Hunger Artists

BY PHYLLIS ROSE

FASTING GIRLS: The Emergence of Anorexia Nervosa as a Modern Disease by Joan Brumberg.

CONVERSATIONS WITH ANOREXICS by Hilde Bruch, edited by Danita Czyzewski and Melanie

THE DUCHESS OF Windsor said, “A woman can never be too rich or too thin,” but she was wrong—at least about thin. Too many women suffer from anorexia nervosa, in which the pursuit of skinniness becomes a killing obsession. There are anorexic jokes—“Of course I had breakfast. I ate my Cheerio!”—but with the highest fatality rate of any psychiatric illness {one out of ten patients dies), anorexia is no laughing matter.

Although anorexia means “lack of appetite,” anorexics don’t lack appetite; rather, they pride themselves on resisting it. Like Kafka’s prophetic “hunger artist,” whose art consisted in his ability to go without food, the anorexic considers her refusal of food an accomplishment and starving a way to achieve distinction. One anorexic quoted by Dr. Hilde Bruch described how pleased she was with herself for being a size one: when she walked into a store and asked for size-one dresses, everyone turned around to look at her. “Before that I was real common; all my friends seem to

wear size 5 or 7, and I didn’t like just being one of the crowd.”

Now epidemic, anorexia seems to have come out of nowhere, but in Fasting Girls, Joan Brumberg gives it a past. Brumberg, a historian, is the director of the Women’s Studies program at Cornell, and her book is an example of how excitingly women’s studies has evolved, from clunky work about “female stereotypes” in the early 1970s to subtle explorations of the way in which culture (especially gender) shapes experience. For Brumberg, even illness is a cultural artifact, and the way people express physical and psychic pain depends on class, age, sex, and other cultural variables.

She couldn’t have found a better disease to make the point that “being sick is a social act.” Anorexia nervosa is overwhelmingly a disease of women—90 to 95 percent of the people who suffer from it are female. Moreover, it has been conspicuously a problem of the upper-middle class, a disease of affluence. Although anorexia is rare in the American population as a whole—perhaps 1.6 cases per 100,000 people—among adolescent girls and young women the incidence of anorexia has been put at five to 10 percent, rising to as high as 20 percent on some college campuses. The more privileged and ambitious the young women, the more likely they seem to develop anorexia. Its typical victim is the good daughter in a tightly knit family that seems to have no problems or conflicts. In fact the families of anorexics are often too close. Harmony has been achieved through excessive compliance on the daughter’s part, and when she is supposed to become independent, she can’t. A girl who has come

to feel incompetent may use the disease as a way to establish her own area of power and control. “You make out of your body your very own kingdom,”one anorexic said, “where you are the tyrant, the absolute dictator.”

Brumberg considers three models for understanding anorexia—the biological, the psychological, and the cultural. The biological model presents the disease as a nervous dysfunction (most likely of the hypothalamus) and would treat it with hormones or drugs. The psychological model considers it a response to the developmental crisis of adolescence. Taking its direction from the work of Hilde Bruch, the leading clinician and theorist in this field, it sees food refusal as an expression of the desire for autonomy and control over sexual development. Appropriate treatment is individual psychotherapy or family therapy, which was first used extensively to treat this disease by Salvador Minuchin, as described in his book Psychosomatic Families.

The cultural model focuses on the worship of the thin female body and places the anorexic’s panicky fear of gaining weight in a cultural context that, through all the visual means at its disposal, associates happiness with being thin. At its most extreme, in the work of some academic feminists who equate mental disturbance with resistance to patriarchy, this view slides into a presentation of anorexia as a paradoxical political protest. Brumberg disagrees: “I believe that the anorectic deserves our sympathy but not necessarily our veneration.” Although she favors the cultural model, she finds all three models appropriate and even necessary to explain the disease, distinguishing two stages in an anorexic’s history—“recruitment, ” which cultural factors best explain, and “career,” for which physiological and psychological explanations are most satisfactory. That is, a girl will begin to refuse food for reasons best described by a cultural historian (she diets to be thin because thin is considered beautiful) and will then spiral into illness for reasons best explained biomedically.

