+ + Camilla Schickova + +
Warning: I am about to make rather controversial use of anthropology to better contextualise Pro-Ana – otherwise short for ‘Promote-Anorexia’ – the movement that safeguards anorexia as a lifestyle. [And no, before questions arise, I do not suffer an eating disorder, nor am I pro-Ana – rather pro-listening].
Pro-Ana’s social and psychological online support for anorexia sufferers is clearly well-meant. But it still appears somewhat contradictory in light of the plethora of lifestyle tips on how to become dangerously thin which it also encourages online. Hence the general argument against Pro-Ana websites is that: not only do they provide a space for harmful collective narratives that otherwise prolong the condition in pre-existing sufferers, but that they also encourage its development in non-sufferers. According to contemporary western biomedicine, anorexia must strictly not be viewed as a lifestyle, but as a seriously deadly disorder that is infamously difficult to treat, with the highest mortality rates of any psychiatric illness. But which comes first – the biological aetiology of the disease, or the cultural norms also influencing its onset? Has anorexia always been perceived as a dangerous, medicalised psychopathology in ages past? And can it ever be viewed culturally rather than medically i.e. as a lifestyle providing alternative cultural narratives for coping with social pressure as well as illness in modern times?
Eating disorders are often regarded, from both socio-cultural and biomedical viewpoints, as psychosomatic and therefore contestable, with their causality and treatment requiring cultural contextualisation. Likewise, the sufferers of other western psycho-somatic illnesses, [such as Post Traumatic Stress Disorder (PTSD), Irritable Bowel Syndrome and Chronic Fatigue Syndrome] have a hard time proving to biomedical authorities and wider society that their illnesses are culturally meaningful and hence very real in terms of lived human experience (Kilshaw 2004; Giles 2006). There are of course also non-western culture-bound illnesses that are contestable and altogether typical of small-scale societies – including Saka in Kenya, Sar possession states in Ethiopian, Sudanese and Egyptian regions, and suicide swims in the south-western Pacific island of Tikopia – where women attention-seek in order to regain normal social status and incorporate themselves back into society (Littlewood 1998). But do modern anorexia sufferers – known as ‘anorectics’ – share this desire to regain ‘normality’ within society? Or [and here I’m being Devil’s advocate] could they perhaps now be actively striving to remain socially excluded, by rejecting normal societal roles and responsibilities through their constant maintenance of ill health? Anorexia is a disease, but to stop at a one-track definition is too simplistic. If we subvert the normal stigma attached to eating disorders, one could instead argue that Pro-Ana is actually a reactionary coping sub-culture, rather than a cause of this psycho-somatic illness which has existed in the West for a very long time, and of which its previously isolated sufferers and potential sufferers are finally gaining community space vital for self-help and support in the 21st century.
Following some [harrowing] personal visual research on Pro-Ana websites contextualised with some medical anthropology literature, I would argue the illness has remained culturally meaningful throughout history as a lifestyle which is now safeguarding sufferers who choose an alternative psychosomatic reaction towards coping with modern life and fighting societal stigma. Pro-Ana gives an opportunity for medical and anthropological study into the socio-cultural and political shifts coming out of the aetiology of eating disorders as we progress into the 21st century. The movement sheds light on how mainstream cultural norms initially triggering psychopathology can perhaps only be treated and healed by a responding sub-culture. Indeed Pro-Ana provides a cultural window into what it means for humans growing up in a modern society increasingly obsessed with bodily image. In light of this evolving disease-lifestyle duality, one needs to instead question the politics of our modern culture and its pressure on young people, and whether the current stigmatisation and banning of Pro-Ana websites will only encourage sufferers to stick with the movement and establish it further as a sanctimonious sub-culture.
Modern Anorexia: evolving body politics & socio-cultural pressure
“In order to understand Anorexia, we must think about disease as
an interactive and evolving process” (Brumberg 2000:40).
Once upon a time, in the Middle Ages, ‘Anorexia Mirabilis’ [literally meaning ‘miraculous lack of appetite’] was not all that undesirable. In fact it was greatly romanticised prior to its official definition as a pathological disease in the 1870s. Over the centuries so-called ‘fasting girls’ became celebrities for their apparently miraculous ability to live off nothing but air. Their self-starvation was associated with spiritual attainment during a time when fat was symbolically associated with sin, slimness with high social status, and frailty with submissiveness and all its sexual undertones. Although extreme fasting was often a girl thing, Lord Byron argued food inhibited his creativeness and that, if anything, starvation helped increase his melancholia which he argued was the source of his own poetic inspiration (Brumberg 2000).
