- Louis Theroux: Talking to Anorexia (BBC2, 29 10 2107)
- The ‘invisible’ and disappearing female body
- Whose power?
- The marginalization of feminist-inspired women-only practice and culture.
There is something both symbolic and literal about anorexia, a condition identified by its signs and symptoms only once these have gained visible momentum: loss of appetite (for food, life and living), rapid weight loss, a sense of powerlessness, physical frailty, often depression, and the highest death rate for any ‘mental illness’.
Louis Theroux: Talking to Anorexia (BBC2, 29 10 2017).
This is, like his other investigations of ‘difficult’ or disturbing human subjects, sensitive, thoughtful, probing and shocking. The camera shows the visible evidence of anorexia (the way it reduces and reshapes women’s bodies), and Theroux in its presence, in institutions providing mental health services, in the women’s familial environments and in personal interviews. Theroux doesn’t emote and is verbally gentle and non judgemental. At the same time, faced with these just-about-alive, emaciated bodies, Theroux’s eyes and face, ostensibly inscrutable, nonetheless convey his sense of disturbance and concern, and his own powerlessness, even as he and his crew witness and document the women’s experience of anorexia.
The ‘invisible’ and disappearing female body.
Anorexia is literally a visible shrinking and drying up: of body tissue and size, as well as social horizons. It is the reduction, even removal, of fat and muscle, for example curves and breasts, as well as organ function, such as menstruation. It is a hollowing out, physically, mentally and emotionally, and can be understood as an effort to become both less visible (increasingly skeletal) and the centre of attention/care (as a visibly undernourished, skeletal body that indisputably signals ‘distress’, crisis, lack, need).
The onset of anorexia is usually in the early/mid teens, a period of pivotal sexual and social transition from girl to woman. In Theroux’s report, the ‘accepted’ discourse applied to anorexia revolves around the concepts of ‘healthy’ and ‘unhealthy’. These gender-neutral medical norms obliterate the reality of anorexia in girls and women. There is no such thing as ‘gender-neutral’ health for girls and women, especially when it is the visible body that is the terrain on which the girl or woman’s trauma is (dis)played.
Given these circumstances, how do we define ‘healthy’ for a woman? In terms of organ function, physical development, the absence of ‘disease’? In terms of conformity to social norms regarding gender and sexuality: an absence of ‘deviance’? But we know that conformity to sexist, racist and misogynist social norms can be very damaging for a girl or woman, in terms of her sense of self, her sexual and social confidence and wellbeing. Anorexia speaks to these pressures.
The shrinking and drying up that takes place during anorexia is of the female body: it is a de-sexing. It can be seen as a literal withdrawal/denial of ‘femininity’ (which is a social and heterosexual category); a refusal to become or be a woman: to be “attractive”, as one of the women interviewed put it (which is a social and heterosexual category). The oldest woman interviewed (63) explains it cheerfully as “not wanting to grow up, wanting to stay a child”. This avoidance suggests that the ‘threat’ of adult sexual intimacy is experienced as coercive and dangerous. And if you choose not to perform heterosexual femininity, by starving your female body, you can avoid both danger and ‘failure’. These are clearly not ‘medical’ conditions or problems.
A report by the then government’s Women’s Unit in 2000, found that “Inside, outside and beyond, young men and women are under continuing pressure to conform to traditional behaviour” (Will Woodward, ‘Gender stereotypes still hamper young’, The Guardian. 20 09 2000). 17 years later, in the age of the internet and expanding sexualisation in every corner of UK society, and widespread sexual harassment and violence against women and girls, this problem looks worse.
The Harvey Weinstein scandal in the US and the UK, which unleashed accusations of sexual harassment and rape that range over a period of 30 years or so, has been followed by the eruption of similar testimony about the ‘inappropriate’ (i.e. sexist, invasive, abusive, violent) behaviour of senior men in the UK parliament towards women, particularly young women. (See earlier commentaries, ‘Sexism and activism: What’s the problem?’ and ‘Thinking through “sexism”: Reflections on the challenge for the “Left” (and willing others)’, both written over a period of weeks in 2012 and posted in category Essays 2013 at togetherfornow.wordpress.com)
Hadley Freeman summarises a culture that has endured unimpeded for way too long:
“By the time harassment stories were emerging from journalism, politics, the arts, it felt like maybe this wasn’t about a single industry, a few bad apples here and there. This is about men. Men harassing women, men dismissing women who say they’ve been harassed and now men bleating that they don’t know how to behave around women today, because not inserting sexualised banter into every conversation they have with women is apparently too difficult a concept for them to handle” (‘The evidence is mounting – a man’s place is in the home’. The Guardian Weekend, 04 11 2017).
