“Just try to explain to anyone the art of fasting,” says the title character in Kafka’s short story “A Hunger Artist.” “Anyone who has no feeling for it cannot be made to understand it.” The emaciated circus freak is right: refusing food at the expense of bodily function is not an easy addiction to convey.
Ginia Bellafante put it well a few years ago, in a book review for the New York Times: “Anorexia is a disease of contradiction: it demands both discipline and indulgence …. The anorexic disappears in order to be seen; she labors to self-improve as she self-annihilates.” Bellafante describes the condition as “an intellectualized hallucination.” That concise definition is better than any I’ve read, and it points to the conflicted way in which we talk about the disease: our intention is critical, but our language is celebratory.
In “How to Disappear Completely: On Modern Anorexia,” Kelsey Osgood parses these paradoxes by looking critically at the writings of and about anorexics. Her project is a contrarian one: to expose the hypocrisy of “treatment texts,” the pseudo-redemptive memoirs written in the past tense by those who see themselves as recovered. She believes that praise of such authors, who are often called rigorously honest and selflessly brave, is naïve, maybe even willfully so: in reality, their books do little more than teach readers to diet and think of anorexia as an aspirational illness. It’s a good point, and, coming from somebody who spent a decade in and out of hospitals and on the brink of death, one that should be taken seriously. Osgood “contracted” the disease as a teen-ager by copying the habits of anorexics, using books that purported to be recovery-oriented “didactically, as diet manuals.” She remembers thinking of anorexia not as an illness “but rather as the most logical progression of self-control.”
Osgood can now see the flaw in this rationale, and she aims to expose it. There is nothing controlled about anorexia. It’s an addiction, though the only one I can think of where a person is dependent on the absence of something. A starving body produces endorphins to counteract a frozen metabolism; the heart rate slows; the body temperature lowers. This accounts for the “high” that anorexics routinely cite. But the addiction quickly becomes behavioral, too. The anorexic’s chronic renunciation—her “pure defiance,” to quote Osgood—makes for a truly delusional, almost Dickensian world view, wherein people’s inner qualities correlate to their physical attributes. Unlike other kinds of addictions, anorexia disguises itself as virtue. The anorexic is a modern-day phrenologist, searching for saintliness and vice in the bone structure of strangers. She is at once insane, dying, and inhumane.
Osgood is angry about this, and her anger drives her to eloquent polemic: “We make anorexia desirable by connecting it to brilliants and also by talking about it poetically, by making it something that enhances a person’s aura, makes them more glamorous,” she writes. “The person writing about his or her own struggle fuels the fire by producing a long, hubristic poem, an elegy, an ode to a presence gone and missed.” The glamorizing language used to describe the disease predates its naming, in 1873. Academics have argued that Melville’s Bartleby—“so thin and pale”—is anorexic, a diagnosis that explains the scrivener’s subsistence on the rare, hand-delivered “ginger-nut,” as well as his maddening passivity. Jane Eyre, “delicate and aerial,” refuses to eat in front of Rochester; Elizabeth Gaskell repeatedly insists that Ruth’s figure is “little” or “beautiful lithe.” In Goethe’s “Elective Affinities,” the young Ottilie moves silently, with “perpetual exquisite motion,” and practices “excessive abstemiousness in eating and drinking”; eventually, she dies.
But Osgood is referring to contemporary literature. Modern books about anorexia are almost exclusively written in the first person—they’re either memoirs or young-adult novels that take the form of intimate, florid monologues. Francesca Lia Block, a kind of patron saint of fictional “thinspiration,” writes laughably elliptical passages that read like demented ads for diamonds or bottled water: “I will be thin and pure like a glass cup. Empty. Pure as light. Music.” If there is any truth-value to this kind of delicate and “poetic” prose, it’s in the fragmentary elisions—not a bad representation of an anorexic’s blinkered but confident thoughts, actually. Marya Hornbacher’s “Wasted,” a smart, self-aware, Pulitzer Prize-nominated memoir, published in 1996, when Hornbacher was twenty-two, is full of similarly bewitching language. “We turn skeletons into goddesses and look to them as if they might teach us how not to need,” she writes. “You feel like an ice cube. You feel like you’re naked and have fallen through thin ice on a lake and are drowning in the ice water underneath. You can’t breathe.”
Osgood does not want to write a long, hubristic poem, and she believes that sentences like the ones above are deplorable on both aesthetic and ethical grounds. But not wanting to connect your illness to your own brilliance is nearly impossible if you also want to be a precise, smart, and beautiful writer, which Osgood is. She quotes Nietzsche, Lacan, and Feuerbach, and uses words like “gossamer” and “ethereal.” Well-versed in rehab best practices—“details are venomous to this work”—Osgood does not provide numbers to illustrate how malnourished she became (no calorie intake, no lowest weight), but she still manages to romanticize the disease, unintentionally, by way of her own felicity with words. The “pro-ana” movement, she writes, “is a kind of nebulous death cult in which every member is his or her own personal and omniscient demagogue.” The disease itself is the “permanent chill from getting too close to death, from inviting it in.” Even when Osgood is taking the disease’s literature to task, she succumbs to exactly the qualities she reviles. “We attempt to debunk the myths of anorexia by couching its intricacies and impurities in pretty language that describes a graceful kind of suffering, a spiritual kind,” she writes. “It is a rapturous lingo, a linguistic stone’s throw from the beatific.”
