Hunger Strike: The Anorectic's Struggle as a Metaphor for our Age

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In this classic text, originally published in 1986, Susie Orbach brilliantly examines the anorectic's struggle. Anorexia is a battle; a battle to be thin; a battle of wills, denial versus desire. It is also about control; by conquering feelings of hunger, the anorectic woman aspires to conquer her emotional feelings as well. For Orbach, the struggle goes further. In this brilliant examination of women and eating disorders, she asserts that the complex relationship between women and food signifies women's battle for autonomy. Women's bodies are both private and public property. Society demands and expects women to look a certain way, to not take up too much space, to be self-effacing and mindful of others. Yet anorexia, whilst an extreme method of conforming to such demands, is conversely a rebellion against such ideas. It is the ultimate control over self, a cry of protest, a hunger strike against the contradictory and overwhelming demands placed on women in contemporary society.Also discussed are attitudes towards eating problems, and how they have changed over recent years, and an innovative approach to residential treatment. This book provides a highly original insight into the underlying causes of eating disorders.

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1 Anorexia; Metaphor for our Time

ePub

Every morning hundreds and thousands of women wake up worrying about whether it is going to be a ‘good day’ or a ‘bad day’ in relation to food. They feel remorse for what they ate yesterday and hope that they will have more control today. They approach the day with dread or hope according to how in control of food they feel. That food routinely plagues women is an acknowledged and discussed aspect of everyday life. An obsessive involvement with food flows out of a cultural insistence that what they eat, how much they eat, and how they cook for others, is their especial domain. Food is the medium through which women are addressed; in turn, food has become the language of women’s response.

The preoccupation with food is linked with a fetishizing of the female form. Women wish to acquire that elusive, eternally youthful body beautiful. A woman’s body becomes the subject of scrutiny, the recipient of enormous amounts of attention, and the vehicle for the expression of a wide range of statements. Women find themselves obsessively engaged with both their food and their bodies. A woman’s body is the beneficiary of hours of attention, worrying and fretting. But at the same time, the pain of being caught up in a never-ending battle to get one’s body right (and the eating behaviours that follow from this) is somehow muted. Women are constantly engaged in trying to mediate the harrowing effects of culturally induced body insecurity. This preoccupation is both a hidden and a public state of affairs. Women accept - at some level - the importance of self-presentation, and so obsession with the body is a permitted form of self-expression and self-involvement for them. But this publicly sanctioned private activity hides the deeply anguished relationship that so many women come to have with their bodies. Women repress the knowledge of how damaging and hurtful this obsession is.

 

2 Situating Anorexia

ePub

Anorexia nervosa, first reported by Richard Morton in 1694,1 has shown a dramatic rise during the past twenty years, and more especially in the last decade.2 It is no longer a physician’s curiosity. Nearly every branch of medicine and psychiatry, including dentistry, gastroenterology, and gynaecology, meets with anorectics in the course of regular practice, and many areas of medicine now contribute to the growing body of literature being assembled about the etiology, course and treatment of anorexia nervosa. This account of anorexia, together with the explanation offered for its recent dramatic rise, builds on work in women’s psychological and social development within two areas of scholarship: theoretical and clinical work on the construction of a feminine psychology,3 and theoretical and clinical work on earing problems in general.4

The rise in the incidence of anorexia nervosa provides us with an unusually visible example of the way in which psychic structure and symptom formation are determined by three factors: the social climate of a period; particular models of parenting; and the attempt of each generation to find its place in the world. This section of the book examines how these influences interact and how the tensions within each one are expressed. In trying to explain the features of this distress symptom, I will draw on sociological evidence important in explaining its locus.

 

3. Starving Amidst Plenty

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The aftermath of the Second World War ushered in significant changes in the production and distribution of foodstuffs throughout Western Europe and the United States. After rationing ceased in the early 1950s, it seemed as though food was plentiful, abundant and reasonably cheap. The notion grew up that the West had eliminated starvation, and although there was much evidence to the contrary, and gross inequities in the distribution of food, the belief in the idea of plenitude was dominant and was to lead to a series of consequences in the meaning of food in everyday life.

In most people’s experience there were vast changes in food delivery. Refrigerators, already a part of the American kitchen, became commonplace in British and European households, thus eliminating the need for daily shopping. Several days’ food in the refrigerator implied more availability than a well-stocked pantry. The growth of supermarkets with their rows and rows of dairy products, canned goods, meats, condiments, bakery goods, vegetables, fruits and staples, brought a large display of foods into everybody’s range. Few people could leave a supermarket without buying more than they intended, and the kitchen - often the centre of the home - contained an ever wider variety of foods.