Darren Jones, the 30-year-old Labour MP for Bristol North West, suggested in parliament: “It shouldn’t be hard for MPs to moderate their behaviour” (cited Heather Stewart, ‘How the drip of allegations turned into a torrent inundating Westminster’, The Guardian, 04 11 2017). He advised:
“It’s very easy to find out if someone’s interested in you without assaulting them: you just ask them; you don’t need to send them creepy text messages or press your groin against them” (ibid.).
What Jones misses in his succinct recommendation, is that this problematic behaviour is not about sex (mutual sexual attraction and the possibility of dating), but the routine abuse of power and male dominance by heterosexual men. Is girls’ and women’s anorexia a response to this pervasive culture of sexual harassment, abuse and violation?
Sometimes the girl or woman knows and is willing to name the trigger for her anorexia. There are glimpses in Theroux’s report: for example, the pressure on a girl/young woman of religious expectations of marriage and children as a duty; the prospect of a forced /arranged marriage; early relational/sexual rejection; bullying or abuse at school.
“A report published a year ago by MPs on the women and equalities committee revealed shocking levels of sexual abuse and harassment of schoolgirls, who complained it was a daily part of life but was often dismissed as ‘banter’ by staff” (Sally Weale, ‘Greening faces legal challenge over pupil-on-pupil sex abuse’, The Guardian, 04 11 2017).
Solicitor, Louise Whitfield, highlights the lack of political attention being paid to this serious problem:
“Repeated promises of new guidance over the last year have not been fulfilled, and every day dozens of schoolgirls are sexually harassed and assaulted without their schools knowing how to handle it” (cited Weale, ibid.).
The above examples provide some idea of the social and cultural contexts/pressures that present a challenge to the mental health of girls and women in our society, including those living with anorexia. However, these may not be considered as part of therapeutic process. Food, on the other hand, figures prominently in the anorexia discourse.
Our primary experience of food/eating is as a social activity, an aspect of intimacy that nourishes us: we start out being fed, as nurture, by our primary carer (usually the mother, at her breast or in her arms). But food is more than essential fuel or nutrition. Reviewing food memoirs, columnist and food writer, Ruby Tandoh quotes Emily Nunn approvingly from her book, The Comfort Food Diaries (2017): “Food has become my touchstone for understanding what real love is”. Tandoh takes up this theme:
“Food pierces to the heart of identity, forging the stuff that makes the bodies and bones of us. . . . The people may be different, the flavours unusual or the places far-off, but the message – that food informs who we are, and how we love – stays true” (‘A table shared’, The Guardian, 04 11 2017).
In the context of anorexia, this is a poignant observation. Anorexia is defined as an eating disorder (not psychosis), a term that rather makes light of its seriousness as a life-changing and life-threatening condition. It disrupts the model of food as nurture and the cultural values it embodies: eating becomes private, solitary, secret, feared and shameful, instead of a sustaining, guilt-free, sensuous pleasure, engaged in as part of human intimacy. It can also become a means of exercising power and control within familial relations, as Theroux’s report glimpses, with perhaps notable consequences for the mother/daughter dyad.
Anorexic process can create a fault-line in the mother/daughter dyad that goes beyond food, because anorexia models difference, implied opposition: that the daughter will not follow the mother’s example regarding heterosexuality / femininity / reproduction. This can constitute (and be experienced as) a rejection of the birth mother, as both a nurturing figure and as a role model, i.e. the means by which the daughter is inducted into normative femininity and its expectations. The mother may be experienced as an agent of social control, and therefore part of the ‘problem’/a trigger.
Anorexia can be therefore be understood as more than ‘disorder’: as a refusal to conform to social norms that require a girl/woman to embody heterosexual identity and male fantasy. This fear of, and aversion to, normative heterosexual responsibility/appearance, result in a closing off of options. It’s as if there is no perceived alternative, and starvation becomes a consuming and defiant distraction: imagined/experienced as power and control.
On the evidence of Theroux’s report, the emphasis of treatment is on stopping the symptoms: disciplinary regimes designed around improving and monitoring food intake (not necessarily appetite), so that the patient can be returned to “normal life”, as the lead therapist breezily summarizes. But there is no evidence of “normal life” being examined, or acknowledged as the source of the problem. (This would presumably be seen as ‘politics’ not healthcare.)
