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Keywords:

  • eating disorder;
  • subculture;
  • cyberculture;
  • illness;
  • pro-anorexia

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References

This paper explores the ways in which young women ‘manage’ the complexities of the presentation of an anorexic identity, the stigma attached to it, and the relationships that are developed with fellow sufferers. A range of ethnographic data and ‘voices’ are drawn upon, including a small qualitative study within a leading centre in the UK for the treatment of eating disorders. The paper begins by outlining the ways in which for many young women, anorexia is a stigmatised identity which in various contexts comes to be perceived as an irrational and self-inflicted condition. It was reported by the young women in our study that many of their peers, families and teachers made sense of their eating disorder through a medicalised discourse which focused on visual aspects of weight gain/loss and often stigmatised the condition, reducing it to a position of pathology or irrationality. It is argued that these experiences form a type of ‘discursive constraint’ (Ronai 1994) which many of the young women attempt to resist by engaging with alternative contexts and relationships through which they can construct more positive self-representations of anorexia or anorexic identities. As is revealed through the various data sources, as these young women negotiate the various discourses which offer them alternative subjectivities, they come to manage anorexia as both an illness and an identity.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References

The increasing prevalence of eating disorders, especially anorexia nervosa and bulimia, has in recent years been described as a modern epidemic. It is, for example, the third most common chronic illness among females in the USA (Goldman 1996). Indeed, Lask and Bryant-Waugh (2000: 97) suggest that ‘anorexia nervosa remains among the most fatal of psychiatric illnesses’. This is particularly alarming given that it is also a condition which not only has an increasing prevalence amongst younger people (see Goldman 1996, Steiner-Adair and Vorenburg 1999: 107) but is also spreading to cultures which were previously believed to be unsusceptible to it. Gordon (2001), for example, notes the increase in places such as China, India, Mexico and Brazil.

With the rapid rise of these conditions has come increasing attention from the popular press and academic disciplines, all contributing towards the discourse around the aetiology of eating disorders. Whilst there is not space here to fully explore what these disorders entail, a large volume of the research points to the associations of negative body image, fear of fat, feeling powerless and insecure (Levine and Piran 1999: 321). Whilst a range of disciplines offer various ways in which we can understand anorexia and bulimia, ‘medicalised’ constructions of these conditions have tended to emerge as dominant discourses. Whilst in many ways medical understandings of any health condition are necessary, not least in terms of treatment, these perspectives tend also to understate various social and moral dimensions of these conditions (Malson 1998: x). In recent years a number of feminist researchers have begun to more fully explore the social influences upon these conditions (see Malson 1998, Hepworth 1999, Fallon et al. 1994). There are now a plethora of studies which explore the discourses around eating disorders. There is, however, relatively little research which addresses how young women actually manage these discourses; or in other words, how they make sense of the various social constructions of eating disorders at an everyday level. Warin's (2002) recent study of anorexia is one such exception. In her ethnographic work on the everyday experiences of living with anorexia, Warin (2002: 123) makes the important distinction between anorexia and many other chronic medical conditions, in that whilst it may be severely damaging to the health of those who experience it, many sufferers describe it ‘as a productive and empowering state of distinction’, particularly in its early phases (Warin 2004: 101). There are, she notes, few other chronic illnesses where sufferers actually seek out, or ‘desire’, the condition. There are now increasing numbers of internet web-sites described as ‘pro-anorexia’ or ‘pro-bulimia’ where sufferers can connect with each other and share their experiences within ‘virtual space’. More alarmingly, these sites have also led to the sharing of advice and tips on how to become anorexic or bulimic, and how to conceal the condition from others. Such websites are indicative not only of the ‘desire’ to have anorexia, but are also illustrative of the ways in which for many people, particularly young women, anorexia is central to the formation of particular subjectivities around which relationships may be formed with the self, and others. They are perhaps also suggestive of the ways in which those people with anorexia may come to ‘resist’ the pathologising stereotypes that often ensue from their interactions with others.

It seems that, given the complexities of these conditions, we still require further knowledge of how anorexia is constructed as a social identity and how various anorexic subjectivities are managed, resisted or taken up within and across various social contexts. In addressing this caveat, this paper presents data from a small ethnographic study of a leading clinic in the UK for the treatment of eating disorders. Efforts are made to examine the everyday experience of living with anorexia, the ways in which it is stigmatised by others, and the practices that young women with anorexia engage in as a form of resistance to such stigmatisation. It is suggested that many of the young women suffering from anorexia sought sanctuary and support from other sufferers. For some young women however, these relationships may take a more alarming focus, including ‘the secret language of eating disorders’ (Warin 2004: 101), often with reference to particular tricks or bodily practices to conceal anorexia. The various data sources point towards the ways in which young women ‘accomplish’ anorexia and in doing so draw upon and contribute to what might be described as a subculture. The complex and contradictory nature of these relationships is also explored, and it is suggested that these are bonds of both connection and disconnection as they simultaneously form a source of comfort and competition.

Methodology and textuality: a patchwork of voices?