 

4. The Breeding of Body Insecurity

ePub

The receptivity that women show to body insecurity is set against a background of contradictory images and meanings assigned to women’s bodies in general. Precisely because of the vicissitudes of social overlay, the development of a personal and stable body-image is extremely problematic for women. How women see and experience their bodies refers to cultural factors outside themselves. In addition, the individual woman can feel a pronounced variation during the course of an hour, a day or a week towards her body. How she feels about her body will frequently affect how she is feeling about herself at that particular moment. How she feels within herself influences how she feels about her body. A felt acceptability in one area tends to extend to the other, so that being in a ‘good mood’ may predispose her to find her body acceptable, even pleasing. For many women the immediate feeling of a sense of self is inextricable from momentary feelings about their bodies. The body is perceived as acceptable or unacceptable, providing a foundation for self-concept. At one moment a women may experience herself as large and ungainly, at another as slim and attractive. Her body shape and size do not actually have to change for her body to receive such projections. The ideas she has about herself that she sees in her body are sufficiently powerful to influence what she expresses physically.1 If she feels comfortable in herself she carries herself in one way, if she feels a dts-ease it is expressed in another.

 

5. Hunger Strike

ePub

Anorexia is a spectacular and dramatic symptom. To encounter an anorectic woman is to be confronted with turbulent and confusing feelings. These feelings can be so uncomfortable that one is inclined to try to distance oneself from the experience by various means. Unknowingly one moves into the role of the spectator. A sense of bewilderment, linked with a desire to understand, shortly turns to discomfort. One begins to look upon the anorectic and the anorexia uncomprehend-ingly. Compassion turns to fear and a wish for distance; a need to disassociate oneself from the painful sight. The anorectic is rarely engaged with, especially not about her experience of anorexia. Turning anorexia into an exotic state, with the attendant labelling and judging, substitutes for engagement. By these means a distance is created between oneself and the anorectic.

This distance is sought because in reality, there is a painful continuity between most women’s daily experience and that of the anorectic woman. Nearly all women feel the necessity to restrain their appetites and diminish their size. The original compassion stirred in us when encountering an anorectic woman is about this continuity of experience. But equally, there is a substantial and qualitative difference between the anorectic experience and the daily experiences of other women. For although both experiences contain the same attempt at restraint, the anorectic relation to eating and not eating takes on a life of its own. While many a woman may unthinkingly envy the anorectic her will-power and ability to withstand the temptation of food, may even desire to catch a small dose, she can scarcely comprehend how involuntary this food refusal has become. So in a sense, we can understand the labelling of the anorectic’s experience as an acknowledgement of this distance.

 

6. Towards a Model of Self-help: Themes to be Considered and Tackled

ePub

A reader who, at this stage, accepts that she is anorectic and recognizes anorexia in its active sense as a hunger strike in the cause of selfhood, may be put off by the prospect of treatment as it appears to render one passive, an object to be acted upon. Such a reader might well ask where one might find a therapeutic context that honours the symptom, the client and her struggle. (Indeed, the next chapter will pinpoint the underpinnings for just such a treatment model.) In this chapter, I propose a set of themes, guidelines and areas of consideration for those women who wish to begin on their own to explore ways of untangling the complex psychological underpinnings of their anorexia.

The notion of self-help in the treatment of anorexia may strike many mental health practitioners as extremely problematic and unrealistic. Anorexia is a frightening syndrome. The psychological nature of the problem and the physical diminution of the sufferer is a deterrent to successful contact and treatment by even the most experienced health professionals. The very fact of starvation can create in the sufferer a mental imbalance, including frequent paranoid thoughts; the physical implications are no less grave, leading most practitioners to recommend hospitalization and a programme for the immediate putting-on of weight. In addition, most workers in the field encounter the anorectic after she has suffered with the problem for many years. The syndrome is entrenched and the practitioner is only the latest in a long line of medical and mental health professionals the sufferer has encountered. The anorectic apparently feels little inclination to change; she projects a curious mixture of diffidence, disdain and dismissiveness. Inpatient treatment has a disappointingly low, long-term success rate, and new psychotherapeutic modalities are continually being developed in order to maximize therapeutic effectiveness. The experiences of those working therapeutically in a wide range of contexts with anorectic women provide few warming or hopeful accounts of the enterprise. Against such a background, what claim can self-help have to the aiding of the anorectic?

 

7. Bridging the Chasm

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As I have attempted to demonstrate in the previous chapters, the upsurge in the incidence of anorexia is bound up in the particular circumstances of our times. This increase cannot be ignored, nor should we content ourselves with explanations or treatment models that fail to address it. To look at anorexia nervosa as essentially a physiological disturbance, a purely psychological one or simply as a sociologically explainable phenomenon, is to miss the chance of understanding anorexia as a metaphor of our times - an especially poignant statement of the way that the predicaments of life in late twentieth-century capitalism can be experienced by the individual woman.