Theroux focuses on residential anorexia services (greatly diminished by Austerity cuts) in medical environments, promptly described by a couple of the women interviewed as “prison”. Treatment is coercive and strictly monitored. This disciplinary model appears to be a process of infantilisation rather than empowerment: guiding (or forcing) the anorexic daughter to become the obedient child, the unreflective ‘good girl’, who can accept ‘femininity’ and its consequences without throwing up. The punitive, disciplinary regime of the medical model reinforces a childlike status. “Do you want to get well?” is asked. “I want to get well” is uttered with varying degrees of conviction. But what does each party to this narrative mean by “well”? What, if any (shared?) meanings are in play?
The medical model of women’s mental health treats anorexia as a medical problem, a technical challenge, as opposed to considering the social determinants of anorexia, its causes and triggers. This inevitably institutes a parent/child hierarchy of victim and authority figure. There is no invitation to understand self and society, nor to achieve self care as self actualization, creative agency and social competence. Crucially, this institutionalised model works to ignore the role of powerful men and patriarchal values in the unravelling of girls’ and women’s mental health in contemporary society. (See footnote at end of this essay.)
Every girl and woman in society has to make her own accommodation with the potential conflict between self-determination and social conformity, between a functioning level of self respect as opposed to self loathing (the lack inculcated by all those industries selling products to ‘cure’ girls’ and women’s [industry-defined] ‘deficiencies’ and ‘sexual imperfections’). Anorexia is perhaps the most extreme and complex of those accommodations: ‘normality’ experienced as trauma, triggers self harm, which leads to life-threatening frailty and vulnerability, mental confusion, and in many cases, death.
In a turbo consumer society in which girls and women are the centre of attention as means and end (as consumed and consumers), being a girl or woman can be a lonely and disturbing place if you do not have good friendship networks with other girls or women, and upbringing and education do not equip you to understand the social forces at work, relentlessly coercing you to ‘participate’ uncritically as a ‘girl’/woman in a market society that drives gender stereotypes as a basis for selling and profit. Defined as a ‘disease’ (a notch up from ‘eating disorder’?), anorexia requires/generates profitable pharmaceutical ‘solutions’, which in turn become legitimised and authorised by the DSM (Diagnostic and Statistical Manual of Mental Disorders). So it’s big business.
The marginalisation of feminist-inspired, women-only therapeutic practices.
Self harm, such as anorexia, must be particularly disturbing for clinicians to deal with. It’s not like a rash or bruise or broken limb. More like protest, anger, rejection, revenge. Anorexia positions clinicians and therapists as gendered, sexual human beings, not just as professional practitioners and figures of authority. Practitioners may not be aware they are deploying gender-neutral concepts of ‘healthy’ and ‘unhealthy’ to frame anorexia as a medical condition, but in 2017 this cannot be viewed as incidental or an oversight. This gender-neutral narrative has become an institutionalized policy: a disciplinary practice (in both senses) that amounts to personal and professional displacement activity, its main function presumably being to enable practitioners to ‘manage’ their role and their relationship with their challenging and bewildering anorexic clients, without being reminded of what they have in common, for example, in terms of society and the social and sexual scripts on offer.
The medical model of mental health thus functions as a distancing device towards those in distress; and the “medicalisation of distress encourages us to see them as having a context-less ‘illness’” (John Read & Jacqui Dillon, ‘Creating evidence-based, effective and humane mental health services’ in Read & Dillon  Models of Madness: Psychological, Social and Biological Approaches to Psychosis: 394).
As a society, as clinicians and therapists, are we identifying this dis-ease we call anorexia as ‘personal’ failure? Do we blame the individual for ‘embarking on’ such a destructive trajectory? Do institutional practices in turn punish her as a culprit? Why is there so much reluctance to scrutinize and challenge the ‘traditional’ social norms that act as obstacles to girls’ and women’s safety, confidence, creativity and ‘health’? Managerialism rules.
“The moral complexity and ambiguity that is inherent in the enterprise of policing human conduct is neatly reduced to the morally neutral and more predictable activity of managing a bodily disease” (M. Rapley et al 2011, De-Medicalising Misery: 4, cited John Read & Jacqui Dillon : 394).
