Profile Books, 160pp, £10.99
As I scoured the shelves for my copy of Fat Is a Feminist Issue before writing this review, I wondered why its message was not more familiar to me. Susie Orbach's first and most famous book was published in 1978, when I was 11; by the time the second edition appeared, in 1988, I was 21 and in thrall to one of the many varieties of eating disorder inherited by contemporary womanhood. It should surely have been my bedside companion. The message, however, failed to get through, something Orbach acknowledges in her introduction to the second edition when she laments that, while her book did a magnificent job of raising consciousness - even spawning a fat theatre group calling itself Spare Tyre - 80 per cent of San Franciscan schoolgirls, to take one example of the disordered eating epidemic, were by then reported to be dieting.
Orbach covers eating disorders as well as the craze for remodelling the body, troubled teenage sexuality, the global hegemony of western models of beauty and transhumanist theory
In fact, in the 30-odd years since Orbach wrote FIFI, as fans of the book call it, our body fascism has intensified in ways that would have seemed unimaginably bizarre in the 1970s. Orbach is our household-name psychotherapist, the woman who famously treated Lady Di for bulimia. Thanks in part to her books, campaigning and clinical practice, our society's dysfunctional relationship with food has become the subject of nationwide debate. And yet, despite her best efforts, we are if anything even more messed up, in more different ways, than we were when she started. There is something poignant, therefore, in the passionate polemic that Orbach, now in her sixties, presents in Bodies. It is a summing-up of issues first presciently explored in FIFI and an exploration of new problems unique to the 21st century. It is also a plea for "bodies sufficiently stable to allow us moments of bliss and adventure when, sure that they exist, we can take leave of them".
Given how intractable these problems are (and in this book Orbach covers not just eating disorders but also the craze for remodelling the body, troubled teenage sexuality, the global hegemony of western models of beauty and the impact of transhumanist theory, to name but a few), it is worth returning to that earlier, hugely influential volume. Certainly FIFI's practical message, that to break the cycle of compulsive eating one should stop dieting and rediscover one's body's natural calibration, is sensible. But, rereading the introduction, I realised that this message was interrupted for me by Orbach's feminist and psychoanalytic take on fat and compulsive eating. "Feminism," she wrote, "argues that being fat represents an attempt to break free of society's sex stereotypes . . . My fat says: 'Screw you' to all who want me to be the perfect mom, sweetheart, maid and whore. Take me for who I am, not for who I'm supposed to be. If you are really interested in me, you can wade through the layers and find out who I am."
With the best will in the world, I couldn't make the connection between eating too much toast and the frankly appalling idea of wilfully creating layers for potential lovers to wade through. Orbach's accompanying psychoanalytic understanding of fat and compulsive eating was concerned with the relations between mother and daughter. "To be a woman is to live with the tension of giving and not getting; and the mother and daughter involved in the process leading to this conclusion are inevitably bound up in ambivalence, difficulty and conflict." That analysis of 1970s womanhood is all too plausible, but Orbach is not able to link it to dysfunctional eating convincingly, except in the platitudinous sense that the pleasure of food can provide a comfort in times of unhappiness.
I return to those earlier arguments because what makes Bodies so interesting is the way it presses for a definitive theoretical development on them. Its central idea is that therapists and psychoanalysts are in error when they treat "body instability" as merely "the dumping ground for emotional anxiety". "Mostly we don't see the body's anxiety as bodily anxiety," she writes. "We misread the anxiety, misinterpret the wish to change the body as aspirational and as psychologically motivated - the outcome of an unfortunate emotional issue, such as lack of control or, more commonly, an inability to digest upset or conflict, which is then visited on the body as a somatic system. But body anxiety is as fundamental as emotional anxiety and we need to recognise this."
Indeed, two of the teenage girls of my acquaintance, the products of happy, stable and loving homes, have fallen victim to anorexia. And at a time when that disease seems no nearer reliable medical treatment, a new approach would certainly seem to be of critical importance. But before addressing these personal issues, Orbach seeks a global and political perspective. Her central contention is that bodies are made, not born; this is reflected across the world by cultural interventions in the body, from dress, gait, hairstyle and personal decoration to rite-of-passage scarring, clitoridectomy and foot binding.
Our own bodies and, by extension, the bodies of our children are under assault from inescapable images of Photoshopped physical perfection
So, there has never been a natural, "innocent" body growing organically and unassisted out of its DNA. Orbach argues that now, however, the rich global diversity of physicality is being eroded by widespread exposure to a western ideal of super-slim, tall, big-breasted beauty. (She likes to quote the anthropologist Anne Becker, who found, three years after the introduction of television into Fiji in 1995, that 11.9 per cent of adolescent girls had developed bulimia in an attempt to change their Fijian build into an OC-style fantasy.)
But even more important to Orbach's argument is an analysis of the way in which we achieve a stable sense of a body we can trust and rely on, can live from and be content with, in the relations we have as babies with our mothers and the wider family. We are so used to having moved from a Descartian separation of the physical from the mental to a psychoanalytic position in which the mind, for good or ill, is utterly master of the body, that this new "bodily" perspective is hard to grasp.
Of course, the care of infants is emotional, but it is also hugely physical - from the way we touch and hold them to the organisation of their eating and sleeping to the way mothers mirror their babies' expressions and sounds, and how babies respond. A mother's experience of her own body, on a conscious and unconscious level and even before the child's birth, will be critical to all this; in fact, studies have shown that a celebrity-style low maternal weight at birth is a risk factor for later childhood obesity.
If "the making" of the physical security of a child's body is disrupted, the end result can be vulnerability to the classic roster of eating disorders and even illness and chronic pain, as documented in Orbach's case study of her client Herta, a sufferer from ulcerative colitis. Orbach calls this process the "intimate imprint of the familial body story".
As she shows, our own bodies and, by extension, the bodies of our children are under assault from the inescapable images of Photoshopped physical perfection presented to us; from the beauty, diet and cosmetic surgery businesses that profit from our insecurity; from a food industry that removes fat from one artificial product only to pump it into the next; and from a phalanx of health professionals who promote one different eating regime after another. Never shy of controversy (she once threatened to sue cuddly, reassuring WeightWatchers because "its philosophy is based on a lie"), Orbach goes on to debunk the so-called obesity epidemic, pointing out that a 1995 World Health Organisation revision of BMI (Body Mass Index) guidelines designated Brad Pitt as overweight and George Clooney as obese.
The usual suspects, in other words. But when bodies are the location of so much distress, dissatisfaction and illness, doesn't it make sense to locate the problem in the physical world, with eating patterns that disturb our natural appetites and visual imagery that reminds us of our own inadequacy streaming into the cerebral cortex? Not least because, instead of blaming ourselves (our messed-up childhoods, our lack of discipline), we can place responsibility where it belongs: with industries whose profit margins depend on our unhappiness.
Orbach's book is the product of a lifetime's reflection on the way in which our bodies, once serviceable and taken for granted but also capable of moments of intense, unselfconscious joy, have become something somehow separate from us - and their inevitable imperfectibility, decay and eventual end are eternally tormenting. The human condition, in other words, has been made hellish by our contemporary refusal to accept it. Mature, nuanced and suggestive, Bodies is no self-help book, but its message is potentially liberating.