This is Eating Disorder Awareness Week, and immediately I think – as do many people – of a teenage girl. Blonde, white, well-educated – she goes to a good school and seems to have everything sorted. Rewarded for what looks like “perfection”, it is very easy for her to take a diet too far and to start counting calories obsessively. Initially, she will be rewarded for losing weight – as women are – and then someone (typically her mother) will be concerned. There will be therapy and then hospitalisation – the availability of these things, and the cost, is never an issue – and then after some resistance, she will accept that she is sick and begin the process of recovery. Sometimes this will be prompted by the death of someone else in hospital – a martyr to our protagonist’s cause. All better now. The end.
I know better, but my ideas are still shaped by the stories we tell about eating disorders, and that pattern is one that appears not only in young adult novels (Deborah Hautzig’s Second Star to the Right, based on her own experiences, is an early example) but in memoirs (Emily Halban’s Perfect, Grace Bowman’s Thin). Eating disorders are for young women with little else to worry about, it might seem – a message reinforced by Meg Rosoff’s How I Live Now, in which the protagonist recovers from anorexia in a war-torn world where she has “real” problems to deal with. They are somehow an indulgence and also to be admired. There is something impressive about the discipline of the anorexic, who takes our step-counting, fitness-tracking, clean-eating habits to a new level and who, in our heads, is always thin.
Book titles reflect this focus on weight rather than on food and an individual’s relationship with it. In young adult fiction there is Skinny by Ibi Kaslik, Fat Chance by Leslea Newman, Massive by Julia Bell – all books which do depict eating disorders realistically between the covers, with Bell’s exploration of how family attitudes towards food and weight influence people particularly impressive.
Memoir titles similarly zoom in on size: Marya Hornbacher has Wasted away, Portia de Rossi tells us of her Unbearable Lightness, Lori Gottlieb describes her Stick Figure. And yet when you read these titles it becomes clear how little this is really about weight. Gottlieb’s memoir – an account of her 11-year-old self deciding one day she is too fat – leans towards humour more than self-reflection, but nonetheless accurately conveys the mixed messages girls are given about food and dieting and self-worth. De Rossi discusses how the acting industry contributes to an obsession with one’s weight but also the sheer unhappiness that goes alongside an illness like this. Hornbacher – who later wrote a memoir about her experiences of bipolar disorder – drags readers into the horrors of a disease that made her approach food like “a psychotic rabbit” and saw her muscles “eating themselves away”.
Yet even after reading these books, it is impossible not to still make the cliched and reductive assumption that eating disorders are firstly, synonymous with anorexia, and secondly, entirely about that visible symptom of thinness. And in a world where thinness is validated, where weight watching is encouraged and supported, anorexia can seem romantic. The worst horrors of it – fine, downy hair appearing on the body in an attempt to warm it; a loss of bone density and increased chance of breakages; heart failure; kidney failure – can feel distant and implausible. For women in particular, even though at least 10 per cent of eating disorder sufferers are male, thinness is such a socially-rewarded state that an illness that causes you to lose weight seems far less terrifying than it should be.
Stories matter. Stories about beautiful, thin girls who look as though they suffer from an eating disorder and who get the help they need and are then cured (often while remaining at a sufficiently light weight to be deemed socially pleasing) obscure the ugliness and complexity of a set of disorders which are not just about weight but about having a damaging relationship with food, with your mind, and with your body.
One of the diagnostic criteria for anorexia does concern weight loss, but for the most part it is behaviours – the obsessive, addictive, harmful behaviours – that medical professionals want to know about. Eating disorders are about thoughts as much as anything else, and fiction at its best shows this and invites us to empathise. Laurie Halse Anderson’s Wintergirls is a difficult read because of this – it is claustrophobic inside her protagonist Lia’s head, and at times exhausting and repetitive. We see her thoughts – including the ones she refuses to acknowledge – vary typographically, with strikethroughs and font changes at crucial moments. We see how hospitalisation is not always a quick fix, and how other areas of life fade away at the expense of this illness. It makes for grim reading, despite the lyrical language and sense of hope at the end, but then again, shouldn’t it?
Another alternative to the traditional narrative about eating disorders comes from the young adult novel Not Otherwise Specified by Hannah Moskowitz. The title refers to the category of eating disorders that don’t meet the specific criteria for anorexia or bulimia but are nonetheless recognised as an illness: “Eating Disorder Not Otherwise Specified”. Bodywhys note that this category is thought to account for up to 50 per cent of eating disorder diagnoses, yet in both fiction and memoir it is barely visible. Moskowitz’s protagonist Etta is in recovery, and the novel explores what it is to not quite fit into neat boxes – identifying as bisexual, she is “not gay enough” for her lesbian friends, and she doesn’t “look sick” enough to be perceived as someone still battling an eating disorder. As a young woman of colour whose rib cage isn’t showing through her skin, she doesn’t quite match up with our idea of the eating disorder sufferer – and she knows it.
There are other stories that need to be told about eating disorders – more about male sufferers (Robin Friedman’s Nothing, about a teenage boy struggling with bulimia, is a good place to start); more about people who are sick but don’t “look” the part; more about the difficulty of finding and funding effective professional support. More about the far less glamorous bingeing and purging; more about individuals of all ages who can be susceptible to eating disorders, not just privileged, white teenage girls. These are not exotic and rare illnesses – in Ireland there’s an estimated 200,000 people affected by eating disorders, with about 80 deaths annually. These are not choices made by silly girls who have just seen too many airbrushed photos of skinny models – although the media certainly doesn’t help – but sets of behaviour that deserve professional intervention and support.
Even though I have read all these books and lived inside those minds, real and imagined, there is still a part of me that is aware she is a woman in a society that would prefer her to be thin and isn’t particularly interested in the nuances of how she feels about food or her body or what poisonous thoughts might creep inside her brain. The standard level of body hatred that women are encouraged to have is certainly a contributing factor to eating disorders, but its prevalence can also mean we forget that eating disorders are mental illnesses – in the same way that some people still feel that “everyone gets sad sometimes” negates the existence of clinical depression.
But despite the pattern of poor-little-rich-girl-goes-to-hospital that turns up in so many of the books about eating disorders, I do believe stories are incredibly powerful tools for generating empathy. So read Wintergirls, read Massive, read Wasted, read Not Otherwise Specified. Press memoirs and novels into the hands of people who need to be reminded that eating disorders are real, are dangerous, are in need of medical intervention. It is easy to forget, sometimes, when we have the familiar story to hand; the stories we tell matter.
Claire Hennessy is a writer, editor and creative writing teacher based in Dublin, Ireland. Her next YA novel, Nothing Tastes As Good, will be published in July by Hot Key Books. She is a co-director of the Big Smoke Writing Factory, co-editor of Banshee, a literary journal, and is the Puffin Ireland editor at Penguin.