Why is there so little political and professional acknowledgement of the accumulated evidence of women’s experiential testimony, feminist research and scholarship that already exists? Why have these experiential, analytical and critical women’s voices been so disregarded? The novelist, Carol Shields, provides a clue. The following is excerpted from a letter written by the narrator (mother/wife/writer) to Dennis Ford-Helpern, in Carol Shields’ complex and life-affirming, final novel (1996), Unless:
Ford-Helpern has written a book about moral problems, in which ‘All the problem-solvers in your examples are men, all fourteen’ (Shields: 219). The narrator writes to protest, in the nicest way possible: ‘I don’t think you intend to be discouraging in your book. I think you have merely overlooked those who are routinely overlooked, that is to say half the world’s population’ (ibid: 220). Unless is a book of multiple strands and meanings, one of which is what it means to be ‘real, ‘good’, ‘moral’, ‘sane’; and the conditions for and obstacles against these states of consciousness and being. Shields offers us the means to explore ourselves, our world, in all our vulnerability, frailty, and strength. We accompany her characters to the edge and beyond. See also the work of Algerian-born, French writer, Marie Cardinal (1991; 1993; 1996). The Words to Say It (1993) has been described as ‘world-renowned as the most important book ever written on the personal experience of psychoanalysis and the journey through therapy to recovery’ (The Women’s Press, 1996).
The women-only spaces, services and organisations, such as women’s refuges, domestic abuse services, Liverpool’s RASA (Rape and Sexual Abuse Centre), VAWG ( Violence Against Women and Girls) organisations, such as IMKAAN, a UK-based black feminist organization dedicated to addressing violence against women and girls, and women’s studies courses in colleges and universities, were developed as a result of feminist activism, research and analysis since the 1970s, explicitly and critically rooted in women’s lived experience of disadvantage: misogyny, racism, homophobia, poverty, subjugation, violence and despair. They openly articulate the importance of anti sexist, anti racist, anti lesbophobic practices supportive of women in our diversity, for example regarding social class, ethnicity, age, neurodiversity and ability. Feminist methodology is fundamental to overcoming fear, healing psychic wounds and achieving empowerment. (See ‘”Into the sunlight”: Gender, narrative, (mental) health. Resources for a missing conversation’ in category Conference Presentations 2005 at togetherfornow.wordpress.com)
A women’s mental health group in Liverpool, located within the statutory provider, Merseycare, brought together women from a range of services and sectors, as both service users and providers. Significantly, it called itself WWW: What Women Want. Over several years, it researched and produced powerful reports on a range of issues, giving voice to women’s experiences, sharing best practice and making recommendations to service funders and providers. In 2017 it was one of the many casualties of Tory Austerity cuts.
A user-led group of women and men that meets in Liverpool, significantly called, ReVision, continues to facilitate the sharing of experience, strategies and ideas, explicitly challenging the medical model of mental health. In both these groups, intellectual engagement joins with experiential sharing to supersede a ‘parent/child’, ‘victim’/disciplinary model of mental ‘disease’. This is in line with the work of ISPS (The International Society for Psychological and Social Approaches to Psychosis), and INTAR (The International Network Towards Alternatives and Recovery). (See ‘A shared “somatic crisis”: enough common ground?’, presented at the INTAR conference, Power to Communities: Healing Through Social Justice [25-27 06 2014]; posted in category Conference Presentations 2014 at togetherfornow.wordpress.com)
There is no evident intellectual dimension to the medicalised approach to anorexia. Treating the ‘disappearing’ woman as a child, reinforces her lack, rather than igniting desire and appetite. Yet it is possible to substitute disciplinary constraints as therapeutic practice, with a model based more in feminist-aware educational, therapeutic and creative practice. For example, by contrast, talking, reading, writing, drawing, singing and dancing variously feature in an environment that addresses the whole woman and her understanding of her context. Nor does treating anorexia as a medical problem appear to be a successful strategy, judging by the high remission rates and the average time taken to ‘recover’ (given as 7 years).
“A 200,000 strong study found that young people in the UK have the poorest mental wellbeing in the world, with the exception of Japan” (cited Moya Sarnev, ‘Campus confidential: the counsellors on the frontline of the student mental health crisis’, The Guardian Weekend, 28 10 2017). “ONS figures show that in the last 10 years, the number of student deaths by suicide has risen more than 50%” (ibid.). But as usual, these statistics are not disaggregated to make visible the different experience of women and men. And “The 2016 Hepi (Higher Education Policy Institute) report notes that in some institutions the funding for counselling services is less than £200,000. [The average pay for university vice-chancellors now exceeds £275000]” (ibid.).
