Anorexia memoirs are not "safe" from triggering readers. Photo: Flickr/Benjamin Watson
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How can a memoir convey the damage done by eating disorders, without passing it on?

Nancy Tucker’s eating disorder memoir, The Time In Between, tackles this problem head-on.

The back cover blurb of Nancy Tucker’s eating disorder memoir, The Time In Between, describes it as “a Wasted for the 21st century”. For the uninitiated, Marya Hornbacher’s Wasted, first published in 1998, sets the standard for no-holds-barred, mesmerising, deeply moving explorations of anorexia and bulimia. While many personal accounts have been published before and since, Wasted is the one that really grabs you by the throat.

Beautifully written and profoundly disturbing, Wasted is a book I still approach with a curious mix of fear and envy, over 15 years since I first read it in my own not-quite-recovered state. I wish I’d been able to immortalise my own suffering in that way; I wish, too, that I didn’t feel so drawn to Hornbacher’s. I haven’t starved myself in years but even now her words can awaken that voice in the back of my head: Go on. You could still do it, you know. Despite all the years of recovery, I am jealous of the person I once was. There are times when I’d rather people looked at me and saw her, not the whole person – the woman – I am now.

In The Female Malady, Elaine Showalter describes how 19th-century doctors saw anorexia as a kind of manipulative performance, an inauthentic illness that could, should the correct pressures be applied, be exposed as “shamming”: “the goal [of treatment] was to isolate the patient from her family support systems, unmask her deceitful stratagems, coerce her into surrendering her symptoms, and finally overcome her self-centredness”.

It’s an approach that is not unfamiliar to me from treatment methods still in use in the Eighties. I’d like to think that now we know better. Anorexia sufferers are not putting on an act. They are not “playing the system”. For far too many, anorexia simply means years of cold, hunger and pain eased only by death. Nonetheless, the disease can still hold an attraction for the sufferer. There is an element of desire as well as hopeless submission. While this is not a reason to withhold sympathy from the sufferer or to treat her with suspicion, it is one of the reasons why writing about anorexia – and reading about it – is so fraught.

Reviewing Wasted for the London Review of Books, Rebecca Mead describes it as “a missive sent from inside a sickness; not just a description of what it is like to suffer from an eating disorder, but an expression of that disorder – a symptom, even”. She questions whether the act of writing about her thinness was, for Hornbacher, “a way of keeping her illness alive”.

Certainly, when Hornbacher claims “I would do anything to keep people from going where I went. Writing this book was the only thing I could think of,” it feels disingenuous. Hornbacher wrote her memoir knowing the power of literature – even bad literature – to fuel the competitive urges and fantasies of perfection that sustain anorexics through day after day of emptiness. She even mentions the main character of Steven Levenkron’s novel The Best Little Girl In The World as providing her with a template for the kind of person she wanted to be: “I wanted to be her: withdrawn, reserved, cold, wholly absorbed in her own obsession, perfectly pure. […] I decided that if I did nothing else with my life, I would be an anorectic when I grew up.”

For me, a similar source of inspiration was to be found in Deborah Hautzig’s Second Star To The Right (and, later, Wasted itself). It is embarrassing to admit to such things (if one really was “perfectly pure”, surely one’s passion for starvation would come wholly from within, not aided and abetted by other people’s stories). Nonetheless, the problem is not that such books exist, or that former (or not-quite-former) sufferers will continue to write them. Like eating disorders themselves, they are offering readers, usually young women, something that they cannot find elsewhere.

Rather than glossing over these complexities or claiming to do one thing while achieving quite another, in The Time In Between Tucker tackles head-on the question of whether or not her own book will have the effect of triggering other sufferers. In the foreword she confesses that her “biggest fear in writing this book – and writing it honestly – was that it would serve the same ‘cheat sheet’ purpose that eating disorder memoirs served during my own struggle”:

I feared it would be thumbed through by others as vulnerable as myself and dissected in search of tips on how to be ill. Why to be ill. Why to stay ill. […] Perhaps it can only be understood by one who has been under the thumb of disease, but there is a voyeuristic something about anorexia which makes sufferers crave its gory, ugly depths. Fainting in public? Yes please. Fur from head to toe? Love it. Nasogastric tube? I’ll take two.