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References

In attempting to engage with the multiplicity and complexity of the experiences of eating disorders, the paper draws upon what Denzin and Lincoln (2003: 8) term a ‘display of multiple refracted realities simultaneously’ by presenting a range of voices and narratives from a number of different perspectives and social contexts. Moreover, in doing so, it enables representation of the ways in which the experiences within and through anorexia are ephemeral, and shifting, as these young people move across a variety of social settings; in the paper reference is made to school, treatment settings, peer culture and even via internet settings, illustrating the complexity of social positioning and construction of subjectivities. In this sense, what emerges is something that relates to the concept of ‘montage’ (see Cook 1981: 323). Within film, montage (a method of editing cinematic images) uses brief images to create a clearly defined sense of urgency and complexity. Montage invites viewers to construct interpretations that build on one another as the scene unfolds. As Denzin and Lincoln (2003) note, the qualitative researcher who creates texts based on metaphors of montage or quilt making have many different things going on together. Thus, included in this paper are multiple voices. What we end up with is a multi-layered ‘hypertext’ (see Lather 1999) in a process of weaving data, method, analysis and the politics of interpretation. Four main voices emerge in this space, as outlined below.

The narratives from semi-structured interviews with young women who were experiencing anorexia or bulimia are presented. These data are taken from an ethnographic project exploring the relationship between disordered eating and schooling at a leading centre in the UK for the treatment of eating disorders (see Rich, Evans and Holroyd 2004, Evans, Rich and Holroyd 2004, Evans, Evans and Rich 2002). The centre caters for both males and females between the ages of 11 and 18. However, reflecting broader patterns in the epidemiology of eating disorders (see Doyle and Bryant Waugh 2000), at the time of the study only one of the 25 young people attending was male, and he did not participate in any individual interviews. The centre is a residential home exclusively for the treatment of children suffering from eating disorders. Children are referred from all over the world, by consultant child psychiatrists, consultant paediatricians and general practitioners. There is also a full-time school at the centre in which four special needs teachers liaise very closely with the patients’ former school. Mealtimes at the centre are monitored, with the careful calculation of calorie content and close supervision, at least for some of the residents during meal times. The young women whose voices are heard in this paper come from ‘middle class families’, and all have attended what might be described as ‘high status’ comprehensive, grammar or private, secondary schools. Indeed the Headteacher at the centre suggested that this was typical of the population at the clinic where ‘the majority of young people at [the clinic] are from well-to-do state schools (i.e. those with a good reputation who are more selective) or private day schools’. All of the study participants have been diagnosed with anorexia or bulimia, and are judged by the clinic to be at different stages of ‘illness’ or recovery, but each is suffering in sufficient severity to warrant residential treatment and care. Collecting stories or narratives about illness and medicine has become increasingly significant in research about health and illness since the early 1980s (Hyden 1997). By collecting narratives through techniques that include interviews, diaries, life histories and biographies, it is claimed that people are given a space to articulate their experiences, perceptions and understandings. Such accounts provide insights into how bodily and emotional changes related to illness are understood outside the prevailing biomedical model (Bury 1982, Kleinman 1988, Frank 1995, Radley 1999, Hardey 2002).

Alongside these young women's accounts there is also the voice of the ‘ethnographer’ who stayed at the centre interviewing and interacting with the girls during their daily routine. The ethnographer was a female academic in her twenties who was of what may typically be defined as a ‘slim’ build, and kindly provided her field notes from her research diary for this paper. The extracts present a number of reflections on the experience of entering the clinic, and of experiencing the ‘subculture’ of anorexia as an ‘outsider’. This provided a useful set of data to include since it alludes to the fluidity of ‘acceptance’ and ‘(dis)connection’. In some accounts, the researcher reports being ‘invited into’ this subculture, with a number of intimate experiences and practices shared, against which the ethnographer reports having to renegotiate relationships and taken-for-granted assumptions about anorexia. Conversely, there are other occasions where these young people remain protective of certain social spaces, knowledges and relations, and position the researcher as ‘outsider’. Part of understanding these experiences entailed learning the distinct language, terminology and practices that were taking place in the centre.

Woven throughout the text, are also ‘cyber voices’. With the increasing use of internet-related communications for the publication of stories of eating disorder experiences, support networks and even the promotion of eating disorders through pro-anorexia websites, some references are made throughout the paper to the various voices that are emerging in this context of cyberspace. Finally, more formal academic voices, as well as extracts from other published narratives of anorectics, are also embedded in the text, providing some of the multiple interpretations of these disorders.

It must be noted, therefore, that whilst the paper draws on a range of voices, these are still represented through the author's interpretations. What is missing from the paper are responses to these data from those within the medical profession and those experts working at the clinic.

Specifically, the paper deploys what might loosely be termed a feminist post-structuralist form of analysis of interviews with young women diagnosed with anorexia and/or bulimia. The analysis explores the interrelationships between discourse and the subject positions made available to and by the young women in our study. As Davies and Banks (1992: 3) suggest, ‘from a post-structuralist perspective, subjectivity is formulated through discourses, given substance and pattern through storyline and deployed in social interaction’. In this sense people move through multiple positioning during various interactions. Davies and Banks (1992) go on to note that positions are discursively and interactively constituted and so are open to shifts and changes as the discourse shifts or as one's positioning within, or in relation to that discourse, shifts. Through taking up these discourses as one's own, each woman is a speaking subject and also one who is subjected to or determined by those discourses (Davies 1982). Thus, the concept of ‘positioning’ is an important one in understanding the ways in which people are constituted in and through existing discourses (Davies and Harre 1990) related to eating disorders. Whilst there have been a number of studies exploring the discourses constructing anorexia (see Malson 1998, Hepworth 1999) we need a clearer understanding of how these exist in the ‘social practices of everyday life’ (Weedon 1987: 111).

