Anorexia nervosa and the reflexivity of the body

The following is a personal description of an episode of anorexic compulsion, written by a woman who eventually managed to fight free from its yoke:

I started to wear odd clothes; from jumble sales and of my own making. And make-up -- strange make-up -- white or black lips; dark, violent-coloured eyelids. I plucked my eyebrows away and back-combed my hair. My mother was outraged and she shouted at me. She wouldn't let me out looking like that, so I removed it all and put it on again on the bus. And it was all a façade: underneath I was scared and lonely but I desperately wanted to be myself, to define who I was, to express my very nature. I couldn't find the words so I used my face. I looked at photographs in magazines: there the girls were beautiful and thin. They seemed to express something that I felt. Yet I wasn't thin and I wanted to be. I stopped eating, not dramatically, but little by little. I became a vegetarian and my mother fussed. I lost weight. My mother took me to the doctor who tried to persuade me to eat fish, at least, so I did....

Later she was taken into hospital to have her appendix out:

Two months after the operation I went to a party. There I met an old acquaintance. He remarked on my weight loss and said that it suited me; in fact, he said, I looked much more attractive. I reduced my intake of food, considerably, from that moment on. I stopped eating potatoes and bread; then butter and cheese. I started to `eat up' all the information I could get about calories; I read diet books with consuming interest. My food was weighed; measured according to calorific value.... My diet was unvaried. Every day had to be the same. I panicked if the shop did not have exactly the brand of crispbread I wanted; I panicked if I could not eat, ritually, at the same time...

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Eventually she found a sympathetic and knowledgeable doctor, who helped her to begin to eat more substantial foods again

I trusted her. I needed her; this person who listened so carefully to what I said, who didn't judge me, who didn't tell me what to do, who let me be. I tried, with her help, to unravel the tangle of my confusing and conflicting emotions.

But in the end it was up to me. It was so hard to accept. She would help me but she couldn't tell me how to live. It was my life, after all. It belonged to me. I could cultivate it; I could nourish it or I could starve it. I could choose. It was such a burden, that choice, that sometimes I thought I could not bear it on my own. ... It is a risky business, being a woman. I have found different strategies to cope; ones that are under my control. The struggle to be myself, autonomous and free, goes on. ⁴⁰

Fasting, and the self-denial of various kinds of foodstuffs, have obviously long been part of religious practices, and are found in many different cultural frameworks. It was relatively common in medieval Europe for individuals seeking salvation to undergo prolonged fasts. Female holiness achieved through food deprivation was particularly important. A variety of chronicles from medieval times recount stories of female saints whose regular fastings helped them achieve spiritual grace -- physicians of the seventeenth and eighteenth centuries labelled the practice anorexia mirabilis, miraculously inspired loss of appetite. ⁴¹ However, it is generally agreed that anorexia mirabilis is quite distinct from anorexia nervosa, which belongs to modern times, and is particularly characteristic of the contemporary period -- the phase of late modernity. Anorexia mirabilis was not especially pronounced among teenage or young adult women, as is often the case today; and was not bound up with the cultivation of bodily appearance, but was rather concerned with overcoming sensual appetites in the pursuit of higher values. Anorexia nervosa begins with the phenomenon of `fasting girls', noted in the late nineteenth century, although this is still largely a transitional syndrome, as it were, `a provocative relic, in a secularising age, of an older female religious culture.' ⁴² The condition proper has only become widespread since the rise of `dieting', in the restricted sense of that term, from about the 1920s through to the present day.

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The fact that anorexia is so closely linked to a gender divide is undoubtedly to do with the association between dieting and changing values about bodily appearance. The pre-established connection between a corpulent figure and prosperity had virtually disappeared by the end of the first two or three decades of the twentieth century. Women began to become concerned about weight in ways that, for the most part, men did not. Yet it is important to recognise that the 1920s was also a period at which `diet' in the broader sense for the first time became associated with the control of weight and the self-regulation of health; and this was also the period at which the manufacture of foods began to accelerate, leading to a much wider diversity of foodstuffs becoming available. `Being on a diet' in the narrow meaning of the phrase is only a particular version of a much more general phenomenon -- the cultivation of bodily regimes as a means of reflexively influencing the project of the self.

From this point of view, anorexia, and its apparent opposite, compulsive overeating, should be understood as casualties of the need -- and responsibility -- of the individual to create and maintain a distinctive self-identity. ⁴³ They are extreme versions of the control of bodily regimes which has now become generic to the circumstances of day-to-day life.

