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Nervosa Revisited

Keenie commented on my anorexia nervosa post, and I wanted to respond in full. Also, I need to post something, don’t I?

I understand the point you are making, but there seems to be, even in the language of it, the need to distance yourself from the fat.

Not at all. And don’t ever assume that someone with an eating disorder or disordered history is has no firsthand experience with being fat. I wrote this in part to dispute the equation of “severely disordered” with “living skeleton.”

Did you read Jill’s original post? The article she and I were responding to was about how society supposedly demonizes the thin and glorifies the chubby (yes, that was his actual thesis). His evidence was the ostracization of anorexics, as represented by the jealous sniping at skinny girls and the “She’s so anorexic!” cliche. Apparently, the fact that women fear anorexia is merely proof of their laziness–anorexics are admirable! Anorexia is merely proper restraint taken too far! Women should be disgusted by fat people, not thin people! We could all use a little anorexia!

I wrote this to explain that while anorexia nervosa must be read in the context of a body-obsessed, fat-phobic culture, anorexia is not about being too thin. In other words, it’s not that you’re fit and then slender and then svelte and then a little underweight and then–oops!–you cross the line into anorexia. That was the calculus the writer of the article was working under: if you weigh eighty pounds and subsist on 500 calories a day, you’re anorexic; if you weigh one-ten and subsist on 1200, you’re necessarily, objectively less afflicted. And if you’re overweight, you clearly need to spend more time hating yourself for eating.

That was what I meant by “inverted obesity.” As far as this argument is concerned, anorexia is to restraint as obesity is to indulgence: the effect of a behavior that’s positive in moderation, inseparable from the impulse that drives one to go hiking on the weekends or to the salad bar at lunch.

That’s a standard that will perpetuate a lot of misery. An eating disorder isn’t defined by your BMI; you don’t become disordered when you’ve dropped a certain amount of weight. It’s defined by self-hatred as expressed in an irrational relationship to food and eating. There are eating disorders that keep you relatively normal, eating disorders that cause your weight to cycle, eating disorders that cause you to gain weight, and eating disorders defined by exuberant physical health. Their defining characteristic is a life bound up in controlling and punishing the body. There is a qualitative difference between that mindset and a healthy one.

I would venture that most people with eating disorders are invisibly ill–particularly since our society encourages women to relate to their bodies in unhealthy ways. That’s why it was so offensive to me to hear someone arguing that anorexia is dangerous only to the body, and that it exists as a social ill only when the body is threatened. By that standard, I was never sick.

No, it’s not. But it isn’t a suffering contest. There are control issues, psychological and physical suffering that go along with being fat (obese, whatever) as well. It isn’t and it IS about the fat. This goes for obesity too. Fat girls have the added shame of being on the wrong side of the ‘Everybody loves a skinny girl’, and a walking neon sign of your inner problems.

Who’s trying to impose a contest on this discussion? Of course all of those things apply to being fat as well, and of course fat people are pressured to define themselves by their bodies in many of the same destructive ways. In a culture that hates fat bodies and fat people, it would be difficult if not impossible to be aware of that hatred.


21 thoughts on Nervosa Revisited

  1. Indeed, thanks for clarifying that eating disorders are not defined by one’s body but by one’s heart and mind. Self-loathing, not a particular appearance, is the sine qua non of defining a problem with over-eating or anorectic behavior.

    And of course, not everyone loves a skinny girl. Ask the naturally thin girls who are falsely assumed to be anorexic, and who draw undeserved ire and envy.

  2. And of course, not everyone loves a skinny girl. Ask the naturally thin girls who are falsely assumed to be anorexic, and who draw undeserved ire and envy.

    I’ve noticed these comments, but I don’t think anyone actually assumes that they are anorexic, since people tend to react to anorexia-the-culturally-defined-disease with sympathy and horror. So I don’t think anyone’s trying to smear these young women by saying that they have eating disorders. I think that it’s just sister punishing and jealousy, and that it exists in a starvation economy of self-respect.