As a way of opening, it serves as a striking “I know what you’re doing” to anyone who is expecting another Wasted. Moreover, Tucker adopts certain tactics with the express aim of making her work less attractive to those in search of thinspiration. The first is to omit all references to numbers (BMI, height, weight, calorie intake), thereby denying anorexia sufferers the cold, hard figures against which to measure their own “progress”. The second is to follow a narrative path which goes beyond the usual route down to lowest weight then back up to recovery. Suffering doesn’t work like that.

It makes for a more unsettling ending but what is important – and what sets this book apart from Wasted in terms of “performance” – is that it breaks the presumed link between lowest weight and greatest distress. After all, if that link were so solid, why would images of emaciation and memories of starvation hold such power over those who ought to know better?

In conversation, Tucker is bright, funny and extremely open about her experiences. She admits to having had to fight with various people along the way, who felt her book would not work without the inclusion of weights. Her first agent told her that readers needed “some way of telling that you’re declining,” as though the description of the subject’s feelings alone could not possibly suffice. But as Tucker points out, “weight isn’t that barometer […] there were periods when I was overweight and in a lot more mental distress than when I was very underweight.”

While it is known that for many sufferers, anorexia can alternate with bulimia and binge eating disorder, such truths are uncomfortable and disruptive (while Hornbacher describes episodes of bulimia at the start of Wasted, she shifts to anorexia effectively enough to create a neat narrative spiral down to near-total self-annihilation; The Time In Between ends far more messily, with flesh regained seen through the prism of loss – “I have gained weight, but lost myself” – as much as hope).

The “time in between” of the title refers to this stage of disorientation, when one is not visibly anorexic but not mentally anything else (“How can I explain that inside I remain an anorexic, but trapped in a fat suit?”). It describes a period leading up to the near-present day, with Tucker switching from anorexia to bulimia and swiftly moving from underweight to overweight. She describes it as the most difficult part to write, “not so much in wanting to get it right but because it was so painful”:

People want to be able to see proof that you’re ill and then of course they want to assume that if you’re gaining weight you’re getting better because people want you to be better. So when I was tipping into this horrendous bulimic period, I felt fraudulent because I was gaining all this weight and people around me were quite happy about it and I felt like, but it’s not real, it’s not me recovering, it’s me being just as sick as ever in a different way.

It’s a feeling I can identify with very strongly and I’d have liked to see more of this section, which only really kicks in towards the end of the book. But then, as Tucker points out, “it was impossible to explore it in the depth I wanted to explore it without going back to the beginning first and understanding the path that had brought me to that place.” There are times when that path does seem a little lingering (do we need to know whether or not it was possible for the subject to “slide [a circle out of middle finger and thumb] from wrist to shoulder”?) but nothing is presented out of context.

Moreover, one thing that bolsters her efforts to minimise harm is Tucker’s impressive sense of the ridiculous, never losing sight of just how bizarre and frankly comical many of the rituals of anorexia can be. A particular highlight is her staged representation of competition amongst anorexia sufferers receiving inpatient treatment, with its shades of Monty Python’s Four Yorkshiremen (“By the time I was admitted I didn’t even exist!”). The idea of anorexia can be seductively pure; the experience rarely is.

The assumption that anorexia sufferers recover mentally upon weight gain has some validity (since constant starvation clearly affects mental processing), but it overlooks the degree to which the anorexic’s suffering is related to her social status and the expectations that surround her (and it is not insignificant that most sufferers are female).

In Hunger Strike, Susie Orbach describes the way in which refeeding programmes – although less commonly used today – betray a desire to “normalise” women not just physically, but socially: “The general consensus is that the patient has recovered when the normal weight is reached and appropriate sex role functioning is achieved.” Yet, she goes on to point out, “if the body protest statement could but be read – be it one of fatness or thinness – it would be seen to be one of the few ways that women can articulate their internal experience.” Indeed, one of the biggest problems in tackling anorexia comes from the fact that in its own twisted way, it works. Comparing starving saints and “fasting girls” to modern-day anorexics, Hilary Mantel highlights the fact that starvation might offer girls an escape route:

Anorexia itself seems like mad behaviour, but I don’t think it is madness. It is a way of shrinking back, of reserving, preserving the self, fighting free of sexual and emotional entanglements. […]  Anorexia can be an accommodation, a strategy for survival.

