The starving daughter emerges in midnight confessions, a best friend’s sudden tears, a suitemate buried in mountains of covers, shades drawn, eating ice cream in the middle of the day, and watching Buffy reruns in the dark.
Starving daughters are full of self-doubt. We don’t want to worry so much about making other people happy but feel like we can never say thank you enough times, never show enough humility, never help enough, never feel enough shame. We feel guilty. We fear conflict. We are dramatic, sensitive, injured easily. We are clinging to all kinds of attachments that, in our minds, we know we should let go of, but in our bodies, we feel incapable of relinquishing. We are self-pitying, sad, even depressed.
We are tired of trying so hard all the time. We feel like giving up. We feel hopeless. We want love, acceptance, happy endings, and rest. We wish that we had faith, that we weren’t ruled by our heads and could live in our hearts more often. We want to have daughters—little girls who will love us unconditionally. We steal small things, such as candy bars and bras—that make us feel special for just a moment. We try to fill the black holes inside of us with forbidden foods. We never feel full. We always feel cold. We starve for a god.
We don’t like to talk about this part of ourselves. Our whole lives, we have received so much affirmation for the perfect part that the starving-daughter part feels like an evil twin. Sometimes we can even convince ourselves that the sadness, self-doubts, and hunger don’t exist, that we like to be this busy, that we like to eat small, unfulfilling portions or work out constantly.
For a while . . . but then the phone doesn’t ring when we want it to or we get passed over for a job or a fellowship. Then the starving daughter makes herself known like an explosion. We collapse from exhaustion, or pick fights with our boyfriends or families, or sob inside the locked bathroom stall. Some girls experience their deep sadness in going on binges (food or alcohol), sleeping all day, sleeping around, buying a lot of clothes they don’t need, ignoring professional or relational opportunities, dropping out of the race altogether. Some of my best friends have retreated inside themselves in this way, refused help, wasted away, or cloaked themselves in excess weight. We get mono and can’t move for weeks. We hate losing control. We hate being “wimps.” We fight these breakdowns, but the starving daughter emerges, young and scared and sick of our shit.
Young women struggle with this duality. The perfect girl in each drives forward, the starving daughter digs in her heels. The perfect girl wants excellence, the starving daughter calm and nurturance. The perfect girl takes on the world, the starving daughter shrinks from it. It is a power struggle between two forces, and at the center, almost every time, is an innocent body.
The Art of Diagnosis
The degree to which women channel their anxiety and ambition into their bodies varies. Some are subtle about the strain between their drive and vulnerability. They would rather pretend that they are above the inane calorie counting or messy bingeing and purging that other girls do. They would prefer to be skinnier but are not going to starve themselves to get there. That would be embarrassing.
Others go through peaks and valleys of obsession, spending months at a time churning through a cycle of destructive self-talk about how unsatisfied they are with their body size and shape, how lazy and weak, then rebounding when they get too busy or too in love to think so much about their imperfections. Their body obsession is seasonal, tolerable, easily brushed under the rug.
I’m one of the girls who has been on the edge of an eating disorder but lucky or scared enough that I have not crossed the line. Yet since the age of about sixteen, I have felt as if I have a common cold. It’s sometimes worse, sometimes better, and I always have this underlying fear that the cold could lead to a more serious, even deadly disease. Sometimes I feel worse about my body than others, but I can generally muffle the nasty bitch in my head who tells me that my butt is too big or my stomach too round. She doesn’t scream the way she does at some of my friends who have full-blown, diagnosable eating disorders.
There are currently three eating disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)—the big book that psychologists use to label what kind of crazy everyone is. They are anorexia nervosa (which made its DSM debut in 1980), bulimia nervosa (1987), and binge-eating disorder (1994).
