Updated: Aug 19, 2020
My last post meanders around a few intersecting strands of thought on the balance between the individual and the collective - our existence both as separate entities and as part of one whole, the value of nuance and non-binary thinking and our intra-personal, inter-personal and societal influences. It explores an outlook that frames my thinking across many aspects of life, both at a personal level and as part of society. The influence of the individual, the collective and wider societal forces in terms of our mental health is something that fascinates me in particular and is something I am constantly exploring in relation to my own experiences with an eating disorder.
The biopsychosocial model (George L. Engel, 1977) is an interdisciplinary model commonly used in psychology, health and human development that recognises three overlapping areas of influence on an individual. In application within mental health, biological factors (such as genetic variation, hormonal and physical variation and effects of drugs), psychological factors (including personality tendencies, thought processes, cognitive distortions and trauma) and social factors (such as unemployment, stress, societal pressures and structural inequality) are considered. Varying vulnerabilities and circumstances across these aspects of life therefore affect different people in different ways and can be used to explore the range of influences acting on a given person’s mental health.
Mental health treatment has a troubled history of consistent misunderstanding, underfunding and stigmatisation, meaning we still face a lack of research and effective treatment for a lot of cases. It is common for a combination of drug-based solutions and psychological or therapeutic-based solutions to be offered to those struggling with mental illness. However, I would argue that the impact of social factors, and therefore the research and effort into developing social-based solutions is still heavily missed. Not only are potential treatments or preventative practices missed, but it also perpetuates the conception of mental health as the problem, the burden and sometimes even fault of the individual.
Despite eating disorders having the highest death rate of all mental illnesses (BEAT, 2019), they remain one of the least funded in research; little understood and still treated in an emergency and archaic way with little attention to prevention or education. Just 1% of all NHS funding for mental health research goes to eating disorders (Mq Mental Health, 2017), an imbalance that is surely exacerbated even further when privately funded research is included. Most private funding comes from pharmaceutical companies, so for eating disorders (where causes are much more likely to be attributed to and treated by psychological factors) pharmaceutical solutions remain very limited.
It is estimated that over 75% eating disorder sufferers are non-male (BEAT, 2017). Given our historical record of dismissing typically ‘female’ conditions as ‘hysteria’, along with the huge gaps in our medical understanding of non-male bodies and health, neither the causes of the illness nor the approach to understanding and treatment feel like a coincidence and I think it is way beyond time it is addressed.
Gender, Food and Bodies | image in our society
Women are consistently socialised very differently around food and their bodies to the way that those identified as men are, with statistics suggesting that this begins even from birth. A US study showed that whilst 99% of baby boys are breast fed, this is true for just 66% of baby girls, who are additionally given an average of 50% less time to feed (Orbach, 1990). This happens even despite nutritional guidelines being equivalent at this stage of life.
As we grow up, so too do gendered ideals. Whereas the image of being ‘manly’ is of strength, maturity, facial hair – the 'gym buff'; being attractive as a woman revolves around looking young, slim, small, even weak – the 'damsel in distress'. There is little tolerance of fluctuation, despite this being a fundamental part of hormonal change – particularly for people with wombs and menstrual cycles. No wonder it is so common for eating disorders to be triggered during teenage years. The image of female beauty as petite, youthful and unchanging makes the female body a constrained one, something which is regulated, conforming and obedient.
As we mature into adulthood, expectations around youth, subservience and smallness are compounded by food-oriented gender roles. Status is given to the male, the ‘working man’ who must have ‘earned a big portion’, the ‘prime cut’ and the manly pork pies. Women instead are the providers, feeding others first and then associated with something much more feminine (and much less caloric!) – a light salad, some fruit, a soup.
At the same time, there is a public relationship with the desire and restriction of sweet treats for women. It is almost universally normalised in Western female culture to apologise for having a ‘naughty’ slice of cake, to lust after desserts but deny oneself. Adverts feature women sexily ‘indulging’ (think of the M&S adverts) for the gaze of others, yet it is shameful when it comes to actually enjoying it yourself. Even Nigella Lawson is famous for her sneaky midnight indulgences, in contrast to Gordon Ramsay’s angry business accument or Heston Blumenthal’s clever food chemistry. No wonder eating disorders so often manifest in a secretive and private way - a desire to have a relationship with food for oneself, not others.
