I’m Judging You – Theories of Eating Disorders

Initially identified as predominantly medical conditions, eating disorders have subsequently been viewed using a variety of non-pathological discourses. In their attempts to ascertain a cause, theorists have developed several concepts of eating disorders including psychosexual, familial and sociocultural.

FREUDIAN THEORY

At the end of the nineteenth century, a new diagnosis of anorexia nervosa emerged that utilised psychoanalytic technique. Equating lack of appetite with loss of sexual desire, the psychosexual model was propounded by Sigmund Freud and Pierre Janet. They conceived the idea that food refusal derived from a desire to maintain the body in a state of pre-sexual adolescence.

In 1895, Freud wrote that ‘“[t]he famous anorexia nervosa of…young girls seems to me…to be a melancholia where sexuality is undeveloped.”’[1] Freud’s theory relating loss of appetite to disturbed sexual development was reiterated in his report of 1918, in which he states ‘“[i]t is well known that there is a neurosis in girls which occurs at a much later age, at the time of puberty or soon afterwards, and which expresses aversion to sexuality by means of anorexia.”’[2] The rejection of bodily appetite was communicated through self-starvation. This resulted in an extremely slender figure, whose postponement of womanhood symbolised a lack of physical desire for both food and sexual interaction.

Freud’s psychoanalytic model continued to be drawn upon throughout the twentieth century. In the 1970s, food refusal was once again interpreted in terms of Freudian theory ‘as expressing anxieties and fantasies of a purely psycho-sexual nature, such as fear of pregnancy or of attracting the sexual attention of men.’[3] In 1978 feminist writer Hilde Bruch described ‘genuine anorexia’ as ‘characterized by the avoidance of any sexual encounter, a shrinking away from any bodily contact.’[4] Fearing sexual maturation and impregnation, at the onset of bodily changes during puberty ‘[t]he girls react with severe anxiety to what they sense are indications of losing control.’[5]

Lack of sexual desire is also associated with anorexia nervosa in the modern DSM which states that ‘[w]hen seriously underweight, many individuals with Anorexia Nervosa manifest depressive symptoms such as…diminished interest in sex.’[6] Contrary to Freudian theory, however, this reduced sexual desire is a result of self-starvation and greatly reduced body fat. It is a symptom of starvation, rather than a cause. Critics of the Freudian model of anorexia nervosa have remarked upon its limitations and its failure to situate psychosexual theory within a social setting. For example, in Unbearable Weight, Susan Bordo points out that the ‘fear of pregnancy may have more to do with fear of domestic entrapment than with suppressed Electra fantasies’.[7]

In order to address the sociocultural dimensions of disorderly eating, new concepts were developed throughout the 1970s and 80s. During this period, there was a resurgence of interest in eating disorders, and the psychosexual model was joined by Family Systems Theory and feminist interpretations.

FAMILY SYSTEMS THEORY

The Family Systems Theory of anorexia nervosa regards self-starvation as ‘a sign of disturbed structure and interactions within the family’.[8] One of the theory’s earliest proponents was psychoanalyst Hilde Bruch (1974) who ‘documented the family dynamics of individuals diagnosed with anorexia nervosa and the tremendous disorganising effects of the disorder on the family’.[9] It is unclear, however, as to whether this disturbance is a cause or an effect of self-starvation.

Amongst feminist accounts of Family Systems Theory, focus is often upon the mother-daughter relationship. Bruch ‘argued that the anorexic’s home was often “too good” because her mother often anticipated her daughter’s needs.’ This ‘led to the development of dysfunctional feeding practices and the child’s self-awareness of hunger and satiation did not fully develop.’[10] Anorexics therefore remained dependent upon their families, particularly upon their mother.  A decade later, Susie Orbach (1986) confirmed Burch’s argument, stating that anorexics have difficulty ‘with developing an independent identity that is separate from her mother’s.’[11]

FEMINIST THEORY

Feminist analyses of the late 1970s were amongst the first to challenge dominant pathological interpretations of eating disorders. Departing from traditional medical conceptions, feminists proposed alternative theories that focussed on women’s social position within the Western world. External pressures and judgement of the body came into consideration as possible causes of female anxiety. This work assumes a feminist stance in the sense that I examine the sociocultural and political conditions of women and how these conditions are manifested in a woman’s relationship to her body. My books challenges psycho-medical definitions; instead examining eating behaviours in light of a sociocultural framework.  It will be argued that patterns of disorderly eating originate in the patriarchal subjection of women and the pressure to accord with an ideal vision of the body.