  3. Piny,

    It’s a bit frustrating that you have missed my thesis entirely, while claiming you know it.

    In your second comment herein, you actually say the same thing that you eviscerated me for saying – that non-anorexic women are being called anorexic out of “punishing and jealousy.”

    If I can gain anything from your putting a great deal of your own words into my mouth, I hope it’s that you and your readers will take a few minutes to read my piece and give it a fair shake.

    The anorexia bullshit is a perfect example of the cognitive biasing power of “availability heuristics” – that is, the perceived danger of a given threat is fueled more by its dramatics than its facts. While I admit to a touch of cartooning (as is my lifelong style to get my point across,) my goal is to bring more facts than drama to the issues I take on.

    Anyway, like I said to Jill, I do appreciate the discourse, even if we disagree. Thanks.

  4. In your second comment herein, you actually say the same thing that you eviscerated me for saying – that non-anorexic women are being called anorexic out of “punishing and jealousy.”

    That is not what I’m saying.

    Non-anorexic women are not being called anorexic out of “jealousy” because anorexia is an enviable level of self-restraint or “punishing” because their condition is read as unnatural, dangerous, or cheating. None of those qualities are negative. They are being called anorexic because women have been taught to be jealous of anorexic levels of what you so offensively refer to as “restraint.” The “fat girls” want to be mentally ill, with all the damage that illness brings, because it will make them thin. They are not looking to the thin body. They are looking at, and honestly fetishizing, the disorder they recognize as the means of reaching a desired level of thinness–and given the standard we live with, they’re right. When they say anorexia, they really do mean starvation. They really do mean eating nothing and working out compulsively. That’s what Teri Hatcher does. They may, thank God, be incapable of developing an eating disorder, but they certainly don’t reject it because it’s horrible for them or because it changes you too much.

    In other words, the problem is not that we equate too thin with anorexic, but that we only recognize the negative aspect of anorexia at the far extreme of too thin. These women–the jealous ones–are so little concerned with their own health and stability that they would be willing to give up their sanity in order to lose a little weight. Unlike you, they do know what anorexia really is, probably because they’ve skirted it and noticed it among their friends.

    I don’t even know how to explain this dynamic to someone so completely clueless. But it’s not, “I wish I could care enough about my body to be thin like her!” It’s, “I wish that disease would come and make me over!”

  5. I tried to engage you constructively, but you insist on changing the subject, misinterpreting what I’ve said, then (in violation of any civilized rules of debate) going ad hominem. My doing so with you would be too easy.

    So instead, I’ll move on, and hope that you eventually shed the anger and explore my points with a clear and open mind.

    And by the way, thanks for helping me finally figure out what it is I find so hot about Hatcher. It had been bugging me.

  6. Anthony, I understand your point (maybe I’m the only one here). I have had discussions about the obesity epidemic and what should be done to try to curb this very unnatural phenomenon. Often the red herring of anorexia has been raised as a reason why we should not disourage people from becoming obese, or encourage them to lose the excess weight once they have become obese.

    Anorexia and obesity are both eating disorders. Why should anorexics be treated any differently the obese? They both are engaging in self-destructive behavior, aren’t they? Shouldn’t both groups recieve treatment and counseling?

    I assume that most of you would not encourage the “anorexia-acceptance” crowd. Would you encourage the “fat-acceptance” crowd?

  7. C’mon, guys.

    Anorexia is a disease that sometimes leads to extreme skinniness.
    Disordered overeating is a disease that sometimes leads to obesity.

    Obesity is an outcome, not a disease. Anorexia is a disease, not an outcome.

    Is that really so hard to get?

  8. Knifeghost, I stand corrected.

    Let me re-ask my questions this way;

    Anorexia and disordered overeating are both eating disorders. Why should anorexics be treated any differently than disordered overeaters? They both are engaging in self-destructive behavior, aren’t they? Shouldn’t both groups recieve treatment and counseling?

