“Perhaps I am no one.
True, I have a body
and I cannot escape from it.
I would like to fly out of my head,
but that is out of the question.” (p. 28)
– Anne Sexton, “The Poet of Ignorance,”
The Awful Rowing Toward God (1975)
No body for nobody
“I cannot convince myself that I am sick and that there is anything from which I have to recover,” a patient named Alma says, insisting upon her identity within the illness (qtd. in Bruch, 2001, p. 2). Can we be said to exist for ourselves if we have defined our existence, both our bodies and our minds, through the eyes of others? This way of living, wretched as it sounds, would be like a life on a screen, except we perform this or that without truly being in our bodies, becoming as if spectators in seeing the self from afar. A problem, among those produced by this non-being, seems to be one’s dependence on being seen as either this or that, something of somebody else’s imagination. Independent from life enlarged only under others’ eyes, the establishment of a sense of self, an integrity of one’s mind in one’s body, what one might call self-reliance, seems of true importance not only for our bodies but also for ourselves.
I illustrate here, albeit short for our sake, a sketch of what life can feel like when one finds the body not as the self, but rather as another―more precisely, the other. Rather than being a “temple,” as one thinks of the form of the virginal female, the body ends up becoming a prison from which the self looks beyond the flesh and the bones. One might feel as if there is nobody, or even nothing, there. Other forms of being ill could be offered for study in the relation between mind and body, but we will consider anorexia nervosa, a psychopathology of awe in what it speaks of the body split from the self.
As German-American psychiatrist and psychoanalyst Hilde Bruch writes, anorexia nervosa seems to be “an incorrect name for this illness” (2001, p. xxi). As Queen Victoria’s physician Sir William Gull termed it in 1873, it involves an- (ἀν-, this prefix denoting negation) and orexis (ὄρεξις, meaning “appetite”), with “nervous”―that is, “nervous absence of appetite.” But this misnaming seems to be that one does not merely exhibit the absence of an appetite, still just something of the nerves; indeed, the illness demands further analysis. It is more than simply the split between one having an appetite versus not having it.
According to American social historian Joan Jacobs Brumberg, in her 1988 book Fasting Girls, Dunglison’s 1865 dictionary, although considering anorexia itself as “absence of appetite,” did not yet define it as a disease of its own (2000, pp. 100-101). At the time, it had been seen as a symptom that would coincide with other diseases causing a decrease of flesh on the bones. The development of the modern disease, at least as we know it now, would come much later, perceived in more recent decades not as a physiological condition, but rather as a psychological one. Defining a disease as either physical or mental defines―and even complicates, sometimes overcomplicates―its actual treatment, from the Victorian asylum to the modern clinic.
Historically, the problem that has plagued the treatment of anorexia nervosa has been how, as a psychopathology, it arises from interacting, even underlying and unseen factors, both psychological and sociological as well as biological and physiological. The complexity of the condition has made for difficulty in treatment, aside from complicating the communication necessary between patient and therapist. In her 1973 book Eating Disorders, Bruch writes:
Anorexia nervosa is not a static condition, but its very existence constantly provokes new problems, and patients come to our attention at various stages of their illness. The state of starvation itself is associated with marked psychological changes which are often denied or camouflaged by rationalized explanations. The patterns of interaction in a family undergo marked changes, with progressively rising anxiety and concern, but also rising annoyance and resentment. In addition, the social isolation deprives them of the new and broadening life experiences so necessary for and characteristic of the adolescent years. (1973, p. 215)
In both Eating Disorders and her 1978 book The Golden Cage, Bruch particularly considers, as we see, the interaction between the physiological and the psychological, namely the impact of starvation on one’s thought processes. In addition, as seen with Italian psychiatrist Mara Selvini Palazzoli’s 1974 book Self-Starvation, Bruch points toward the dynamics of family communication and the profound impact on the psyche. A factor seen above, which perhaps applies even more so to our time than before, is “social isolation,” feeling paradoxically worse even in our time of social media.
Here, as part of what I consider to be an ongoing project in the study of the body and its being, I will bring us through some literature, with a special focus on case studies from Bruch.