Of course any book that tries to capture some of the strange euphoria that attends addiction must make it sound appealing, at least when the writer is discussing the manic highs and fiendish dedication of its early throes. But there’s a difference: nobody wants to be an alcoholic, nobody wants to one day attend Narcotics Anonymous meetings. “I watched with glee as my collarbone emerged from the flesh of my chest,” Osgood remembers. There is no parallel recollection for any other sort of addict. Nobody writes that they watched with glee as their track marks materialized on their forearms or as their family members one by one gave up on them.
Osgood’s project, then, seems doomed: any writing about anorexia makes it more interesting than it really is—even a book that sets out to condemn the very act. Much as she protests, it’s clear from the way Osgood writes that the disease still excites her. In this sense, the book is an incredibly realistic portrayal of anorexia, which is all but predicated on the delusion that it is exciting.
I subsisted for an entire year of college on lettuce, nonfat yogurt, pickles, an overpriced and hard-to-find kind of low-calorie noodle, and baroque puddings involving canned pumpkin and expired spices. When I wasn’t preparing meagre (and in retrospect disgusting) meals for myself, I was doing truly disturbed things: purposefully “forgetting” books at the library so that I would have to walk back and get them, unconsciously flipping over boxes of inedible items (pens, soap) because I was so accustomed to looking at nutritional labels, doing homework in the gym’s sauna fully clothed because it was the only way that I could get warm. I can barely bring myself to think about this time, not because it depresses me but because it’s so utterly dull. Those foods and bizarre behaviors are infinitely more alluring listed out than they were to consume or perform. Even writing this bores me, and if there weren’t some tiny, tiny part of me that wishes I were still sick I would have never wanted to do it.
When it comes to writing about anorexia, the only truly radical move, as far as I can tell, would be to show clearly just how profoundly boring it is—not sad or prurient or overdetermined. The very premise is an unappealing one: we’d like to believe that such unhinged myopia would have psychological roots in trauma or in some sinister personal history, but usually it doesn’t. “If you can starve with some consistency, all you need is two weeks,” Osgood writes. Her point is that anorexia is often little more than a kind of self-inflicted tautology: the act of starving is what allows you to starve. It’s true, but a voluntarily isolated person choosing not to eat until she’s addicted to not eating doesn’t make for a very good story.
I don’t know what a deliberately boring book about anorexia would look like. The closest Osgood gets is when she writes, “I used to sit in trigonometry class and calculate my intake obsessively in the margins of my notebook, each time coming up with the same answer, each time dismissing my mathematics as unreliable.” That is a much more accurate description of the disease than anything involving clavicles or frozen yogurt or sexual abuse or the fear of feeding tubes. If we really wanted to protect our supposedly susceptible youth, we’d paint anorexics as they are: slowly suicidal obsessives who avoid other people and expend ninety-five per cent of their mental energy counting the calories in green vegetables. We wouldn’t see them as worth reading about at all.
Alice Gregory is a writer living in New York.
Illustration by Emi Ueoka.
Anorexia nervosa is characterized by persistent restriction on food intake, an intense fear of gaining weight or of becoming fat, and a distortion of body weight or shape. An individual with anorexia nervosa will maintain a body weight that is below a minimally normal level for age, sex, and physical health.
Some people with anorexia lose weight by dieting, fasting, or exercising excessively; this is called the restricting type of anorexia. Others lose weight by self-induced vomiting or misusing laxatives, diuretics, or enemas. People who use these methods are considered to have the binge-eating/purging type of anorexia. More characteristics of anorexia nervosa include:
- Significant weight loss
- Continual dieting
- Intense fear of gaining weight or becoming fat, even if underweight
- Undue influence of body weight or shape on self-evaluation
- Preoccupation with calories or nutrition
- Preference to eat alone
- Compulsive exercise
- Bingeing and purging
- Brittle hair or nails
- Infrequent or absent menstrual periods (in females who have reached puberty)
- Growth of fine hair over body
- Mild anemia, and muscle weakness and loss
- Severe constipation
- Low blood pressure, slowed breathing and pulse
- Drop in internal body temperature, causing a person to feel cold all the time
Some people with anorexia nervosa feel they are overweight in all areas of their body, while others may recognize that they are thin but are concerned that certain body parts are "too fat," such as their abdomen or buttocks. They may use many different techniques to evaluate their body size or weight, such as frequent weighing and obsessive measuring of body parts. Additionally, the self-esteem of individuals with anorexia is closely tied to their perceptions of their body shape and weight. Weight gain is often viewed as a major failure, while weight loss is an impressive achievement.