Anorectics starve themselves until they are 15 percent or more below a normal body weight for their height and lose their periods. Even when they are skeletally thin, many of them still see themselves as fat— a phenomenon called “body dysmorphic disorder,” which scientists are just beginning to understand is associated with blood flow in the parietal cortex of the brain. The girls who develop anorexia are often poster girls for perfectionism: control freaks, straight-A students, big-time pleasers. Many are suspected of having a genetic predisposition as well, a component still being explored by clinicians and scientists. Anorexia nervosa is the most deadly psychological disease; 5 percent of those who have anorexia for up to ten years and 20 percent of those who battle the disease for twenty years eventually die as a result of it.
With both bulimia nervosa and binge-eating disorder, women eat large amounts of food, far more than they need, in one sitting. Bingeing is defined, in the DSM-IV, as eating an amount of food that is larger than what most people eat in a relatively short period of time, such as an hour or two. The size of a binge varies according to a woman’s size, but the average is fifteen hundred calories. To be diagnosed as bulimic, one must vomit twice a week minimum.
Usually these women mistake emotional hunger for physical hunger. Women who suffer from bulimia take drastic and immediate measures to purge after a binge. Most commonly they make themselves throw up, but some use laxatives or extreme exercising to get the food (and the associated feelings of guilt, shame, sadness, and anger) out of their systems. Women with binge-eating disorder usually eat and wallow in their guilt, refraining from any of these alternatives.
Psychologists are beginning to realize that perfect girls don’t like to be pigeonholed. A lot of young women suffer from combinations of these diseases depending on the time of life (or the time of day). Professionals often describe these women as suffering from bulimiarexia, though it is not an official diagnosis in the DSM-IV.
A grab-bag category called “eating disorder not otherwise specified” (EDNOS for short) does appear in the bible of psychological diagnosis and is applied to those who don’t satisfy all the requirements outlined for the other diseases. Binge-eating disorder was distinguished from this category in 1994, when enough research indicated that it was a separate disease. Experts expect that the DSM-V may feature similar additions or, alternatively, a revision of the rigid restrictions on current diagnoses. For example, large numbers of young women binge and purge once a week and therefore don’t “qualify” for a bulimia nervosa diagnosis. But clearly these women need the same intensity of attention as those who happen to purge once more. Many young women starve themselves but don’t lose their periods, a requirement for the official diagnosis of anorexia nervosa. The very existence of the EDNOS option is a telling indication of the “art,” as opposed to “science,” of diagnosing eating disorders.
Those women who have a more extreme version of the common cold—i.e., a time-wasting, confidence-draining obsession, a binge and purge a month, a tendency to undereat—get lumped together in a category called “partial-syndrome eating disorder.” They are not likely to see their neurosis as anything other than a nagging preoccupation. It’s normal. In fact, you would be hard-pressed to find a woman who doesn’t think more than she would like to about food and fitness. This is especially scary because repeated studies have proven that the gateway to a full-blown eating disorder is the simple trendy diet. “Oh, I’ll just go on Atkins for a little while” quickly shifts into “If I’m not eating bread, I might as well cut out lunch altogether.” In my informal e-mail survey of more than a hundred women, not one said that she was satisfied with how much she thought ab
out her diet or her workout regimen every day. Each described too much obsession and too little action, the internal battle of the perfect girl with a militaristic agenda and the starving daughter who is too tired to satisfy her.
Another interesting tendency emerged in my survey. One of the early questions was “Have you ever had or do you now have a diagnosable eating disorder? Please elaborate, i.e.: When did it start? Are you still struggling with it? Please describe in as much detail as you are comfortable.” Over half the women answered “No, but ...” and then went on to describe a time in their lives when they stopped eating, ran ten miles every day, started throwing up a few times a month, or sometimes, every once in a while, used laxatives. A few examples:
No, but I threw up food for a couple of days after I realized I had been gaining weight. I told my boyfriend (in tears) after blood came up, and he made sure I stopped.
—Jenna, Bloomington, MN, 18
I never had a diagnosed eating disorder, but in seventh grade I attended an all-girls Catholic school and I stopped eating altogether. I guess I am still struggling with it because I still have a bad relationship with food.
