The Spirituality of Anorexia

A Goddess Feminist Thealogy

Emma White

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781351103343
• Edition: 1
• Topic: Theology & Religion
• Subtopic: Abnormal Psychology

Widely popularized images of unobtainable and damaging feminine ideals can be a cause of profound disjunction between women and their bodies. A consequence of this dissonance is an embodied performance of these ideals with the potential development of disordered eating practices, such as anorexia nervosa. This book develops a spirituality of anorexia by suggesting that these eating disorders are physical symptoms of the general repression of feminine nature in our culture. Furthermore, it puts forward Goddess feminism as a framework for a healing therapeutic model to address anorexia and more broadly, the "slender ideal" touted by society.

The book focuses on the female body in contemporary society, specifically the development of anorexia nervosa, and what this expression communicates about female embodiment. Drawing upon the work of a variety of theorists, social commentators, liberation theologians and thealogians, it discusses the benefits of adopting female-focused myths, symbols and rituals, drawing upon the work of Marion Woodman and Naomi Goldenberg. Ultimately, it theorises a thealogical approach to anorexia aimed at displacing the damaging discourses that undermine women in the twenty-first century.

Offering an alternative model of spirituality and embodiment for contemporary women, this book will be of keen interest to scholars of theology, religious studies, gender studies and psychology.

1
Anorexia nervosa

The starting point for our discussions surrounding the complex aetiology of anorexia must be on its definition, the basis upon which a diagnosis is made, its location alongside other eating disorders, risk factors and triggers. As such, in the following pages, I will examine the current medical classification systems used to make a diagnosis of anorexia and the complications of applying this to such a multifaceted and complex cluster of symptoms. In this we start to unpack the undercurrents of anorexia and to identify the meaning behind the statistics that show a growth in incidences over the twentieth and twenty-first centuries. The second and third sections of this chapter will provide an overview of the history of anorexia as we explore the aetiology of this eating disorder and identify common risk factors as drawn on by researchers in the field. The aim of this chapter is to provide an overview of contemporary research and developing understandings of anorexia before examining contemporary therapeutic and medical responses to the expression.

The term “Anorexia Nervosa” was first named and identified in medical literature by Sir William Gull in 1873. However, very similar afflictions dating back to the fourteenth century of fasting girls and Catholic saints have been found in historical accounts. Features common to these accounts include, but are not limited to, deliberate self-starvation, excessive activity, amenorrhea (absence of menstrual cycle for at least three months in post-menarcheal women), a fear of being fat or gaining weight and ‘a fear and terror of food and an obsession – although secretive – interest in food’.¹ Those who suffer from anorexia express their preoccupation with food by becoming thin ‘to the point of emaciation and sometimes even to the point of death through starvation’.² The term anorexia, originates from the Greek an meaning “little”, and orexis which translates as “appetite”. Thus, the literal translation can be summed up as a lack of desire to eat. This could not be further from the truth as anorexic individuals do not escape the pangs and cramps of hunger, rather ‘this extreme form of self-starvation is distinguished by a struggle to transcend hunger signals’³ and to control the hungers and desires of the body. Thus, medical conditions and mental disorders that lead to significant weight loss should be excluded from a diagnosis of anorexia as the individuals desire to reduce their weight is absent. Therefore, the primary distinction made should be whether or not the weight loss is intentional.

Anorexia is considered a mental illness and is therefore classified according to a clinically approved list of symptoms and behaviours. The most common of which are taken from The Diagnostics and Statistics Manual for Mental Health Disorders (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems (ICD-10). There is a slight discrepancy between these two definitions but for the most part the following description covers the “essence” of the disorder from a medical and treatment perspective. In the ICD-10 anorexia is defined as:

A disorder characterised by deliberate weight loss, induced and sustained by the patient. It occurs most commonly in adolescent girls and young women, but adolescent boys and young men may also be affected, as may children approaching puberty and older women up to the menopause. The disorder is associated with a specific psychopathology whereby a dread of fatness and flabbiness of body contour persists as an intrusive overvalued idea, and the patients impose a low threshold on themselves. There is usually under nutrition of varying severity with secondary endocrine and metabolic changes and disturbances of bodily function. The symptoms include restricted dietary choice, excessive exercise, induced vomiting and purgation/purging, and use of appetite suppressants and diuretics.⁴