Many people with anorexia have coexisting psychiatric and physical illnesses, including depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, and impaired physical development. The semi-starvation state of anorexia can also result in serious and potentially life-threatening conditions. The 12-month prevalence of anorexia among young females is estimated to be 0.4 percent.
Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food (binge-eating), and feeling a lack of control over the eating. This is followed by some type of behavior that compensates for the binge, such as purging (vomiting, excessive use of laxatives or diuretics), fasting, and/or excessive exercise. Unlike individuals with anorexia nervosa, people with bulimia maintain body weight at or above a minimally normal level. Additional symptoms include:
- Recurrent episodes of binge eating
- Purging by strict dieting, fasting, vigorous exercise, or vomiting
- Abuse of laxatives or diuretics to lose weight
- Frequent use of bathroom after meals
- Reddened fingers
- Swollen cheeks
- Self-evaluation that is unduly influenced by body shape and weight
- Depression or mood swings
- Irregular menstrual periods
- Dental problems, like tooth decay
- Heartburn or bloating
- Intestinal distress and irritation from laxative abuse
- Kidney problems from diuretic abuse
- Severe dehydration from purging of fluids
People with bulimia tend to feel embarrassed or ashamed of their eating behaviors and try to hide their symptoms by binge eating in secrecy. The most common triggers for binge eating are negative affect (e.g. sadness, fear, guilt), interpersonal stressors (e.g. arguments), inadequate food intake, negative feelings about body weight or shape, and boredom. The 12-month prevalence of bulimia among young females is estimated to be 1.5 percent.
Binge-eating disorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control over his or her eating. An episode of binge-eating is defined as eating an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. Unlike bulimia, binge-eating episodes are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese. Community surveys have estimated that 1.6 percent of females and 0.8 percent of males experience binge-eating disorder in a twelve-month period.
Characteristics of binge-eating disorder include:
- Binge-eating occurring, on average, at least once a week for six months
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not hungry
- Eating alone because of embarrassment caused by how much is eaten
- Feeling disgusted with oneself, depressed, or guilty after binge eating
- Marked distress about the binge-eating behavior
- Binge-eating not associated with regular use of compensatory behaviors (purging, fasting, excessive exercise)
Avoidant/Restrictive Food Intake Disorder
Avoidant/restrictive food intake disorder (ARFID) is characterized by the avoidance or restriction of food intake. This diagnoses replaces the DSM-IV diagnosis of feeding disorder of infancy or early childhood, and broadened the diagnostic criteria to include adults. Individuals with ARFID have a lack of interest in eating or food, or avoid food based on a past negative experience with the food or the sensory characteristics of the food (e.g., appearance, smell, taste, texture, presentation). This form of "picky eating" typically develops in infancy or early childhood and may continue into adulthood. It may also be present in individuals with heightened sensory sensitivities associated with autism.
Characteristics of ARFID include:
- Significant weight loss
- Failure to achieve expected weight gain in children
- Significant nutritional deficiency
- Inability to participate in normal social activities, such as eating with others
Rumination disorder is characterized by repeated regurgitation of food after eating. Individuals with this disorder bring up previously swallowed food into the mouth without displaying any signs of nausea, involuntary retching, or disgust. This food is typically then re-chewed and spit out or swallowed again. The regurgitating behavior is sometimes described as habitual or outside of the control of the individual.
Characteristics of rumination disorder include:
- Repeated regurgitation of food over a period of at least one month
- The repeated regurgitation is not a result of an associated gastrointestinal or other medical condition
- Weight loss and failure to make expected weight gains in children
- Attempts to hide the regurgitation behavior by placing a hand over the mouth or coughing
- Avoidance of eating before social situations, such as work or school
Rumination disorder can develop in infancy, childhood, adolescence, or adulthood. Infants with the disorder tend to strain and arch their back with their head held back, making sucking movements with their tongue. Malnutrition may occur despite ingestion of large amounts of food, particularly when regurgitated food is spit out. In infants as well as in older people with intellectual disability, the regurgitation and rumination behavior seems to have a self-soothing or self-stimulating function, much like other repetitive motor behaviors (i.e. rocking, head banging).
Pica is characterized by the eating of one or more nonnutritive, nonfood substances on a persistent basis. Some of the substances commonly eaten among people with pica include paper, soap, hair, gum, ice, paint, pebbles, soil, and chalk. People with pica do not typically have an aversion to food in general.
In order for Pica to be diagnosed, the behavior of eating nonnutritive, nonfood substances must be present for at least one month. Children below the age of two are typically not diagnosed with pica to exclude the developmentally appropriate mouthing of objects by infants that may result in ingestion. People may experience medical complications from pica, such as bowel problems and intestinal obstruction. People may also experience infections if they have eaten feces or dirt. The prevalence of pica is unknown, but it is more prevalent among people with intellectual disability. Some pregnant women also develop pica when specific cravings such as chalk or ice occur.