Freud, writing on women at the turn of the century in bourgeois Vienna, was well aware of the fact that social influences play on the construction of the feminine personality: ‘psychoanalysis does not try to describe what a woman is … but sets about inquiring how she comes into being/1 Psychoanalysis has implicitly recognized that the shape of a psychology and the psychopathologies that span the continuum at any particular point in time, uniquely fit women’s lives. The work of Renee Spitz2 or John Bowlby3 with children in nursery care during the Second World War is significant in this context because they saw a widespread phenomenon - the failure of infants to thrive - as a result of the impact of the absence of meaningful personal relations, a condition resulting in turn from wider political considerations. In other words, the political situation rebounded in the psychologies of wartime children in care. Again, the recent widespread acceptance of the notion of the narcissistic4 personality is not simply the sign of the hegemony of one particular school within psychoanalysis. Recognition of narcissism is only the most recent example of the phenomenon of analysts and psychotherapists observing in their patients distinct constellations of particular psychological symptoms during distinct historical periods. Similarly, the well-developed syndrome of anorexia is not simply the result of a particular psychopathology. While, manifestly, the anorectic response is an attempt at a psychological solution, the solution that is sought and the underlying psychology that makes such a response possible are formed with reference to a particular set of social relations - the inheritors and transmitters of the ideas, values, tensions and contradictions inherent in our culture. As such, any treatment model that is generated to address the rise in anorexia needs to take into account those circumstances and an understanding of the ways in which an individual psyche absorbs and interprets cultural values.

 

8. Food: From Poison to Palatable

ePub

Food refusal, as we have seen, is not a passive act but the outcome of much determination and resolve on the part of the anorectic woman. It is a refusal born out of a deep feeling of unentitlement to actual food and what it symbolizes: in other words, an unentitlement to what the environment in general has to offer, as well as to one’s emotional life and one’s own body. The food refusal is an attempt at reparation, at making good out of what is felt to be bad - i.e. oneself — by transforming the raw material of the unacceptable self into an acceptable human being. This, then, is part of what one meets when working with an anorectic woman. One encounters a woman whose sense of self and of her rights in the world are so severely in jeopardy that she feels she can only exist if she minimizes her presence and her needs. Although her actions give disturbing messages to others, for her they are about the difficulties ‘she has in being in personal relationships. They are actions to assuage the discomfort of her inner world (communications in the world of object relationships). They are attempts to find an inner peace that will provide her with some internal reassurance that, having suffered or paid sufficiently, she can feel some entitlement to live in the everyday world with others.

 

9. Focusing on the Body: The Corporeal Sense of Self

ePub

Untangling the meanings of the food refusal and helping the individual woman to develop a new and positive relationship to eating goes hand in hand with the exploration of ideas the woman has about her body-image. Consciously, the food refusal was first instigated as a way to cope with discomfort in her body. Commonly the unease arose from bodily desires she felt, her disgust at ‘the fat’, or the appearance of her first period before she was prepared for it, and so on. Obviously such issues are very important and will need to be taken up in the therapy in the process of helping her to eat again. But the resistance to engaging again in so-called normal eating behaviour is often subsumed by the twin fears of weight gain and ‘going out of control’. These two fears exemplify the anorectic woman’s relationship with her body. The body is experienced as an object that must be controlled or it will control. The emaciated body demonstrates that she controls her body whereas the average-sized body controls her. There are but two options.

 

10. Behind the Defence

ePub

The effectiveness of the work that the therapist and client engage in to understand and reverse the food refusal and to change fundamentally the woman’s physical experience of self depends on restarting developmental processes that have been arrested for a considerable length of time. Anorexia is a psychological symptom and distress pattern that is the outcome of the blocking of arrested developmental processes. These developmental processes are always shaped by the particular set of cultural attitudes prevalent in contemporary Western society. The complex of forces that have resulted in a truncated development in the anorectic need to be understood in order for the attempt to restart the development to be successful. What do I mean by this?

Modern psychoanalytic theory and the contributions of feminist theories have focused attention on the infant’s early relationships, on the formation of personality, and on the implications of gender in the critical ‘mothering’ relationship. They have shifted the terrain of psychological inquiry from the Oedipus complex to the vicissitudes of object relations and to the role of the mother in the psychology of the developing person. These theories have illuminated the difficulties and ambivalences in the mother-daughter relationship that create a particular shape to women’s psychology. Feminist psychoanalytic practice, meanwhile, is detailing the ways in which these difficulties and the vastly important consequences of being mother-reared can be addressed within the therapy relationship.

 

11. Medical Issues

ePub

When a therapist first meets an anorectic woman, she cannot help but be aware of several striking physical features. Firstly there is the physical diminution, which may be accompanied by a puffy face and prominent eyes. Unless it is the height of summer, the woman will doubtless be wearing many layers of clothing, to keep her warm and to disguise her level of thinness. If she is not well clad her body will have a skeletal-type appearance and her skin may well be blotchy. If asked about any physical symptoms, she may mention that her extremities are uncomfortably cold, her stomach feels distended whenever she eats, she is constipated, suffers from insomnia and an excess of energy. Many of the symptoms that arise from chronic starvation are not immediately obvious, however, either to the observer or to the sufferer.

Because serious physical problems are associated with starvation — most of which can be reversed as the woman comes to eat regularly above a certain threshold - many therapists are disinclined to take on an anorectic for fear that they do not understand the medical side of things. This can mean that a therapist, who would not hesitate to take on someone with very obvious mental symptoms of a fairly extreme nature, would be reluctant to work with an anorectic for fear of seeing her wasting away, of not being able to help the person reverse the pattern of starvation, or of encountering a medically qualified person who is in a position to come along and be critical of a treatment protocol that does not include refeeding.

 

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