It takes a canny historian to make the connection between medieval piety and contemporary illness: an anorexic like the singer Karen Carpenter, who starved to death in pursuit of a sublime thinness, and a medieval fasting saint like Catherine of Siena, who starved as an act of piety, are presented as two ends of a long line of women expressing themselves through appetite. There are other similarities between medieval anorexia mirabilis (miraculously-inspired loss of appetite) and today’s anorexia: “anorexia nervosa appears to be a secular addiction to a new kind of perfectionism, one that links personal salvation to the achievement of an external body configuration rather than an internal spiritual state.” Nevertheless, in drawing a line of continuity between medieval saints and modern anorexics, Brumberg is careful to distinguish between them. As she puts it, Karen Carpenter and Catherine of Siena did not die of the same disease. Here her elegant distinction between recruitment and career comes into play. The recruitment stage of anorexia mirabilis was totally different from that of anorexia nervosa, even though the starvation, once established, followed a similar course.

In the nineteenth century “fasting girls” made news periodically by their stupendous feats of food refusal. They were often presented as pious creatures on the medieval model, but Brumberg shows how their status was contested by the new medical establishment, which wanted them seen as victims of illness. The doctors won, food refusal became secularized, and the hunger artist moved from sainthood to patienthood.

By the 1870s anorexia had been identified. There were documented cases, medical histories, a diagnosis. A French doctor, Charles Lasegue, understood the disease as a dysfunction of the bourgeois family system almost a hundred years before family therapy became a clinical option. Of course it had to be a French doctor, Brumberg notes, because, being French, he saw more clearly than others that food was central to family life.

Wanting to be thin because it looks good turns out to be a passing historical moment in the history of anorexia. T he disease has more fundamentally to do with food’s place at the center of a symbolic network involving gentility, spirituality, sexuality, and family love. Long before Chanel and the flapper silhouette, women were anxious about food, and Brumberg explains why.

A family that hardly otherwise meets is likely to meet over the dinner table. A family that hardly otherwise disciplines its children will train them to eat in certain ways. Correct eating has been an expression of gentility since at least the nineteenth century, with pressure exerted particularly on girls to eat discreetly. Remember Scarlett O’Hara’s eating in her room before the picnic? In extremely genteel circles it was thought that a woman should not be seen eating at all. Eating reeked of carnality. What went in must come out. With symbolic material like this, with such connotations and prohibitions, it’s no wonder women used their eating habits to make statements on other subjects.

WHY is THERE AN epidemic now? Why, as Brumberg puts it, have food and eating become a psychological battlefield for middle-class young women? As she sees it, you can’t explain the proliferation of the disease, which seems to be spreading beyond its middle-class base, with psychological or biological models. Culture is essential. She notes, in addition to the relentless selling of slimness by fashion magazines, a renewed preoccupation with food. Our palates have expanded and become international .since the Second World War. More food is available: even among ice creams, among goat cheeses, the choice is enormous. The overabundance of interesting food in a society that hates fat demands ever greater self-control. Among urbanites issues of status and identity are often involved in choice of restaurants and styles of cooking. “We could get close with David and Elizabeth,” said one New Yorker cartoon, “if they didn’t put bearnaise sauce on everything.”

As the obsession with food grows, so too does the problematic nature of heterosexual maturity. Girls are warned more now than they have been for decades about the dangers of sex. More selfcontrol is now expected of them in this area, too. A competitive generation reacts competitively even in its ill-

nesses: anorexics push themselves to outdo their peers in skinniness and, in the eighties, combine hyperactivity with self-starvation. “Sadly, the cult of diet and exercise is the closest thing our secular society offers women in terms of a coherent philosophy of the self,” Brumberg writes. It all makes so much sense that by the time you have finished this book, you wonder how any girl escapes anorexia.

THE PSYCHIATRIST Hilde Bruch, who died in 1984, devoted her long and distinguished professional life to the study of anorexia. In the 1960s the illness was virtually unknown in America. Bruch put it on the map, first with Eating Disorders, in 1973, and then with The Golden Cage, in 1978. The books in turn affected the course of the epidemic, as Bruch herself said. “Formerly no anorexic patient had ever heard of such a condition; each one was, in a way, an original inventor of this misguided road to independence.” As the disease became well known, it entered the adolescent repertory of gestures. Me-too anorexia increased, and Bruch wondered if the illness would lose one of its characteristic features—that it represented to the victim a very special achievement.