We see gender intersecting with eating disorders across the spectrum. Though eating disorders are still critically misunderstood and therefore under diagnosed, statistics suggest that they disproportionately affect young women. Even less studied, is the extremely high prevalence of eating disorders in people who don’t conform to the traditional gender binary or don’t identify as the gender assigned to them at birth. One flagship study into the relationship between disordered eating, sexuality and gender found eating disorders to be 8x as common in those identifying as transgender of any sexuality than in cis-gender heterosexual women, and 27x higher than in cisgender heterosexual men(!) (Diemer et al., 2015).
Gender dysphoria, a psychological component of mental health, is known to be a high trigger factor for body dissatisfaction and body dysphoria, easily leading to a desire to control the body and the development of an eating disorder in itself. The added pressure of social factors, such as being consistently judged by a physical image you don’t identify with, having to regularly justify and explain your body and a lack of privacy regarding your own body, sexuality and thoughts surely add to this burden on mental health. An increased awareness of, and pull towards, the physical and emotional expression of gender norms must understandably take some transgender persons down the path of damaging behaviours around food and body as a way to feel a sense of ownership, control and societal acceptance.
For men, the portrayal of eating disorders as a sign of weakness and femininity brings an increased shame and secretiveness around suffering. Yet masculine ideals of being bigger, stronger, muscly also socialise an unhealthy relationship with food and exercise, just often in a different way. For the cis-male, the desire to get jacked on protein shakes and make themselves bigger can trigger disordered associations with being in a smaller body and lead to gym addiction, restriction of food groups and disordered diets.
Eating disorders come in many shapes and sizes and impact people of all ages, all races and all body types. Failing to recognise this only exacerbates our misunderstanding and misrepresentation of someone who suffers with an eating disorder as a young, White, weak girl, typically suffering with anorexia.
In fact, only 10% reported eating disorders are diagnosed as anorexia nervosa, with binge eating disorder and bulimia occurring far more commonly. I suppose it doesn’t pull the same heart strings to represent the overweight, apparently unrestrained side of eating disorders as it does the emaciated victim? This misrepresentation and skewed concern is deeply rooted in fatphobia and so must be acknowledged, questioned and challenged. Similar desires to restrict, control and shrink tend to underlie all eating disorders, despite the behaviours and coping mechanisms differing, leading to differing visible impacts on the body.
For this among many reasons, it is therefore essential to see past the image of an eating disorder and its manifestation in body to consider the other, less noticed and less obvious aspects of eating disorders. The aspects that really drive the disorder and which are just as influenced by a patriarchal society as the superficial problem of skinny girls in magazines.
Beyond the Body | to the fullness of womanhood
Taking up Space
"if you are always making yourself smaller, it does something to you psychologically. If you are always going 'oh sorry, sorry, sorry' and then you go into your big negotiation meeting, you're bound to just get out of the way"
- Deborah Frances-White, 2017
A big part of feminism for me is about learning to ‘take up space’. To resist the narrative that people socialised as women are spun of meekness, passivity and subservience. For anyone who identifies more as an introvert, who has a quieter voice or maybe struggles with a lack of confidence, it is easy to slip into the role of the docile woman. The one who squeezes into the window seat with legs crossed to avoid the manspreading balls of the guy on the aisle seat. Who stops talking the moment someone else enters or has something to say. Who is not just physically small, but socially and emotionally. I believe it goes hand in hand with an eagerness to please, putting others first and a need to earn the right to the space your body needs. It makes sense that for someone who has grown up without automatic representation, voice, public presence or power that taking this can feel daunting – like something that is on trial and must bring returns before it is accepted as needed, valued. Until worth can be proven, it feels safer to stick to the outskirts and take the least possible.
