I am both an anthropologist and a clinical psychologist. In my latter role, I have treated people from many different populations. Some of them are marginal in many ways. In this post, I want to refer to a special population with whom I have worked—the developmentally disabled. This population has been interesting from an anthropological perspective for a long time. One should go to medical and psychological anthropologist Robert Edgerton’s The Cloak of Competence: Stigma in the Lives of the Mentally Retarded (University of California Press, revised edition 1993). This anthropologically groundbreaking work focused on how developmentally disabled people coped with being labeled and excluded, as well as not being able to function at the same level as other people. Anthropologists concern themselves with populations at the borders of society; consequently, developmentally disabled people are deserving of study in terms of social issues.
In this post, I am drawing on my work with people who are medium to high functioning. This is my clientele. They live either in group homes, worthy of study as a social institution in their own right, with parents even as adults, or independently. They have some food problems which I think may be of interest to anthropologists of food and nutrition. Moreover, they share some behaviors with other populations which put them at health risk, which is of interest to medical anthropology, medical personnel, and policy makers.
First, many developmentally disabled people are significantly under or overweight. (For a discussion of obesity among the developmentally disabled, click here.) There may be a variety of reasons for this condition. Developmentally disabled people may have significant genetic or hormonal imbalances, which then lead to weight problems. A person may have Williams Syndrome, for example, which can involve hypercalcemia syndrome and hypertension. Williams people may have shorter lifespans as well.
Second, a person may have poor impulse control. Part of this lack of impulse control may result in the need for instant or quick satisfaction. I’ve noticed many of my clients tend to eat fast food and a lot of it. It’s salty, greasy, without fruits and vegetables, and often not especially nutritious. Moreover, in many areas, those who live “independently” live in apartments close to fast food restaurants and, if they are lucky, near supermarkets. Other researchers have seen that this pattern of residential dwelling and food consumption leads to obesity (cf. Hurvitz et al.: 2009).
Third, quite often, many developmentally disabled people have been sexually molested. Sexual molestation can lead to a variety of eating disorders, including obesity, anorexia, bulimia, and self-injurious behavior (for more information on the connection between sexual abuse and eating disorders, see Cohen n.d. http://www.edreferral.com/sexual_abuse_&_ed.htm).
The result is that person may have significant food-related problems. These problems raise the risk of food-related diseases, including Type II diabetes, back, and joint problems. Furthermore, given the frequent lack of impulse control, a person may aggravate these conditions by not eating correctly and not following doctor’s orders. If a person is taking some antidepressants, the person may experience weight gain. The additional weight may also aggravate many medical conditions.
There may be also additional complications. Often the person has poor dental hygiene problems. S/he may rarely brush and/or floss and rarely see a dentist or dental hygienist. Some relatively recent research that poor dental practices can intensify the risk of Type II diabetes (See this web posting for a longer discussion of this issue: http://www.dentalclinicofmarshfield.com/poor-dental-hygiene-leads-other-health-problems.) Medicaid cuts worsen the dental situation; they also reduce the possibility of seeing physicians and specialists.
Some states have regional centers or similar programs which help higher functioning people live either in group homes or on their own. Caregivers or provider agency staff can help the person maintain better food buying and cooking practices. Often, however, people go out on their own and “binge eat” terribly. Ideally, they can get further help by going to psychological therapy, most often behaviorist-focused.
Thus, this special population incurs special risks. As anthropologists, we need to be alert to the personal and policy needs of these people.
Comments by Richard Zimmer