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15 April 2023

The dark world of anorexia

Hadley Freeman’s Good Girls is ruthless and revealing on her illness but too soft on our culture’s damaging obsession with thinness.

By Megan Nolan

When Hadley Freeman was 14, a passing comment from a schoolmate sparked a nightmarish battle with anorexia that would consume decades of her life. These precipitous events or remarks that can trigger an eating disorder are often chillingly mundane, innocuous to most who would hear them, but calibrated to excite the latent illness in a sufferer. Freeman takes care to stress that despite their initial significance, they are not causative. Sensitivity to such remarks, rather, is the indicator of illness brewing, and if it were not this particular remark then it would be the next.

In Freeman’s case it was an unusually thin girl who could not buy clothes in standard sizing, and told Freeman, “I wish I were normal, like you.” In Rachel Aviv’s book Strangers to Ourselves, which deals partly with her own childhood anorexia, she reports a fellow inpatient’s trigger was having been described as “medium” sized. It’s striking how many triggers seem to work along these lines, suggesting ordinariness or general good health. I remember in the later stages of my teenage eating disorder – no longer worryingly underweight, but still eating little enough that I would sometimes faint at school – being attended to after one such incident by a teacher, who asked why this was happening, since “you’re not all skin and bones any more” – a statement that sent me straight back into starvation with renewed fervour.

Some hear trigger comments such as this, feel their sting for a moment but are able to tidy them away, to be revisited only in times of particular vulnerability. Others internalise them: the always glowing embers of a lifetime’s food-related anxiety. Freeman’s illness, on the other hand, was “instantaneous and vertiginous”. She stopped eating, exercised compulsively. Her hair fell out, her period didn’t begin until many years later, and – one of many unforgettably bleak physical details recounted in her book Good Girls: A Study and Story of Anorexia – her spine protruded through her back, breaking the skin as she rushed to fit in more sit-ups. Eventually, she would spend three years in and out of psychiatric institutions, and, years after regaining enough physical health to live in society and work as a successful journalist and author, she still battled related illnesses such as obsessive-compulsive disorder (OCD) and drug addiction.

[See also: Are you mentally ill, or very unhappy? Psychiatrists can’t agree]

Good Girls, then, is in part a memoir of her particular experience with an illness so torturous you would not wish it on your worst enemy. It provides a new insight into a solitary, self-constructed universe, defined by laws of deformed logic that are barely legible to those outside of it. There is one particularly useful breakdown of the sort of twisted listening an anorexic person can employ, a list of common refrains said by well-wishers and then the perverse translation the anorexic person instinctively wrings from them:

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“‘Don’t you get hungry? ’ – You are so strong and special, and I envy your strength and specialness.”

“‘Don’t you want to be healthy again?’ – Don’t you want to be fat again?”

In the best passages of Good Girls, Freeman opens up that hidden world. She is ruthlessly incisive and illuminating about anorexic thinking that cannot be argued with by desperate parents, and about the power dynamics between mostly male doctors and mostly female patients. Her account of her stints as an inpatient is shocking in parts, revealing a casual punitive barbarism among some staff that sounds more like the 1950s than the 1990s. As muddled as many of our ideas about eating disorders remain to this day, the past few decades have seen a huge increase in public discussion on the topic. When Freeman was in hospital, the prevailing approach was that the errant child must only be fed back up to a stable weight and then sent on their way to cope as best they could outside.

I was moved, too, by sections about Freeman’s mother and her own relationship with food. This is fraught territory; mothers are always the most convenient culprit for any problems in a child’s life, but this is especially true for particular mental illnesses and psychiatric disorders. In Aviv’s book, she recounts that her mother – having read up on the dominant psychoanalytic perspectives of the day, which held that the mother of an anorexic is to blame for the anorexia – wrote in her journal: “It’s I who has caused all the pain – and the original injury.” Freeman’s mother had her own restrictive relationship to eating, a brief stint of anorexia followed by decades of the sort of moderated disordered or fear-inflicted eating that many women contend with all their lives.

Freeman is very good on the incoherent rage that sick teenage girls feel toward their mothers, rage that is indivisible from the dreadful burden of love and obligation inherent in being mothered. I would not be surprised if the elucidation of this complicated anger will be of use to parents in the midst of a similar nightmare.

[See also: The NHS can’t help the mentally ill – can influencers?]

The problem with Good Girls as a whole is the attempt to provide a thesis rather than allowing the subjective account to stand alone. On certain points Freeman is undoubtedly correct, but I wonder if they are new-enough observations to interest anyone who has given this disease more than a moment’s thought. Her main argument is that anorexia is still dangerously misunderstood as a disease of vanity, as an extension of a superficial wish to be beautiful and popular, instead of the horrific and often fatal illness that it is. I’m sure there are many people with no direct experience of eating disorders who believe them to be frivolous – and for whom this book’s insight might be useful – but in terms of serious thought on the subject this is not fresh territory. And it is unfortunately undermined elsewhere by peculiar conclusions backed up by spurious evidence.

Freeman has become known in recent years as an active “gender-critical” voice in the media, objecting to various freedoms accorded to transgender people, and here brings in her belief that many gender dysphoric girls seeking treatment are reconfigured anorexics who have access to a new way of physical self-correction. She uncritically quotes a doctor saying (of gender dysphoria): “This could be the new anorexia.” Simple as that! This is proved by quoting some figures showing that in 2014 Google searches for the word “transgender” surpassed searches for the word “anorexia” and this has continued to be the case since. I need hardly point out how unscientific a means of interpretation this is, and its inclusion felt incongruous and cheap.

Similarly jarring is Freeman’s swift negation of male anorexics. She writes that they are too non-representative for her to include in her work here, and also that, “This book is rooted in my own experience, and my experience was so typical of many anorexics’ experience that I decided to focus on that, rather than trying to cover all ground.” This is fair enough in an overtly subjective account, but less so when you are describing “anorexia” as a whole, given that 10 per cent (the figure she quotes male anorexics as occupying overall) is not that negligible a minority. If it is true, as she writes, that it is a different illness, then those differences are surely vital and revealing for everyone, including women.

There is also a slightly muddled perspective on how culpable our thin-worshipping culture is in all this. Freeman firmly rejects the idea that we can blame Vogue for anorexia – and quite right too, this being a crass and reductive opt-out of a much more complex situation. This assertion, though, seemed to waver and become confused at times. It failed to completely convince me of Freeman’s argument that anything can be a trigger, so we must stoically accept the fashion- and celebrity-industry influence and focus single-mindedly on our ability to get or be well.

As she details, the underlying issues that lead to anorexia are not conjured by thin models. But culture’s saturation with the ideal thin body is loud and inescapable from the time we are toddlers, and it feels a little depressing to resign ourselves to it.

Yes, anorexia becomes something very different to the desire to be as thin as a model (as Freeman says, the anorexic person doesn’t want to look like Kate Moss – they want to be visibly ill). But the background noise of thin supremacy is not just a trigger: it is how some people manage to maintain their illness unchallenged for too long to get timely help.

Good Girls: A Story and Study of Anorexia
Hadley Freeman
Fourth Estate, 288pp, £16.99

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[See also: Eating disorders are a greatly misunderstood silent killer]

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This article appears in the 19 Apr 2023 issue of the New Statesman, Axis of Autocrats