A different focus is captured in The Diagnostics and Statistics Manual for Mental Health Disorders (DSM-5), which places more importance on self-evaluation (as opposed to the ICD-10’s ‘dread of fatness and flabbiness of body contour’). The DSM-5, a slightly amended version of the previous DSM-4, was revised from the following diagnosis classification system: ‘refusal to maintain body weight over minimum expected for age and height’⁵ (usually a body weight less than 85 per cent of what is expected); an intense ‘fear of gaining weight or becoming fat’;⁶ a disturbance in ‘the experience of body weight and shape, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of low body weight’;⁷ and, amenorrhea (the absence of three consecutive menstrual cycles). The updated version removes the word “refusal” as it infers intention on the part of the individual which can be difficult to diagnose along with the amenorrhea as this previously excluded men, women taking contraceptives, premenarchal or post-menopausal women. A patient exhibiting partial criteria would fall into the Eating Disorder Not Otherwise Specified (EDNOS) diagnosis. Both of these definitions require the individual to have lost a signifi-cant amount of weight (although the actual weight lost in order to constitute a diagnosis is ambiguous and open to interpretation in both classification systems). This ambiguity can lend itself to the pejorative understanding that anorexia is limited to those individuals who display extreme emaciation; a common misconception. For example, a study carried out by researchers at Australia’s Murdoch Children’s Research Institute found that between 2005 and 2010, there was a ‘fivefold increase in the incidence of hospitalised adolescents who, apart from not being underweight, met all of the criteria for the diagnosis of anorexia nervosa’.⁸ Professor Susan Sawyer, director of The Royal Children’s Hospital Centre for Adolescent Health maintains that ‘[e]ating disorders can emerge at any weight’⁹ and can be indicated by any sudden weight loss, even if ‘the young person is not underweight at the time they present’.¹⁰ She argues that many health professionals overlook or delay a diagnosis of anorexia based on the individual’s weight loss and because of this, the patients may be extremely unwell before they are finally admitted to hospital. Carrie Arnold identified the moment she became anorexic as follows ‘I wasn’t clinically underweight… but I was unable to start eating on my own, I was terrified of gaining weight, and I was unable to see what the issue was’.¹¹

The clinical classifications used to make a diagnosis of anorexia, whilst standardizing the symptoms and allowing for a common approach towards diagnosis and treatment, have been criticized for their limited scope and exclusionary nature. For example, the previous inclusion of amenorrhea meant that a diagnosis of anorexia in post-menopausal women¹² and premenarcheal women was prevented although, as we have discussed, steps have been taken to make the criteria more inclusive. Anorexia varies between individuals and it is quite possible for a person to exhibit eating disordered emotions and behaviours whilst meeting only partial ICD-10 and DSM-5 criteria. Also, standardized criteria lend themselves to a similarly standardized approach in therapy which, as we will explore throughout this book, can be problematic. The use of bespoke therapies that utilize a number of approaches whilst working towards recovery is often necessary in order to truly unpack the varied and complex factors that led to utilizing this expression. Whilst I will not go into detail here about the pros and cons of the diagnostic criteria (which is by-and-large far beyond the scope of this work), it is important to clarify that questions have been raised about the absolute nature of the classification criteria and where the line should be drawn between dieting behaviour and anorexia. Incorporating all aspects of eating disordered behaviour into one working definition is a problematic task. The clinical criteria are clearly an attempt to recognize the physical effects of anorexia and to move away from, what could be criticized as, vague psychological features such as the inability to recognize internal states and emotions (as we shall examine later with the work of Hilde Bruch) and a deficient sense of self. The inclusion of amenorrhea was an example of this. However, the criteria are clearly moving towards becoming more inclusive. It is worth remaining mindful of the classification systems subjective nature and what the consequence of a diagnosis might mean for the women suffering from such extreme eating behaviours. For example, by including anorexia nervosa, bulimia nervosa, and EDNOS into the DSM-5 and ICD-10, we pathologize disorders and label them as “abnormal”, which is in itself damaging for the individual exhibiting symptoms. This movement towards pathologizing mental health disorders, which finds its grounding within biological and “concrete” developmental explanations, may also result in people seeking pharmaceutical interventions¹³ instead of considering the benefits of behavioural and therapy driven strategies – the latter of which is usually side-effect free.

