It's arrogant to say anorexia is a personal choice rather than a mental illness

A response to Rachel Cusk's New Statesman article "The anorexic statement".

In November 2010, almost exactly two years ago today, a 28-year-old French model called Isabelle Caro died from complications arising from anorexia. A few years before, in 2007, she had risen to increased prominence after appearing in an advertising campaign to raise awareness of eating disorders within her field. Stick-thin, with vertebrae clearly on show, she stared straight out of the billboards that lined Italian cities and were later (controversially) banned. The image was undoubtedly shocking; some even found it outright traumatic. Its accompanying message - "No Anorexia" - made a clear statement about the fashion industry when it was pushed out to the Italian public during fashion week.

If you’re looking for an "anorexic statement", then Caro’s is as close as you can get. She suffered from the disease from early adolescence, and she spoke about being in its grips as a personal struggle. She talked publicly of how she wished to be rid of the crushing mental illness, right up until the two months before her death. The "No Anorexia" campaign was about drawing attention to the downright ugliness of a body destroyed by an anorexic life, the ironic lack of glamour in an illness that pervaded industries priding themselves on allure and desirability. And these reasons are why, for many, Rachel Cusk’s recent article on anorexia in this magazine hurt so much.

Does every woman’s body make a statement? Cusk thinks it does. She claims that the anorexic state "returns the woman to the universality of a child", a pre-pubescent state wherein she doesn’t have to think about menstruation or lactation or childbirth or sex. She paints the sufferer of anorexia as a narcissistic martyr of the modern age, obsessed with her image, privileged enough to impose an illness upon herself, sitting "screaming about a spoonful of peas" while other people just get on with the practicalities. Needless to say, sufferers and former sufferers of the disease, as well as their loved ones, didn’t take kindly to this reductive and convenient analysis.

Why is such an analysis convenient? Precisely because mental illness is infuriatingly inconvenient in its individuality and nuance. Treatments and causes are varied and often inexplicable. Personalities are, by their nature, all very different. By positing an "anorexic type", Cusk makes the problem of anorexia wonderfully simple: it’s just a "sickness of the modern age" manifested in a certain type of defective personality. If they’d stop indulging themselves for one pea-eating second, or experienced some real type of hardship, then they’d snap out of it once and for all, right? If Isabelle Caro had really sat down and thought about it, then she could have saved herself the massive setback of dying during her anti-anorexia campaign.

Even aside from all of this offensive hypothesising, it’s strange enough that Cusk maintains throughout her article the idea that women speak with their bodies, but men don’t. She talks about periods and childbirth as physical states to escape from as if men are beings wholly removed from such concerns (because blood is a problem, but semen is supposedly totally cool.) And feminists have fought for a long time to remove the basic assumption that women are "naturally decorative", "speaking" through their bodies alone, expressing their complaints about society by getting thinner and a little bit childlike, while men are naturally intellectual, objective, and altogether more adult. We suppose that the last fifty years of feminist thought have passed Cusk by, as well as the fact that male sufferers of anorexia exist, unfortunately, in substantial numbers. 

Indeed, Cusk appears to have done little research about the illness, instead relying on verbose rhetoric. At one point in her dense treatise, she implies that anorexics of craving visibility. The "anorexic statement", as she so coldly calls it, seeks attention. And yet, so many sufferers speak of wanting to disappear. This does not compute. Cusk speaks with the authoritative and detached voice of a scientist, but she is no scientist. Her overwrought prose serves to raise her essay up to the status of literature, concealing her crass generalisations beneath "sophisticated prose". And yet, it is lacking in any of the perception or insight associated with that term. Her continual use of "the anorexic" throughout the essay makes her seem emotionless and removed, and she seems to forget that this is a disease that affects real people, not simply medical cases whose motives must be dissected and speculated upon in florid prose.

Anorexia is a complex, awful, terrifying disease, the causes for which are a constant topic for research by medical professionals. Its causes do not fit neatly into a single tick-box, and thus lumping all its sufferers together into one group is supremely unhelpful. As a commenter who had reached recovery noted beneath the original article, "no book or article that I read has ever explained how I got there". To presume a statement on the part of another belies supreme arrogance. Cusk has projected that "statement" onto women and girls who are suffering from a life-threatening illness, women and girls whose friends and family may be reading Cusk’s words in between hospital visits. That she should imply that mental illness is a choice is verging on the unforgiveable as far as anyone who’s ever suffered one is concerned.

At one point in the piece, Rachel Cusk refers to the male gaze. She blames what she calls "the preponderance of male values", and yet there she is, judging these women’s bodies, projecting her agenda, her pseudo-psychoanalysis onto them. In other words, it is not their bodies speaking. It is not their story. Isobel Caro’s "anorexic statement" was just that because she, the sufferer made it, and no one else. In light of this, we should be aware that the only statement that Cusk is making in her article is applies to herself.

