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  • Anorexia: A Disease of Doubling
  • Drew Leder (bio)
Keywords

anorexia, embodiment, mind-body relationship, phenomenology

In his excellent paper, Svenaeus describes “the double experience of being plagued and depressed by the anorexia, but still being unable to give it up because it provides the only security, control, and identity that there is to have” (Svenaeus 2013, 88–9). This phrase ‘double experience’ is worth pondering. His analysis highlights the dialectical nature of a disease characterized by doubling, contradiction and paradox. Or paradoxes, we should say—let me enumerate some.

Thin Versus Fat

From the outside, an anorexic is often painfully, even dangerously, thin and underweight. This can be confirmed by others perceptually unless the body is well-hidden, and through medical examination. But inwardly the anorexic often sees herself as fat, her body disfigured by bulges and paunches. The DSM-IV-TR (American Psychiatric Association, 2000) diagnosis speaks of “an intense fear of gaining weight or becoming fat” coupled with “a misperception of one’s weight and shape” often demonstrated in self-accounts (“Although Ruth was slim and petite, she felt fat and self-conscious…” [Halse et al. 2008, 127]).

Seeing Versus Being Seen

This paradox of mistaken self-identification depends on another dialectic—that of being both the looker and the looked at. Ruth mentioned above is described as “a cheerful, lively girl,” but “all this changed when she began dance classes. Ruth looked around the class and all she could see were ‘skinny’ girls” (Halse, Honey, and Boughtwood 2008, 127). Viewing exemplars of a cultural ideal of thinness, she turns her critical gaze upon her own body, becoming newly aware of its deficiencies. She is now the one ceaselessly being seen—by others, but also primarily by herself.

Control (Identity, Security) Versus Loss of Control (Identity, Security)

Svenaeus describes eloquently how the project of control initiated by the anorexic—control particularly over food and body, as the leading edge of a project of life-control—gives rise to a paradoxical loss of control. One falls victim to the voices of others, the rebellious body, the disease itself surfacing as a foreign persona or demonic presence. The individual’s use of dieting, exercise, and the like to exert control, to stabilize identity and security, lead precisely to a destabilization of these as the illness progresses. [End Page 93]

“Femininity” Versus the Refusal of “Femininity”

Svenaeus (2013, 83) writes, “in a way what the anorexic girl is doing is exactly refusing to be a woman by living out cultural ideals of femininity (slenderness) to a point at which the body ceases to be female (cessation of menstruation and disappearance of female forms).” Here is another aspect of the paradoxical “double experience” characteristic of an anorexic. Usually, though not always, female, she enacts a paradoxical glorification/refusal of the idealized “female” body.

Healthy Lifestyle Versus Unhealthy (Potentially Deadly) Lifestyle

Ruth pursued her fitness campaign and quickly lost her puppy fat. Her parents, Beth and David, were proud of her determination to get fit and healthy and saw this as a positive lifestyle move, and Ruth revelled in the flurry of compliments from family and friends.

(Halse et al. 2008, 127–28)

We see implied here a final paradox of anorexia—it is poised somewhere between the praiseworthy and the scandalous, an ideal of health and fitness in action—and a wasting disease. Where to draw the line is not always clear to parents, loved ones, and friends, and certainly not to the anorexic.

To speak thusly of anorexia as a disease of ‘double experience,’ of lived paradox, is not merely to sketch a structural analysis of characteristic features. It is also a way of suggesting the dialectical motives and mechanisms that cause the progression of the disease. For example, the anorexic, concerned about her potentially ‘out-of-control’ appetite and weight, clamps down on food and exercises obsessively. The body, now even hungrier, grows more insistent in its demands. The anorexic must then fight harder to suppress bodily urges. This can form a positive feedback loop, that ‘feeds on itself’ through the very refusal of the anorexic to feed herself.

Svenaeus not only shows the paradoxical tensions at the heart of...

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