Split selves and “the great put-on”
The split between the mind and the body seems of significance with anorexia nervosa as with other illnesses of the mind that affect the body. Among the cases discussed in his 2014 book The Body Keeps the Score, psychiatrist Bessel van der Kolk notes the circumstances of a patient named Mary. As Kolk describes her, Mary had been in psychotherapy “dealing with the ravages of her terrible history of early abuse” (2014, p. 279). At three months into psychotherapy, Kolk encountered another self within Mary named “Jane,” dressed differently than Mary, telling him not to trust Mary. Over the course of their sessions together, Kolk tells us that, more than Jane, he encountered “a hurt little girl and an angry male adolescent,” marking “the beginning of a long and productive treatment” (2014, p. 280). For Kolk, his work with Mary had marked his first experience with a patient exhibiting dissociative identity disorder (DID), then, as of that case, called multiple personality disorder.
As with any similar illness, even being itself psychological, symptoms around anorexia nervosa can be mild to severe, aside from varying along with other symptoms. Most striking among the symptoms, at least in analysis of the case studies, seems to be the fear of femaleness exhibited by many girls. Otherwise feminine, one girl named Dawn had described her otherwise “sweet, compliant, submissive behavior” as “the great put-on,” that is, her “whole life had been something of a performance” (Bruch, 2001, p. 54). She came to believe, in a sense, that artificiality, whatever gender she felt that she must perform, must be her only authenticity.
According to Bruch, the girls lack a sense of self-direction, mostly exhibiting a kind of fragmentation of the self. “Many experience themselves and their bodies as separate entities,” Bruch adds, “and it is the mind’s task to control the unruly and despised body” (2001, p. 55). The girl learns to see her own flesh as something foreign to her, feeling as if the self must be born by her despising the body, hating that it holds her. Bruch tells us that there is a part of the self, this other self, that embodies everything denied of the girl’s desires. She goes on:
When they define this separate aspect, this different person seems always to be a male. Though few express it openly, they had felt throughout their lives that being a female was an unjust disadvantage, and they dreamed of doing well in areas considered more respected and worthwhile because they were ‘masculine.’ (Bruch, 2001, p. 55) (emphasis mine)
For the female, the fantasy of maleness, this fiction of a male self, becomes an expression of the innermost urge to be free from femininity. Thoughts like these do tend to follow with the desire of the girl not to grow up into womanhood. Elsewhere, Bruch writes:
In other girls, reaching puberty may be the end of a secret dream of growing up to be a boy. Only a few admit frankly that they would have preferred to be a boy. Some will talk about it when they start to express their disgust with the female body. (p. 69) (emphasis mine)
Fear of menstruation, which seems to be a significant feeling expressed by girls with anorexia, cannot be underestimated as part of what engenders the individual girl’s own fear of her femaleness. The girl fears the otherwise natural process of even growing up. Throughout Bruch’s work, we might notice the repeated appearance of girls feeling a split between their minds and their bodies, also possibly linked, in some cases, with abuse―indeed, an overlooked influence.
As Susan Bordo writes in her 1993 book Unbearable Weight, mind-body dualism, the point of view from which one perceives the body as a prison holding “the inner and essential self,” has its roots in the Western philosophical tradition (1995, p. 144). That is, the idea that the self is separate from the body can be found in the philosophical works of Plato, Augustine, and Descartes. Although most with anorexia nervosa, especially the very young, might not themselves read these philosophers, these influences remain but a few surrounding factors in society. It tends to intersect with the mortification of the flesh, whether religious or nonreligious, and the mystification of the body itself, especially fitted onto female bodies as metaphysical binding. We see the split self embodied, or rather disembodied, even dismembered, in the ideology of “pain is beauty.”
