Food fuels life and answers to that primary appetite of hunger. Like all appetites, humans sporadically attempt to control it. Food has always, also, carried a diversity of uses and meanings. It separates out insiders from outsiders, believers from non-believers. It can designate wealth and status or, served to a stranger, friendship and hospitality. It can signal love from mother to child, or communion between humans and God in a rite where it stands in, cannibalistically, for body and blood. Some of its transformations as it moves from raw to cooked, or penetrates the body to metamorphose from tantalizing titbit to excrement, retain their mystery even for sophisticated, information-weary adults. Food can succour and it can poison. It can make the female body mimic pregnancy or return to pre-pubescence. By an invisible process food alters the eater. That invisibility, itself, has always been a crucible for religion or science, let alone the imaginings of an adolescent girl.
Indeed, in the permissive West, eating has arguably now outstripped sex as the key psychic experience of the body. It underlies the sense we make of health and happiness, identity and destiny. The way we eat separates rich from poor, good from bad, moral from deviant, reward from punishment, thin from fat. Eating now has its attendant medical, scientific and psychiatric discourses, a code of moral prohibitions and injunctions. It has its perversions and its normality: its decadent, over-refined or over-processed and its natural or organic. It has its secret delights, sinful excess and social rituals, just as sex has masturbation, brothels and marriage. Nutritionists and dietitians invoke standards of health, investigate chemistry, invent a new expert language of contents and effects, always insisting on and changing what constitutes appropriate eating activity. Photographers, television cookery programmes, books and supermarkets fetishize, create food porn, while doctors warn and prohibit, invoking fresh terrains of science–from the effects of good and bad cholesterol to the hypothesis of a set-point mechanism, a kind of inner thermometer made up of genetic and metabolic factors, which regulates body weight and may account for the notorious failures of diet.
Food is no longer matter for simple home economics taught to high school girls. It is the very stuff of science and genetics, replete with scares and protests. A sure sign of its status is that male celebrity chefs have taken over the kitchens of the world, while aspirants to the now noblest profession write serious literary evocations of their stations of the cross on their own path to the altar of cuisine. Needless to add that eating also has its own politics and power relations: from sanctions on food coming from ostracized countries to altruistic vegetarian purity and animal rights, to an enmeshment with a beauty industry which some have said sells ‘thin’ in order to enslave women, once more constricting their lives to their bodies. Hardly surprising, then, that psychic disorders related to eating have escalated radically from the 1980s on. And it is women who as mothers have traditionally been the providers of food, from breast to table, despite the recent gender-bending of celebrity chefs, who are also most directly implicated in these disorders; though the number of men to be affected is rising.
ANOREXIA NERVOSA
Most prominent amongst these disorders and most intractable is the fasting disease anorexia nervosa, which commands such attention that it yields an astonishing fourteen million hits a year on the Internet. There are three times more sites for anorexia than for schizophrenia–the disorder which had such a metaphoric quality for the sixties. Anorexia is only topped in the Google lists by depression. The ubiquitous prominence of the disorder in the media, its many prize-winning memoirs of ‘survivors’, gives the condition the feel of an epidemic, even though the actual number of sufferers hardly constitutes epidemic size.
The figures, however, are bad enough. According to the American National Institute for Mental Health anorexia takes hold of from 0.5 to 3.5 per cent of the American female population. In the UK, the most cited figure is 0.1 per cent of women, or sixty thousand individuals. The worrying statistic is that the number of anorectics in America rose threefold through the nineties, while the most recent indicator in Britain shows a rise of 130 per cent in incapacity benefit claimed on the basis of eating disorders. Whether this rise is linked to the guidebook effects of media and memoirs as well as more general cultural factors isn’t clear, but it has resulted in the fashion industry responding to criticism and in certain countries banning skeletally thin models from the catwalk.