The participants

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References

Before exploring the data, it is worth saying a little about the backgrounds and status of the young women in the study, at the time of interview. Lydia was 14 years old, and had been in the clinic for seven weeks. Mia was 16 and had been at the centre for 25 weeks, had engaged in bingeing and self-harm and suffered from clinical depression. Hayley was 15, and had been at the centre for 53 weeks. Lauren was 17, and had a three-year history of anorexia and had previously taken overdoses. Ellie was 11, and had been at the centre for 16 weeks. Emily was 13 and had been at the centre for 16 weeks. Karen was on a return visit to the centre, having previously been admitted, and had had one other admission to another clinic. On this occasion she had been at the centre for three weeks, was an obsessive exerciser and had engaged in self-harm, had experienced physical and sexual abuse, and had suffered from depression and agoraphobia.

Discursive constraint: the stigmatisation of anorexia

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References

All of the young women in our study reported feeling misunderstood and isolated, and bemoaned having their eating disorder pathologised or medicalised by ‘significant others’ within a variety of social contexts. As highlighted elsewhere (Rich, Holroyd and Evans 2004), many of the young women described how they had felt alienated or disconnected from their families, teachers, friends, health professionals and even their own bodies. Most significantly, many of them found that this disconnection was related to the ways in which others ‘read’ the anorexic body, in ways that they felt served only to pathologise them:

One of my teachers came up to me and said ‘oh how have things been’ and I said ‘Oh not too well, I think they’re thinking of putting me back in a unit’ and he goes ‘well you don't look too thin’, and I was like (sighs) ‘but you don't understand, there is more to it than just being thin’ . . . And also when I came back to the sixth form, the same teacher saw me in a corridor and the first thing he said to me was ‘are you putting on weight’. He shouted it across the whole corridor. He saw me and it obviously triggered in his head ‘oh weight issue, are you putting on weight?’ and I was like ‘Oh my God!’ (Lauren).

The focus here is on the increase or decrease in weight, rather than understanding the social and emotional dimensions of what it is like to be a young woman suffering from an eating disorder. A number of the other participants in our study recalled similar experiences where significant others focused only on the relationships with weight gain and food:

One time a teacher had made a comment when I was in the lunch queue at school [on an occasion when her mother had made her have lunch with her sister who was in a higher year group]–‘which was bad enough’. She [her teacher] said ‘well Hayley, is this really you in a queue for food?’ It was awful. I mean, especially there in front of all those people (Hayley).

In these and other examples, the health and wellbeing of these young women is reduced simply to a matter of weight loss or gain. Much of the basis of this monitoring is linked to a larger biomedical focus on ‘physical’ dimensions of health and illness. As Austin (1999: 247) notes:

in the practice of medicine, diagnosis and classification are founded on the clinical sign, a construct that presupposes that any underlying pathology can be linked to a physical sign, an indicator that can be observed and measured.

Biomedical discourse, in this sense, produces a language through which illness is deemed to be ‘recognisable’. Such monitoring of health via ‘physical signs’ (size and weight) may, however, overlook the fact that many young women who appear to be a ‘normal weight’ might still be struggling with the day-to-day problems of anorexia, not least the ways in which they may experience their bodies and bodily processes as ‘unworthy’ with regard to any pleasurable relationship with foods:

And I think that most people who are anorexic don't fully recover from it, because I know a lot of people who have been anorexic who still worry about what they look like and you know, you have to get over it I suppose but they've still got it in their heads (Lydia).

The public privileging of the ‘visual’ dimensions of illness in this way also reduces anorexia to what Warin (2004: 95) terms ‘the spectacle of thinness’, in many ways resulting in the objectification of young women's bodies. Whilst there is not space to fully discuss why it is that this ‘spectacle of thinness’ (2004: 95) accompanies anorexia, it is worth alluding here to the ways in which the perceived ‘voluntarism’ that it entails may well serve to legitimise how others come to make sense of anorexia or approach those who experience it. Moreover, Warin (2004: 96) suggests that this ‘spectacle of thinness’ has historically held public fascination through the carnivalesque context of European amusement culture (see Gooldin 2003) where ‘living skeletons’ and ‘hunger artists’ were mediums of entertainment. Whilst in the 21st century we no longer have ‘carnivalesque’ performances as such, the ‘spectacle of thinness’ can be seen in both popular discourses surrounding self-starvation and indeed through the ‘showcasing of personal trauma’ that we see in popular postdocumentary culture such as TV talk shows, lifestyle programming and reality television (Biressi 2004: 335). One such example of the ‘spectacle’ of self-starvation was an event which took place in England in September 2003, by illusionist David Blaine, who performed an ‘endurance feat’ when he chose to stay in isolation in a glass box over the River Thames in England for 44 days and 44 nights with no food, only water and no human contact. Whilst many of the young women refer to wanting others to understand the pain, anguish and emotional difficulties that lie beneath the surface features of the ‘body’, it is not difficult to see that the fascination with thinness, and the biomedical approach of associating health with a physical sign, is very difficult to relinquish. In other words, teachers, friends, families and significant others are reading anorexia first and foremost through physical signs. Consider the following extract from the field notes of the ethnographer in our own study, who reflects on how difficult she found it to surrender the connection between physical appearance and health and well-being:

I was struck by how ‘normal’-looking these young people were . . . (but why should that be surprising?) The only thing that distinguished them from any other group of adolescents was their reaction to food/mealtimes (Ethnographer's field notes).

