Part I
Contexts
1 Modern vs early modern bodies
Anorexia nervosa and other historically situated forms of self-starvation
Given that anorexia nervosa is now a well-known and increasingly common (if problematically represented) condition, it is worth using this opportunity to draw a clear distinction between the starvation-related behaviour of early modern women and this modern phenomenon, a syndrome that was the subject of almost simultaneous publications in England, the United States, and France in the early 1870s. (There are obvious parallels here with the roughly simultaneous pathologisation of homosexuality, that other attempt to contain a visible threat to the cultural status quo.) As Joan Jacobs Brumberg pointed out, the symptomology we now refer to as âanorexia nervosaâ is a âhistorically specific disease that emerged from the distinctive economic and social environment of the late nineteenth centuryâ (facilitated and refined by the cultural environment of the late twentieth and early twenty-first), and early modern self-starvation bears even less resemblance to modern diagnostic criteria than to those early definitions.1 Helen Malsonâs The Thin Woman offers a brilliant analysis of the gendered discourses of âanorexia nervosaâ, from its initial appearances in early âmedicalâ texts to the present day. Malson emphasises the extent to which the category of âanorexicâ has been constructed around and through a patriarchal concept of the category âwomanâ, despite acknowledgement from the very first that some 10 per cent of sufferers are male.
The two main sets of current diagnostic criteria are the American Diagnostic and Statistical Manual for Mental Disorders (DSM) V, and the World Health Organisationâs International Classification of Diseases (ICD) 10 (with 11 on release, presented at the World Health Assembly in May 2019, and due to come into effect on 1 January 2022). Whilst their schema differ, both predicate diagnosis on (a) the conscious maintenance of a body weight considerably lower than the expected norm through restricted eating or other dysfunctional behaviours, (b) âintense fear of gaining weightâ, and (c) âdisturbance in how body weight and shape are experiencedâ or âundue influence of body weight or shapeâ on self-evaluation. The last two aspects are conspicuously absent from early modern accounts of similar bodily experiences, which to the modern eye are noticeable for the absence of any articulated fear of becoming physically fat, the practice of dysfunctional behaviours with the specific aim of avoiding bodily growth in mind, the distortion of external bodily perception, or the influence of weight or shape on self-evaluation.
These diagnostic criteria are in general adhered to in current clinical practice. The (increasing) problem is that some of those criteria apply to the majority of Western women and girls to some degree, regardless of their shape or size. Modern anorexicsâ food refusal belongs to a cultural context that ideologically approves restricted eating for women, whose bodies are often constructed as objects rather than subjects of sexuality. The contemporary medical establishment, faced with an ever-increasing number of patients with disordered eating behaviours, have nevertheless striven to maintain a strict theoretical division between âanorexicâ and ânon-anorexicâ food behaviours, even though numerous studies have demonstrated the increasing normativity of disordered eating and that âdieting and body dissatisfactionâ (two crucial diagnostic criteria) are âmore prevalentâ, and therefore more ânormalâ or normative, than non-dieting amongst women and girls.2 This renders the assertion that there is a clear distinction between âanorexia nervosaâ, a discrete physical and psychological condition, and ânormalâ (feminine) eating behaviour increasingly problematic, especially given that multiple studies have repeatedly demonstrated that this is not the case.3 The proportion of Western women âdietingâ â not including those not doing so but unhappy with their weight, appearance, or existing food intake â at any one time, regardless of racial or class background, has been estimated to be as high as 80 per cent.4 On the contrary, âeating disordersâ (of which self-starvation is one) represent merely one end of a problematic food/weight behaviour continuum inhabited by the vast majority of women, as the increased flexibility of the âanorexia nervosaâ DSM and ICD categories (and the expansion and subdivision of DSM Vâs âUnspecifiedâ and âOther Specified Feeding or Eating Disorderâ sections) problematically demonstrate. So âanorexia nervosaâ becomes not an absolute condition but a discursively constructed category, representing either a collection or constellation of various more or less common symptoms â or, further, simply one end of a continuum of dysfunction on which the entire population can be situated.
Reba-Harrelson et al.âs revealing 2009 study of âPatterns and prevalence of disordered eating and weight control behaviours in women ages 25â45â, involving thousands of women selected through a national (US-based) quota-sampling procedure, found that
disordered eating behaviors [sic], extreme weight loss measures, and negative cognitions about shape and weight were widely endorsed by women in this age group [regardless of racial background]. Thirty-one percent of women without a history of anorexia nervosa or binge eating reported having purged to control weight, and 74.5% of women reported that their concerns about shape and weight interfered with their happiness.