Today the cultural factors influencing self-starvation and eating disorders in the West remain very similar. Fasting continues to be strongly associated with spiritual attainment in many societies. Fat and obesity are associated with a lack of discipline and even failure, whilst slimness pertains to wealth, high-class and success – with praised skinny celebrities made example of. And submissively frail childlike bodies are [alarmingly] deemed attractive. Pro-Ana even remains true to anorexia’s historic melancholia, with its followers posting song lyrics as well as their own poetry online. But capping all this is the 21st century cultural obsession with dieting, now overtaking the spiritual motivations of historic anorectics (Brumberg 2000). Exercise has become ritual as the West has become obsessed with food stats and Body Mass Index (BMI), so that ‘the image of personal control is now the commodifiable advantage’ within a largely consumerist society (Littlewood 2000:80). Consequential diet-driven obsessions with body, clothes, food and celebrities have become culturally ‘normal’, and their normality increasingly legitimises perceptions of anorexia as a lifestyle in synch with modern times. Indeed ‘as with many psychiatric disorders, the behavioural symptoms are an expression of prevailing cultural concerns’ (Brumberg 2000:253).
21st century anorectics are, crudely enough, groundbreaking and ahead in the socio-cultural evolution of dieting. They succeed in total exaggeration and subversion to the point of mastering “an alternative sense of health in which a body size that the mainstream would consider unhealthy and morbid is to be managed pro-actively to sustain life” (Fox et al. 2005:966). Gender is one such cultural norm being subverted. Up until now the rules in the cultural race to achieve the ideal body shape have remained those of men. Anorectics of patriarchal ages gone by were greatly admired for their female obedience through spiritual submissiveness. And indeed modern anorectics appear to continue playing to a modern male preference for less sexually threatening [but no less controversial] Lolita-esque figures. But anorectics do not stop there. In their quest to attain a super-slim female size that might win admiration and advance social status in a world where being thin is attributed to success, many end up pushing it too far – achieving bodies that horrify and subvert once male-led cultural gender preferences. It would seem the rules are fast becoming those of women. Several of my male friends have remarked they find the actress Keira Knightley unattractive because she is too thin; but a visit to some pro-Ana sites would dictate otherwise – anorectics still adore her, regardless of what men say. Pro-Ana followers are mostly female, speaking out on mainly female-chaperoned sites. From my own experience of friends suffering anorexia during my single-sex education, female anorectics appear to be far more competitive, assertive, driven, and power-laden than their historic spiritual predecessors. In a world where women are now expected to rise to the top with men, arguably modern anorectics are now leading a socio-cultural evolution by rejecting ‘the core aspects of the female role in Western society (as) reflected in the ideals still held out to women: concentration on marriage, home and children as the primary focus of concern with reliance on a male provider for sustenance and status’ (Littlewood 1998:248).
But the independence of western women, from their growing public roles to their sexuality, is altogether fairly new, and thus still contested and ambiguous (Littlewood 1998 & 2002). If anorexia has indeed evolved into a condition of greater female self-empowerment and independence, it still remains highly introverted, individualised and driven by a potentially dangerous desire for thinness which now manifests unchecked and independent of gender norms. Sexual preference may be a starting point driving girls to achieve a culturally ideal body which pleases men and threatens other women, but such ideals are quickly side-stepped as the deeper psychological, gender and body politics underlying young people’s modern-day concerns shine through. The illness appears to have shifted from a spiritual submission with sexual undertones once kept in line by male cultural gender preferences, to ‘a dramatic expression of the internal compromise wrought by young Western women in their attempt to negotiate their passions and desires in a time of extraordinary confusion’ (Orbach 1993:4). Anorexia is indeed a 21st century disease par excellence.
And the socio-cultural evolution continues: as fashion and media continue to dictate cultural preference for slender bodies, and as public concern increases over obesity affecting both sexes, linking fat with weak character no longer remains a female prerogative. Men are becoming just as obsessed with looking good and perfecting their bodily aesthetic. And anorexia’s gender boundary is beginning to blur as men equally push the extremities of bodily expression as a means for shaping social identity. Indeed, male anorectics are appearing on Pro-Ana forums.