When making sense of anorexia through the discourses outlined above, it is hardly surprising that one might then be struck by the ‘normal’ physical appearance of some young women with eating disorders. This may be particularly so when our understanding of anorexia rests not upon the thinking and relationships that these young people have with food, self and the body, but with the biomedical issue of weight loss/weight gain, of the ‘physical’ dimensions of health and illness. During her time at the clinic the researcher reported that the weight and physical appearance of the girls changed as they moved in and out of different phases of recovery. Relinquishing the focus on thinness, however, appeared only to come with repeated efforts to learn more about the social experiences and other aspects of eating disorders throughout the fieldwork. Perhaps in some ways this reflects the need to move beyond the biomedical objectification of seeing these young women as ‘thin bodies’, rather than as complex and unique young women with multiple identities. Of course, it is incredibly difficult not to focus on extreme and dangerous thinness, after all it often invokes an emotive response. In the following extract, the researcher reported learning about one resident, a young woman who had not been to an eating disorders clinic before but had been to hospital claiming ‘I tried to kill myself’:

This (I tried to kill myself) was said quite calmly and bluntly with a cheeky smile on her face and I remember thinking how bizarre it was that she wasn't phased by it at all – I on the other hand found it hard to know how to respond – I left the conversation feeling like I'd had a reality check. I'd spent the last couple of days coming to the conclusion that the young people at [the clinic] were just ‘normal’ (can't find another word!) adolescents in many respects, before finding myself in a conversation with two 11-year-olds drawing pictures and colouring-in while discussing suicide as if it were nothing out of the ordinary. Makes you realise there's a lot more going on under the surface (Ethnographer's field notes).

In the safety of the clinic, where they are surrounded by other girls with eating disorders and those who might better understand them (than say other friends, families, teachers, etc.), many of the young women in our study felt more able to express these feelings and talk about the anguish of the relationships with their body, self, food and eating. However, it was these very voices which they felt in other contexts were ‘being hushed up’ to use the words of Karen, one young woman with anorexia:

It [her eating disorder] was not something that was talked about . . . They [teachers] could have told people about it, and informed them about what it meant. Because I used to get bullied for being anorexic, and I knew that people must be talking about it because people I didn't even know used to look at me really strangely and talk about me behind my back (Karen).

Indeed Karen commented that ‘I had to try and hide the fact that I was ill when I returned to school’, and commented that when she had been in hospital ‘I had to think of different reasons for why I had bandages on my hands where the drips had been [ . . . ] as if having anorexia was not an acceptable illness’. The ‘hushing up’ of these eating disorders also had the effect of silencing the complexities of relationships with food, body, self and others that these young people were negotiating:

although my friends were aware that I was anorexic, they didn't always appreciate that I also had a problem . . . they [school] didn't seem to understand just how much was going on in my head, they thought, I don't know, that I was being stupid or trying to get attention or something (Carrie).

Others recalled similar experiences:

Mmm, not just what happens, because that was what I was taught, and not just what happens physically but what happens mentally. People don't often realise what extreme pain and agony it is, they just think, it's like a glamorisation of getting attention and things like that. Which is not true (Mia).

Without an engagement with the complex emotional and social dimensions of experiencing an eating disorder, it thus became very difficult for others around these young women to understand why someone would want to ‘starve themselves’:

All I can do is try and talk to them [parents and teachers] about it, but you know (they say) ‘the issue is here Lydia, you know you've got to get better’ and I'm like ‘shut up’. And you know they don't really want to know what I think, because they’re like ‘why can't you eat?’ and I'm like ‘why can't you understand?’ . . . It's really really frustrating . . . (Lydia).

It feels like this is a hospital for the gifted people that have gone wrong, do you know what I mean? And my mum always says that she doesn't understand why such beautiful and talented people want to destroy themselves (Lauren).

Without wishing to understate the sophistication of the perspectives that abound within a variety of fields (see Lask and Bryant-Waugh 2000) it is worth noting here that:

anorectic behaviours and experiences have tended to be viewed, both in the popular media and much of the mainstream academic press, as pathological conditions distinctly different from the ‘normal’ and ‘healthy’ experiences and practices of non-anorexic women and girls (Malson 1998: x).

As Cogan (1999: 231) suggests, the most widely used theories to explain the aetiology of eating disorders are individually focused. The person with anorexia or bulimia is seen to have character flaws that need reparation, for example the person is emotionally unbalanced, needy, a perfectionist, desires control or has cognitive distortions. Indeed, these young women are acutely aware of the pathologising caricature of anorexia as the ‘slimmer's disease’. Severe weight loss, and the accompanying ill health, comes to be seen by many as a lack of reason, as a form of individual irrationality (Cogan 1999: 242) and ‘attention seeking’. In the extract below, Karen is all too aware of her excessive behaviour to burn off calories being read in such ways:

I used to go and run up and down the stairs in the school corridors over lunch instead of eating anything, just so I could burn off more calories. They must have thought that I was mad (Karen).

