What do you think of when you hear the word ‘anorexia?’ Most likely, the word conjures up images of emaciated bodies - probably white, female ones. You might think of impressionable, image-conscious teenagers, attempting to live up to impossible beauty standards set by glossy magazines and Instagram influencers. If you’ve seen a film like To The Bone or Girl, Interrupted, you might even think there’s something glamorous about anorexia: a malaise of troubled celebrities, high fashion models and public school girls.
It wasn’t until I became unwell myself that I realised how poorly the images of anorexia that pervade cultural consciousness reflect the lived experience of the illness. In struggling to come to terms with my diagnosis, I was forcefully confronted with the stigmatising nature of these images, and spent many months of treatment in denial, or working through feelings of shame and confusion.
For a long time, despite hard evidence to the contrary, I harboured a strong sense of guilt for having succumbed to anorexia, as if it is something I had brought upon myself. I worried that employees, relatives and acquaintances would mistake my illness for a spell of vanity; a diet taken too far. I worried that I would be seen as weak, silly, or irrational: words that I would never have applied to the brave and intelligent men and women I encountered in my treatment, but which haunted my ruminations in the early hours nonetheless.
These anxieties, however unfounded, don’t come from nowhere. They are a product of a society that all too often misinterprets, trivialises and casts judgements on eating disorders. And they are reinforced by the stigmatising attitudes that diffuse our day-to-day interactions: an ill-considered joke at work; a Kardashian Instagram story in which Kim is praised for how ‘anorexic’ she looks; a recruiter advising me to lie about the gap in my CV because ‘while employers shouldn’t discriminate, they do.’
The preconceptions we have about illnesses shape how we judge them and speak about them and, as I myself discovered, how individuals respond to treatment and the very experience of being ill. Stereotypes constrain who feels able to seek help for particular illnesses, and create a self-perpetuating cycle that limits treatment, research and public understanding.
There is a dangerous mythology surrounding anorexia, that obscures perceptions of the illness and those who suffer from it. Here are some less glamorous truths about anorexia that I wish I had known earlier.
1. Anorexia isn't about wanting to look good
While certainly not helped by a society that idealises thinness and places undue emphasis on bodies, anorexia has very little to do with aesthetics. Once a pursuit of thinness reaches the clinical description of anorexia, looking good is rarely an object of concern. Instead, the fixations and compulsions around food and body image that accompany the illness are most often merely symptoms: manifestations of much more deep-seated traumas or anxieties; an ingrained means of coping with intolerable distress. Anorexia is fundamentally self-destructive: the antithesis of vanity. As Laura Freeman so aptly puts it: “it is not prettification of the self that drives the illness, but annihilation of self. It is the scraping-back of flesh from bone, it is punishment, will to destruction. It is the belief that you are not worthy of food, nourishment, life. Vanity, beauty? They have nothing to do with it.”
2. Anorexia doesn't discriminate
Anorexia is generally presented as a disease of young, privileged white girls. This demographic is certainly overrepresented in treatment and research, but they are far from the only group susceptible to the illness. In reality, anorexia can affect anyone, regardless of race, gender, age or socio-economic status.
However, stereotypes can be self-perpetuating: the less someone sees themselves represented in the conversations about anorexia, the less likely they will be to identify the problem, speak openly about it and seek treatment. This creates an echo chamber within research, treatment programmes and the media, where only certain voices are heard, diagnosed, studied and treated.
Men suffer from eating disorders too. Although they seem less predisposed to anorexia (due, perhaps, to genetic factors, or to differing social pressures), the significant stigma and misunderstanding surrounding male eating disorders makes it much more difficult for them to seek help.
3. Anorexia isn't a lifestyle choice
Anorexia is not a diet gone wrong, a show of will power or a fashion statement. While mainstream disordered eating and clinical eating disorders are closely linked, and can certainly slide into one another, it is important to see them as separate entities.
For many, anorexia is a death sentence, with the highest mortality rate of any mental illness. It is something that happens to you: often gradually, and in ways that are hard to distinguish from your own agency, but independent from you and entirely out of your control. It is an illness, and a brutal one at that. If it were a lifestyle choice, no one would choose it.
4. There's a lot more to anorexia than food and weight
Preoccupation with food and weight in anorexia is generally a symptom of much more existential and deep-rooted concerns. Although a focus on weight restoration is important for the more critical stages of treatment, over-emphasising these factors in treatment risks overlooking the underlying causes of the illness, as well as invalidating the suffering of those who are weight restored but not fully recovered psychologically, or those whose weight never falls low enough to make them 'clinically' underweight. There's a real problem in most healthcare systems of denying treatment to people who need it purely based on their BMI, despite the fact that we now know that there are many more factors at play in anorexia than simply weight loss.
5. There's nothing enviable about anorexia
I distinctly remember girls at school wishing they had the ‘discipline’ to be anorexic. I’m pretty sure I had similar thoughts myself. Having been there, done that and got the child-size t-shirt, I can report that there is nothing to envy. There is no joy to be found in a thigh gap, no higher ground in a flat stomach or protruding ab.
With extreme thinness comes hair loss, osteoporosis and constant exhaustion, not to mention the crippling depression and anxiety that accompanies a low BMI. The world, to one with anorexia, becomes pitifully small, reduced to a microcosm of numbers and micro-fears. The longer one is ill, the more difficult to entangle oneself from anorexia’s clutches, and in treatment I came across many whose lives were characterised by repeat admissions and stasis: unable to move forwards, unable to think beyond the next meal or to forgive themselves for the last. On average, one with anorexia loses 25 years of their life: more than any other mental illness.
Having experienced the hell of anorexia, and witnessed the damage it wreaks on so many lives, the thought of envying someone for their anorexic ‘discipline’ is laughable - or would be if it wasn’t so sad.
Written by Tasha Kleeman.