The desire to achieve bodily independence by breaking with traditional gender constraints has arguably risen from historical shifts within western social-cultural structure, which now caters for secularised individuals over the more dividualistic community dependence otherwise found in past and traditional societies. But individualness is arguably a deluded perception, since young people now exist within a reality of ageing populations where parents are set to become increasingly secularly dependent on them. Since the turn of the 20th century, rising public health awareness has driven parents to scrutinise the health, nutrition and body shape of their children as well as their own. Young people are growing up in confusing and contested times, with more freedom to move at individual speeds towards ‘individual’ modern ideas of body shape. But this is juxtaposed with more immediate, secular dividual family and community loyalties as well as cultural norms and societal pressures. Indeed, past and present female anorectics have tended to be of middle-class families with domineering parents investing in their children for longer. However, human sexual maturity arises prior to social maturity, and arguably the former comes into conflict with the latter, perhaps increasing the risk of anorexia’s onset within a modern society where preserving immaturity can delay sexuality and maintain loyalty to an over-protective family. Anorectics appear to challenge but also give in to such walls by seeking control over their parents and others via their bodies, manifesting in psychological obsessive compulsive and competitive behaviours (Brumberg 2000; Littlewood 1998; Littlewood 2002).
So in light of such socio-political upheaval ‘is anorexia an exaggeration or a rejection of the dominant cultural norm?’ (Littlewood 1998:258). Surely both? On the one hand anorectics are exaggerating otherwise culturally normal health and image into an alternative, distorted extremity of thinness synonymous to happiness, purity, perfection and achievement which would normally be deemed dangerous and wrong, but which is altogether increasingly legitimised in a society aspiring to thinness in general. And on the other hand, arguably the anorectic’s rejection of food along with their collective desire to legitimise anorexia-as-lifestyle, is also their political rejection of modern, mature, normative, gendered adult roles within a society where they face increasing pressure to be beautiful, successful, family-loyal, and where gender is undergoing a makeover (Orbach 1993). This juxtaposition between exaggeration and rejection arguably culminates at the site of the human body, so that the meanings surrounding Anorexia Nervosa are altogether associated with societal pressure and cultural change from the outside-in, rather than simply an inner psycho-pathological illness (Littlewood 2002). So with anorexia today we are arguably seeing how ‘rapid social change and disintegrating social boundaries stimulate both greater external and internal control of the physical body. In short, disorder in the body politic has implications for the individual body” (Brumberg 2000:241).
Again I am not pro-Ana, but appreciating the complexity of the cultural politics surrounding the illness and contributing to young people’s confusion over obesity, gender, family relations, and societal pressure to be healthy, successful and beautiful – makes it easier to empathise with how Pro-Ana has become an attractive means for expressing socio-culturally derived inner turmoil.
Pro-Ana online communities: the return of anorexia-as-culture
The Pro-Ana movement is evidence of anorectics no longer seeking individual re-balance within society, but rather a shifting away from norms by creating their own peripheral status-quo through a new desire to ‘achieve’ illness and adopt the shared identity of ‘Ana’, or (for bulimics) ‘Mia’. Pro-Ana online collectives are secretive, with their own social hierarchies, discourses, terminology, symbolic imagery, songs, and poetry altogether creating a unique underground cultural system (Rich 2006). Pictures posted on the sites pertain to beauty, femininity, weightlessness – such as angels, flowers and butterflies – and also pain. This altogether constructs the movement’s unique cultural artefact –Thinspiration or ‘Thinspo’.
Thinspiration is aimed at further encouraging anorectics to lose weight or stay thin. It consists of photos and video montages of thin to alarmingly skinny models and celebrities, as well as the pro-Ana anorectics themselves, alongside dieting statistics and biomedical facts about anorexia. Most photos appear to be genuine, but there is often speculation and criticism on online forums as to whether some images are Photoshopped to enhance skinny-ness. Likewise reverse-thinspo consists of food, fat and obesity images to disgust anorectics, amounting to the same weight-loss effect. Thinspiration even retains the same spiritual aesthetics of historic anorexia – by upholding words and imagery pertaining to bodily purity, perfection, struggle against sin and corruption evident from posts expressing fear and disgust of being overweight, and support for mantras, ‘Ana’s creed and commandments’ reminding sufferers to stay thin, and even angelic flight imagery. Such is the boomeranging of anorexia’s cultural spiritual significance, from medieval fasting to modern sufferers.
