Negotiating Thinness Online

The Cultural Politics of Pro-anorexia

Gemma Cobb

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9781138589223
• eBook ISBN: 9780429958960
• Topic: Art
• Subtopic: Art General

This book interrogates the thin ideal in pro-anorexia online spaces and the way in which it operates on a continuum with everyday discourses around thinness. Since their inception in the late twentieth century, pro-anorexia online spaces have courted controversy: they have been vilified by the media and deleted by Internet moderators. This book explores the phenomenon during its tipping point where it migrated from websites and discussion forums to image-centric social media platforms – all the while seeking to circumvent censorship by, for instance, repudiating 'pro-ana' or adopting hashtags to obfuscate content. The author argues that instead of being driven further underground, 'pro-ana' is blurring the boundaries between normative and deviant conceptions of thinness. Situating the phenomenon in relation to accepted constructions of thinness, promulgated by establishments as far ranging as medicine and women's magazines, this book asks if 'pro-ana' holds the potential to critique that which has long been considered normal: the culture of compulsory thinness. Engaging with debates including the current climate of postfeminism and neoliberalism, digital censorship, the pre-eminence of white, middle-class, heterofemininity, and the articulation of pain in realising the thin ideal, Negotiating Thinness Online examines what happens when the margins and the mainstream merge.

1 Medicine, maladies and anorexia nervosa

I take the psychopathologies that develop within a culture, far from being anomalies or aberrations, to be characteristic expressions of that culture; to be, indeed, the crystallization of much that is wrong with it.

(Bordo [1993] 2003, p. 141)

The folding into each other of pathologised, therapeutically intended and normative constructions and practices suggests instead the need to disrupt the normative rather than scapegoat the therapeutically intended.

(Malson 2008, p. 39)

For Susan Bordo, we might better understand a culture through interrogation of its designated ills; for Helen Malson, it is a culture’s norms that must be probed. The pro-anorexia phenomenon offers an opportunity to critique both factions: it has been pathologised in the press and in scholarship, yet all too often its texts are indistinguishable from normative constructions of the female body. In order to appreciate how pro-ana online spaces came to be, first we must attend to the cultural landscape from which they emerged. As such, the first two chapters of this book are contextual, interrogating the disciplining of the female body within medicine and popular culture, respectively. In this first chapter, I explore the history of the medical gaze, tracing the way the female body has been discursively produced by medicine. As I highlighted in the introduction to this book, the pro-ana phenomenon has been examined at length in the health sciences and has, therefore, been framed as a medical issue. However, pro-ana’s relationship with medicine is more complex than this and feminist and socio-cultural scholars of the phenomenon read it as an affront to medical authority (Bell 2009; Day and Keys 2008a, 2008b, 2009; Gailey 2009). Mebbie Bell, for instance, argues that pro-ana spaces ‘“teach” individuals how to perform a “normal” body in order to evade the regulatory authority invested in the medical gaze’ (2009, p. 152). Thus, whilst there is important work on pro-ana in the health sciences, to read it as solely medical disregards the extent to which it is constituted by mainstream thinness culture. To be clear, my argument is not that anorexia is borne out of young women’s uncritical consumption of media images of thin bodies (cf. Malson 2009, p. 143), nor do I suggest that pro-anorexia is. Rather I propose that pro-ana culture utilises media images of thin bodies as well as the language of health and medicine in order to service its aims. In so doing, it disrupts the constructed boundaries between acceptable and pathological renderings of thinness.

This chapter, then, outlines how the medical gaze became an almighty force in Western culture, specifically attending to the impact this has had on women. It is divided into four sections. The first explores the development of the medical gaze during the European Enlightenment; the second interrogates how the medical gaze played a part in the subordination of women: their removal from the medical profession and subsequent objectification – here I attend to the medicalisation of the female body and the construction of norms of femininity. This leads to the third section where I explore the cultural construction of anorexia nervosa. I suggest the way anorexia has been utilised as a form of social control is symptomatic of the treatment of women’s bodies in Western culture, as well as the ubiquity of disordered eating. In the final section, I interrogate opportunities for resistance under the medical gaze.

