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This is a post by Cathrin Fischer (UCD), a speaker from our Spring 2021 Seminar Series. If you would like to attend a seminar, please sign up using this link. You can also download the full schedule here.
Eating Disorders such as anorexia nervosa and bulimia nervosa are dangerous illnesses that are globally on the rise. People with anorexia usually restrict their food intake, whilst people with bulimia eat (large) quantities of food and then purge. Neither disorder is very well understood; researchers are baffled by what causes them and clinicians have not yet developed very effective treatment. The way we talk about eating disorders and diagnose them, however, rely on one central notion: those with anorexia or bulimia want to be thin. But is that really true? In the following, I will explain why discussing eating disorders benefits from a phenomenological perspective and how I research the experience of shame in anorexia and bulimia.
Medicine frequently relies on a third-person perspective. Those who wrote the diagnostic criteria for mental illnesses probably did not have that illness; the doctors, nurses and psychologists who treat individuals with anorexia or bulimia take their knowledge of the disorders from their own observation or books. This causes an oversight: we do not pay great attention to what an eating disorder is like for those who have it.
The problem is that ‘lived experience’ (experience from the first-person perspective) is often much more complex than can be observed from a third-person perspective. Take the following example: a familiar image in narratives about anorexia is that of a young, starving woman looking into a mirror and a much larger version of herself stares back. It is generally thought that this phenomenon indicates a distorted body image in those with anorexia, meaning they literally cannot see their real size.
And yet, when asked, these women report that they are well aware that they are thin1. They just also ‘feel fat’. How can we make sense of this contradiction? The model of the distorted body image struggles to offer an explanation. One way to understand what happens in experience of anorexia and bulimia is through phenomenology.
Phenomenology is a philosophical discipline which emphasises the importance of the body. We usually speak of the body and the mind as separate things but phenomenologists such as Maurice Merleau-Ponty emphasise that we are embodied beings2. Our bodily experience has two dimensions: on the one hand, we can experience our body as an object, just like a table, and reflect on it, which is what creates a body image. On the other hand, we experience our bodies as subjects. It is through the body that we can engage with the world. In other words, we do not just have bodies but we are our bodies. Our understanding of this lived or subjective body is the so-called body schema.
In the case of eating disorders, then, the lived body and the object body do not come together in harmony, as they usually do. Instead, those with eating disorders suffer from an abnormal experience of objectification. The object body takes over in their experience, which might explain why they have a sensation of being ‘heavy’ or ‘large’3. At the same time, the sense of oneself as a subject comes under attack because the experience of the object body takes primacy over the experience of the subjective lived body, the sense of oneself as an agent. The practices of eating disorders, such as restricting food intake, are therefore not merely symptoms of an underlying mental disorder but in themselves meaningful responses to this objectification.
One of the ways in which bodies are objectified is through shame. The feminist philosopher Simone de Beauvoir famously wrote about what it is like to be a woman in The Second Sex and argues that women’s experience is shameful4. This does not mean that all women are always ashamed but rather, that an aspect of what it means to be a woman in our society is learning to understand your own body as shameful. Women’s bodies are scrutinised and sexualised, they are frequently judged for being too large, unclean (such as in the case of menstruation) or out of control.
Jean-Paul Sartre, a friend of Merleau-Ponty and long-term partner of de Beauvoir, wrote extensively on how shame is a deeply uncomfortable experience that involves seeing ourselves negatively through the eyes of other people5. Shame is therefore a way in which our bodies present themselves to us as objects. Shame is normal and usually easily resolved, but it can threaten our sense of self if it becomes chronic.
In this light, we can understand eating disorders as something which arises against a background of objectification. Since women’s bodies are culturally portrayed as shameful, this can help us understand why eating disorders dis-proportionately affect young women.
There is another reason at shame in the context of eating disorders. Our culture is deeply fascinated by anorexia and the imagery of starving bodies it evokes; bulimia, in turn, is often disregarded. Although it has severe long-term health effects, it seems less medically dramatic and frequently does not cause the same worry in friends, family and even medical personnel6. There are two different sets of diagnostic criteria for anorexia and bulimia, yet research typically does not discriminate between the two.
