Üsküdar University Founding Rector, Psychiatrist Prof. Dr. Nevzat Tarhan, was a live guest on EKOL TV's 'Balçiçek ile Bu Gece' (This Night with Balçiçek) program. Tarhan made striking remarks regarding 'the psychology of women in the pursuit of beauty and thinness, and the deterioration in society and entertainment culture.' Stating that anorexia cases are rapidly increasing globally, Tarhan said that it is a brain disease. Emphasizing that mandatory treatment is necessary for anorexia, Tarhan stated that this disease cannot be cured with advice. Tarhan also noted that digital showcases severely affect young people, stating that young people admire and imitate the individuals they see on social media.
“Anorexia cases are rapidly increasing globally”
Prof. Dr. Nevzat Tarhan, during EKOL TV's live broadcast, comprehensively addressed Anorexia Nervosa, a disease that has once again come to the agenda with the death of Nihal Candan. Psychiatrist Prof. Dr. Nevzat Tarhan, stating that the disease is a brain disorder, noted that its prevalence is increasing globally. Tarhan said; “Anorexia cases are rapidly increasing globally. Anorexia nervosa is a brain disease. In this disease, the brain's way of perceiving body image is impaired. Regions in the brain related to body image, such as the insular cortex and fusiform gyrus, are linked to the reward and control system. In some individuals, the risk in these regions increases due to genetic predisposition. Even if a person weighs 29 kilograms, they perceive themselves as 150 kilograms. This is a matter of feeling; they are not lying, they genuinely feel that way. For example, even if a person drops from 29 kilograms to 23 kilograms, they may still perceive themselves as 150 kilograms. Their brain plays this trick on them. In this situation, the person can no longer recover with mere advice, persuasion, or classical therapy methods. However, in the early stages of the disease, when symptoms are mild, solutions are easier. In advanced stages, the brain's neuroplasticity is disrupted, and the neural network in the brain is damaged. Beyond a certain point, the brain begins to accept this distorted perception as normal. You can no longer change that person by persuading or convincing them. At this stage, the person needs long-term hospital treatment.”
“This disorder cannot be cured with advice”
Tarhan, stating that mandatory treatment is necessary for anorexia; “Psychiatric diseases are not only psychological but also have a neuropsychological dimension. In the past, for such disorders, the understanding was 'If the person wants treatment, they get it; if not, they don't.' It was left to the patient's free will. However, this approach has now changed. New brain research reveals that there are impairments in the neural networks of these individuals. These impairments can be detected through brain mapping methods. There are specialized network databases prepared for eating disorders. A person's brain map is created and compared with this database to determine which regions are impaired. This system is a QEEG, or brain mapping system, known as SW-LORETA. With this method, we can show on a map which regions in a person's brain have impaired function. When these findings are shown to the person, the process of convincing them to treatment becomes much easier. Because this disorder cannot be cured with advice. It is a biological, concrete disease. Therefore, when a person's body mass index starts to fall below 18, this situation can no longer be considered under the scope of free will. Mandatory treatment is required. Because no one can have the freedom to harm themselves. If a person says, 'I'm going to jump from the 10th floor,' can we say, 'That's your freedom'? This situation is no different from that.”
“Some individuals may develop excessive control due to aesthetic anxiety”
Tarhan, stating that some individuals may be excessively preoccupied with aesthetic anxiety; “In a stressed brain, the need for dopamine increases. The brain rapidly begins to consume dopamine, and the person turns towards seeking pleasure. A weakness for pleasure develops. If the person has grown up in a cultural environment that glorifies physical appearance, this pursuit of pleasure is directed towards body perception. Therefore, some individuals may develop excessive control due to aesthetic anxiety. In some people, this pursuit of pleasure creates a similar effect to substance use. That is, similar biochemical processes are activated in the brain. In this case, genetic predisposition also plays an important role. For example, the serotonin transporter gene (5-HTT) affects serotonin regulation in the brain. In individuals carrying the SS allele of this gene, the gene works slowly, and the person becomes more sensitive to stress. Even a small stress can lead to serotonin deficiency in the brain. This creates a basis for depression or anxiety. These are not disease genes but risk genes. In other words, this genetic predisposition increases the person's vulnerability to stress. With this information, the biological dimensions are now scientifically proven. If a biological predisposition is identified in an individual, a more determined and disciplined approach should be followed in the treatment process.”
“The person is made to believe that the more they consume, the happier they will be”
Tarhan, stating that serotonin-based happiness is more lasting; “Endocrinologist Dr. Robert Lustig wrote a book in 2017 titled 'The Hacking of the American Mind: The Science Behind How the Rich and Powerful Have Conquered Our Brains and Bodies.' In this book, Lustig criticizes the hedonistic, or pleasure-oriented, philosophy of life prevalent today. In fact, this distinction was also made 2,500 years ago by Aristotle. Aristotle divides happiness into two types. Hedonistic happiness is a short-term, dopamine-based happiness pursued through pleasure. Eudaimonic happiness, on the other hand, is a more lasting, serotonin-based happiness focused on meaning and purpose. According to Lustig, modern society, especially American culture, constantly directs people to pursue pleasure within the cycle of consumption. The 'earn, consume, spend' cycle affects individuals through the brain's dopamine system using neuromarketing techniques. In this system, the person is made to believe that the more they consume, the happier they will be. However, this biologically exhausts the brain and prevents true satisfaction in the long run.”