Even the emotions we are taught to feel and express as women are the ones that diminish – shame, guilt – emotions that internalise and target ourselves. Meanwhile, men are taught to express themselves through anger, to enlarge themselves, externalise. Feminine emotionality, or even emotionality at all, is associated with the domestic sphere, for women to deal with alongside other women. Whilst our emotionality is becoming something to value, even enviable and missing for men, it is still barely acceptable in the public realm. Uncontrolled emotions are shameful and should be contained internally or dealt with in female circles, before appearing to the public with a controlled front to participate at the level of a man. Yet the accepted masculine expression of emotion through anger, control of others remains unattractive in women. Whilst men occupy the positions of power, channelling their emotions into the management and control of others, women can only reach these spaces through private control of themselves.
Controlling and restricting food intake, or even just enjoyment around the food, has dramatic impacts on not just the physical, public presentation of the self (including, but not limited to physical size) but also on cognitions, mood and personality; reducing emotions and experiences into something diminished. It creates a smaller space to occupy, suited to the smaller person, yet at the same time it drastically diminishes the power in the woman. Undernourished, this self-restraint leaves little energy to express emotions, to fight, to have a presence in the external world. As formulated by Naomi Wolf in her book The Beauty Myth, "Dieting is the most potent political sedative in women's history; a quietly mad population is a tractable one" (Naomi Wolf,1990). It is not just a personal, individual issue that emotions are suppressed, energy lost and passivity increased. It becomes a societal issue, a political policing and yet another way the full power of women is suppressed under the patriarchy.
Comparison and Identity
"To emancipate woman is to refuse to confine her to the relations she bears to man”
- Simone de Beauvoir, 1949
Simone de Beauvoir’s analysis of the role of the woman as 'the second sex’ reveals how our patriarchal society constructs man as the assumed human being, the whole, and (wo)man as a comparative (fe)male, a subsect of the species. “Man is defined as a human being and woman as a female – whenever she behaves as a human being she is said to imitate the male” (De Beauvoir, 1949). Instead of recognising and valuing femininity and feminine identity for our own intrinsic qualities, womxnhood is measured in comparison to the assumed universality of mankind.
This idea of comparison, the (wo)man, the other, the second sex, can begin to manifest in an extremely disordered way as the need to justify oneself, one’s desires, even one's needs becomes a painful measuring of everything in comparison to those around us. Eating disorders are well understood as competitive illnesses, with sufferers becoming painfully conscious of their body and eating habits in relation to those around them. It can feel really difficult to allow oneself to take more than anyone else around them, to occupy a larger body, or to take up more space. I don’t see this as something unique to those suffering with the illness at all, but a common feeling amongst women in general, exacerbated and made disproportionate by the illness.
A sense of a lack of identity is also a common theme for sufferers, which rings true to the idea that womxnhood is not strong enough an identity in itself, but is quite literally a fraction of the man – the rib of Adam. The pro-offered identity of the slim one, the restrained, the ‘good’, the ‘pure’ becomes something to latch onto, a front to give to society. The eating disorder serves to fill that hole. Restrained purity is complimented and rewarded. Weight loss is almost always met with gushing compliments of how great people look, turning down an extra portion is “you’re so good, so restrained”. Why the concept of restraint conjures the same reaction ‘good’, rather than bound, cramped and trapped is a bit of a mystery.
Binary guidelines of 500 fewer calories per day for women compared to men, rather than a nuanced understanding of endlessly different bodies and needs still sends the message that we must feed others first, put other needs before our own. What subtly but consistently underlies that message? That we are less important, less deserving. That our right to nutrition and our very existence must be earned in comparison to others, not assumed and granted.
Even as traditional gender roles break down and reinvent themselves, I don’t see the same progress as we are making in terms of access to career opportunity within ideas around beauty, youth and image. In many ways, we are instead taking these same beauty standards with us as we try to fit the female form into the male box under the same patriarchal system. The pressure to achieve across all areas of life: professionally, personally, image-wise, domestically and in the family all at once, is overwhelming. Perfectionism, justification of intake via achievement and the idea of ‘earning calories’ are all key aspects that commonly underlie eating disorders. It is no surprise that societal pressure to perform across the board before ‘earning’ your space latches onto mental health. Not only are (some of us) now gaining greater access to university courses, career paths and higher flying jobs, but we are still expected to achieve that alongside the ideal of beauty, youth and humility. Think of the image that comes to mind when you think of a high flying career woman – young, probably pre-children, slim, attractive is still the trope.
