Beyond the Anorexic Paradigm: Re-Thinking ‘Eating’ Disorders
The answer to this question regarding the nature of ‘eating’ disorders is not a deﬁnition, but a history – in fact, three histories. One is a history of the body, and the mutable, ingenious, and sometimes self-destructive ways it searches for meaning, security, and power in the world. Another is the history of medical naming, categorization, and explanation, which has brought disordered eating under diﬀerent diagnostic umbrellas, in accordance with prevailing medical models, but also stretching to accommodate the ever-shifting shape of the phenomena. And a third is a history of consumption in the socio-economic sense, which has produced and continues to nourish particular forms of disordered relations with food, body image, and the regulation of hunger and desire. These histories are not self-contained; they have partnered, struggled, reinforced and challenged each other – and human biology – over the centuries. Human biology indisputably plays a role in eating disorders, both in contributing genetic vulnerabilities
and in various physiological processes brought on by excessive and/or habitual dieting, binging, purging, and other practices. However, unlike a disease process such as cancer, in which a clear biological boundary can be drawn between healthfully contained cell-growth and destructive, ‘disordered’ cellgrowth, what constitutes disordered eating has psycho-cultural as well as physiological dimensions. While the physiological dangers of starvation dieting, binge-and-purge patterns, and over-consumption resulting in obesity are well-documented, whether or not these practices are considered ‘disorders’ depends on why they are engaged in, who is engaging in them, in what cultural context, and who is making the call. Gandhi starved himself as a mode of political protest; he came very near to death, but we would never consider him as suﬀering from an eating disorder. The ancient Romans binged-and-purged, as do many young women today; yet medical science diagnoses the latter as a species of eating disorder, while regarding the Romans as engaging in a physically unhealthy, but psychologically benign group activity. Competitors in hot-dog eating contests gorge themselves to the point of passing out; the fact that they are driven by the desire for prizes and 10 seconds of fame rather than an emotional need for the food itself exempts them from the class of those with eating disorders. And there are ambiguous, borderline cases: The medieval nuns who fasted to achieve spiritual purity have been called ‘holy anorexics’ because of their obsession with self-denial and transcendence of bodily need (Bell, 1985 cited in Silverman, 1997: 9). Henry VIII, in his later years, was arguably not just dangerously obese but a compulsive eater, who stuﬀed down his well-known anxieties over dying without an heir (as well, perhaps, as guilt and emptiness over his multiple domestic disasters) with huge amounts of sugar and fat-laden king-size portions.