Anorexia and its slightly less intractable twin, bulimia, ravage girls’ schools and campuses with fierce copycat mimicry and take a disproportionate toll on young lives; while its sister act, ‘self-harm’, follows suit–sometimes an indicator of suicidal wishes, at others, like an addiction, bringing release when confusion, a roller-coaster of incoherent emotions and pain, needs gouging out. ‘I cut myself to get the pain out,’ Kurt Cobain, lead singer of the grunge band Nirvana, famously said before committing suicide. Britain’s self-harm figures are now the highest in Europe, and in 2004–5 some twenty-five thousand were severe enough to result in hospital admissions. Young women outnumber men by seven to one in these statistics, and Asian women are high in the figures.
The ‘illness-patterns’ that anorexia and bulimia now take are popularly known, but these have not always been fixed in diagnostic stone.
Anorexia nervosa was designated as a disease entity in the 1870s at the height of Victorian restrictions on women’s possibilities. Fasting was hardly new. Deliberate self-denial and starving had long been part of the arsenal of sanctity: the holiness of women in the High Middle Ages was evidenced by their control of appetite and dedication to the Eucharist, wafer and wine miraculously providing the necessaries of existence. With secularization, fasting took on new meanings. No longer a saint, the girl engaged in starving as a means of self-definition and protest. Permitted, as Florence Nightingale so aptly noted in her book Cassandra, ‘no food for our heads, no food for our hearts, no food for our activity’, and with ‘Our bodies…the only things of consequence’, woman became a patient–or perhaps a hunger-striking suffragette.
Anorexia has its origins firmly in the particular conditions of the bourgeois family: relative affluence, a sexual division of labour making the domestic woman’s realm, a template of parental love in which daughters are long infantilized, dependent and sexually ignorant, while being groomed for the competitive rites of courtship and marriage. Here a slim figure and the spirituality which a restrained appetite evokes are useful assets. Asceticism and purity are valued.
The term ‘anorexia’ sprang up all but simultaneously in France, Britain and the USA, to designate a condition of adolescent girls who refused to eat. Sir William Gull (1816–90), a society doctor in London attached to Guy’s Hospital, used the term to designate a ‘morbid medical state’ differing from tuberculosis–that other wasting disease accompanied by a lack of appetite. Anorectic patients were girls between sixteen and twenty-four who demonstrated, to begin with, an excessive energy. This eventually led to amenorrhoea and starvation. Rest, regular–if necessary, forced–feeding, and removal from the family were recommended treatments. William Smoult Playfair (1835–1908), a reputed obstetrician and gynaecologist, recognized the disease’s prevalence but refused it a separate category status, subsuming it instead under neurasthenia.
In France, in 1873, the leading alienist Charles Lasègue classified anorexia as a ‘hysteria of the gastric centre’. Interested in the psychological aspects of the condition, he wrote an influential paper which charted a progress from the anorectic girl’s general uneasiness after eating and vague sensations of fullness, to a reduction in food intake on a variety of pretexts including headache, distaste or fear of pain, to the point when eating was reduced to almost nothing and the disease was declared. Hyperactive in the initial stages of the condition and able to pursue a ‘fatiguing life in the world’, the patient was obstinate about eating meals at home. Meanwhile, parents swung between spoiling the child with titbits, entreating and punishing. Lasègue aptly characterizes the discourse of lo
ve and rejection that food in the family takes on: the patient is ‘besought, as a favour, and as a sovereign proof of affection, to consent to add even an additional mouthful to what she has taken; but this excess of insistence begets the excess of resistance’. The daughter, dutiful in all ways but this, chose food as her form of rebellion against family love and as a troubled call for attention.
Though he never focused on anorexia at length, Freud stressed its prevalence: ‘It is well known that there is a neurosis in girls…at the time of puberty or soon afterwards, and which expresses aversion to sexuality by means of anorexia.’ He linked anorexia to other conditions, sometimes to melancholia or depression; or saw it as one of the manifestations of hysteria–as did most early analysts, given its greater incidence in girls on the cusp of womanhood. When the young woman refuses to eat, finding food disgusting and dangerous, she is also refusing that adult sexuality which will engage her in taking the other, the male, in, and in making babies, like her mother.