“The body is the instrument of our hold on the world.”
- Simone de Beauvoir, 1949
Whilst men have always occupied positions related to their whole personhood – their achievements, their intelligence, their wit or their hard work; femininity and feminine expression is in the body. Our identity needs to be a visual one, and no more so than within feminine sexuality.
Traditionally built around the male gaze rather than the female experience, our conception of female beauty takes two forms - the pornographic, oversexualised (which often centres around big boobs, big bum, small waist etc) or the subservient, the youthful, even childlike (clean shaven, slim legs, ‘flawless’ complexion, pre-pubescent). “If you’re not beautiful enough for porn, you may as well be anorexic” (Wolf, 1990), or otherwise aspire to live in constant restriction and get caught by similar restrictive, binging or purging patterns. Restriction, hunger and denial themselves have become eroticised and desire restrained. When it is hard to live up to pornographic beauty standards, or to feel sexy enough, there is always slimness, youth, subservience and restriction to fall back on.
Whilst male sexuality is assumed, accepted and celebrated, desire and lust are associated with sin and denial for women. The body should be kept pure and virginal, it is ‘ruined’ by childbirth and breastfeeding. Lusting after men is performative rather than experiential – making him feel wanted and attractive but not ‘ruining her body’ in return. The same applies to the desire and lust for food. Whilst we are allowed to sexily desire the chocolate and desserts in order for M&S to sell their indulgence, it is a sin to actually consume it (literally when it comes to Weight Watchers!). A moment on the lips, a lifetime on the hips – body ruined, undesirable.
Even our relationship with our own sexuality is controlled. Whilst it is commonly acknowledged, even bragged about for men to masturbate frequently, female masturbation remains very taboo and hidden – again used mainly for the pornographic gaze rather than exploration of our own bodies. Undereating drastically reduces sex drive, studies showing that people stop masturbating at 1700 calories per day (Wolf, 1990). With most diets targeted at women allowing just 1500 calories or under, we are again policed out of a relationship with our own sexuality, desires and even our own bodily experience.
As an eating disorder spirals out of control, the loss of connection to desire, self and bodily experience become stronger and stronger. Individual experience clearly varies dramatically, but body dysphoria can often become overwhelming, making it feel impossible to inhabit one’s own body. All sense of what is enjoyable to eat, to feel and who you are is diminished as obsessions often instead revolve around the visual performance for others. What they notice you eating, what they notice you doing or how your body looks to them. Unlike the common conception of an eating disorder, this doesn’t necessarily mean a desire to be thin, to not eat in front of others or to draw attention, but actually frequently becomes the opposite – a loss of sense of self and so an attempt at a new, performative mask for the gaze of others – something you hope resembles normality.
There is also a strong correlation between sexual trauma and the onset of eating disorders. I am lucky to not to identify with this so will leave the topic for survivors to speak for themselves. However, it is crucial to acknowledge the impact of the control of our own body by others; whether through expectations, language and emotional control or physically through unconsenting sex, violation of boundaries or gender violence. It can all lead to severe experiences of body dysmorphia, disassociation and a need to regain the boundaries of control.
Victimisation | power at play
Is it innately wrong to be small, or meek, to put others first?
When these qualities get out of balance, as with illnesses such as eating disorders, sure. However, I would say that traits such as empathising with others, considering others’ needs, being aware of influences and positions within our collective whole - even shyness, introversion and taking up a little less space and resource - are all things the world could do with a bit more of.
Still, they are consistently devalued and disempowered in favour of those who shout the loudest, those who take more to make more (shout out to capitalism!). Those who work in logic, rationality, facts and statistics that supposedly provide consensus, authority and correctness. It is understandable that we dismiss emotionality, and softer qualities as weak and useless.