All of the above experiences point to the ways in which the young women were subject to ‘discursive constraint’ (Ronai 1997: 125, cited in Cordell and Ronai 1999) wherein their

behaviour is constrained by the threat of having a negative category applied to . . . her self. These categories are disseminated throughout society so effectively that they take on a taken for granted or given quality (Ronai 1997: 125).

Anorexia therefore comes to be defined as a negative social position through which to define the self, implicitly working to persuade someone to return to ‘normal/healthy’ weight. It literally constrains the discourse that these young women can apply to their self (Cordell and Ronai 1999), reducing the available subjectivities to positions of irrationality or other pathologising stereotypes. In this sense, these young women diagnosed with eating disorders came to be viewed as ‘different’ from their peers or ‘deviant’. This is compounded when such ‘deviance’ is made sense of through a medicalised discourse or biomedical model which views the body as a series of separate but independent parts (Doyal 1995). As Doyal (1979: 35) explains: ‘health is defined in individualistic ways, it is always individuals who become sick, rather than the social, economic or environmental factors to cause them to do so’. The medical and psychological professions possess a profound capacity to structure the mainstream discourse on ‘thinness’ and ‘eating disorders’, medicalising weight and defining the clinical categories (Sobal and Maurer 1999). Indeed as Haworth-Hopner (1999) notes, medical discourse on eating disorders does not necessarily reflect people's lived experiences, and the ways in which illnesses are shaped by socio-historical power relations (Good 1994). A central focus solely on medicalisation has tended, if not to ignore, then at least to understate some of the other human and social dimensions of individual experiences of these disorders. Medicalising eating disorders in this way can result in dislocating responsibility for them from wider society, and can produce apathy about public responsibility ‘lessening the likelihood that audiences will respond to eating disorders as social problems worth doing something about’ (Way 1995: 91).

It is no coincidence that many of the girls indicated that, before coming to the clinic, they had few people whom they could turn to, who could understand the experiences of anorexia. Even within their own peer culture, many of the young women suggested that there were few people to whom they could talk about their problems and experiences of eating disorders. Many of the girls reported being bullied, of further suffering from depression and/or self harm, and of coping with anorexia on their own. In other words, they were having to manage the various dimensions of being ill in accordance with others’ constructions of their subjectivities. How these young women manage such stigmatisation, their bodies and their selves therefore raises questions about how anorexia is lived out by young women within and against various discourses. The first key point here is that all of the young women in our clinic felt that their eating disorder was not well understood by others around them, and that this propelled them to wanting to find alternative contexts within which they could find sanctuary, support and comfort with others, usually other sufferers. Secondly, there is also evidence to suggest that the relationships that are formed within and through ‘connections’ with other sufferers are illustrative of the ways in which these young women not only attempt to retain their anorexia, but simultaneously attempt to resist the negative effects of discursive constraint, as outlined above. The following section explores how some of these connections are lived out.

Negotiating connections and boundaries

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References

The above discussion raises an interesting question – where do these young women feel that they are understood? For many of the women in our study, it was primarily through contact with other people with eating disorders. Increasingly, on a wider scale, such contact is being sought through the internet. In recent years, we have seen the emergence of various internet communications which may be described as ‘computer mediated social support’ which have a focus on self-help or support for those with various illnesses (Burrows and Nettleton 2000). These include for example, web sites, email groups, chat rooms, online narratives and discussion forums. Burrows and Nettleton (2000) suggest that in such cases the internet might be described as a global health advice network, or a ‘virtual community of care’ that extends beyond the on-line self-help group. These contexts are particularly important for those who suffer from health problems that are stigmatised in the wider society, whereby the only point of contact with fellow sufferers may be through the internet, helping them to feel less isolated and in some cases providing resources to deal with stigmatisation. Indeed cyberspace has emerged as a critical context for the construction of alternative identities and narratives relating to eating disorders. In recent years, an array of anorexic narratives has been published on the internet presenting the intimate everyday experiences and nuances of living with an eating disorder. These narratives, which focus on the social and emotional dynamics of anorexia and/or bulimia, may provide alternative spaces for these young women to voice their experiences without the threat of feeling pathologised. One only has to visit any of the web pages and support groups online to see that there is a concern from those who use these sites that without these contexts they would have no alternative space through which to share experiences, as illustrated in the following extract from a debate in a ‘pro-anorexia’ discussion site on the internet:

I'm glad that there are people out there that are interested in helping eating disorders but you need to also look at the whole picture. The site I belong [to] could be classified as proana [pro-anorexia] but they offer everything from recovery to those 12 year olds begging for advice on how to become an anorexic. Most of all it is a place for people to [go] and vent about every issue you could imagine. It frightens the hell out of me that people like you go around and take away our rights to freedom of speech.

They are the ONLY form of consistency and true support. You would not believe how many of us spend hours talking to the younger ones about the consequences and yeah about death. These kids learn fast and no one holds back. Once the talking about the eating disorder is talked about the real pain comes through. The thought of you shutting my support down like, when I just read some of the posts the first thing that popped into my head was, I can kill myself (message posted on eating disorders discussion board).