“My real shape, my boy shape, my ‘normal’ shape”
“The anorexic body seems to say: I do not need. It says: Power over the self. And our culture, in such a startlingly brief period of time, has come to take literally the idea that power over the body has a ripple effect: power over the body, over the life, over the people around you, power over a world gone berserk. We are about to watch one person’s systematic, total loss of any power at all.” (p. 85)
– Marya Hornbacher, Wasted: A Memoir of Anorexia and Bulimia (1998)
American―and, later, German―sexologist Shere Hite has pointed toward the problems arising from the mystification of the female body. As psychosexual development occurs differently in girls versus in boys, namely in terms of sexual being in the body as the self, we see the mystifying of femaleness mark the teenage girl, in particular. Hite suggests that the relationship between a mother and her daughter, herself developing into womanhood from girlhood, can become strained in part because the mother feels unable to speak of sex. Seen as taboo, the sex question becomes a subject to keep secret. But this secrecy toward female sexuality, the making of the daughter’s body into a mystery, presents certain problems for her sense of self. On her fear of sexual development, arising from a dread of her mother discovering her maturing femaleness, one girl had reflected:
I dreaded the moment my mother would discover I had breasts. I was disgusted when I developed hips. I decided I’d better diet to get back to my real shape, my boy shape, my ‘normal’ shape. At my all-girls school, big breasts were considered tarty; small were better. Having your period later was better too. We were part of the anorexia cult, we were all so thin we began menstruating very late. I desperately didn’t want to become like my mother. I wanted to stay a child, a young girl, forever―not become one of those hated women. (qtd. in Hite, 2006, p. 307) (emphasis mine)
This girl, as we see here, had grown to feel a sense of disgust toward her otherwise natural female development, growing fearful of her developing breasts and hips as signs of that sexual development into femaleness. Of significance, she refers to “my real shape, my boy shape, my ‘normal’ shape,” framing her own femaleness as Other, where her mind, seemingly identified with a fantasy of maleness, has come into conflict with the reality of her developing female body. Hite tells us that this reaction to the mother’s silence manifested in the daughter “thinking that her new, developing body was ‘not her,’” as she “tried to get rid of parts of her body that were feminine―reminding us of the problems of anorexia” (2006, p. 307). Seeing it said as “the anorexia cult,” brings to mind enculturation. One makes an entrance into a culture under which, in its social contract, one internalizes both its norms and values, even at the expense of one’s individuality.
Girls’ fear and family communication
Family communication poses certain problems, already seen in some ways here, to the development of both boys and girls, with lifelong consequences, particularly with regard to psychosexual development. As Selvini Palazzoli and Bruch have observed, such circumstances, among others, can be contributing factors to engendering anorexia nervosa. Hite adds:
Girls especially find gender inequality in the family mixed with love hard to understand, confusing, even terrifying. This is, of course, because for girls seeing this reality means vowing that ‘my life will be different’ or coming to terms with the position of women in the world, either despising their mothers for ‘letting it happen’ or ‘understanding.’ Girls in such families wonder: Can they avoid being considered lesser beings when they become women? How can they love a father who represents such a system? Or a mother who lets herself participate in it? What can love mean for them? (2006, p. 336)
In addition to Hite’s questions above, we might ask: What is the status of women, and, more significantly, would a girl want to grow up into a woman if seen as subordinate? The impact of society on the psyche cannot be overstated. And, once again, we observe the theme of the perception of female powerlessness versus the fantastical promise of male powerfulness. If the father is a tyrant and the mother is a slave, then it should be no surprise that the girl feels massive conflicts about maturity. For better or worse, familial interaction, as internalized within the imagination of the child, provides the critical framework through which the child relates to the society around the self.
Within Bruch’s studies, the case of Laura seems indicative of this sort of situation described above. A girl, she grew to admire what she saw as the perfection of her father, whose admiration she craved, and whom she felt never showed his true feelings. Bruch writes:
As the anorexia persisted, she also expressed concern about the quality of her parents’ marital relationship. She felt her mother maintained what only looked like harmony by being always conforming and obedient to what the father wanted. Now she was impatient with her mother because she saw in her what she dreaded would be her own fate―to be a nothing, to be devoted to a husband, to be devoted to her children, but without a life of her own. (2001, p. 29)
Seen here, Laura’s battle against her body, the sense of fighting her own flesh, had seemingly manifested from an inner fear of being molded into her mother’s state of subjection. “The anorexic grows up viewing her body as a reflected image of the desires of others,” Noelle Caskey writes. “It is not herself; it is something exterior and foreign, and at the same time more relevant to others than to herself” (1986, p. 179). One sees one’s own body as other than oneself. With Laura, as in other cases, her obsession with the body, followed by its discipline and punishment, had thus denoted that very desire to run away from the rigidity of the sex-role stereotyping she felt that she must inherit.