For Freud, as for Klein, eating and sexuality had a complicated relationship. The Freudian child, satiated by mother’s breast, radiates a bliss which is the prototype of all sexual satisfaction. Breast and milk, however, separate out, and the child has to lose the breast, this first object of desire, to form an idea of the whole person to whom this object that brings it satisfaction belongs and to form a sense of its own separateness. All future pleasures will be an attempt to find again this lost object, which always exceeds in scale and sense the food it produces. Eating maps out the zones of gratification that continue to bear the memory traces of maternal care. The child will retrace these within itself during a phase of auto-eroticism.
Klein’s infant is a cannibal: it devours all the objects of the outer world to install them inside itself in fantasy, constructing its inner world by a process of incorporation. This inside can become a nightmarish tomb, the child’s greed or need having made it devour too much so that these inner objects, these internalized parents, threaten in turn to devour the child, and rob it of all mastery.
Freud’s gloss on femininity in his late essay on Female Sexuality(1931) offers a further clue to eating disorders. He argues, as he had before, that girls reproach their mothers for depriving them of a penis, but also–and here he seems to draw an equivalence between penis and breast–because ‘the mother did not give them enough milk’. He doubts that any quantity of food could satisfy the infantile libido. The passage has led later theorists to question whether femininity itself is structured on an insatiable need.
For Klein, the mother is the storehouse of all hidden treasures–penis, food, babies–all of which the infant wants to devour. Split off and taken in so that it becomes part of the girl’s identity, the mother’s dangerous body is also a persecuting and far too powerful devouring object, which may demand excision by self-harm or elimination by puking, or starvation.
This linkage between sexuality, the mother’s body, food, need and feminine identity plays through most of the contemporary accounts of anorexia. Interestingly, the therapy Freud notes for advanced anorexia is not in the first instance talk. Twice he warns that ‘Psychoanalysis should not be attempted when the speedy removal of dangerous symptoms is required, as, for example, in a case of hysterical anorexia.’ The starving girl, whatever the origin of her symptoms, needs more radical help than psychotherapy can at first provide.
Sometimes, it seems, what she also needs, needs most of all, is social change–or so one could interpret the suffragette’s use of self-starvation as a form of political protest. Needless to say, the hunger-striking suffragettes were not anorectic, but the fact that they turned to self-starvation, the most passive and conventionally feminine form of dissent and the one which needs no external tools, is emblematic of the closeness of food to women’s armoury of protests as well as symptoms. If authority quelled that protest by the use of force-feeding, it only underlined what women already felt: reduced to body, even that body wasn’t ultimately their own.
After the First World War, anorexia as a psychiatric disorder was less often noted. It re-emerged again in the sixties. Hilda Bruch (1904–84), a German Jewish doctor from one of the early generations of women to struggle their way into higher education and a medical degree, pioneered contemporary psychological explanations for ‘eating disorders’, the title of her 1973 book. Bruch had fled Nazi Germany to come first to Britain and then to the USA, where she worked with Theodore Lidz, theorist of the ‘schizophrenegenic mother’, in Baltimore during 1941–3. At the same time she trained as an analyst with Frieda Fromm-Reichmann. Taking her cue from them, she looked to the shaping influence of the family and argued that anorexia, like obesity, had to be seen within that developmental context: it was most often a child’s neurotic response to an unnatural rejecting or over-nurturing mother. Sander Gilman contends that Bruch rebelled against the racially and biologically defined textbook arguments about obesity that she had imbibed during her medical training in Germany with a view to providing a new ‘treatable’ model. The Nazi discourse had linked obesity to Jews and stereotyped it as non-productive: the fat Jew, sluggish, lazy and stupid, was opposed to the thin, healthy German who found joy in work. Haunted by deterministic racial explanations, Bruch transformed the eating disorders into curable conditions.