Connections formed through anorexia are not only evident in cyberspace. In our study, the young women referred to developing similar bonds of understanding with fellow sufferers. It is not only support and understanding that is found through these relationships. Through interviews with the young women, and observations at the clinic in our study, it was evident that the relations formed with others with eating disorders emerge as a medium for the sharing of certain knowledges and practices involved in learning to become anorexic or bulimic, or concealing it from others, as is being revealed elsewhere (see, for example, Warin 2004: 101). One practice was the sharing of what are termed ‘anorexic tricks’ (Warin 2002: 132), involving various methods of giving face compliance to recovery from an eating disorder, yet also carrying out practices to conceal continuing efforts to lose weight:

You don't have control of what you’re doing, but you do have control of the food that you eat at home. Because you’re like ‘oh yeah, I'm eating’ and you show them your food and then you just skank it. You make it and skank it, you feel bad but . . . (Lydia).

In the above comment, Lydia refers to ‘skanking’ her food, which meant the anorexic practice of hiding food whilst pretending to others that she had eaten it. During observations at the clinic, it was clear that many of the young people in their relations with others, were sharing such ‘resistant practices’ with each other:

There were one or two of the young people who had been there longer . . . who were sharing tips on how to get around eating high calorie meals (what things to put as your ‘dislikes’ or what combination of things to put; getting yourself onto stepping stone meals (stepping stone meals are high calorie and small volume given if they are struggling to eat their other meals in a set time) (on purpose) so you could avoid difficult meals like fish and chips or roast dinner; saying you had certain food allergies etc. One resident was explaining to me today the laxative effects of chewing gum and mentioned that she used to have six packs a day. She is chewing gum as I speak to her (and chewing gum is banned at the centre) but she told me that she sneaked some packets in with her.

A common ‘trick’ seemed to be squashing the chips onto the plate to try and get rid of some of the fat (Ethnographer's field notes).

As our researcher spent more time at the centre, more of these anorexic practices were revealed to her including the specific terminology for these methods which included; skank – to hide meals and pretend to have eaten them; tank – to drink lots of water and retain it to increase weight; purger – someone who vomits after meals. Increasingly, our researcher reported becoming more familiar with the various dynamics within this context:

It's funny how you get used to things at the clinic. I found that I had to get used to the occasional fits of screaming/crying; Ellie's usual tantrums at every meal after her calories are changed; the language used by both staff and students (jargon, etc.) and had got used to the fact that food didn't really have a name anymore, just a calorific value. In other ways you feel you get more acclimatised to more serious things e.g. you don't feel shocked any more when you see scratch marks, or scars on peoples’ arms/legs. I don't think it odd that a lot of young people wear shorts and T-shirts in the middle of winter (shivering burns calories) or that young people are happiest to speak to you standing up or walking around (burns more calories). You even get used to the constant leg twitching or standing up and sitting down (burns more calories). You do, however, start to recognise little tricks or patterns e.g. at one meal time Ellie was told to stop moving her feet up and down so she stopped this but kept her feet slightly off the floor. Another time, a group of the young people changed their midmorning walking route because they knew it was a little bit longer (a new member of staff didn't). In addition, it was often a common thing for the young people to get one thing out of their lockers at a time – getting up to walk backwards and forwards burnt more calories (Ethnographer's field notes).

Such forms of connection through the desire to ‘retain’ anorexia (despite being under treatment), or indeed become a ‘better or best anorexic’ are particularly prevalent within the ‘pro-anorexia’ movement on the internet. In recent years, there has been a great deal of media attention about the nature of such ‘virtual freedoms’. The pro-anorexia (or pro-ana) movement has tended to take place primarily through cyberspace, and is made up of interactive chat rooms, forums and websites which centre on an individual's right to have an eating disorder. The content of these internet sites ranges from discussion and support groups for sufferers, to more controversial advice on how to develop an eating disorder, ways to conceal eating disorders from others, and even the hosting of competitions to find the ‘best anorexic’. For example, one site called ‘ana girl’ is described by its web creators as ‘a pro ana site with lots of triggering pics and thinspirational quotes, tips, and tricks. There is also an updated message forum and a chat room where people can go and share tips’ (http://www.angelfire.com/pq2/anagirl). Other sites include such titles as Anagirls livejournal, anorexic beauty, anorexic nation, Go Ana, Love it to death, worship in vain, starving for perfection, wasting away on the web, dying to be thin. There is not space here to discuss the ethical implications of the development of these web spaces. Instead, these sites have been highlighted as an example of the ways in which young people are forming bonds with others, perhaps as part of the process of managing their eating disorder. It is worth reiterating that for many of these young people, in other contexts and relationships these eating disorders are seldom understood, and come to be stigmatised and marginalised.

The above raises questions about how such practices of concealment or ‘face compliance’ with treatment might be a form of resistance to discursive constraint. Warin's (2002) ethnography of eating disorders has most usefully addressed some of the complexities of the nature of concealment and secrecy of such anorexic practices. Drawing on Herdt (1990: 368) and Strathern (1988: 115), Warin (2002: 142) asserts that:

The power of secrecy is not only in what it conceals, but also in what it reveals and creates. Strathern and Herdt both argue that what is missing from the comparative study of secrecy is an understanding of how secret collectives, in the creation of social hierarchy, are systems which produce cultural meaning (Warin's emphasis).