The development of the medical gaze

Any discussion of the Western medical gaze must begin by looking to the Enlightenment period. It is well documented that during this time Western culture witnessed a significant shift in medical knowledge and practice: it was a process whereby doctors were conceptualised, through a discourse of scientific objectivity and authority, as the arbiters of bodily meaning. As societal faith in an all-powerful God was waning, belief in the abilities of the medical practitioner was growing, and medicine came to replace religion (Ehrenreich and English 1979; Hepworth 1999; Turner 1996). As Foucault argues, ‘In the patient’s eyes, the doctor becomes a thaumaturge’ (1967, p. 275), and as the doctor’s power grew, the patient ceased to be actively involved in their own medicalisation: ‘only an external fact; the medical reading must take [the patient] into account only to place him [sic] in parentheses’ (1973, p. 7). This dehumanising process rendered all individuals subservient to the medical gaze, regardless of gender. The gaze sought to penetrate all aspects of society, ‘growing in a complex, ever-proliferating way until it finally achiev[ed] the dimensions of a history, a geography, a state’ (Foucault 1973, p. 29). Foucault calls this manifestation of control on the micro and macro levels, ‘bio-power’, suggesting that it ‘was without question an indispensable element in the development of capitalism’ (1976, pp. 140–141). Illness and morbidity had to be prevented in order to maintain a productive workforce and ‘this preventive focus later became instrumental in structuring a national health care system in England’ (Hepworth 1999, p. 21). Thus, as Martin Hewitt reminds us, ‘the entrance of the human sciences into administration was not guided by humanitarianism but by the advent of disciplinary technologies’ (1983, p. 243).

Control over the population then, was enacted through technologies of normalisation where bodies came to be differentiated and managed by their proximity to or aberrance from the norm (Foucault 1973, 1976). As such, what was considered healthy and what was considered normal became interchangeable – a legacy that persists. For instance, in the present day, the healthy citizen is encouraged to use the Body Mass Index (BMI) calculator to determine whether they are of a healthy weight, through measurement against a regulatory norm (Czerniawski 2007). Technologies of normalisation are by no means limited to the regulation of body weight though: Miah and Rich (2008, p. 53) note that public health websites such as the NHS and BBC not only provide advice on disease prevention, but they also feature lifestyle advice more broadly. Deborah Lupton views such guidance as ‘a form of pedagogy, which like other forms, serves to legitimize ideologies and social practices by making statements about how individuals should conduct their bodies’ (1994, p. 31). Consequently, health is deployed as a means of obscuring unhealthy practices, a device which, as I show in later chapters, pro-ana users adopt in order to safeguard their spaces. Used in this way, health is reduced to discourse because, as Foucault argues, ‘power is tolerable only on condition that it mask a substantial part of itself. Its success is proportional to its ability to hide its own mechanisms’ (1976, p. 86). If the disciplinary practices in which we engage are recast as necessary for our own good, we are much more likely to enact them. Simon J. Williams therefore suggests that health is ‘a contested notion and an elusive phenomenon’ (2003, p. 42; emphasis added). What it means to be healthy is increasingly ambiguous which, in turn, renders it susceptible to appropriation, whether by public health services, the diet industry or – as I will argue – creators of pro-ana online spaces.

Above all, contemporary culture elides good health and weight loss: ‘Reformulated as health maximising, weight-loss practices, particularly dieting, have now been made to appear necessary, beneficial and hence seemingly above reproach’ (Malson 2008, p. 29). The impact that this has had on understandings of ‘obesity’¹ is therefore extensive: it is widely seen as dangerous; as a health threat in need of prevention (Cogan 1999, p. 231). Compulsory thinness and the avoidance of ‘obesity’ are often framed as moral obligations and scholars of Fat Studies have argued that if one is ‘obese’, one is understood to be a moral failure (Hartley 2001; Haworth-Hoeppner 1999; LeBesco 2004). This has led to a repudiation of the fat body in Western culture, which is both justified and encouraged. As Cecilia Hartley (2001, p. 65) points out, ‘fat-phobia is one of the few acceptable forms of prejudice left in a society that at times goes to extremes to prove itself politically correct’. If ‘obesity’ and fatness are conflated with illness (LeBesco 2004, p. 30) then thinness has, albeit fallaciously, come to be read as a marker of good health and good morals (Bordo [1993] 2003). In this current (Western) climate of plenty, only the most disciplined individuals are able to achieve thinness. This, in turn, makes the quest ever more elusive.

Dieting as a moral obligation, however, is not new and Bryan S. Turner locates it within nineteenth century control of disease, whereby cleanliness of both the masses and the individual corresponded with one another:

The diseases of civilization were to be countered by personal salvation and clean water. The dietary management of the body was thus parallel to the management of water and sanitation in the environment, since both were aimed at moral control of impurity.

(1982, p. 165)

Cleanliness and dietary management are both concerned with ‘policing the boundaries of the body, by maintaining strict control over what enters and what leaves the body’s orifices’ (Lupton 1994, p. 32). As I discuss in chapter four, thinness and cleanliness continue to be elided and this discourse manifests in pro-ana online spaces and mainstream guidance around healthy-eating alike. Although self-regulating the body through diet may sound Foucauldian, Turner (1992) points out that in Foucault’s examination of Jeremy Bentham’s Panopticon, he overlooks the science of diet and its relationship to capitalism. Turner argues that the provenance of the dietary regime lies in the work of eighteenth-century physicist to the elite, George Cheyne, who advised upper-class individuals on how to control their weight through careful eating and exercise; practices which then permeated all strata of society (1992, p. 192). What began as a specific lifestyle for the elite became an aspiration for all, but this was not a lifestyle for the poor, rather for ‘people who could afford to eat, ride horses and enjoy the luxury of a regular vomit’ (Turner 1992, p. 190). Thus, possession of a slim body was not simply a means of showing one’s distance from the working class, rather, as Bordo points out, ‘the gracefully slender body announced aristocratic status; disdainful of the bourgeois need to display wealth and power ostentatiously’ ([1993] 2003, p. 191). Thinness, as it is today, was a way of indicating one’s refinement, but only the refined had the resources to achieve it. Consequently, the thin cum healthy body is not accessible to everyone: it is located at the intersection of a range of privileges, as chapter four’s critical enquiries demonstrate.