    The point Anthony was making (and I agree) is that anorxia is understood to be a mental condition and that it’s sufferers need help. Disordered overeating is generally considered more acceptable and it’s sufferers (and defenders) often bring up anorexia as a reason why it is dangerous to encourage people to maintain a reasonable weight, or from losing the excess weight brought on by disordered eating, or from seeking help for their disorder (“there’s nothing wrong with being fat – standards of reasonable weight are not medically substantiated, and are just being used as a way to oppress women”).

    Does anyone have answers to my questions asked above?

  9. Why is it not an option to trust someone when she says, “I would rather be overweight and mentally all right than obsessed with food and weight and miserable in order to conform to your idea of what a healthy body looks like”? What I see here is concern that seems to be a poorly-disguised need to control other people, and an inability to listen to what women are saying about their experiences with food and dieting.

    Like offering advice about how not to be raped, expressing this kind of “concern” about a woman’s body is a way to tell someone something she already knows; a message that she’s surrounded by all the time. We all know that skinny equals desirable, and that fat is unacceptable. This isn’t news to anyone.

    But skinny does not equal healthy. Skinny people smoke, do drugs, abuse their bodies in countless ways; sometimes some of those are related to the desire for thinness, sometimes they aren’t. But excess weight is not by definition unhealthy. Fat people can exercise and be fit and still not lose sufficient weight to attain a desirable level of thinness. Not eating is always unhealthy, even if the person works out, even if they’re happy about not eating. Obsessing about food is always unhealthy, even if you never lose your teeth from stomach acid or have a heart attack from emaciation.

    Eating disorders can wreck a metabolism in such a way that even a healthy-seeming skinny (as opposed to the unattainable desirably skinny) body is unattainable. Many people with even moderately disordered eating put on weight that they’ll never be able to take off without resorting to the drastic measures that damaged their bodies in the first place. Many people would rather die than go back to that self-punishing frame of mind.

    So if you express “concern” to someone about her weight, and she says that she’s worried about taking dieting too far, maybe you should try believing her and offering some support, instead of seeing it as self-excusing and lazy. Why is valuing mental health over a specific, aesthetic definition of physical health a bad thing? Why can’t women make that choice? Why don’t you go bother some smokers?

  10. Erin,

    “So if you express “concern” to someone about her weight, and she says that she’s worried about taking dieting too far, maybe you should try believing her and offering some support, instead of seeing it as self-excusing and lazy.”

    That’s my point. I believe people who have eating disorders should recieve help whether they are too thin or too fat. Too many people see being severely underweight as the problem that it is, but they refuse to consider being severely overweight as just as serious a problem, and far more prevalent. They see being severely overweight as a choice people make, and not a mental issue that needs to be addressed.

    And I’d put smokers on that list, too. Many smokers have your attitude that “smoking is not by definition unhealthy. Smokers can try to quit and be unsuccessful in quitting and becoming more healthy, which makes them depressed and less able to quit. Therefore trying to quit in the first place is more dangerous than continuing to smoke. Many people would rather die than try to quit smoking.”

    It doesn’t make sense regarding smoking, and it doesn’t make sense regarding obesity.

  11. Piny, as I said, I understand the point you are making and I pretty much agree. I think KnifeGhost summarizes my underlying irritation with this. Under that definition, how would you (soceity at large) know when someone who is obese has disordered overeating or anorexia. The subtext of this ends up being ‘yeah, because anorexia is a real eating disorder and being fat is just about being weak.’

    This is pretty much what I encountered trying to get treatment. No matter what pain or mutilation I would inflict upon myself, it’s not like I have an eating disorder.

  12. Part of the problem is that many women are never going to look like the models do simply because of genetics. It doesn’t matter how much body fat you lose, you’ll have to start shaving off bone in order to get below a certain dress size. The popular ideal is physically unachievable for women who don’t have a very gracile skeleton, which means that many young girls are being set up for failure by being told that one particular body type as the standard.