In this sense, certain sets of meanings are created and sustained as having value across the narratives of these young women, affording them not only alternative subjectivities but relations of power and knowledge. Hiding practices or ‘anorexic tricks’, be this as a form of non-compliance to treatment in clinics/centres, or concealment from family and friends, is not just about the practical issue of avoiding treatment in order simply to lose weight. It is also bound up with the symbolic associations and discursive meanings attached to the eating disorder, and with personal biographies (Bury 1991, Atkin and Ahmad 2000). On this basis, it needs to be seen as part of the wider process by which young people make sense of the relationship between their body self and illness as they struggle to maintain particular self images and identities (Bury 1991). Concealing anorexic practice is then a symbolic site as these young women struggle not only to reassert their self-determination but also to attempt to retain an identity, albeit an ‘anorexic identity’. The selective passing on of the practices or techniques of anorexia is a way of not just reaffirming the identity, but also ensuring that it is the ‘right’ and ‘accepted’ identity:

I was too busy concentrating on being anorexic at school. I was too busy on saying the right thing, doing the right thing. I truly believed that my role in this world, my place, was to be the anorexic. Because you have the dominants, the leaders, the thinkers, I was just the anorexic, that was who I was (Lauren).

Being a ‘successful’ anorexic was seen to afford them a certain status and sense of empowerment. Many of the young women in our study attempt to manage their selves and to minimise the damage of the negative social positioning they experience. To do so, they present alternative narratives within which they construct themselves not as irrational, seeking attention or ‘abnormal’, but as in some ways embodying extraordinary strength and finding ‘empowerment’ through anorexia. As Lauren commented:

It [anorexia] shows that you have a strength that others don't, because, let's face it, not many people have the ability to starve themselves to death all the girls seemed to, I don't know, idolise it . . . and because now everyone is aware of anorexics even if they don't understand them, everyone's just so interested (Lauren).

I always used to look at my friends and think that I wanted to be as good, or as pretty, or as clever as them. So I decided that not eating was a way that I could maybe achieve that (Hayley).

The above might be considered as forms of narrative resistance (Ronai 1994) to the constraints that they experience in relation to others’ perceptions of their eating disorder. It becomes a way of resisting discursive constraint and constructing a positive ‘anorexic’ identity. It involves rejecting the negative labels of pathology or irrationality and instead constructing a narrative of anorexia as affording them status, and empowerment. For some of the girls, the ending of anorexia would entail the loss of a particular subject position, and thus it was not unusual for them to engage in boundary maintenance between those who were inside and those who were outside anorexia – or those who might ‘take it away’. Karen for example, commented that she hated her therapist, ‘she's such a bitch, she's the one that turns my parents against me, she makes them really strict with me’. Karen and Annie both described similar feelings, suggesting that ‘it makes you more determined’ (Karen). There were occasions where our own researcher felt as though she was being positioned on the outside of these social spaces and relationships:

P and T are missing school and sit in the lounge watching television. Lydia joins them at one point and the first thing they discuss is what they will ask for tea. P decides on cereal and says ‘it's because . . . well you know why’ (this after realising I am there). Later I find that the reason is because she was sick after eating the same thing for lunch (Ethnographer's field notes).

This was in part due to the association with ‘authority’ and the perception of being a member of staff and therefore as someone who might threaten to take away their eating disorder:

When asked to help out in various ways (e.g. meal preparation and supervision) . . . I felt a little awkward doing this because I felt it wasn't really a good thing to be seen as staff by the Young people (Ethnographer's field notes).

Anorexic disconnection

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References

It should be noted here that these are complex conditions, and the resistant practices outlined above did not occur in the absolute sense; the relationship with anorexia was contradictory, as was the relationship with other sufferers. The young women we talked to referred to the constant negotiation of contradictory relations with anorexia, of feeling both empowered by it, yet also having awareness of it being paradoxically destructive:

I'm OK now, I feel like I'm winning, I feel like I'm finally giving it the boot. But it does destroy lives, it really does . . . Yeah, and it's like I want to go somewhere where there's a pressure to eat, because there there's a pressure not to eat . . . It's so crap having anorexia, all you can think about is the way you look and how fat you feel. It's such a deadly illness, you know because before I came in here I could have collapsed at any minute on the floor, and my heart beat was really slow, my sugar levels were low, and I think everyone before they came in here could have dropped dead at any minute . . . But you know it's hard to figure out what triggered anorexia you just need to be aware of the signs, because I wouldn't wish anorexia on anyone. It's really, really frustrating, and it really does, I couldn't wish it on anybody because it really, really screws up your family (Lydia).

This shifting response to their illness partly explains the contradictory relationships with treatment and the need to share methods of non-compliance with treatment, whilst at other times complying with it and making efforts to recover (the young girls in the study were at various stages of recovery). This is illustrative of the complex relationship these young people have with anorexia. Secondly, such complexity extends into the relationships with others wherein they are simultaneously feeling close to other sufferers, but also very quickly disconnected from them. Relations between the young women in our study were transient, fluid, indeterminate and often seemingly contradictory since whilst they often encouraged the ‘sharing’ of anorexic practices, and offered support to one another, they were also simultaneously engaging with each other in more competitive and even hostile ways:

And when this other girl at the school became anorexic, I felt that I had been pushed out of my place and I was furious [ . . . ] and how dare she, that was mine, that's who I had been, and who was I going to be now that she was there and now that she was obviously thinner than me (Lauren).