—Debbie, New York, NY, 26
No, as a teenager I would crash diet, eat 800 calories a day, but I’m over that. 25% of the girls in my high school class had eating disorders and I didn’t want to be one of them.
—Lauren, Atlanta, GA, 27
These women’s responses indicate that the way we have been socialized to think about food and fitness obsessions is to “otherize” them. It makes us feel safe to think that those girls, over there, the ones with the really serious problems and the really screwed-up families, are the ones who develop full-blown disorders. They are the ones who have to go the hospital and all that. They are the ones who need therapy. The rest of us are just dealing with the everyday “stuff” of being a girl in this society. We can live with it. (We don’t consider that we don’t have to.)
The media have contributed to this inaccurate notion that food and fitness obsessions are dangerous only when they reach a lethal level. Shows such as Entertainment Tonight and magazines such as Us Weekly show skin-and-bones shock photos of anorectic models, dramatize the glass jars filled with vomit hidden in bulimic girls’ closets, reenact their grotesque binges with actresses paid to look like wild animals. Unless we are seriously debilitated by our obsession—dropping out of school, fading away into skeletal form, or throwing up after every single meal—the media make us feel as if we are okay. We aren’t like those girls we’ve seen on TV. We’re not that out of control.
The media have an obvious love-hate relationship with these disorders. Magazine editors know that publishing Kate Bosworth’s latest diet sells copy, just as entertainment tabloid shows have proof that footage of skeletal women boosts ratings. The media moguls, however, don’t like the idea of analyzing their own role in promulgating these images. In an analysis of the women’s magazine coverage of eating disorders since 1980, the Drexel University communications professor Ronald Bishop found that “treating eating disorders as aberration allows the editor to deal with a serious problem while at the same time sustaining a discourse that contributes to the problem.”
Many health care professionals—doctors especially—also encourage this me-versus-them attitude when it comes to eating and exercise pathology. Some are so weary of the concurrent epidemic of obesity that they have put on blinders when dealing with the other extreme. These doctors encourage rigorous exercise and restraint in diet, regardless of the profile of the individual patient. A good friend of mine recently had a doctor recommend that she avoid carbs for breakfast and eat boiled eggs instead, despite the fact that she solicited no advice on how to lose weight, has a history of anorexia, and was in for a routine checkup. The doctor was a woman. Another girl I interviewed talked about seeing a doctor in college, secretly praying that he would notice her dwindling weight, but as she left his office, he hollered after her, “Keep up the good work. Lookin’ great!” My former gynecologist showed me the body mass index in her office and pointed out how many pounds I had to go before I was overweight. She didn’t mention a thing about the other end of the scale. I wondered if she was trying to subtly let me know that I needed to “watch it” (as if every girl isn’t already).
The media and so many doctors would have us believe that eating disorders are like the chicken pox: Either we have one or we don’t. But there is no blood test we can take to confirm that we are misdirecting our energy, time, and money. There is no urine sample that proves your life is being watered down by your focus on the inanity of counting calories. Susie Orbach, a feminist psychologist who has helped thousands of women with her 1978 book, Fat Is a Feminist Issue, argues that eating disorders are many and varied in the way they manifest themselves, and women should not consider themselves “out of the woods” because they don’t fit the textbook diagnoses.
I’m with Susie. Eating disorders are more extreme versions of what nearly every girl and woman faces on a daily basis—a preoccupation with what they put in their mouths and how it affects the shape and size of their bodies. We all have some degree of obsessiveness about food and our bodies. A lucky few feel guilty only for major Thanksgiving binges or when they haven’t been to the gym in months. Some of us are relatively healthy, doing a decent job of avoiding the cultural influences that make us feel bad about ourselves, making choices about what we want to eat based on what we are hungry for, restraining or restricting ourselves only when it seems necessary. Others are somewhere in the middle—sometimes obsessing, sometimes coasting. And the majority are struggling somewhere beyond what we know is healthy but shy of having a diagnosable eating disorder. We struggle in limbo because we can convince ourselves that, as long as we don’t hit starvation, full-blown self-hate, or weekly purges, we are average. We find comfort in being almost as screwed up as everyone else.