Bruch argued that both anorexia and obesity revolved around the girl’s problem with body image and needs distorted during early development. In the case of the anorectic there was a delusional misperception of the body as fat. This was combined with the girl’s inability to distinguish hunger from a range of other needs and desires; and an overriding sense that neither emotions, nor thoughts, nor actions come from within, but passively mirror external and maternal expectations. She distinguished a form of primary anorexia, in which the girl was compulsive in her pursuit of thinness, and felt a deep sense of self-estrangement. In a secondary form, self-starvation had a symbolic function, though the underlying problems were not necessarily linked to a distorted body image. Bruch popularized her ideas in the women’s magazines and became an adviser on weight matters for the agony aunt, Ann Landers.
The women’s movement within the psy professions took on body-image and eating disorders from the first. In her Fat Is a Feminist Issue, psychotherapist Susie Orbach records that in March 1970 she went to the Alternate University in New York City and registered for a course on compulsive eating and self-image. The structure of the course had grown out of consciousness-raising groups, where problems were shared and discussed. Here the problem was compulsive eating–‘a very painful and on the surface self-destructive activity. But…feminism had taught us that activities that appear to be self-destructive are invariably adaptations, attempts to cope with the world.’ The compulsive eaters ate when they weren’t hungry, thought about food, diets and thinness much of the time, felt out of control around food and submerged by the activities of dieting or gorging.
They also felt terrible about being out of control, and about their bodies. As the group talked and thought over their individual and common difficulties, it emerged that beneath the desire to be thin lay an equal and opposite desire to be fat, to fill a larger social space unhampered by men’s eyes, advances, and the rat race of attraction. When the brackets of fat and thin, what they represented, and what each individual perceived were the characteristic personalities of both were gradually filled out, the focus on diet and food fell away. In the place of a woman who felt out of control about food, there emerged a woman unafraid of the categories and their relation to sex and maternity.
The particularities of the female body, its sexual and reproductive aspects as well as its image, continued to preoccupy the women’s movement. The highly mediatized rejection of bras and the display of female flesh at the Miss World Competition played its part, alongside the more mediated search for an understanding of the ways in which women had taken in the feeling of being the object of the male gaze and incorporated it into the structure of their inner lives. In The Female Eunu
ch, Germaine Greer charts all parts of the body that make woman, woman. She also sounds the clarion call for thinness as a rebellion against traditional, oppressed femininity with its ‘hallucinating sequence of parabolae and bulges…The characteristics that are praised and rewarded are those of the castrate: timidity, plumpness, languor, delicacy…All repressed, indolent people have been fat.’ Free women are thin, free and active, is the message.
Since women treat their bodies as the object of the male gaze that they have interiorized, inevitable distortions between how the body is imagined from within and how it appears to others are common enough. But the gulf between inner and outer perceptions can be so deep as to produce wild distortions, which is when anorexia or dysmorphia can occur. This latter has now become known as BDD, the body-dysmorphic disorder listed in DSM IV. The condition is common not only amongst anorectics (there is apparently a 32 per cent co-morbidity between dysmorphia sufferers and eating disorders) who have little sense of their real size, but amongst adolescents and seekers after plastic surgery obsessed by the shape of a purportedly ugly nose or breasts around which all anxiety and hopes of happiness are concentrated.
According to some figures, one in fifty adolescents suffer from BDD: whether, like the accompanying ‘social phobia’ that it can produce, this should qualify as a psychiatric disorder is another question. What is clear is that the prevalence of images, many of them other than life size and constantly morphing from the hugeness of a billboard or movie screen to the smallness of a home screen, cannot but impact on our inner sense of our bodies and their size and shape in the world. Nor is it difficult to imagine that living in the presence of screen beings may make their embodied and real versions frightening: they look different, perspire and smell, they can’t be zapped or moved by a mouse; nor can they be stopped, rewound, repeated; they require response–speech, movement and facial gestures.
Mad, Bad, and Sad: A History of Women and the Mind Doctors Page 46