Dismissing the virtues of these qualities leads to the victimisation of, and by, sufferers. Instead of seeing and recognising the valuable aspects, we see them as problems to overcome. Psychological treatment frequently focusses on ‘raising self-esteem’, ‘challenging distorted thoughts’ and ‘assertiveness’. Whilst I value all of these skills in their place, I don’t believe they deserve power over and above ‘soft skills’ such as reflection, consideration and valid concern.
I challenge the assumption that self-esteem is a binary, uni-faceted thing that can be considered universally ‘low’ and would instead encourage a wider view of self-esteem as varying through time, experience and situation. It is just as determined by the interactions of others and society in general as it is a reaction by and within the individual. Equally, distorted thoughts are often an unbalanced reaction to a very real problem. The heart of the problem itself must also be addressed, not simply dismissed as over-reactive, disordered and mad.
Instead, it is so easy to fall into yet another binary power dynamic of the healthy and the sick, the rational and the mad, the saviour and the victim. A disempowered victim is very easy to dismiss and control, especially a mad one – a young girl who doesn’t know any better.
Conclusions | towards collective health
Returning to the biopsychosocial model, these social impacts of a binary and patriarchal society do not dismiss the genetic component of mental illness. Neither are they an excuse to ignore the psychological component, the agency and therefore responsibility of the individual, shifting blame to external forces. However, I believe we focus far too much on either drug-based and medical solutions (for some illnesses) and psychological for others (as with eating disorders). Failing to pay attention to the social factors misses the important opportunity and responsibility we have to tackle the wider issues at play within a collectively sick society. It leads us far too often towards blaming, victimising and disempowering the person who carries the illness.
We need to fight back against diet culture and the media representation of beauty to embrace the diversity of our bodies, sure, and I love seeing movements that challenge this are growing. However, I think we must also remember to understand eating disorders in their complexities and diversity - beyond their expression through a (thin) body to the emotions, thoughts and beliefs that make up the person as a whole. We need to challenge ourselves beyond the idea of feminine beauty as small, restrained an object to be seen, and challenge the whole position of womxn as small, constrained and performative persons. We need to stop victimising and belittling sufferers. To stop seeing them as disempowered, not thinking straight and in need of control and instead see what they are: experts in themselves.
This means we stop belittling eating disorders as something affecting young teenage girls, too easily influenced and troubled by a lack of identity and low self-esteem. Aren’t we all troubled by these things? Its just that some people’s masks perform a much louder sense of self – much easier to see as successful, confident. It means we stop treating femininity as absence of masculinity, a lack of identity, lack of self-esteem, confusion and lack of clarity and see it rather as a subtle identity of its own.
When the treatment system itself is built on hierarchical power: patriarchal, colonial and disempowering, it doesn’t surprise me that eating disorders remain one of the least understood, most ‘dangerous’, with one of the highest relapse rates of all mental illnesses. We need to create empowerment for people who are not socialised as male, who have different values and alternative views to offer the world. Who knows, maybe a more collective, more feminist way to construct society could start in the therapy room?
More to come on that one I can assure you…
A few recommended resources:
The Beauty Myth by Naomi Wolf - a really enlightening and scary read altogether, but particularly relevant is the chapter on Hunger
The Second Sex by Simone de Beauvoir - classic feminist literature including the relationship of (wo)man to man
Trans Like Me by CN Lester - must read book conveying important issues within trans rights and gendered experience in general
Fat is a Feminist Issue by Susie Orbach - another ground-breaking read
https://www.transfolxfightingeds.com/ - Trans Folx Fighting Eating Disorders
https://www.beateatingdisorders.org.uk/ - BEAT is the UK's leading eating disorder charity and campaign group, including a helpline, help finder and information
https://www.eatingdisorderhope.com/information/statistics-studies - good resource for statistics and education
The Guilty Feminist Podcast - really great for exploring the dark corners of the patriarchy and how it impacts us in so many ways
The Hoovering Podcast by Jessica Fostekew - great anti-diet, body positive outlook
The Eating Disorder Recovery podcast with Tabitha Farrar - HAES, anti-diet approach to recovery with loads of really great and informative episodes on lots of aspects of eating disorders and recovery
and many more for some great fat positivity and representation!