An Outdated Paradigm

Background

    The mechanistic, reductionist, dualistic, patriarchal paradigm or world view that has dominated Western culture for the past several 100 years is a legacy of the great thinkers of the Scientific Revolution including Isaac Newton, Francis Bacon, and René Descartes as perhaps the most influential. Among the ideas and values that comprise this paradigm are the view of the universe as a mechanical system, the separation of matter and spirit, the view of life as a competitive struggle for existence and the belief in the natural domination of women by men.¹

    This world view provides the foundation for the biomedical or "medical model" that directs conventional approaches to health and disease. The medical model views the human body as a machine, disease as a malfunction of the machine, and the physician as the repair person. There is an overwhelming focus on disease, and particularly on discovering and eradicating the physical determinants of disease.² And true to its patriarchal roots, biomedicine has been characterized by a historic neglect of women's health issues.^3,4

    Although the medical model has resulted in tremendous advances, particularly in the treatment of acute trauma and illness, it also has contributed to an inability to deal effectively with many of the chronic conditions that have arisen as the result of the rapid progress in civilization over the last 300 years.^5,6

The Body as Machine

Traditional treatment approaches to weight management strongly reflect the underlying assumptions of this 17th century paradigm. The human body is seen as a "finely calibrated combustion engine that should weigh a certain amount," and therefore scientists have issued "recommendations about exactly how many calories, calibrated to age, height, and activity levels are needed to achieve this goal."⁷

    Because body weight has been considered largely a mechanical matter of calories in (diet) and calories out (exercise), weight management is reduced to a measurable numeric equation and everyone can attain their goal by merely adjusting these variables. Furthermore, scientists have determined the exact amount of calories and nutrients needed for health and efficiency, and food therefore has become "an instrument of science, stripped down to a quantity of energy and deprived of all its sensual and emotional aspects."⁷ The resulting reductionist view of weight- and eating-related issues "is typical of the medicalization of complex conditions, in which contextual factors are treated as single variables to be overcome."⁸

    These premises continue to guide medical weight management efforts. Yet it is common knowledge that weight, like almost all other human characteristics, varies according to a normal distribution. Furthermore, the existence of different body types is well documented, and it is likely that each has its own range of normally distributed weights and body fat percentages. Strong arguments have been made that the height/weight tables that have provided the foundation for traditional approaches are flawed to the point of being meaningless for the majority of people.^9,10  World renowned researcher Dr. Ancel Keys described them as "arm-chair concoctions starting with questionable assumptions and ending with three sets of standards for "body frames" which were never measured or even properly defined."¹¹

    The oversimplified view of weight control as a simple mathematical relationship between caloric intake and expenditure has been shown to be inaccurate.^12,13  Furthermore, the reduction of food to caloric input, devoid of other less measurable qualities, denies the reality of the complex interaction of emotional, psychological and cultural variables that determines voluntary food intake.¹⁴ The resulting diet mentality "reinforces the split between the dieter's mind and her body, and asks her to distrust her body, which is seen as the source of sabotage."¹⁵  This separation of mind from body inhibits the development of internally regulated eating in children ¹⁶ and contributes to the current epidemic of adult eating disorders, disordered eating and exercise addiction.^17,18

The Power of Paradigms

    The power of paradigms to direct research and practice in science, even in the face of substantial conflicting information, has been discussed at length.¹⁹ Indeed, the influence of social and political fashions on "objective" science is the subject of a recent heated debate among scientists.²⁰ A number of prominent physicians have discussed the limitations imposed on medicine by adherence to the tenets of the "Cartesian" paradigm.^5,6  In his landmark book Meaning and Medicine, Larry Dossey, MD, writes that "our illusions regarding the body . . . that it behaves essentially like a machine . . . have paved the way for the loss of meaning in health and illness."⁵  Our continued reliance on interventions based on the "calorie in vs. calorie out" and "ideal weight" hypotheses in spite of substantial, contradictory scientific evidence and the demonstrated lack of efficacy of such interventions may well be, at least in part, a result of this legacy.

Weight and Patriarchy

    The domination and control of man over nature is a central theme of the 17th century world view. According to Sir Francis Bacon, "nature takes orders from man and works under his authority," and the purpose of science is to "torture nature's secrets from her" so she can be "forced out of her natural state and squeezed and molded."²²  It is no mere coincidence that, in a patriarchal culture, nature is described as a female to be controlled and even tortured by a "masculine" science. As attorney general to King James I, Bacon was intimately familiar with the witch prosecutions of the era which resulted in the torture and murder of millions of women. Indeed, many of the metaphors used in his scientific writings echo the terminology of these proceedings.²²

    Given this world view, it also is no coincidence that the need to control women's body shape and size to support a particular fashion has long been promoted by medical science in the name of health. Beginning in the Victorian era women wore corsets to achieve the plump, hourglass figure deemed desirable for the leisure class. This style of dress was advocated by the medical establishment though it often resulted in constricted lungs, squeezed livers and bladders and dislocated stomachs.^23,24,25

As the dictates of fashion began to change in the late 1800s, medical recommendations for women followed suit. For the next 100 years, medical science would promote a wide variety of potentially dangerous and sometimes lethal diets, drugs and surgeries to help people reduce their weight in the name of health .²⁶  The vast majority of those participating in and suffering from these "cures" would be women, despite the fact that women's fat confers only a fraction of the health risk of men's and may actually carry with it significant health benefits.^27,28,29  This legacy continues today, as young girls and women continue to divert significant proportions of their resources to the pursuit of ideals of body shape and size that are, for the vast majority, neither achievable nor healthy.³⁰

    Keeping women occupied by continually striving toward an unreachable ideal of perfection serves the purposes of a control-oriented, patriarchal society.^8,25  When women's energies are diverted by the pursuit of dieting and body improvement, they are kept from dealing effectively with the realities of existence in a man's world and from participating more fully in art, politics, literature and life in general.

    Much has been written concerning the historical association of female fat particularly on the abdomen, buttocks and breasts, with the "feminine" values of nurturance, compassion, etc.^31,32,33 Throughout history, soft, rounded hips, thighs, and bellies have been considered ideal for women in the vast majority of cultures.³⁴  As long as women were content to stay at home and bear children, these associations remained relatively intact. It has been argued convincingly that the obsessive hatred of fat in this country began with the women's equality movement and that the more powerful women become, the more pressure there is to alter the aspects of their bodies that distinguish them from their male counterparts.^32-36 The continuing trend toward an ever thinner, androgynous ideal for women would seem to support this view.⁹  Thus:
 

"taking on the accouterments of the white male world may be experienced by many women themselves as a chance to embody qualities such as detachment, self-containment. self-mastery, and control which are highly valued in this culture" ³⁶
 

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© Fall 2001