Writing about eating disorders can get frustrating when so many people just don’t seem to know what they’re talking about.
Alex Williams penned a salacious piece in today’s New York Times centered around the “weight anxiety” experienced by girls leading up to Spring Break. That we are, for “sufferers of eating disorders”, moving into “the most dangerous time of year.”
Self-denial and restraint in America? Now that’s dangerous … to our way of life.
Setting aside that the backdrop of alcohol abuse over Spring Break dwarfs any danger of starving oneself into a bikini, I should start by saying that I understand anorexia nervosa can be debilitating and dangerous for those affected by it. Just as I sympathize with people in plane crashes or victims of pit viper bites and lightning burns…
We can quibble over how common anorexia*, bulimia and other eating disorders are, but they’re a heck of a lot more common than lightening burns and pit viper bites. There are various degrees of eating disorders, and they affect a lot of young women. Anorexia is mental illness that is most likely to kill you — that’s substantial. And it’s not just about “denial” and “self-restraint.”
A few years ago, Cornell University professor Joan Jacobs Brumberg wrote that we must “consider the ways in which different societies create their own symptom repertoires and how the changing cultural context gives meaning to a ‘symptom’ such as non-eating.” For sure. Our cultural views on this matter could not be more schizophrenic. The primary threat posed by anorexia is as a dramatic affront to our cherished, biggie-sized way of life.
I’m gonna go ahead and suggest that the primary threats posed by anorexia are death, heart failure, kidney problems, reproductive problems, and on and on. You know, things that physically affect peoples’ bodies, not how we view Big Macs.
Xanga’s chief executive, John Hiler, is quoted in the Times article saying it is their corporate policy to delete any “pro anorexia” groups from the system. While that’s certainly their prerogative, they don’t appear to have the same policy about food or alcohol abuse (apparently the “food slut club” and “alcohol is my friend” group do not similarly offend Hiler’s sensibilities). Since these two unquestionably pose dramatically more risk to their participants, this corporate policy represents irrational, institutionalized stupidity.
I’m sorry, enjoying food unquestionably poses dramatically more risk to people than starvation? Wrong. I enjoy food, and probably qualify as a “food slut.” I also drink alcohol. Those behaviors, when taken to the extreme, can certainly be dangerous. But are they more dangerous in and of themselves? Of course not. On the other hand, anorexia by definition is an extreme behavior. Starvation is more dangerous than eating, period. Is it always more dangerous than over-eating? No. But groups about food are simply emphasizing what is already a natural — and indeed, necessary — activity. Pro-ana groups are emphasizing a dangerous, extremist, unnatural activity. There is a big, big difference there.
My personal offhand estimate had been that we might lose about 100 Americans annually to anorexia. My research this morning showed that I was not far off – a 2001 study by the University of British Columbia’s Department of Psychology of every American death for the most recently available five year period showed only 724 people with anorexia as a causal factor – 145 per year. Christina Hoff-Sommers, in her research for the book Who Stole Feminism, came up with a number below half that. In a presentation to the International Congress of Psychology, one expert (Dr. Paul Hewitt) estimated a death rate for anorexia of 6.6 per 100,000 deaths. Even if you assume that sufferers outnumber deaths by a few orders of magnitude, it would still seem that all objective evidence shows the health impact on Americans from anorexia is statistically nil. Now, I know that doesn’t make for very good shock journalism, but it doesn’t change the uncomfortable fact that it’s true.
Well, I don’t give a lot of deference to “Who Stole Feminism,” but let’s ignore that for now. Death isn’t the only issue that comes with anorexia. A whole slew of other health complications are involved, and women who die or suffer sever health consequences because of their eating disorders are seldom tracked. Most anorectics don’t die of starvation — they die of organ failure or some related complication, sometimes after they’ve begun to recover. And regardless of the death rate, anorexia is problematic because it’s a mental illness that a whole lot of people suffer from, and it’s been on the increase. It’s at least partly culturally motivated. Would anyone argue that schizophrenia isn’t a problem because people don’t usually die from it, or because people die more often from something else? Of course not. So why are we making that argument with anorexia? It’s also a greater cultural problem that girls are starving themselves in order to fit a particular ideal, whether or not they’re anorexic (extreme dieting is an eating issue in itself, but not necessarily anorexia nervosa). In Naomi Wolf’s “The Beauty Myth,” she mentions that many popular diets encourage women to keep their food intake to around 600 calories — which is about what Nazis offered those living in concentration camps in order to minimally sustain their lives. If that’s not problematic, I don’t know what is.