    Take me, for instance. I’m medium-boned, and the slimmest I’ve ever been while healthy is a size 8. I did drop lower than that at one point, but as a result of kidney problems, not dieting. And even when I was really sick, my hipbones, ribcage etc didn’t get narrower. I was still able to wear size 8 clothes. They were looser on me, but not ridiculously so (and I was too busy being sick to go shopping). Even though I lost a lot of weight, I didn’t become a size 1 when I was ill, I just looked like I had skin stretched over my skeleton.

    Look at most female swimmers, speed-skaters or tennis players. Most of them have much stockier body types than is the norm for models and actresses, but they’re probably extremely healthy, given that they’re athletes. There are probably very healthy gymnasts and figure skaters, too, but that’s a different type of sport, and a different body type is likely to come in useful at the elite levels.

    P.S. Take it from someone who’s been there. Being 20 pounds overweight is a hell of a lot less bad for you than being 20 pounds underweight. These days I could stand to drop a dress size or two, but I’m healthy, I go to the gym regularly, I don’t smoke, I don’t eat a whole lot of junk food, etc. etc. I’m probably healthier than someone who smokes, takes Dexetrim, and doesn’t eat enough, even if she’s slimmer.

  13. Too many people see being severely underweight as the problem that it is, but they refuse to consider being severely overweight as just as serious a problem, and far more prevalent.

    Good lord, you’re thick.

    “Being seriously underweight” is not the same as having anorexia nervosa. Some people are really thin because that’s the way they’re built. Some people are really thin because they have a physical illness that makes them really thin, and they don’t have any anorexic behaviors or attitudes. Similarly, some fat people are compulsive overeaters who have an eating disorder, but some fat people are fat for other reasons. Eating disorders are not defined by weight. There are normal-sized people who have eating disorders, and there are people who you wouldn’t think of as normal-sized who don’t. Eating disorders are defined by having a dysfunctional relationship with food, regardless of where that leaves you in terms of size. If you can get that through your skull, you’ll come off like less of a dingbat.

  14. Scare quotes are unattractive. What you’ve attributed to me is not even a paraphrase of what I said above, so the quotation marks are also dishonest.

    Therefore trying to quit in the first place is more dangerous than continuing to smoke.

    This, for example, is patently ridiculous as well as dishonest; there’s nothing dangerous about attempting to quit smoking. People don’t ruin their health in an attempt to quit smoking. Where you’re trying to draw a parallel, there is none.

    Slowly, now: what I am saying is that, if a person decides that, all other things being equal, it is his/her preference to maintain extra weight (and I didn’t say obesity, but why not?) and good mental health, rather than sacrifice mental health in the service of a goal that s/he may never be able to meet, why is that your business? People make lots of decisions in their lives that you probably wouldn’t approve of; why is this different?

    I’m saying that this constant blurring of the terms “health” (a physical state of good functioning), and “thinness” (an aesthetic judgement of size based on a height/weight ideal) is unhelpful and dangerous. I’m saying that, beyond the people at the visible extremes of weight, more people share in the mental health void that is the mindset of the anorexic, and that these people often include the overweight and obese. Encouraging self-flagellation in the guise of concern is not a productive way to bring about any positive change. And, since you are (I’m assuming) unable to actually enter the minds of the people for whom you are concerned and intuit all of their thoughts and experiences, I’m suggesting that your concern may, in many cases, do more harm than good. Harm that you can’t see (again, superpowers excepting).

  15. Well put, Erin. Yes, in many cases of someone being overweight or underweight, there’s a problem with food, but not in every case. If I see a very thin, frail, unhealthy looking woman and assume she’s anorexic, I might miss the fact that she’s undergoing cancer treatment or has another serious illness that has the side effect of weight loss. Similarly, not every overweight person is overweight because of disordered eating.

