Richard A. O’Connor and Penny Van Esterik. From Virtue to Vice: Negotiating Anorexia. Food, Nutrition, and Culture Series. V. 4. New York: Berghahn Books, 2015. ISBN: 978-1-78238-455-7 hardback; ISBN: 978-1-78238-456-4 ebook
Sonoma State University
Richard O’Connor and Penny Van Esterik have written an excellent and very readable book on anorexia nervosa using anthropological perspectives. Anorexia occurs when a person “obsessively chooses” not to eat. A person then puts her/himself at medical and psychological risk. It is extremely difficult to treat. Because anorexia relates to food in general and to many foods in particular, and because anorexia is a very “modern” disease (as is explained by the authors) this book is of importance to those interested in the anthropology of food and nutrition, as well as in medical anthropology and psychological anthropology. It is also of use to medical and behavioral personnel treating patients/clients with anorexia. Lastly, because of the way it is formatted, it can serve as a helpful resource for people struggling with anorexia, including those recovering from it.
Before proceeding, I need to make several disclosures. The first is that I am an anthropologist and a licensed psychologist. In the latter role, I have treated many clients with anorexia. Whatever the procedures are for treating anorexia, the standard of care mandates that the clinician work with the client’s/patient’s physician because of the health risks involved, including malnutrition. Furthermore, I also do pre-surgery psychological assessments for gastric bypass surgery for people with severe obesity. This assessment is a necessary pre-condition for getting the surgery. In the near future I will be reviewing another book in the Berghahn series about obesity. Moreover, I have been a long-time board member for an agency which services people with disabilities–Disability Services/Legal Center, in Santa Rosa, California. As a board member, a psychologist who works with people with disabilities and as an advocate for people with disabilities, it should be known that the politically correct and acceptable term is “a person with anorexia,” not an anorectic person, the term employed in the book. The reason is simple: the focus is on the person first, the disability second. For the sake of simplicity and readability, however, I will use “anorectic” or “anorectic person” in this review. Lastly, the question arises: is anorexia a disability? According to our agency’s legal center, it is, when it actually impacts major life functions.
By taking an anthropological and historical focus, O’Connor and Van Esterik bring a holistic, person-centered, and behavioral dimension to understanding and treating anorexia. Before detailing how they do this, it is important to review some current understandings about the causes and treatments for anorexia–which they review.
1. There is no single accepted etiology for anorexia.
2. There is no single, acceptable cure/treatment for anorexia.
3. Certain kinds of approaches can backfire, worsening the situation.
4. Anorexia is believed to have become a recognized issue in modern times, seemingly starting in the nineteenth century.
5, Anorexia seems to be more common among children/adolescents who are affluent and been given educational opportunities.
6. Conversely, it seems to be less common among less educated and less affluent and in minority communities.
7. While often portrayed in the media as a feminist issue, anorexia is found among teenage boys and young men at significant rates, although it is less prevalent than among teenage girls and young women.
8. While anorexia is often understood as an extreme reaction to modern ideas about body image, especially for girls and women, the subjects/informants that O’Connor and Van Esterik interviewed were less concerned and less influenced by contemporary images. Rather, they were motivated by other considerations, as will be discussed shortly.
9. O’Connor and Van Esterik situate their discussion about anorexia in a larger discussion of the emergence of Cartesian dualism and its effects of splitting mind and body. Anorectics thus act on this split, using mind over body. Coupled with this, anorectics preoccupy themselves with cleanliness, following Mary Douglas’ ideas about purity in general. This preoccupation is complemented with rituality in preparing and eating foods.
These considerations revolve around the idea of control. Briefly, the young person who is becoming anorectic becomes entranced by the idea of control over her/his body, about the idea of perfecting this control, about the daily process of not eating, of getting “high” from a self-reinforcing feedback loop in the same way the authors say that ascetics do. The anorectic person eventually loses control of the ability to control–control becomes an end in itself. The anorectic withdraws from much social interaction, usually rejecting any parental, friendship, and sexual interaction. According to the informants, this, too, becomes self-fulfilling.