The advertising campaign featuring French actress and anorexia sufferer Isabelle Caro. Photograph: Getty Images

Rhiannon Lucy Cosslett and Holly Baxter are co-founders and editors of online magazine, The Vagenda.

Photo: Getty Images
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How can the left make the case for immigration?

All too often, we drift into telling people we want to convince that they just don't get it.

We don’t give the public enough credit. You’ll often hear their views dismissed with sighs in intellectual circles. In fact on most issues the public are broadly sensible, most are these days supportive of cutting the deficit and dubious about political giveaways, but in favor of protecting spending on the NHS and education. Yet there is one issue where most, “knowledgeable” folks will tell you the public are well out of step: immigration. 

With [today’s] net migration figures showing yet another record high, it is an ever more salient issue. On a lot of measures ‘too much immigration’ ranks highest as the number one concern (see Ipossmori). The ongoing rise of right wing political parties across Europe demonstrates that simply enough. But concerns about immigration don’t just sit with those with more extreme views, they’re also shared across the mainstream of public opinion. Yet unlike thinking on cutting the deficit or funding the NHS the public consensus that immigration is bad for Britain, flies flat in the face of the intellectual consensus, and by that I mean the economics. 

Given the intense public debate many a study has tried to spell out the economic impact of immigration, most find that it is positive. Immigration boosts the nation’s GDP. As the theory goes this is because immigrants bring with them entrepreneurialism and new ideas to the economy. This means firstly that they help start new ventures that in turn create more wealth and jobs for natives. They also help the supply chains to keep ticking. A example being British agriculture, where seasonal workers are are needed, for example, to pick the strawberries which help keeps the farms, the truckers and the sellers in business. 

Most studies also find little evidence of British jobs being lost (or displaced) due to immigrants, certainly when the economy is growing. Indeed economists refer to such “ “they’re” taking our jobs” arguments as the “lump of labour fallacy’. On top of all that the average migrant is younger than the native population and less likely to rely on welfare, so their net contribution to the state coffers are more likely to be positive than natives as they don’t draw as much state spending from pensions or the NHS. 

So why haven't the public cottoned on? Many progressive types dismiss such views as racist or xenophobic. But it turns out this is to misunderstand the public just as much as the public ‘misunderstand’ immigration. When you study people’s views on immigration more closely it becomes clear why. Far from being racist most people asked by focus groups cite practical concerns with immigration. Indeed if you go by the British Social Attitudes Survey a much smaller number of people express racist view than say they are concerned about migration.  

The think tank British Future broadly set out that while a quarter of people are opposed to immigration in principle and another quarter are positive about it the majority are concerned for practical reasons - concerns about whether the NHS can cope, whether there are enough social houses, whether our border controls are up to scratch and whether we know how many people are coming here in the first place (we don’t since exit checks were scrapped, they only came back a few months ago). But more than anything else they also have very little confidence that government can or wants to do anything about it. 

This truth, which is to often ignored, begets two things. Firstly, we go about making the argument in the wrong way. Telling someone “you don’t understand immigration is good for our economy etc etc” is going to get a reaction which says “this person just doesn't get my concerns”. Despite the moans of progressives, this is precisely why you won't hear left leaning politicians with any nous ‘preaching’ the the unconditional benefits of immigration.

More importantly, the economic arguments miss the central issue that those concerned with immigration have, that the benefits and effects of it are not shared fairly. Firstly migrants don’t settle homogeneously across the country, some areas have heavy influxes other have very little. So while the net effect of immigration may be positive on the national tax take that doesn't mean that public services in certain areas don’t loose out. Now there isn't clear evidence of this being the case, but that could just as well be because we don’t record the usage of public services by citizenship status. 

The effects are also not equal on the income scale, because while those of us with higher incomes scale tend to benefit from cheep labour in construction, care or agriculture (where many lower skilled migrants go) the lower paid British minority who work in those sectors do see small downward pressure on their wages. 

It’s these senses of unfairness of how migration has been managed (or not) that leads to the sense of concern and resentment. And any arguments about the benefit to the UK economy fail to answer the question of what about my local economy or my bit of the labour market. 

Its worth saying that most of these concerns are over-egged and misused by opponents of immigration. Its only a small factor in stagnating wages, and few local areas are really overrun. But the narrative is all important, if you want to win this argument you have to understand the concerns of the people you are trying to convince. That means the right way to make the argument about immigration is to start by acknowledging your opponents concerns - we do need better border controls and to manage demands on public services. Then persuade them that if we did pull up the drawbridge there is much we’d loose in smart entrepreneurs and in cultural diversity. 

Just whatever you do, don’t call them racist, they’re probably not.

Steve O'Neill was deputy head of policy for the Liberal Democrats until the election.