    Many asthmatics are overweight, in part because their disorder can interfere with exercise, but also in large part because the steroid-based medications which let them breathe properly often cause weight gain. Anti-depressants and anti-psychotics also tend to have weight gain as a side effect. Oddly enough, though, many people with clinical depression, bipolar disorder, or schizophrenia prefer being overweight and functional to being slim and in hospital.

    The assumption that someone who is overweight must have arrived at this state through lack of willpower is not necessarily so. Yeah, it’s quite possible that they’re binge eaters, but it’s not impossible that they are overweight as a side-effect of another medical problem. And if you’re not fairly close friends with someone, you won’t know, you’ll just have to assume. And as you say, intuiting the thoughts and experiences of a stranger may harm that person.

    BTW, this applies to very thin people as well. A co-worker of mine’s wife had extremely severe morning sickness while pregnant, to the point that she lost a lot of weight during her first trimester, and briefly ended up in hospital on an IV. Apparently when she was in hospital, nurses and other medical professionals routinely assumed that she must have an eating disorder, and scolded her about hurting her baby by not eating.

    Naturally she found these assumptions upsetting, considering that she was extremely worried that she might miscarry, and didn’t especially want to be throwing up everything she ate. Also, a few months previously she had gotten pregnant, had the severe morning sickness and sudden weight loss, and DID miscarry in her first trimester. So being told that she was hurting her baby was really not something she needed to hear. Not being a medical professional, I don’t know whether that miscarriage occurred as a result of malnutrition or not, but she and her husband certainly suspected it might have been a factor.

    And these medical professionals in her hospital ward had access to her chart. If they’d bothered to look on her chart prior to intuiting that she must be anorexic or bulimic, they might’ve realized that they were totally off-base. Given that most people don’t have access to someone’s chart, the chances of offending someone by making a blanket assumption are fairly high. And having myself previously become underweight as a result of illness, I know firsthand that it is not fun to have people assume you must be anorexic simply by looking at your matchstick arms.

    If you’re taking bets as to the cause of a third party’s weight problem, then yeah, statistically speaking you would probably do well to bet that the that third party got that way becauase of disordered eating. But if you express concern to a stranger or near-stranger and you’re wrong in your assumption as to the cause, you could really hurt their feelings. Wait until you know someone well enough that you don’t have to assume, for heaven’s sake.

    Plus, I know quite a few people who are very overweight, and none of them seem to be unaware that there is a correlation between food and weight. It’s not a secret that you’re letting someone in on. If you see someone lighting up, you don’t say to them, “Excuse me, I just thought you should know that smoking is bad for your health.” Chances are they’ve already heard that, and assuming they’re illiterate and culturally unaware isn’t going to make them appreciate you. Anybody who can read the warning on a pack of cigarettes knows about the health risks, and anyone who can read the cover of a magazine knows about dieting.

  16. There is very little support out there for people with compulsive overeating disorder. Believe me, I know because I’ve tried to find it. I have had counselors and medical professionals tell me that it’s just a matter of willpower and that I’m being lazy. Would they say the same thing to an alcoholic?

    And I’ve wished to be anorexic. The combination of my antidepressants and birth control make it very difficult for me to lose weight. I eat healthily and I exercise, but my weight is pretty static. But I’d much rather be sane and fat than skinny and covered in scars from self-mutilation. And it’s not even a divide like that; the compulsive overeating, for me, is part and parcel of my depression.

    In short: the next person who gives me the stink-eye when I have my weekly dessert with dinner is going to get a bloody nose.

  17. ““I would rather be overweight and mentally all right than obsessed with food and weight”

    “preference to maintain extra weight (and I didn’t say obesity, but why not?) and good mental health, rather than sacrifice mental health in the service of a goal that s/he may never be able to meet”

    “But I’d much rather be sane and fat than skinny and covered in scars from self-mutilation.”