The informants interviewed in this book were drawn from Canada and the US. The authors give these informants the opportunity to express themselves at length throughout each chapter, addressing different aspects about their anorexia, including their family life, their starting point for not eating, their social life, their decision to address their condition, and their recovery. They all said that they enjoyed experimenting with food, including eliminating fats, sugars, and eating more vegetables and fruits. To paraphrase the authors, the anorectic becomes what s/he eats and does not eat.
Because this is a contemporary study, these anorectics indulged in “Virtuous Eating (Chapter 10.)” They thus shared the modern preoccupation with food–what to eat, what not to eat, how many calories, how large the proportions should be, and the provenance of the food. As Poulain notes, the anorectic fits into the category of the “fearful eater” (2017:165.)
This preoccupation with the kinds of food one ate in the West arose from historical movements begun in the early nineteenth century, such as those started by William Kellogg and Sylvester Graham: “Diet reform emerged from a distrust of 19th century medical practices, as well as the temperance movement led by Protestants which gained popularity in the United States at the same time (https://www.lib.umich.edu/janice-bluestein-longone-culinary-archive/diet-reform-and-vegetarianism.)” Moreover, as Jonathan Kauffman notes throughout his book, Hippie Food (2018), modern and post-modern society promotes experimentations with food as a virtue in and of itself. Consequently, the anorexia informants in this book talk endlessly about which foods to eat and how much of them they eat.
These extremes of virtuous eating were coupled with religious beliefs and asceticism. For many they were tied up with ideas about “purity” and “danger,” after Mary Douglas. They were also tied up with notions of attractiveness and thinness (Chapter 12). Thinness became another virtue for people, particularly women in many Western societies after WWI. One need only look at the Flapper craze in the 1920’s.
The authors note that the informants said that they began their practice of control in their adolescence. Whatever the causes, the informants noted that they saw their practice as an emerging practice of creating identity, one that differentiated them from their families and friends because of the prime focus on what they ate and did not eat. So-called “traditional” societies, where one has a socially given identity and close monitoring, do not see the presence or rise of anorexia as modern societies do. Furthermore, the authors note that the prevalence of anorexia increased in post-modern times in part because the number of different identities available to an adolescent multiplied. The anorectic person is the one who does not eat, just as the Goth dresses in black. What is striking, from a psychological point of view, at least for the informants in their survey, is that they were all “good” kids, not prone to rebellion, successful in school, and most were involved in sports or dance.
The informants the authors have chosen have all recovered. They do note that their sample is skewed. (It would probably be difficult to find anorectics who have not recovered and who would be so willing to talk about their history, a point they address as well). The lessons learned from this sample, because not all anorectics do recover fully or partially, are that recovery is an individual choice. No one intervention worked to get someone to change. Overmedicalization and stigmatization were counter-productive. Sometimes it was just “accidental”–the person decided one day that not eating was not working for her or him.
These lessons are clinically useful because they enable the physician and therapist to see the person as a whole trying to form an identity, rather than as a problem with medical issues. The professional can have the anorectic strike a path forward that s/he chooses, giving that person agency. The self-reports of the informants give those who treat anorectics sensitive ways to help the person. The case examples, including statements about reasons to change and successful outcomes, provide resources that speak to the anorectic in language and sentiment to help her/him become their own change agent.
n.d. https://www.lib.umich.edu/janice-bluestein-longone-culinary-archive/diet-reform-and-vegetarianism (accessed March 5, 2019.)
2018 Kauffman, Jonathan. Hippie Food: How Back-To-Landers, Longhairs, and Revolutionaries Changed the Ways We Eat. Harper Collins. New York.
2017 Poulain, Jean-Pierre. The Sociology of Food: Eating and the Place of Food in Society. Bloomsbury: New York.