a long time. I guess I shouldn’t be so discouraged. And since, in many ways, for some people, psychology is the new religion, I suppose I shouldn't be so surprised when some of those trained in this and related fields (such as medicine) sometimes respond to ideas that contradict their training with rejection and even anger.
Case in point: Ignaz Semmelweis. Never heard of him? If you are a woman you may owe him your life.
Dr Semmelweis was born in 1818 in Hungary. He was an obstetrician who was tormented by the high death rates of women in childbirth from what was then called puerperal (childbed) fever. It struck him that women died more frequently giving birth in the hospital than they did giving birth in the streets. The more famous the physicians, the worse the outcome. How could this be? Eventually, after much experimentation, he introduced the simple measure of having the delivering doctors wash their hands in an antiseptic solution before examining a woman in labor. This concept of hand-washing was based on his theory that “contagion” was the origin of this terrible disease. (Please keep in mind that this was before Louis Pasteur proved germs existed and could cause illness, a fact of life and health that we now take absolutely for granted). The death rate among women in Semmelweis’ hospital plunged to an unheard-of low level.
Wikipedia describes what happened subsequently: “Despite various publications of results where hand-washing reduced mortality to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory and Joseph Lister, acting on the French microbiologist's research, practiced and operated using hygienic methods, with great success. In 1865, Semmelweis was committed to an asylum, where he died at age 47 after being beaten by the guards, only 14 days after he was committed.”
Some doctors were offended at the suggestion they should wash their hands? Bah!
That is a very, very sad story, of course, infuriating even, but what is more universally interesting to our discussion here is the fact that there is now something called the “Semmelweis reflex”. Again Wikipedia: “The so-called Semmelweis reflex -- a metaphor for a certain type of human behaviour characterized by reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs or paradigms.”
Now that I know about the Semmelweis reflex (hilariously, expanded on by none other than Timothy Leary), I can feel in good company as we watch ideas about anorexia nervosa in particular, and eating disorders in general, evolve and change.
Stay tuned to the science, folks, with an open mind and heart, and let the evidence lead us where it will.