“What is popular is now considered valuable”
Tarhan, stating that eating disorders deeply affect body perception; “Today, the measure of value has changed. What is popular and visible is now considered valuable. This understanding deeply affects body perception, especially in eating disorders. For this reason, we apply a body neutrality approach in the early stages of treatment. The aim here is to ensure that the person establishes their values regarding their body not just through external appearance, but through the body's function. That is, the person can say, 'I exist not by my body, but by the function my body provides me. My body undertakes a task as a tool to live, move, and produce.' This method is called brain neutrality therapy. In addition, we also use virtual reality technology to support this treatment. We have implemented a VR program developed in Vienna at our hospital. Initially, we planned to develop our own software, but seeing that this program was very well designed, we decided to use it. In this application, the person sees their own body image in a three-dimensional environment. This creates a high level of anxiety in the person with an experience that feels real. However, as the person repeatedly experiences this anxiety in a controlled manner, they gradually become desensitized. Thus, the brain's body perception is restructured, and fear decreases. This process should definitely be supported not only with classical psychotherapy but also with neuropsychiatric treatment.”
“There is a global system that sanctifies popularity”
Tarhan, stating that popular culture leads to an epidemic of narcissism; “In the treatment of eating disorders, we also definitely conduct family research. Because the child's mental infrastructure is shaped according to the values they were raised with at home. If there is a family environment where physical appearance is glorified, even sanctified, the child thinks, 'If my physical appearance is good, I am valuable; if not, I am worthless.' This leads to a serious shift in meaning in the brain and ultimately to a loss of meaning. There is a global system that sanctifies popularity. In fact, they sometimes legitimize this under the name of artistic freedom. However, this system targets the biological vulnerabilities of the human brain. One of these vulnerabilities is the desire to be visible. The human brain is very sensitive to stimuli, especially sexuality and violence. The desire to display oneself is also part of this biological structure. This characteristic exists in everyone, but some aspects vary according to gender. In the female brain, the tendency to display oneself through physical appearance is more dominant. In the male brain, however, arousal focused more on eroticism is prominent. The global capitalist system traps people through these vulnerabilities and does so solely for commercial gain. However, the severe consequences of this system are now beginning to be seen. Especially during adolescence, this culture leads to an epidemic of narcissism among young people. Because visibility, popularity, and external approval are constantly glorified. Therefore, a meaning-oriented philosophy of life needs to be brought to the forefront again on a global scale.”
“This is a psychotic-level anorexia case”
Speaking about the recent case that came to the agenda, Tarhan said; “This is a psychotic-level anorexia case. At this level, the individual's reality testing is impaired. That is, the brain's network system that analyzes whether incoming information is real ceases to function properly. When this system breaks down, the person feels as if they are living in a separate universe. In their mind, there is a false but, to them, consistent reality they have created. In this world, they are often not unhappy. Even if we think they are suffering from the outside, they continue to live in their encapsulated world. Eating is perceived by this individual as a threat, even an enemy. Because the brain has coded eating behavior as dangerous. Behind this situation is the independent functioning of some brain regions, disconnected from the general brain integrity. That is, the person lives within a system isolated from the rest of the brain's functioning. At this level of impairment, classical therapy methods are no longer sufficient. A treatment process that will completely restructure the impaired neuroplasticity in the person's brain is needed.”
“Digital showcases severely affect young people”
Addressing the concept of digital showcases, Tarhan said; “Digital showcases severely affect young people. Young people admire and begin to imitate the individuals they see on social media. This situation is especially common in individuals with low emotional awareness. Awareness is of two kinds. Mental awareness is being aware of one's thoughts. Emotional awareness is recognizing and managing one's feelings. In conditions like anorexia, emotional awareness is usually impaired. The person recognizes their own emotions but cannot analyze and manage them. These individuals are quickly influenced by their emotions and, due to their weak emotional literacy, do not know how to manage these emotions. Consequently, with a small emotional trigger, they immediately start imitating what they see in the social media showcase. At this point, we conduct emotional regulation studies during the treatment process. When a person learns to recognize and manage their emotions, they also gain the power to say no to digital showcases. There is a frequently overlooked issue here. Young individuals are not encouraged to embark on their own journey of inner discovery. Society constantly presents them with a happiness model based on external approval. However, true happiness is built within the individual's inner world and with a sense of internal responsibility. Modernism's biggest mental transformation error begins here. People are taught external happiness, but a fundamental, internal philosophy of life based on meaning is not instilled.” He concluded his words.