The books established Bruch as America’s leading expert on anorexia, and anorexics followed her from all over the country to Houston, where she was teaching at Baylor. Conversations With Anorexics, a posthumous volume edited from Bruch’s dictated draft by two of her associates, describes in some detail the actual course of her treatment of several patients. There are themes in her approach: she refused to engage in discussions of food with anorexics but plunged directly toward the personality disorders underlying their food refusal, and she tended to see a radical absence of selfesteem as the root problem, produced by well-meaning but intrusive parents, whose very kindness toward their children sometimes inhibits their independence. A supremely gifted therapist, she inspired trust in these notoriously difficult patients, all of whom (it is sobering to realize) had failed in treatment with other psychiatrists. Her evident concern for them, her respect for their intelligence, her imaginative understanding of their obsession, her insistence that any cure involves joint work—these seem to be the secrets of her success.

The obvious audience for this book consists of therapists and anorexics and their families, but others will want to read it too, including therapy voyeurs like me who find it as irresistible to listen to other people’s privileged conversations as to read their collected letters. In this respect Conversations With Anorexics, which is organized thematically and reverts under different headings to talks with the same patients, is less gripping than Salvador Minuchin’s Psychosomatic Families, which provides exact transcripts of therapeutic sessions. It is also less satisfying than Bruch’s evocative classic on anorexia, The Golden Cage. Nevertheless, a complete course of reading in this subject should include Conversations for its vivid representation of the anorexic’s inner world.

ANOREXIA IS SO metaphorical that people are unusually eager to say what it means. “It’s all about control.” Or “The point is postponing sexuality.” I know a former anorexic who says that in the days when it took her two hours to eat an apple, all she wanted was to be thin. Simple as that. Much simpler than the experts make it. “They’re wrong to say anorexics lack self-esteem. I thought I was the greatest. I thought I looked fabulous. My friends said I looked awful, like someone in a concentration camp. I thought they were saying that because they were jealous. They wanted to destroy this beautiful thing I had created.” It is eerie to hear someone speaking just like Hilde Bruch says anorexics speak, providing textbook examples of the use of the disease as an achievement to mask low self-esteem, of distorted body image, and of competitiveness. “And you know,” my stable and reasonable friend goes on, “part of me still thinks I never looked better and my friends were just jealous.” Another friend, a mental-health professional, supports her suspicion: “There were these two angels on the ward. You could practically see their halos, they were so beautiful, so ethereal. Then they got cured and looked like everyone else.” (Men who think that women aspire to look like Marilyn Monroe or some other curvy movie star don’t understand the power on female imaginations of fashion magazines and their anorexic models.)
An artist named Eleanor Antin did a conceptual piece in the late sixties or early seventies that I’ve never forgotten. It consisted of nude photographs of herself taken at intervals over some months while she dieted. The photos recorded the gradual sculpting, as though by an

invisible Praxiteles, of her body into ever more iovelY forms—an inspired tribute to an art many practice who would never wield brush or chisel.
You can draw the line wherever you want—pierced ears and sculpted nails are where I call it quits—but there are few American women, no matter how serious about business, politics, or the life of the mind, who do not participate in creating their bodies as works of art. When I sit down at my makeup table, look in the mirror, and improve my face with pencil, shadow, mascara, and blush, I feel part of a tradition that includes Cleopatra, Colette, Simone de Beauvoir, and Gloria Steinem. When I try to think of women I respect whom I can’t imagine sitting in front of a mirror and making themselves up, I think of two—Virginia Woolf and Simone Weil— who were probably anorexic. One way or another, it gets to you. That’s why I suspect that many women who never had anorexia, who rather wish they’d had a touch of it, will be as fascinated by these books as I was. Although we may not follow the anorexic across the border into self-destructive illness, many of us, weighing ourselves daily, anxious about eating, wary of calories, obsessed with food, regarding our bodies as a willed achievement, can feel with her a frightening kinship.