More Americans die from obesity-related illness in two hours than die from anorexia in a year. Two-thirds of Americans are overweight and one-third are obese. About ten million Americans have “clinically severe obesity” – and ambulance manufacturers are producing new “bariatric ambulances” that can support patients several hundred pounds overweight. Las Vegas, the first city to purchase the units, said that they had handled 75 calls in the past six months involving patients approaching or exceeding 500 pounds. Yet, when we speak of disordered eating, we still don’t seem to be referring to ourselves.
And more far more Americans die in car crashes every day than die in terrorist attacks at airports or in airplanes. But does that mean that we shouldn’t focus pretty heavily on airport security? No. And it’s not an either-or proposition. Air travel and car travel are both forms of transportation, but they aren’t polar opposites, or even directly related. Ditto for anorexia and obesity. They both relate to food intake, but that’s about as far as it goes.
Here’s a big problem: He seems to think that anorexia is the opposite of obesity. It’s just not. Anorexia is a complex mental health problem. It isn’t just about skinny girls wanting to be skinnier. It’s a complicated interplay of psychological problems, control issues, body image and cultural expectations. The argument that “Anorexia shouldn’t be emphasized so much because obesity is a worse problem” completely misses the boat on what anorexia actually is. Anorexia is a behavior, and a way of interacting with food. Obesity is a physical state. Big difference.
I know several girls whom others consider “anorexic” because they are very lean and don’t have emblematic American appetites. They are in fact not anorexic; but they are more cautious about their intake than most. They are vibrant, healthy, and adequately nourished; they can even run a couple of miles at a good pace. And that’s much more than most Americans can say.
So, please, ladies – the girl who has the body the rest of you wish you had is not anorexic. The girl who delicately refuses the eighteen-ounce wedge of deep-fried cheesecake the rest of you dive into after dinner is not anorexic. The girl who is obsessed with fitting back into those size 1 jeans is not anorexic. She’s just thinner than you, knows how to say no to herself, and it makes you jealous.
And I’ve known several anorexics, including one of my closest friends who was hospitalized for her condition and still goes to therapy four times a week. It’s no joke. Anorexia isn’t defined by spiteful women who hate their thighs any more than depression is defined by serial optimists. It’s not about refusing deep-fried cheesecake. It’s not about being jealous that other women are thinner. It’s about recognizing that eating disorders affect a lot of women, and just because we aren’t dying en masse from them doesn’t mean that they aren’t problematic. The idea that anorexia is just a synonym for “skinny” the way that obese is a synonym for fat is a profound misunderstanding. It’s sort of like arguing that schizophrenia is synonymous to “acting weird.”
More broadly, the idea of anorexia threatens our view of our bodies, our consumption-obsessed culture, and our deeply held personal ideas about how much nourishment we “need” (read: “deserve.”) Perpetuating the myth of anorexia helps us demonize denial as some kind of blasphemy, rather than looking at our own dinner plates or in the mirror and asking: am I fat? (Probable answer: yes.)
Well, no. Anorexia isn’t about “deserving” nourishment. It’s not about fighting obesity. And it’s certainly not a myth.
That said, anoexia also tends to be a disease of the wealthy. In order to be able to deny yourself food, you have to have plentiful food in the first place. That isn’t to say that very poor women are never anorexic, but there are class and entitlement issues going on as well.
And as for denial, on a most basic level, fuck that. Sorry, but why are the values of self-sacrifice only brought up when we’re talking about women’s bodies? We’re supposed to deny ourselves food in order to stay thin so that someone else (always male) will enjoy looking at us; we’re supposed to deny ourselves sex so that the virginity fetishists can have an all-access pass once we’re married; and even then we’re supposed to sacrifice all of our own wants and needs for our children and our husband, and still deny sex if we don’t want any more babies. I call bullshit. I’ve had enough of the cult of female martyrdom, and I feel no need to let other people tell me that I should feel guilty for enjoying pleasures like food and sex. I own a vibrator, I use birth control, and I make myself steak au poivre and drink good red wine every Friday night. These things bring me far more pleasure than skinny thighs or blood on my wedding-night bedsheets. And if that makes me an over-indulgent pig, then so be it.
The moral outrage against the ghost of anorexia is intellectually puddle-deep; it is similar to so many other moral panics of our generation. It hardly represents a statistical blip on our health-care radar – but it’s a dramatic affront to our way of living – and that’s far more dangerous than any 500 calorie-a-day diet could ever be.
Well, considering that a 500-calorie-a-day diet can kill you, I’m gonna go out on a limb here and suggest that it’s a little more dangerous than this “dramatic affront to our way of living.”
*a note: When I use the term “anorexia” here, I use it as shorthand for anorexia nervosa. Thanks to Laurie for reminding me to clarify that.