Producing the problem in the project
In her 1997 book The Body Project, Brumberg notes that, as time has progressed, “most adolescent girls control their bodies from within, through diet and exercise, rather than externally, with corsets or girdles” (p. 123). Binding the body into this or that shape, the corset here comes from the inside rather than coming from the outside. In our time, however, one could argue that there seems to be a mixture between controls upon the body both externally and internally, as the female body transitions from individualized “project” into socialized “product.” Applied to anorexia nervosa, we might consider a phrase Bordo uses: “psychopathology as the crystallization of culture” (1995, p. 141). This illness provides, at a glance, a picture of cultural ideals as imposed upon the female body.
Although Brumberg praises more recent generations for being more attentive to cultural pressure, analyzing consumerism and culture, she finds it troubling to see the neglect of any serious historical understanding of the body. Namely, many, especially young women, have not seemed to notice “the historical process by which women exchanged external controls of the body for internal controls” (Brumberg, 1997, p. 197). That is, they have neglected understanding the historicity of body politics and the way in which the body has become a site to signify the self, felt so deeply by anybody coming of age.
Cultural ideals of femininity, which, at this point in history, present conflicting images of virgin and whore, with sex-role stereotypes increasingly emphasized, take a toll on girls. Further, we cannot forget intertwining capitalism and consumerism as well as the significantly negative impact on female self-image, which arises in a context of the female body being seen more as a commodity. Toward the end of her book, Brumberg tells us:
Contemporary girls are in trouble because we are experiencing a mismatch between biology and culture. At this moment in our history, young women develop physically earlier than ever before, but they do so within a society that does not protect or nurture them in ways that were once a hallmark of American life. Instead of supporting our early-maturing girls, or offering them some special relief or protection from the unrelenting self-scrutiny that the marketplace and modern media both thrive on, contemporary culture exacerbates normal adolescent self-consciousness and encourages precocious sexuality. (Brumberg, 1997, p. 197)
While, in some ways, women have gained somewhat greater freedoms, at least perceivably so, it matters, as Brumberg writes, to make note of how otherwise normal feelings during adolescence have been distorted. Even human sexual development, which corresponds with conflicts of self, can become packaged as pathological in our time. The contemporary lack of critical attention toward the historical position of women, which Brumberg observes as odd, has made possible the propagation of a “freedom fallacy” that has simply reproduced the subjection of women.
She becomes it, as it becomes her
“These bandages of image wrap my head
when I put my hand up I hardly feel the wounds.” (p. 5)
– Muriel Rukeyser, “Poem Out of Childhood,”
Theory of Flight (1935)
“We are not only what we eat, we are what we feed our children,” Orenstein writes (2018, p. 351). Her observation here applies to more than just what we eat in terms of feeding ourselves and our children, although, as Bruch would argue, meeting needs of nutrition does matter for the mind. But, still, Orenstein’s words could be further applied to our interactions with children around us, whether positive and negative as factors in the development of the mind in relation to the body for the child.
Far more so than male children, female children, from a very young age, learn to fixate on what their bodies look like rather than what their bodies can do. Having done much research and having written a few books on girlhood, Orenstein tells us that, not to much surprise, making life better for our girls seems far easier said than done, for many reasons. In her 2011 book Cinderella Ate My Daughter, Orenstein writes of the advice to parents we assume to be the easy fix: “stress what your daughter’s body can do over how it is decorated” (p. 137).
All other typical advice might sound something akin to us needing to praise our girls for their achievements, not their appearance; to promote their participation in team sports; and to encourage volunteerism and foster media literacy. But Orenstein adds that, like anybody practiced in delivering what seems, at first, like infallible words of wisdom, she had “rattled off those solutions with the greatest confidence and authority”―that is, until she had a daughter of her own (2011, p. 137). It would seem like, with decades of ongoing studies, many of which can be seen in the International Journal of Eating Disorders, we would have a solution, or something closer to it. But we have yet to find a cure, an immunization of sorts, for this peculiar infection of the psyche.