The sites dauntingly demonstrate how anorexia has become a ‘trendy’ psychopathology, so that anorexia-as-illness now appears secondary to the lifestyle (Rich 2006). Long-term anorectics, who tend to set up the sites, have had longer to come to terms with their illness, with many declaring they have chosen not to cure themselves or find professional help. Their collective solidarity in self-starvation, along with their mutual construction and sharing of ‘Ana’ as a unique identity, upholds a subculture associated with achievement through illness and anti-recovery as opposed to any failure or social pressure to recover (Fox et al 2005). But this can be dangerously appealing to young impressionable girls not yet suffering eating disorders, who are seeking to be radically different by finding social acceptance elsewhere. Pro-Ana all too readily provides a means for rebellion against the modern pressures faced in young adulthood. But many official sites do stress that they only offer sanctuary to pre-existing sufferers, and that they condemn ‘haters’ and anorexic ‘wannabes’ – or ‘wannarexics’ – from entering, and most have forum gatekeepers to deal with hate or ‘flame’ messages in order to protect the sanctity of their members. Quite a few pro-Ana sites have even become critical of thinspiration for having given Pro-Ana a bad image (Giles 2006).
Like a lot of things on the internet, the ideology and imagery can be abused and therefore Pro-Ana will always remain controversial. But there appears to be no statistical data otherwise suggesting the Pro-Ana movement is having a direct influence on anorexia’s incidence. Indeed, the cultural significance of Anorexia Nervosa appears to have boomeranged: from the spirituality and romanticism of medieval anorectics, to the public consensus regarding it as dangerous psychopathology in modern anorectics, and finally to the cyberspace collective and subculture of pro-anorectics who now challenge dominant cultural and biomedical definitions by bringing back anorexia’s historic romanticism. But overall it is important to see that, at the present stage of anorexia’s cycle, pro-Ana is still only reflecting not causing an illness which has always existed in the West.
During his fieldwork, Professor Roland Littlewood, social anthropologist and psychiatrist based at University College London, found no cases of anorexia in Africa, and only one case in the Caribbean – in the daughter of a wealthy businessman. As Anorexia Nervosa reaches epidemic proportions in the West, this western culture-bound syndrome appears to be increasingly affecting girls in developing countries which are now rising in affluence, with incidence gaining pace in Brazil, China, Mexico and even India (Gordon 2001). By ‘culture-bound’ we mean that any contributing biological factors are in fact secondary to the overriding socio-cultural and psychological influences of a disorder which spreads hand-in-hand with a particular culture. Hence the incidence of Anorexia Nervosa varies in direct accordance with western cultural ideals of female body shape discussed above, rather than anything biological (Littlewood 1998 & 2002).
And the incidence of anorexia is arguably set to rise globally as developing societies are modernised, with the spread of the internet increasing exposure to pro-Ana. But again, it will only be spreading on the back of western body-obsessed cultural norms such as dieting, rather than pro-Ana alone. It is our western consumerist society that promotes rather than controls a culture bent towards pursing our human desires via our bodies. Hence western biomedicine starts down the wrong route if it fails to first acknowledge how anorectic’s view their condition as a lifestyle in conjunction with modernity, where obsessions and ideologies surrounding health and body are increasingly the norm anyway.
Conclusion: biomedicine cannot ‘cure’ western culture
Pro-Ana now puts forth the same old philosophical dilemma within a world bent on democratic freedom of expression, individuality and hence (surely) the acceptance of difference: who now has the final word on what being ‘normal’ entails anyway? Culture-bound reactions in traditional societies involve a ‘dislocation, exaggeration, inversion and restitution’ of cultural norms, and pro-Ana followers are simply doing the same within modern society (Littlewood 1998:246). If anything, pro-Ana is evidence of western biomedicine’s neglect of the socio-cultural elements feeding into the psychology of modern anorectics. The non-compliance of anorectics undergoing treatment within biomedical institutions raises the daring question as to whether the alternative support given through the narratives on pro-Ana forums is perhaps more beneficial than professional medical support. Anorectic strife for achievement is arguably driven by their fear of being pathologised within a normative biomedical framework, which otherwise trivially contextualises their disease according to food and weight. This only further provokes sufferers to pursue belonging to a sanctimonious subculture which they feel understands their deeper, non-food related psycho-somatic experiences better.
