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26 February 2014updated 28 Jun 2021 4:46am

We must go beyond disapproval and pity to help those with eating disorders

I don’t want a culture that is eating disorder-friendly. I want a culture that supports sufferers and respects the overlap between their eating disorder and their sense of self, but one which also recognises the harm and the horror of what they are doing.

By glosswitch Glosswitch

This week is Eating Disorders Week. Thirty years ago there was no such thing. We were ignorant. Anorexia was known as “the slimmer’s disease,” prompting images of someone who’d foolishly overdone it with the celery. We knew that Karen Carpenter had died of it, and that Lena Zavaroni would possibly follow suit (“silly girl,” my grandma muttered, disapproving of Lena’s oversized head  and fragile body appearing on Blankety Blank). 

We didn’t really know about bulimia (making yourself vomit was for the ancient Romans). We knew about fat – a Feminist Issue, no less – but we cared more about not being able to pinch more than an inch. Of course there were people suffering behind closed doors, and sometimes we knew this from the jutting bones, or the bite marks on the hand, or the leftovers that disappeared without a trace. Even so, the stigma that surrounded eating disorders was tremendous and sufferers were judged harshly – spoilt little girls, vain manipulators, failures who had either no self-control or far too much.

I was diagnosed with anorexia in 1987 and the treatment matched the judgment: a punishment for bad behaviour. The first hospital used force-feeding and the withdrawal of “privileges” (visits, letters, books, eventually light) until I ate. The second – a psychiatric one – did the same, only this time I got to sign a contract to make it appear consensual. I still have the document, my twelve-year-old signature scrawled beneath the weight at which I would be allowed to visit the toilet alone. The third hospital (by this time we were in the mid-nineties) was immeasurably better. I look back on the first two with resentment and sometimes anger. Then again, there’s also a voice that whispers “well, who knows? You might otherwisehave died.”  And the truth is, I like being alive, so I might as well move on.

I am glad that we are more aware of eating disorders today and that there is greater understanding. Nowadays it is rare for an eating disorder to be described as misbehaviour, vanity or a character flaw (I am sure some people still think this, but such viewpoints are unlikely to form the basis of entire NHS treatment programmes). And yet with this gladness comes some concern. I think there is also a dark side to this improvement in ED knowledge. Every now and then, as a recovered anorexic, I feel the line between quashing stigma and presenting EDs as a lifestyle choice has become blurred. I feel myself being tempted back in, as though cultural acceptability has rendered the thing that almost killed me utterly benign.

Diagnoses of anorexia, bulimia and EDNOS are increasing. This may reflect our greater understanding of the problem, but it’s also a factor of normalisation. We have welcomed anorexia into everyday life, orrather, we’ve become accepting of the idea of it. The practical experience of it – constant coldness, lack of concentration, fear, tantrums in restaurants, hours spent in supermarkets reading labels and buying nothing – remains thoroughly isolating, but no carer or sufferer will ever find that out until it is too late. 

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We have moved from pitying anorexic celebrities to viewing suffering as a form of celebrity. Women such as Nikki Grahame, Ana Carolina Reston and Isabelle Caro cannot be imagined without their illness. It holds a certain fascination, if only because we view it from the outside. We’re not with them when they are weighing out the same portions of food again and again, avoiding contact with others, or drifting off mid-conversation to dream of chocolate and perform perfunctory fat tests. We’re not with them when they’re hoarding rotten groceries under the bed and behind the dresser. We’re not with them when they die.

We are addicted to concern trolling, shaking our heads at the latest BODY SHOCK! headline on the cover of Heat or Closer. The pro-ana movement (if one might call it that) tries to find uniqueness and beauty in the mundane reality of endless hunger (which is, apart from anything else, unbearably boring. You cannot choose what to think of when all you can think of is food). We think “controlled” anorexia is a possibility. Ana and Mia have become the cultish imaginary friends of girls who hate their bodies and themselves.

In parallel to this, however, we have become more conscious of psychological dimension to EDs. We recognise anorexia, bulimia and EDNOS as serious mental illnesses. This is a double-edged sword. It removes blame from the sufferer, no longer seen as hopelessly vain, but it also removes blame from the culture that surrounds him or her. I don’t think this is entirely fair. It enable fashion industry leaders to parade skeletal models then shake their heads in mock horror at the very suggestion that anorexia can be anything other than a serious mental illness provoked bydeep mental trauma. “It’s not because these girls want to wear our dresses!” they will say, implying that all those who suggest otherwise are terribly ignorant. I don’t buy it. Any culture in which self-imposed starvation is encouraged is a breeding ground for eating disorders because self-imposed starvation has a profound effect on the mind. For some people at least, I imagine the “deep mental trauma” that prompts an ED can be nothing more than going on an extreme diet and sticking to it.

We have a huge amount of work to do if we want to minimise the suffering of those with EDs. I don’t want a culture that is ED-friendly. I want a culture that supports sufferers and respects the overlap between their ED and their sense of self, but one which also recognises the harm and the horror of what they are doing. To aspire, not to be thin, but to have a happy relationship with food and one’s own body should be a great thing indeed. If we shrug our shoulders and tell ourselves that this is out of reach in a world obsessed with thinness, then we have given up on a great many people. For their sakes we need to move beyond disapproval, beyond pity and beyond admiration to a place where it becomes possible to save more lives.