Against the artificial
Seeing how the symptoms manifest for teenage girls with anorexia nervosa, as seen in other psychological disorders, clinical practice must take care not to misdiagnose, and thus mistreat, this disorder. To assume it as another, followed by medicalization, could do far more damage to the patient, both physiologically and psychologically. At the end of Bruch’s Golden Cage, Ida reflects on her recovery from anorexia nervosa, underscoring social expectations and the awful sense of artificiality. She says:
Once you set a pattern for yourself, you want to live up to what you think everyone is expecting from you. It is this artificial pattern that becomes the cage, something to impress people. I would say now that I had created a golden cage studded with jewels, that they were flashing because I wanted to make an impression. (qtd. in Bruch, 2001, pp. 149-150)
One can become trapped in “this artificial pattern,” the prison being not the actual body, imagined in its own awfulness as “the body prison,” as one might first believe indeed, but rather the mind that makes it seem as such. In the end, we find the fall, the fear, and the flesh. Symptoms as signs communicate to us a language within ourselves, seen with the body itself, when so many words otherwise seem to fail us in our communication.
Thinking of Susan Sontag’s 1978 book Illness as Metaphor, we might consider our communication about anorexia nervosa, although a mental illness, much like that regarding physical illnesses like both cancer and tuberculosis. According to Sontag, more problems become produced by seeing any disease as a peculiar sort of punishment, something it seems rather easy to do with mental illness, too. This mentality, of course, leads to denial of causality, if not denial of the illness itself. But “making it an expression of the inner self,” Sontag adds, although it “might seem less moralistic,” “turns out to be just as, or even more, moralistic and punitive” (1990, p. 46). To see identity in illness, as can happen for anorexia nervosa, presents the mistreatment of the malady, tragically making it into a metaphor for the self. That, at least to me, truly does call for our attention, lest we mistake harming others for helping them.
Let us now recall the words of Anne Sexton, who, in her poem “Children” from her 1975 book of poems The Awful Rowing Toward God, writes:
Listen.
We must all stop dying in the little ways,
In the craters of hate, in the potholes of indifference—
A murder in the temple. (1975, p. 6)
True, we have bodies from which we cannot escape. But we truly also must wonder, even to ourselves, about how these feelings arise. What do they signify as symptoms in us living our everyday lives? Not rather surprisingly, I suggest that there seems to be more to the story in matters of the body in relation to the mind. That is what the matter is here.
References
Bordo, S. (1988). Anorexia nervosa: Psychopathology as the crystallization of culture. In I. Diamond and L. Quinby (Eds.), Feminism & Foucault: Reflections on resistance (pp. 87-117). Northeastern University Press.
Bordo, S. (1989). The body and the reproduction of femininity: A feminist appropriation of Foucault. In A. Jaggar and S. Bordo (Eds.), Gender/Body/Knowledge: Feminist reconstructions of being and knowing (pp. 13-33). Rutgers University Press.
Bordo, S. (1995/1993). Unbearable weight: Feminism, western culture, and the body. University of California Press.
Bruch, H. (1973). Eating disorders: Obesity, anorexia nervosa, and the person within. Basic Books.
Bruch, H. (2001/1978). The golden cage: The enigma of anorexia nervosa. Harvard University Press.
Brumberg, J. (1997). The body project: An intimate history of American girls. Random House.
Brumberg, J. (2000/1988). Fasting girls: The history of anorexia nervosa. Vintage Books.
Caskey, N. (1986). Interpreting anorexia nervosa. In S.R. Suleiman (Ed.), The female body in western culture: Contemporary perspectives (pp. 175-189). Harvard University Press.
Hornbacher, M. (2006/1997). Wasted: A memoir of anorexia and bulimia. Harper Perennial.
Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.
Orenstein, P. (2011). Cinderella ate my daughter: Dispatches from the front lines of the new girlie-girl culture. HarperCollins Publishers.
Orenstein, P. (2018). The fat trap. Don’t call me princess: Essays on girls, women, sex, and life (pp. 351-354). HarperCollins Publishers.
Rukeyser, M. (1995/1994). A Muriel Rukeyser reader. J. Levi (Ed.). W.W. Norton & Company.
Selvini Palazzoli, M. (1978/1974). Self-Starvation: From individual to family therapy in the treatment of anorexia nervosa. A. Pomerans (Trans.), Jason Aronson.
Sexton, A. (1975). The awful rowing toward god. Houghton Mifflin Company.Sontag, S. (1990). Illness as metaphor and AIDS and its metaphors. Picador.
Donovan Cleckley 