More widely, the political economy of medicine maintains a number of systemic inequalities. According to Foucault, this stems from what he calls ‘the great confinement’ in the classical age where those believed to be disruptive to order, ‘the unemployed, the idle, and vagabonds’, were very literally incarcerated (1967, p. 50). The poor and disenfranchised were alternately confined and deployed to contribute to the economy: ‘cheap manpower in the periods of full employment and high salaries; and in periods of unemployment, reabsorption of the idle and social protection against agitation and uprisings’ (Foucault 1967, p. 51). This meant that even those who departed from socially acceptable norms were rendered useful during this time. Although confinement does not operate so literally today, there are still many instances in which medicine is deployed to increase an individual’s capabilities and thus make them useful under late-capitalism. Using examples such as the prescription of anti-depressants or meditation to divert patients’ attention from socio-economic factors which may be impeding them, Lupton argues that ‘in their relative dominance over patients, doctors are empowered to make statements that reinforce dominant capitalist ideologies by directing patients’ behaviour into non-threatening channels’ (1994, p. 108). In this way, medicine colludes with capitalism to shore up the status quo by, at times literally, anaesthetising its subjects. The medical gaze thus operates as a form of social control on both the individual and societal level. Through bio-power, we become self-regulating, self-disciplining citizens. Our quest may be one which aims for good health, but health, as we have seen, is often deployed to obscure practices which uphold the hegemonic order. Nowhere is this more prominent than in the treatment of women by medical authority.

The medical gaze and women

Foucault’s account of the birth of modern medicine, whilst important to this study, neglects to address the position of women. In order to make way for medical authority as we now know it, women were effectively ousted from the profession and rendered passive objects of a gaze, which would ensure their subordination for centuries to come (Ehrenreich and English 1979). This crucial moment deserves sustained discussion: consequently, the remainder of this chapter, whilst drawing upon a Foucauldian framework, focuses on the side-lined history of women and medicine. As I have shown, medical discourse has long impelled individuals to engage in regulatory practices which it legitimates under the umbrella of science, a form of ‘objective’ authoritative knowledge. But the development of this knowledge, together with the process by which it was legitimated, was by no means neutral; rather as I will now explore, it was masculine.

Barbara Ehrenreich and Deidre English’s (1979) important work on women’s expulsion from the medical profession describes how their mutual support networks were effectively destroyed in the name of medical legitimation. Women were isolated from one other and subsequently made dependent upon those same men who had banished them. The purging of midwives in the early twentieth century was a pinnacle moment in ensuring women’s inferior status:

With the elimination of midwifery, all women – not just those of the upper class – fell under the biological hegemony of the medical profession. In the same stroke women lost their last autonomous role as healers. The only roles left for women in the medical system were as employees, customers, or “material”.

(Ehrenreich and English 1979, p. 88)

With women confined to the margins, men’s status as experts was confirmed, and it was middle-class men who were said to possess the expertise to transform conventional medicine into ‘scientific’ medicine (Ehrenreich and English 1979, p. 70). As a result, the medical profession became, as it arguably remains, primarily the reserve of the middle-class, white patriarch.

Because women have long been seen to ‘occupy the world of private emotion and affections, whereas men are allocated to social roles emphasizing reason, instrumentality, and public responsibility’ (Turner 1995, p. 95), science did not look kindly on them. Consequently, ‘the very notion of the dispassionate scientist, whose mind transcended his body, defined science as a male pursuit. The object of scientific knowledge – that is nature – was female’ (Hesse-Biber 1996, p. 19; emphasis added). If women were too weak and lacking in reason to be doctors, then they were perfectly positioned to be patients (Ehrenreich and English 1979, p. 92; see also Turner 1995, pp. 102–103). This subjugation served a...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of tables
• Acknowledgements
• Introduction: ‘girls in danger’
• 1. Medicine, maladies and anorexia nervosa
• 2. ‘Lose weight without dieting’: disciplining the body in women’s magazines
• 3. Normalising pro-anorexia
• 4. Intersectional privilege in pro-anorexia online spaces
• 5. Articulating pain: investment or lament
• 6. From counterhegemonic to counterpublic? The political potential of pro-anorexia
• Epilogue: from the mainstream to the margins and back again
• Appendix: information on pro-anorexia online spaces
• Index