In my research, I focus on different responses to shame in anorexia and bulimia. Restricting food intake typically leads to feelings such as pride for individuals with anorexia. Bingeing and purging, on the other hand, are experienced as shameful. People with bulimia often hide their eating disorder for a long time, partly because of this shame, and partly because they are shamed for bulimic practices in clinical contexts. This means they do not get the help they need. As such, a better understanding of bulimia and the ways it differs from anorexia is crucial for providing adequate care for those with bulimia.
There are therefore two reasons why we might attend to eating disorders philosophically. On the one hand, phenomenological accounts of eating disorders are generally important in the context of care because they can help support alternative forms of treatment, such as bodypsychotherapy which emphasises the interconnectedness of body and mind7. They also stress the importance of addressing the social context in which eating disorders arise in therapy. This is useful because relapse rates for anorexia and bulimia are high8, 9. Moreover, treatment focus on weight restoration can, in fact, reinforce the feelings of powerlessness, objectification and dehumanization in eating disorders10.
On the other hand, eating disorders are interesting to philosophers because they serve as a phenomenological case study. Phenomenologists frequently turn to experiences of illness and psychopathology to understand the structure of our experience. Eating disorders can tell us about the centrality of our bodies in consciousness and cognition, for example because practices such as bingeing are embodied responses to embodied emotional states. For our understanding of the ways in which people relate to their bodies, both with or without pathology, it is therefore interesting to investigate what eating disorders are like for those who have them.
About the Author
Cathrin is an MA student in the School of Philosophy at University College Dublin. She is broadly speaking interested in phenomenology, embodiment and the socially shaped body. Her research often brings together phenomenology and social theory to challenge normative assumptions in both disciplines and center the lived, bodily experience of marginalised people. Recently, she has been writing about the phenomenology of eating disorders, shame, selfhood and queer futures. This summer, Cathrin will start a Wellcome Trust-funded PhD with https://itdfproject.org/, exploring the embodiment and imaginaries of disability and prostheses through a queer-feminist phenomenological lens. She is also a co-founder of the UCD Minorities and Philosophy (MAP) chapter. You can contact Cathrin via email.
References
Hornbacher, M., (1999). Wasted: A Memoir of Anorexia and Bulimia. London: Flamingo.
Merleau-Ponty, M. (2012). Phenomenology of Perception. Translated by Donald A. Landes. Abingdon: Routledge
Bowden, H., (2012). A Phenomenological Study of Anorexia Nervosa. Philosophy, Psychiatry & Psychology, 19(3), pp. 227-241.
de Beauvoir, S. (2011). The Second Sex. Transl. by Constance Borde and Sheila Malovany-Chevallier. New York: Random House.
Sartre, J. (1956). Being and Nothingness: An Essay in Phenomenological Ontology. Translated by Hazel E. Barnes. New York: Philosophical Library
Warin, M., (2010). Abject Relations : Everyday Worlds of Anorexia, Studies in Medical Anthropology. Rutgers University Press, New Brunswick, N.J.
Marlock, G., H. W. & [ed.], (2015). The Handbook of Body Psychotherapy and Somatic Psychology. Berkeley, California: North Atlantic Books.
Berends, T. et al. (2016). Rate, timing and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study. BMC Psychiatry, 16(1):316, 7p.
Richard M, Bauer S, Kordy H. (2005). Relapse in anorexia and bulimia nervosa—A 2.5-year follow-up study. European Eating Disorders Review, 13, pp.180–90
Kwee, JL. and Launeanu, M. (2019). Practical Strategies for Promoting Embodiment in Eating Disorder Prevention and Treatment. p.342-358, in: McBride, HL.; Kwee, JL. [eds.]. Embodiment and eating disorders: theory, research, prevention and treatment. Routledge: New York.