Anorexia shares many of its traits with other mental illnesses, such as mood and anxiety disorders and obsessive-compulsive disorders, which can lead to additional complications when it comes to correctly diagnosing and treating the underlying issues. Furthermore, the effects of starvation can exacerbate some characteristics. For example, anhedonia (the inability to feel pleasure in usually pleasurable situations), insomnia (an inability to sleep) and depressed mood can be explained as a consequence of starvation and malnutrition. The same could be said for the anorexic’s obsessive and secretive interest in food and the ritualization of eating. Therefore, a depressed mood and anxiety diagnosis should not be made if the symptoms could also be explained as features of anorexia. The same is true for the compulsive desire to calculate calorie intake, which should not be confused with obsessive-compulsive syndromes and the need to keep belongings in a certain order (although commonalities clearly exist). Other common features of anorexia can be identified as social phobia and reluctance towards eating food in front of family and friends for fear of being challenged or judged. This judgement is not just limited to the quantity of food being consumed (whether too much or too little) but also the act of eating itself. Other common features of anorexia are the presence of body image disturbance ‘in the forms of fear of weight gain or denial of the seriousness of low weight’¹⁴ and a fixation on the body as an arena for control and discipline.

Anorexia often begins with the decision to diet which provides the individual with powerful feelings of control and mastery for both internal (power, control and euphoria for someone who previously felt weak, depressed and empty) and external reasons (conforming to the slender ideal in an environment where the thin body represents a great achievement). A secondary satisfaction might also be gleaned from the power of manipulation that the individual exerts over her family and friends. As Richard Gordon writes: ‘in a situation in which she may have felt herself discounted, the refusal of food evokes a powerful response from others, an assertion of her presence that can no longer be ignored’.¹⁵ In addition to these social and psychological factors, there will be physiological consequences that result from the effects of starvation. These factors can be independent of the causes that produced the initial symptoms. As dieting becomes fasting and fasting becomes wilful starvation, the body has little energy left to heat the outer extremities and focuses instead on keeping the internal organs warm; this results in the anorexic individual feeling continuously cold. Malnutrition can also lead to heart irregularities (bradycardia) and electrolyte disturbances such as low potassium and chloride levels. As the body is put through gruelling exercise regimes, the consequences of starvation can become even more exacerbated. The “fasting high” that is often experienced at the start of this disorder is quickly replaced by feelings of hopelessness, emptiness and depression. It is these feelings that come to have dominance throughout the life of the disorder. When the weight loss becomes extreme, tactics of deception and secrecy are employed by the individual to defend herself from reprisal. She attempts to fool both the people in her immediate environment and herself as she seeks to justify this behaviour by denying the seriousness of her condition. This denial can often extend to families and friends who seek to rationalize this behaviour as a “passing phase”. Thus, when the diagnosis is finally made, the individual is already caught in a complex web of physiological disturbances and psychological attitudes. Similar effects were captured by the Minnesota studies which examined the mind-set of the conscientious objectors of World War Two. Attitudes identified here included an obsessive preoccupation with food, social withdrawal, difficulty concentrating and depression.

Anorexia has been identified as a disorder of adolescence (with peak ages between fourteen and eighteen) as the disorder is typically ‘triggered by stresses that challenge the individual’s sense of personal identity and competence’¹⁶ which is pivotal during this period especially in an environment which values the slender disci...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Preface
• Introduction
• 1 Anorexia nervosa
• 2 The female body as mediated by society
• 3 The female body as a politically mediated form
• 4 The female body as a historically mediated form
• 5 The female body as a thealogically mediated form
• Conclusion: the spirituality of anorexia
• Bibliography
• Index