While demand has grown across the country for mental health provision, and Tory rhetoric acknowledges the problem, services have been slashed by Tory governments since 2010. While demand has grown for women-only services over the years, these services have struggled to stay afloat in a political climate that has hardly eased its suspicion of women-only spaces and feminist initiatives and campaigns that seek, for example, to mitigate and heal the wounds inflicted on girls and women by heterosexual men’s sexual harassment, misogyny and violence: their unregulated gender-based power.
Yet there are young women students today who, offered mental health sessions that are “practical, positive and solution-focused” . . . with no suggestion of delving below the surface and into the past to explore where these problems might stem from, are not interested in therapy that might ask these sorts of question (Sarnev, ibid.): “I’m just interested in finding ways to deal with it, seeing if I can try to resolve it, rather than looking at why it started” (cited Sarnev).
This is an instrumental, problem-solving approach to mental health issues, which implicitly defines mental health as a technical challenge. Perhaps because of the ubiquity and power of hetero-patriarchal dominance in contemporary society, this may seem the ‘safer’ (i.e. least demanding, disturbing, disruptive) option, for both service user and therapist. A mutually acceptable pact. But in a neoliberal society, in which individualism and autonomy rule a market economy, girls and women (perhaps especially students) will be wary of identifying themselves as ‘victims’ in need of help: experienced as stigma, rather than as a political act, this can be seen as adding to their gendered disadvantage, rather than empowering them.
But in the context of a society seemingly determined to avoid confronting and articulating the politics of women’s mental health (i.e. our collective position and experience in society), this behavioural approach gets close to submission: a polite deferral of girls’ and women’s full and equal citizenship, not just as individuals, but as a political constituency with clout.
I have suggested that there are two (longstanding) limitations to the evidence presented in Theroux’s otherwise sensitive report, which together have significant consequences for our understanding of anorexia and its ‘treatment’: the acceptance of the medical model of women’s mental health as applied to anorexia; and the evident lack of feminist analysis and understanding within mental health services, which denotes a lack of feminist institutional presence and professional power, resulting in what could reasonably be described as culpable negligence and avoidable ignorance.
As a consequence, by politely displaying the evidence of anorexia in women’s lives through the lens of its official medicalisation, Theroux takes the MSM route, and avoids critical engagement with the evidence, and by extension, the politics of women’s mental health. The bestselling author on “race, fitting in and giving a voice to those without power”, Celeste Ng, asks:
“whether progressives who politely follow the rules yet give up nothing that really costs will ever achieve meaningful change. The surface may appear smooth but lurking problems will eventually rise: disruption is required for truths to be revealed” (cited in interview with Paul Laity, ‘”When you’re in a marginalized group, your existence is politicised for you”’, The Guardian, 04 11 2017). Emphasis added.
The disturbance we are ‘allowed’ by Theroux is mainly at the level of being positioned as appalled spectators: bystanders to a ‘context-less illness’, rather than having our own identities and lives thrown into the mix, thereby removing the protection of the ‘them’ and ‘us’ binary. But the social, cultural and political context in which we now view this report has been overturned: as I mentioned earlier, in the week of its screening, and since, UK society has erupted, forcing the issue of men’s predatory heterosexual behaviour and abusive power to the fore as never before.
The medical model of women’s mental health makes no sense (nor is it meant to): it is an act of denial regarding the role of men’s predatory heterosexual behaviour and society’s acceptance of a masculinity that seems to depend on the submission, subjugation and control of girls and women for its own ‘health’. Girls and women as collateral damage in the ‘war zone’ we call society, attests to a squalid and brutal inequality that no decent society should tolerate, and no political culture in 2017 should simply emulate, feign confusion – and then apologise for.
See, for example, a selection of unpublished letters to The Guardian at togetherfornow.wordpress.com: (02 07 2010) Opening a dialogue on rape, violence and gender [posted 19 09 2013]; (06 07 2011) Rape, violence and gender: the new normal? (posted 19 09 2013]; (07 04 2013) The Philpott case and the media: sensationalism, denial, obfuscation, irresponsibility. [posted 19 09 2013]; (17 05 2013) Daniel Cohn-Bendit: children of the ‘revolution’ [posted 19 09 2013]; (02 06 2013) Gender, violence and the media: free speech or irresponsible speech [posted 19 09 2013]; Anachronistic conduct [posted 21 01 2014]; Gender-neutral language ‘disappears’ men and masculinity [posted 20 04 2014]; Murder in a UK classroom [posted 02 05 2014]). There are other related posts in other categories since 2014.
val walsh / 07 11 2017