In her work The Social Construction of Anorexia Nervosa, Julie Hepworth outlines the contribution of feminist writings to the canon of literature regarding eating disorders: ‘they introduced a conceptualisation of anorexia nervosa that drew directly on women’s experiences of themselves and social relationships’.[12] My work considers abnormal patterns of eating from the perspective of the female disorderly eater, drawing attention to the distress that women face when placed under pressure to achieve a physically impossible ideal.

Early feminist interpretations drew on social theories. Susie Orbach (1978) argued that eating disorders, particularly self-starvation, were a form of protest in a response to oppressive social structures.[13] I argue, however, that patterns of disorderly eating are not a protest against these structures, but are symptomatic of their internalisation.

Some feminists argue that self-starving behaviours are a product of masculine representations of women’s bodies and that such discourse has ‘belied, distorted, and imagined’[14] the female body. The story of the cultural ideal regarding women’s bodies over the past century is one of struggle over the female body politic. Women’s increase in power throughout history correlates to an increasingly slender ideal. The ideal serves as a backlash against the feminist movement: an ideal that aims to keep women thin, frail and weak. This counterattack has been expressed through efforts to influence and control the shape of women’s figures and subsequently, their eating behaviours. External judgement that is placed upon women thus results in a power struggle over the female body. In this way, the body is removed from individual ownership and becomes a site of political battle.

Women adopt society’s slender vision of the body because of its attendant physical and social rewards. These ideals result in female preoccupation with weight and body shape. Disorderly eating and food obsession is so culturally widespread that it has become a norm. As Hesse-Biber states, ‘disorderly eating is not a sign of psychopathology, but a strategy that is a “normal” part of female existence.’[15] These requirements of body shape and weight are imposed for the purposes of female subordination and socio-economic gain. While eating disorders are a product of external oppression; women are themselves the agents of its enforcement, moulding their own bodies in a desperate attempt to accord with sociocultural ideologies.

Despite the assumption of slenderness as a masculine representation which serves to oppress and restrict, Hesse-Biber argue that the ideal of slenderness can also be a source of female power. This theory is proposed in Am I Thin Enough Yet?, in which it is argued that ‘dieting and physical fitness are not methods for the subordination of women, but ways that women can feel powerful’.[16] ‘For many women’, Hesse-Biber observes, ‘feeling fat means feeling powerless.’[17] Yet other feminists such as Orbach argue that while women who conform to the slender ideal perceive themselves as powerful, they are in fact subordinating themselves to a masculine ideal which connotes thin with attractive and ‘good’, and fat with unattractive and ‘bad’. These associations are internalisations of patriarchal forms brought about by the prevailing norm of representation. As Orbach continues to argue, fat is feminist because it opposes social and cultural norms of the attractive, slender body. Bray and Colebrook argue in the affirmative, stating that ‘the personal is political’[18] and that ‘eating disorders cannot be explained at the level of individual pathology.’[19] However, uniting Hesse-Biber and Orbach is the belief that whether fat or thin, the feminist approach to body size lies in women’s ability to choose to shape their bodies according to their own volition. The question that remains unresolved is whether or not the ideal to which they aspire has in fact been shaped for them by the pressures of contemporary culture.

