Diagnosis as Subculture: Subversions of Health and Medical Knowledges in the Orthorexia Recovery Community on Instagram

Abstract

Diagnoses are powerful tools that fulfill various practical and symbolic functions. In this paper, I examine how a contested diagnosis called orthorexia nervosa has been taken up by users on Instagram, where tens of thousands of posts engage with the topic, many of them from individuals who identify with the condition. I put scholarship on medicalization and diagnosis in conversation with literature on subcultures to foreground the subversive work that is enabled through this diagnosis. Drawing on more than 350 hours of online ethnographic fieldwork and 34 in-depth interviews, I examine how participants construct a shared identity, draw on common language and norms, and undertake collective practices, as they negotiate dominant understandings of health. I show how they draw on the legitimacy endowed by the diagnostic label to validate and make sense of experiences of suffering but also to counter dominant health-seeking discourses, practices, and aesthetics in an online space where these are highly visible and valued. I also discuss some ways Instagram as a digital platform shapes its uptake by this community in meaningful ways. On the one hand, participants draw heavily on the language and framing of medicine to make sense of their fraught experiences with food and their bodies, effectively advocating for the medicalization of their own suffering while also creating a sense of community and shared identity. However, on the other hand, they actively use the diagnosis and the recovery process enabled through it to effectively resignify dominant beliefs, values, and practices that are experienced as injurious, including some that are particularly prevalent on Instagram.

“Your struggles are valid, you are worthy of help and you deserve to recover”: Narratives of recovery from Orthorexia Nervosa

“…Users in our study also noted the importance of 'shifting identities' during recovery, mirroring the ndings of Ross Arguedas [9] who identi ed that people with ON experience identity-con ict due to exclusion from health-oriented cultures. These ndings have implications for future therapeutic interventions for ON, which may be successful in harnessing social identity resources to support transition to a recovery identity and targeting beliefs about diets and 'health' that are rooted in societal norms.…”

“…Preliminary research in this area suggests that self-re ection is an important rst step in recovery, through which individuals with ON learn to accept their behaviours as disordered and begin their journey of recovery [8]. In an online ethnography, Ross Arguedas [9] found that shifting identities is central to recovery from ON. The changes that individuals experienced during recovery were associated with a sense of marginalisation or exclusion from health-oriented cultures and were left questioning who they are.…”

“…As people with ON are using social media in this way, researchers have examined online data to gain insight into lived experiences [9,23,26], particularly through the analysis of Instagram data [27]. Researchers have investigated the hashtag '#Orthorexia', nding that Instagram encourages problem realisation and a sense of belong through this hashtag [24].…”

“…While some of these researchers have included recovery hashtags (i.e., #OrthorexiaRecovery) in their data collection strategies [23,24], internet-mediated research that speci cally focuses on recovery is limited [9]. We address this gap in the literature, building upon the work of Valente et al [23,24] and Ross Arguedas [9] to examine narratives of recovery under the hashtag '#Orthorexia Recovery'. At the time of writing, there are over 121,000 Instagram posts with the hashtag '#OrthorexiaRecovery', representing a previously untapped source of knowledge about recovery processes.…”

“Your struggles are valid, you are worthy of help and you deserve to recover”: narratives of recovery from orthorexia nervosa

“…Preliminary research in this area suggests that self-reflection is an important first step in recovery, through which individuals with ON learn to accept their behaviours as disordered and begin their journey of recovery [ 9 ]. In an online ethnography, Ross Arguedas [ 10 ] found that shifting identities is central to recovery from ON. The changes that individuals experienced during recovery were associated with a sense of marginalisation or exclusion from health-oriented cultures and were left questioning who they are.…”