A History of Eating Disorders, CliffNotes-Style
One of the first questions that skeptics ask about the prevalence of eating disorders is: Haven’t eating disorders been around for years in one form or another? This is nothing new, is it?
Yes and no. Joan Jacobs Brumberg, feminist author, Cornell professor, and badass historian, provides a thorough, surprisingly entertaining education in the social history of women’s relationships with food, fitness, and their own bodies in her 1997 book, The Body Project: An Intimate History of American Girls.
Religious martyrs sometimes exhibited eating-disordered tendencies. Joan of Arc wouldn’t have called herself anorectic, of course (the term hadn’t been invented yet), but she did starve herself to make a point. Bingeing and purging was actually a communal ritual at some ancient Greek feasts, where people would rock out so hard and eat so much that they had to make themselves throw up. Yet this did not amount to diagnosis, just debauchery.
During the 1870s, however, doctors in France and England scrambled to name and develop treatments for a new crop of girls who came into their offices with the mystifying tendency to reject food altogether. Charles LeSac, from France, and William Withy Gall, from England, competed head-to-head to be the first to name the disease the starving girls suffered from. France won with anorexia, perhaps because “Gall disease” didn’t catch on. Gall suggested that young women needed “parentectomies” in order to heal properly. Both doctors employed artists to draw before and after versions of their patients—eerie portraits of an anomaly that predicted a future epidemic.
It isn’t surprising that the Victorian era marks the birth of modern eating disorders. As they are today, control and thinness were characteristics of wealthy, attractive women. Food, by contrast, brought to mind sexuality, appetite, and indulgence—all things that the prim-and-proper woman was supposed to steer clear of. Victorian gals even converted to the ultimate modern-day eating disorder cover, vegetarianism, because meat was considered carnal. (Funny, my boyfriend says that there is nothing sexier than me taking a big bite of a cheeseburger.)
Around the
same time in America, lunatic asylums were reporting the presence of starving girls suffering from “sitophobia”—literally translated from the Greek as “fear or loathing of bread” (and Atkins hadn’t even been invented!). The word image started appearing in American girls’ diaries in the 1920s—the same time movies became a public obsession. Brumberg explains that “girls learned that images could be malleable” from Hollywood actresses, who changed identities and looks as fast as moving pictures could be produced.
Anorexia would not become a household term in the United States until much later. In fact, Brumberg herself remembers returning to her eastern college dorm after her first day at a hospital internship and telling her roommates about this strange woman who was starving herself. That was 1965, and none of them had heard of anorexia.
I believe that Brumberg’s discovery is representative of the experiences of many women my mom’s age. I’ve been cornered frequently by middle-aged women who tell me stories, after they hear the subject of this book, about the mysterious sorority girl who used to throw up after meals or the disappearing sister whom no one knew how to treat. In the 1960s and most of the ’70s, anorexia and bulimia were still exotic and undiscussed. They were seen not as diseases so much as aberrations, phases, sounds: the roommate who always rushed to the bathroom immediately after meals, the little sister who always picked at her plate and avoided mealtimes, the best friend who got depressed and shrank to the size of nothing.
One of the first public memories of eating disorders that many middle-aged women have is of the singer Karen Carpenter, who first dieted in 1967 and by the fall of 1975 weighed just eighty pounds. After collapsing on a Las Vegas stage and being rushed to the hospital, she was diagnosed with anorexia (though she suffered from a combination of fasting, purging, and laxative abuse). The headlines were a shock to the average American. Karen Carpenter died in 1983, though most of her fans mistakenly thought she had been cured.
Perfect Girls, Starving Daughters: The Frightening New Normalcy of Hating Your Body Page 4