The contemporary understanding of the disease needs to be contextualised within a socio-cultural framework. As with Freud’s call for a decreased focus on the physicality underlying hysteria, clearly another shift in the understanding of anorexia within western biomedicine is needed, from the trivial externalities of food and weight, to a greater empathy and understanding of anorectic sub-culture as a reaction to normative culture, and the socio-psychological trauma involved. Only then might we stop objectifying young people as thin bodies, and start fully appreciating them as complex cultural beings striving to fulfil modern expectations to be unique individuals with multiple personalities. To ignore anorexia as a lifestyle choice, as disconcerting as it may be, is to risk the reduction of highly complex cultural human behaviour to universal biomedical units.
With pro-Ana’s continuing online presence, the boundaries of its ideology become increasingly concrete, and with a greater following there is less need for anorectics to regain a normative status-quo within wider society as they establish a new sense of sub-cultural belonging. The foundations for an alternative political structure of self-help for both sexes are thus being established as the movement challenges the biomedical definitions of anorexia more than ever. Pro-Ana groups may maintain a stigmatised ‘sick’ identity but, like other self-help groups and rituals in traditional societies, ‘their organization may provide a dynamic mechanism for social mobility and even institutional change’ (Littlewood 1998:243). Pro-Ana is only further legitimised by the malicious criticism and stigma received from normative societal and biomedical frameworks, and “the irony of affirming a stigmatised identity is that this identity remains determined by the dominant culture” in that Pro-Ana’s very existence is born out of such stigma (Littlewood 1998:267). Anorectics should not be accused of being directly responsible for their disorder, since their expressions, exaggerations and rejections are altogether collective, cultural coping-strategies in the face of greater socio-cultural ambiguity arising with modernity. Banning the sites would therefore have the effect of further isolating sufferers, and driving their subculture underground without reducing its size or appeal. Perhaps only when society-at-large faces up to the modern socio-cultural pressures cushioning the movement, might we begin normalising the movement’s appealing rebellion, sanctuary and alternative norms, so that ‘Ana’ has less justification for putting up a fight, causing her subculture to break down and disappear.
Bibliography & further reading
Becker, E; (1994) Nurturing and negligence: working on the others’ bodies in Fiji. In Embodiment & Experience: The Existential Ground of Culture & Self (ed) Csordas, T; Cambridge University Press, p 100-113.
Brumberg, Joan Jacobs (2000) All chapters in Fasting Girls: the History of Anorexia Nervosa / (ed) J.J. Brumberg. 1st Vintage Books New York: Vintage Books, 2000.
Fox, Nick; Ward, Katie; O’Rourke, Alan (2005); Pro-Anorexia, weight-loss & the internet: an “anti-recovery” explanatory model of anorexia. In Sociology of Health & Illness . Vol. 27(7) p.944-971
Giles, David (2006); Constructing identities in cyberspace: The case of eating disorders. In British Journal of Social Psychology. Vol. 45 (3), p. 463-477.
Gordon, R.A (2001) Eating disorders East & West: a Culture-bound syndrome unbound. In Eating Disorders & Cultures in Transition / (eds) Mervat Nasser, Melanie A. Katzman, Richard A. Gordon. Hove: Brunner Routledge, 2001.
Kilshaw, Susie 2004; Friendly Fire: The Construction of Gulf War Syndrome Narratives. In Anthropology and Medicine 11(2) p.149-160.
Littlewood, Roland (1998); The Butterfly & the Serpent: culture, psychopathology & biomedicine. Ch.13 in The Butterfly & the Serpent: essays in psychiatry, race and religion / Roland Littlewood. London : Free Association, 1998.
Littlewood, Roland (2002); The Instrumental Body in the Transition to Modernity. Ch.5 in Pathologies of the West: an anthropology of mental illness in Europe and America (ed) Roland Littlewood. London: Continuum, 2002.
Orbach, Susie (1993); Anorexia: a metaphor for our time. Ch.1 in Hunger Strike: the anorectic’s struggle as a metaphor for our age / Susie Orbach. [2nd edition.]. London: Penguin, 1993. p.3-11.
Rich, Emma (2006); Anorexia dis(connection): managing anorexia as an illness & identity. In Sociology of Health & Illness . Vol 28(3) p.284-305.
Warin, Megan, J (2006); Reconfiguring Relatedness in Anorexia. In Anthropology & Medicine. Vol 13(1) p.41-54.