Well I competed with my friend to see who could lose the most weight (Mia).

oh, I was really jealous of all those kids because they were this thin (indicated a very small distance). They were all saying ‘oh I'm fat’ and I was like ‘yeah, shut up’ (Ellie).

The dynamic nature of anorexia in terms of management of the everyday practice is revealed once more here. The following extracts from the researcher's field notes allude to the fluidity and indeterminacy of managing anorexia, and the ways in which bonds with others may be weaker or stronger in particular social spaces and/or times:

Mealtimes. I suppose I was aware that this would be an interesting situation to observe but nothing really prepared me for the fact that mealtimes would be a really Big Issue. There were tears, fights, tantrums, shouting, constant comparisons to others ‘she's got more than me’ etc. . . . Some were eating completely different foods though, and I was told that these were ‘stepping stone’ meals. These are meals of quite high calorie value which are small volume (usually pasta/rice dishes). Individuals get these stepping stone meals if they are struggling to eat their other meals in the set time (usually 20 mins main course and 10 mins dessert) or if they are caught ‘playing’ with/hiding/smearing their food (Ethnographer's field notes).

There seemed to be two approaches taken by the young people. Either head down and get on with eating (blinkered from others) or constantly looking around. S accused Ellie of staring today which nearly caused world war three. The staff are constantly reminding people to ‘eat properly’ or giving warnings/reminding young people of the time that they have left to finish eating. Staff eat their meals before they come in so that all their attention can be given to supervising the meal. Often this means the young people have five or six people watching them (Ethnographer's field notes).

During mealtimes and ‘weigh in’ days disconnection can be particularly strong, and perhaps relates to the need to retain not just any anorexic identity, but the ‘best’ anorexic identity. Whilst these support networks and connections may well provide a context or space in which these young women are understood, there are mixed reactions to such groups or networks in that it may well provide a context which only fuels levels of competition and secrecy amongst those who already share unique connections. For example, some research suggests that in face-to-face therapy women may evaluate themselves and others and use this information in attempts to be the thinnest, or may use this as a way to assess themselves as unworthy to participate in the group (Bereson et al. 1989). In other words, in negatively evaluating the degree of their eating disorders ‘women tend to call into question, or challenge, their own support group participation status’ (Walstrom 2000: 763). These are the types of issues that are being raised as a point of concern following the proliferation of pro-anorexia websites, and the connections that are formed between young anorexics within a variety of other settings.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References

This paper has drawn on a range of data and ‘voices’ to illustrate the ways in which, for many young women, anorexia is a stigmatised condition which in various contexts comes to be positioned as irrational and self-inflicted. In the narratives of the young women in this paper, it was often stressed that their condition was misunderstood by their peers, families, friends, doctors and even their therapists. At its worst, they reported being positioned as ‘seeking attention’ or engaging with a ‘slimmer's disease’. As a way of managing discursive constraint, some young women were propelled towards contexts and relationships wherein they could construct alternative, more positive self-representations of their anorexic identities. For some, comfort and understanding was found through relationships with other sufferers, be this through pro-anorexic websites, friendships formed in schools or clinics where they were producing alternative subjectivities and social positions. Many of the young women in our study engaged with the concealment of anorexic practices, of ‘face compliance’ with treatment (appearing to comply when they were not, or complying reluctantly), and constructed narratives which described anorexia as both empowering and destructive. It was suggested that such practices might be understood as a form of resistance to the discursive constraint and stigmatisation of their eating disorder. For the women in our small study, and for many of those who are visiting and hosting pro-anorexic websites, anorexia is described as a symbolic point of struggle in their lives both in terms of the relationships with the condition, and indeed with the ways in which it is made sense of by others. In other words, they have to manage their eating disorder as both an illness and an identity. The subject of anorexia is being located here at the intersection of multiple and intersecting discourses. Whilst there is a discursive struggle over what anorexia means (amongst sufferers, doctors, parents, etc.) the voices of the young women presented in this paper point towards their own refocus on meaning and representation, and the difficulties of efforts to reduce experiences to object or subject.

It seems incumbent that if we are to develop our understandings of the relationships young people have with eating disorders, then we must continue to develop our understandings of such complexities. Peters (1995, cited in Gooldin 2003: 30) argues that a reconceptualisation of anorexia is needed, towards one that overcomes the psychiatric rhetoric and includes reference to the ascetic aspects of anorexic experience. Peters (1995) suggests that this should include an understanding of ‘the pleasant aspects of asceticism’, including, for example, feelings of euphoria, control, ‘specialness’, independence and efficiency. In doing so, we may better understand the active role that young women take in understanding their identities within and through anorexia.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References

I would like to thank the staff and students at the eating disorders centre used in this study, for their invaluable support and co-operation. This paper emanates from the research project, ‘Education and the Aetiology of Eating Disorders’, based in the School of Sport and Exercise Sciences, Loughborough University. I would like to thank Rachel Holroyd and John Evans, members of this research team, for their valuable contributions to this paper. My thanks also to Megan Warin and the two anonymous reviewers for their useful comments on earlier versions of this paper.

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  4. Methodology and textuality: a patchwork of voices?
  5. The participants
  6. Discursive constraint: the stigmatisation of anorexia
  7. Negotiating connections and boundaries
  8. Anorexic disconnection
  9. Conclusion
  10. Acknowledgements
  11. References
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