Anorexia is a complex phenomenon, about which there is now a voluminous literature, and it would scarcely be possible in this context to offer a properly detailed analysis of it. I want to concentrate only on those features directly relevant to the overall theses of this book. Anorexia can be understood as a pathology of reflexive self-control, operating around an axis of self-identity and bodily appearance, in which shame anxiety plays a preponderant role. All of the important elements to do with anorexia appear in the experience of the individual described at some length above. Her concern to become thin emerged, not as a sudden antipathy towards food, but as a controlled and progressive phenomenon, which happened `little by little'; she devoted a great deal of care and concern to her diet, a deliberate asceticism in bodily regime amid the plural choices of food available; there was a marked reflexive component, as signalled by her determination to `eat up' all the information about calories she could obtain; awarenes of the need to forge a distinctive lifestyle, in relation to her self-identity, emerges very clearly; and a polarity

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of shame and pride comes out plainly in the `façade' she sought to construct as contrasted to her eventual conviction that she could `nourish' her self-esteem rather than `starve' it.

Why should anorexia nervosa be primarily characteristic of women, especially relatively younger women? One reason is no doubt the greater premium placed on physical attractiveness for women as opposed to men (although this imbalance is changing), coupled to the fact that early adulthood is a crisis phase in identity formation. A common view of anorexia is that it represents a `refusal to become an adult' -- in effect, a denial of puberty, the wish to remain a girl rather than become a woman. But this interpretation is not convincing and, as one observer remarks, treats anorexia misleadingly as a specific pathology rather than as `an extremely complicated response to a confusing self-identity'. ⁴⁴ Anorexia should rather be understood in terms of the plurality of options which late modernity makes available -- against the backdrop of the continuing exclusion of women from full participation in the universe of social activity which generates those options. Women today have the nominal opportunity to follow a whole variety of possibilities and chances: yet, in a masculinist culture, many of these avenues remain effectively foreclosed. Moreover, to embrace those which do exist, women have to abandon their older, `fixed' identities in a more thoroughgoing way than do men. In other words, they experience the openness of late modernity in a fuller, yet more contradictory, way.

Anorexia, as Orbach puts it, is a form of protest: one characterized not by withdrawal, but by a sustained engagement with the reflexivity of bodily development. ⁴⁵In previous times, when women's social positions were in general tightly defined, women expressed rebellion in the body in the form of hysterical symptoms. Today, their protest is intertwined with the reflexive control which a post-traditional order implies: `The anorectic woman encompasses in her symptom a way of being entirely at odds with the phlegmatic response of her nineteenth-century hysterical sister. Not for her the fainting, falling, or flailing fists; her protest is marked by the achievement of a serious and successful transformation of her body ...' ⁴⁶ When the options open to a woman were few and narrowly focused, her unconscious resistance

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through the body was diffuse; in a situation of an apparent multiplicity of possibilities, her reaction is confined and exhibits tight control. As Orbach points out, the anorectic individual is not the passive victim of the dietician: on the contrary, anorexia involves body regimes that are highly active and coordinated.

In anorectic lifestyles, then, we see a specific version of Rainwater's admonition: `You're in charge,' save that the attempt at mastery becomes compulsive. The body regimes of anorectic individuals are often extreme. A person may, for example, run for several miles, take part in a punishing and lengthy exercise class and then go on to work out for a period on exercise machines. Such activities bring about a sense of achievement, rather than simply despair, and one can clearly see in them important aspects of empowerment. There is `an urgency and strength' in the asceticism of anorexia, which is thus more to do with the self-denial per se rather than with a body image of slimness. `Starving to death in a sea of objects,' as John Sours puts it, is a denial which paradoxically asserts with great force the reflexive making of self-identity and body. ⁴⁷

Compulsive mastery is quite different from authentic reflexive monitoring, however, and it is hardly surprising that the anorectic person frequently feels herself `taken over' by the very regime to which she submits her body. In the terms of Winnicott and Laing, the body becomes part of a false-self system, detached from, yet rigorously governed by, the individual's inner aspirations. Feelings of destructiveness, deriving from unconscious shame, become focused on body regimes. The extraordinary intensity which anorectic asceticism can assume carries the hallmark of a ruthless inner dedication, of whose sources in the project of self-identity the individual is only partly aware. The `alienness' of the body -- in which the self cannot feel at home -- helps explain why anorectic regimes may sometimes be pursued even to the level of an actual `fasting unto death'. The individual only feels `worthy' on the basis of a regime of self-regulation so complete that the slightest lapse is threatening.

Anorexia represents a striving for security in a world of plural, but ambiguous, options. The tightly controlled body is an emblem of a safe existence in an open social environment. As we read earlier in the personal account: `It's a risky business, being a

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woman.' The making of a self-identity and body occurs in the framework of a risk culture, which it will be the business of the next chapter to look at more directly.

Date: 2016-04-22; view: 793