In conversation, Tucker describes how realising that all she had to worry about was being thin “felt like the best moment of my life”: “It was like I’d been going along this path at 100mph and suddenly I realised I could step off it and there was a side exit and I didn’t have to do it anymore.” This strange plus side to anorexia – the exemption from womanhood, which isn’t all it’s cracked up to be – comes through even more clearly in the book, particularly in the later descriptions of longing for a return to former thinness:

… for all its cold, cruel torture, anorexia was safe. It was controlled, and it was safe. The denial of my need for nourishment allowed me to renounce my status as a Living Thing, and escape from the whole messy business of Being Human. I had discovered a glorious, ingenious ‘get out of jail free’ card, and the more I flashed it at the prison wardens the gladder I became of its presence in my arsenal.

This should not be a world in which teenage girls wish to escape from the pressures of being human, but it is. Moreover, it’s one in which we’re reluctant to listen to their stories unless they’ve showed us their bare bones first (Tucker ruefully considers how “it’s not fair for me to look like this – it doesn’t properly reflect my inner pain”).

Tucker doesn’t make promises regarding whether or not her book has the power to trigger others:

I wanted to write a book which conveyed the devastating damage caused by eating disorders, but not one which passed on this damage. To give people something to think about, but not something to emulate. Have I managed it? I suppose that’s up to you.

The Time In Between is a tremendous achievement, particularly from someone so young and still so close to experiences of disordered eating. Nonetheless, anorexia memoirs will not be “safe” until women are free to tell their own stories of vulnerability and refusal while still clinging on to their female flesh. It should not be necessary to reject one’s body and halt one’s growth to make others see the person inside. There has to be a space where need can be articulated without an accompanying display of self-denial. Tucker’s work offers the beginnings of this. One hopes it will leave potentially vulnerable readers hungering for more. 

Glosswitch is a feminist mother of three who works in publishing.

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UK to reconsider blood donation ban for men who have sex with men

Under current rules, men who have had sex with another man in the past twelve months cannot donate blood.

During Women and Equalities questions this morning, Jane Ellison MP slipped in a bombshell: men who have sex with other men may soon be able to donate blood. 

Ellision, who is Undersecretary of State for Public Health, said that Public Health England has carried out a new survey of blood donors which is currently being analysed. Next year, the Advisory Committee on the Safety of Blood Tissues and Organs (SaBTO), which sets blood donation guidelines, will use the evidence to review the current policy. 

She said:

Donor referrel for MSM [men who have sex with men] was changed from lifetime to 12 months referral in 2011. Four years later it is time again to look at this issue. Public Health England has conducted an anonymous survey of donors and I'm pleased that the advisory SaBTO will review this issue in 2016.

The current ban (which also applies to a range of other groups including sex workers) is based on the fact that MSM are at higher risk of contracting HIV, according to every Public Health England survey ever conducted on the disease. Both HIV and Hepatitis C don't show up in blood tests immediately, so the 12 month rule is based on leaving a "window" for the diseases to develop and be testable. The rules are ostensibly based on sexual activity, not on sexual orientation.

However, as Michael Fabricant pointed out in response to Ellison's announcement, in practice, it also looks a lot like discrimination - there is no ban on blood donation from straight people who have had unprotected sex, for example. Fabricant continued that "equality on this issue" is needed, and clinicians themselves feel a change is "long overdue".

Blood donations in the UK have fallen by 40 per cent in the last decade, a fact which may have contributed to the decision to review the current rules.

A Stonewall spokesperson said:

We’re delighted the Department of Health Minister Jane Ellison has announced this review.

We want a donation system that is fair and based on up-to-date medical evidence. Currently gay and bi people cannot give blood if they have had sex in the past 12 months,  regardless of whether they used protection. Yet straight people who may have had unprotected sex can donate. These current rules are clearly unfair and we want to see people asked similar questions - irrespective of their sexual orientation - to accurately assess the risk of infection. Screening all donors by sexual behaviour rather than by sexual orientation would increase blood stocks in times of shortage and create a safer supply by giving a more accurate, non-discriminatory assessment.

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.