Women within the Western world are exposed to the same cultural environment, yet not all women develop an eating disorder. Some are more vulnerable to social influence than others. The extent to which a woman is affected by ideologies of bodies and female beauty depends upon the individual. Susan Bordo identifies various non-social factors that contribute towards the development of disorderly eating. These include ‘”deficits” in autonomy, tendency to obesity, perfectionist personality traits and defective cognitive patterns, perceptual disturbances, biological factors, [and] emotionally repressed familial interactions’.[20] There is no institution solely responsible for creating patterns of disorderly eating: they result from multidirectional dynamics of power.

The struggle to assume control of the female body accords with theorist Michel Foucault’s notion of power. Rather than being distributed throughout society via a ‘top-down’ system originating from a single source, ‘power must be understood in the first instance as the multiplicity of force relations immanent in the sphere in which they operate’.[21] From a Foucaultian perspective, the responsibility for the prevalence of eating disorders does not lie solely with top-down sociocultural powers. Instead, patterns of abnormal eating arise from various factors, including economic, psychological, familial and biological.

[1] J. Strachey (ed.), The Standard Edition of the Complete Psychological Works of Sigmund Freud Vol. 1, Pre-psychoanalytic Publications and Unpublished Drafts (London, 1996), pp.200-201, in Brumberg, Fasting Girls, p.213

[2] From fasting saints to anorexic girls, p.174

[3] unbearable weight p.46

[4] Hilde Bruch, The Golden Cage: The Enigma of Anorexia Nervosa (Harvard University Press: Cambridge MA, 2001), p.70

[5] Hilde Bruch, The Golden Cage: The Enigma of Anorexia Nervosa (Harvard University Press: Cambridge MA, 2001), p.59

[6] Diagnostic and Statistical Manual of Mental Disorders 4th Edition, Text Revision (Arlington, VA: American Psychiatric Association, 2004), p.585

[7] Susan Bordo, Unbearable Weight, p.46

[8] From Fasting Saints to Anorexic Girls, p.3

[9] Julie Hepworth, The Social Construction of Anorexia Nervosa (Sage Publications, 1999), p.50

[10] Julie Hepworth, The Social Construction of Anorexia Nervosa (Sage Publications, 1999), p.55

[11] Julie Hepworth, The Social Construction of Anorexia Nervosa (Sage Publications, 1999), p.56

[12] Julie Hepworth, The Social Construction of Anorexia Nervosa (Sage Publications, 1999), p.45

[13] Julie Hepworth, The Social Construction of Anorexia Nervosa (Sage Publications, 1999), p.45

[14] Bray, A. and Claire Colebrook ‘The Haunted Flesh: Corporeal Feminism and the Politics of (Dis)embodiment’, in Signs 24 (1998) 35-67 http://gateway.proquest.com/openurl?ctx_ver=Z39.88-2003&xri:pqil:res_ver=0.2&res_id=xri:lion&rft_id=xri:lion:ft:mla:R03813339:0

[15] Sharlene Hesse-Biber Am I Thin Enough Yet?, p.94

[16] Hesse-Biber, Am I thin Enough Yet?, p.29

[17] ibid, p.29

[18] Bray, A. and Claire Colebrook ‘The Haunted Flesh: Corporeal Feminism and the Politics of (Dis)embodiment’, in Signs 24 (1998) 35-67 http://gateway.proquest.com/openurl?ctx_ver=Z39.88-2003&xri:pqil:res_ver=0.2&res_id=xri:lion&rft_id=xri:lion:ft:mla:R03813339:0

[19] Bray, A. and Claire Colebrook ‘The Haunted Flesh: Corporeal Feminism and the Politics of (Dis)embodiment’, in Signs 24 (1998) 35-67 http://gateway.proquest.com/openurl?ctx_ver=Z39.88-2003&xri:pqil:res_ver=0.2&res_id=xri:lion&rft_id=xri:lion:ft:mla:R03813339:0

[20] Bordo, Susan, Unbearable Weight: Feminism, Western Culture, and the Body (University of California Press: London, 1995), p.52

[21] Foucault, The Will to Knowledge: The History of Sexuality vol. 1, trans. by R. Hurley (London: Penguin, 1998), p.92

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