    These quotes were taken from this site. They have proven my point; many people equate moderate eating habits or needed weight loss with mental disorders. I don’t understand why people think that thin and sane are mutually exclusive. There were a few posters here (myself included) who watch what they eat and exercise to remain thin. Are we suffering from a mental disorder? When did discipline and restraint change from virtues to mental disorders?

  18. ““I would rather be overweight and mentally all right than obsessed with food and weight”

    “preference to maintain extra weight (and I didn’t say obesity, but why not?) and good mental health, rather than sacrifice mental health in the service of a goal that s/he may never be able to meet”

    “But I’d much rather be sane and fat than skinny and covered in scars from self-mutilation.”

    These quotes were taken from this site. They have proven my point; many people equate moderate eating habits or needed weight loss with mental disorders. I don’t understand why people think that thin and sane are mutually exclusive. There were a few posters here (myself included) who watch what they eat and exercise to remain thin. Are we suffering from a mental disorder? When did discipline and restraint change from virtues to mental disorders?

    Bullshit! Where in any of these quotes do you see the word moderate? At least one of these quotes is the words of an eating-disorder survivor. When they say that they equate being thin with being disordered, they mean that embarking on a weight-loss program would immediately cause them to take up all their disordered habits. And they’re absolutely right. An ED-survivor should diet like a recovering alcoholic should drink wine with dinner.

    Furthermore, the non-ED-survivor quotes are taken out of the context of a discussion about how anorexia and disordered eating receive more positive feedback than even moderate weight gain at any level of physical health and cardiovascular fitness.

    No one here equates moderate weight loss–or moderation, period–with an eating disorder. The point of the series of posts was that moderation is not an ethos much in evidence. Your inability to read the difference is pretty striking support for that.

  19. Raging Moderate:

    Go back and read what I said. The entire post, this time.

    I eat properly and exercise (not at the moment, because I’m living on caffeine while I finish a thesis and three other papers). I have a fairly stable weight due to genetics, compulsive overeating (a disorder that left me fat, not thin, but still crazy), birth control pills with hormones that shifted my metabolism, and antidepressants that have a similar effect.

    If I gave up the birth control pills, I would lose a week of every month to being curled up on the bed zonked out on painkillers and spend the rest of my time anemic. If I gave up the antidepressants, I would go back to self-mutilation and compulsive eating to deal with the lows of depression.

    I am not equating anybody else’s thinness with their possibility of having an eating disorder. I simply stated that for me, my sanity and my fat are inextricably tied together, and that I am tired of people assuming that I could lose the weight if I just tried a little harder.

    Piny – thanks for the words of support.

  20. Raging Moderate, if you look at my replies, you’ll notice that I was referring to people who are overweight as a side-effect of medication. If someone is thin but suicidally depressed when she’s not taking her anti-depressants, and overweight but not trying to kill herself when taking them, that’s a very good example of how being thin and sane CAN be mutually exclusive. There are quite a few medications without which an individual person’s health would be severely compromised, but which cause weight gain as a side effect. So yeah, some people do have to make a trade-off. Not all, of course, but it’s most definitely an issue for some people. And at the risk of sounding melodramatic, if it’s life and death, most people would pick life. I have several friends who have struggled with severe depression, and been helped by medication (which has weight gain as a common side-effect). I have a good friend who’s been heavy for most of her life because she’s severely asthmatic, and the medications which allow her to keep BREATHING cause weight gain. Plus, plenty of women would much rather be on the Pill, the most reliable form of contraception, than lose the (on average) 10 pounds that many women gain when going on the Pill.

  21. Raging Moderate, get over yourself. It’s nice for you that you’re easily able to control and maintain your weight and that you are mentally healthy. But it is not helpful to this discussion, or to any other, to project your own experiences onto everyone else in the world. This discussion is not about you or people like you. It is about people with disordered eating.

    An ED-survivor should diet like a recovering alcoholic should drink wine with dinner.

    Piny, thanks for pointing this out. I’ve been there too, and always thought that we should use the phrase “recovering anorexic” for the same reason.

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