The researchers concluded, unsurprisingly, that âunhealthy approaches to weight control and negative attitudes about shape and weight are pervasive even among women without eating disordersâ.5 Many studies suggest that a majority of participants, regardless of age, relationship, or employment status, suffer from body dissatisfaction and assess their food intake accordingly, perceiving cultural pressure to maintain a specific body shape and themselves to be continually judged thereby.6 Insisting, then, that âa dread of fatness [persisting] as an intrusive, overvalued ideaâ constitutes a specific psychopathology is deeply problematic in a society that persistently mocks and devalues fatness, where subjects are surrounded by intrusive media representations of the âobesity epidemicâ and its dire physical implications, and doctors themselves have been demonstrated to make unfair judgements of their patients purely on the basis of their physical size.7 Such a fear of âfatnessâ seems to be particularly prevalent among younger women and teenagers, perhaps because of greater media exposure and the normalisation of digital editing for cultural images.8 One of Courtney Martinâs interviewees, enthusiastically corroborated by her peers across the social spectrum, concluded disturbingly that body hatred and obsession was âjust being a girlâ, and Perfect Girls, Starving Daughters provides ample evidence that feminocentric spaces and bonding rituals hinge heavily on evaluation and criticism of the physical self.
Itâs not just women, either: increasing attention is being given specifically to boys and men, and more recently non-binary or agender people, suffering from eating disorders.9 Susie Orbachâs 2009 Bodies, in an evaluation of her cross-gender clinical practice, argues persuasively that authentic embodiment is increasingly problematised in modern culture regardless of gender; not only has the body increasingly become the subconscious site of articulation for purely psychological concerns (as in psychosomatic symptomologies in response to psychological triggers), but postmodern culture renders authentic and unquestioned experience of the body so problematic that problems with embodiment have begun to create their own psychopathologies.10
In modern Western culture, food and body size are all-pervasively associated with moral values â thinness as virtue, attractiveness, sex appeal, self-control, perfection, power; fatness as greed, self-indulgence, excess, gluttony, weakness, need, insatiability.11 This recalls a Cartesian duality between a valued masculinised (thin) intellectual and a devalued feminised (fat) physical.12 Physical substance â body weight â is overwhelmingly negatively loaded, regardless of gender. Many cultural narratives, particularly prevailing medicalised media discourse, âcreate fat as a âspoiled identityâ ⌠that can communicate only its own failureâ, allowing little space for representations of fat people as aspirational, powerful, effective, sexual, or appealing.13 (In particular, there is hardly any cultural space at all for portraying fat women thus. The majority of fat women in the public eye, outside fat activist circles, reinforce with self-loathing cultural accounts of fat as failure, although the welcome emergence of figures like Lindy West, Tess Holliday, Roxane Gay, and Ashley Graham into the mainstream suggests this may be changing.)14 It is more complicated than a simple duality, however. Whilst excessive thinness, for example, can be constructed as âpetiteâ, hyperfeminine vulnerability, for many anorexia sufferers it can also represent androgyny (and thus freedom from the many demands and expectations of adult femininity) and/or the defiant lack of need. Excessive thinness can signal both adherence to cultural dictates of (often masculinised) self-restraint of a (feminised) body as a virtue (for either gender) and a grotesque parody of such demands, a refusal to conform, a drive for an externally documented individuality, a concrete self.15
From a Foucauldian perspective, this relentless self-criticism is an expression of âdisciplineâ, an exercise of control by a âClassical Ageâ which âdiscovered the body as the object and target of powerâ.16
He [sic] who is subjected to a field of visibility, and who knows it, assumes responsibility for the constraints of power ⌠he inscribes in himself the power relations in which he simultaneously plays both roles; he becomes the principle of his own subjection.17
(Given the extent to which women, in particular, have internalised such subjectivity, I cannot be alone in finding Foucaultâs pronouns here ironic.)18 In fact, modern capitalism ensures that it is âprimarily through consumption that we construct our identitiesâ, and it is the body which provides visible evidence â and evaluative potential â of the selfhood thus constructed.19 Perhaps the original inclusion of appearance-focused criteria in the diagnostic assessment of âeating disordersâ stems from the fact that such concerns are readily understandable within the dominant self-evaluative cultural paradigm. Their inclusion thus enables eating-disordered behaviour to be rooted firmly in individual psychopathology rather than cultural realities or everyday experience. This in turn lets off the hook an increasingly criticised (and, demonstrably, partially effective at best) medical treatment model that has been shown to exacerbate eating-disordered thought-patterns, recreate problematic gender/power relations, enhance focus on food intake as means of self-articulation and identity formation, and magnify misogynistic cultural forces.20
The cultural experience of food, gender and the body in modern culture, then, is fundamentally different from that of the early modern person, particularly the early modern woman. Modern diagnoses, food behaviours and experiences of the body hinge on several factors entirely absent from the early modern body: systemic cultural devaluation of the fat body and fetishisation of the thin one; persistent, widespread, and socially ...