Like many women, Simone Weil had a difficult relationship with food. When she was six months old, her mother fell ill; in adulthood, Weil would joke that she had been poisoned by her sick mother’s milk. Weil was weaned at eleven months old, but she stubbornly refused to eat off a spoon; her mother fed her mush, to be sucked from a bottle, until she was two. As an older child, she would go door to door with her brother, gleefully pretending parental neglect and begging for sweets, which were banned (along with toys and dolls) in the Weil household. In her teenage years, her friends report, she ate very slowly, as though it were painful to chew. She was plagued by digestive problems. Later, living in England and gravely ill with tuberculosis, she let herself starve, insisting that she would share in the suffering of those in Nazi-occupied France. After spending time in a London hospital, she was moved to a sanatorium in Kent, where she fantasized about Christmas turkey and mashed potatoes but left her meals untouched. When she died, aged just 34, she was ruled to have killed herself by refusing to eat.
Food, hunger and eating are recurrent preoccupations in Weil’s writing; they serve as the props and symbols through which she articulates her harsh ethical vision. Weil wanted to devote herself to the world—to fully attend to its beauty. But, she thought, she could only be swallowed up by the world—“eaten and digested by God”—if she made herself empty. Love, for Weil, was not a relation that a self can stand in, but a steady, merciless undoing of the “I.” To refuse food when one is starving, Weil wrote with stern approval in her notebooks, is “to tear the eternal part of the soul violently away from the self and fix it to the not-self.” Hunger destroys the personality, collapses it into a pure, howling need. And in that experience of need, we encounter something real: our wretchedness. Because the wretchedness is real, we must love it.
Was Simone Weil anorexic? Her refusal of food is often read as an empathetic impulse—as an expression of what one biographer calls her “pathological need to share the sufferings of others.” (Aged six, after all, she refused to eat sugar, because French soldiers at the front had none.)
Such readings locate Weil’s fasting in a political, rather than in a mystical, context. But toward the end of her life, Weil was writing prayers in her notebooks: pleading with the Father to “rend this body … away from me … let nothing remain of me, forever, except this rending itself, or else nothingness.” In 1938, she spent ten days at Solesmes Abbey, a Benedictine monastery. She wanted to immerse herself in the liturgy; but, she later wrote, “I was suffering from splitting headaches; each sound hurt me like a blow.” By effort of will, she reports, she was able “to rise above this wretched flesh, to leave it to suffer by itself, heaped up in a corner, and to find a pure and perfect joy in the unimaginable beauty of the chanting and the words.” To be oriented toward the good, Weil thought, the soul must be unpicked from the body’s false demands. Weil’s insistent fasting, then, should be read as an attempt at discarnation. She didn’t want to understand the lives of the needy so much as she wanted to stand outside need altogether.
Simone Weil is just “Simone” for Emmeline Clein in her first book, Dead Weight, a memoir-laced study of eating disorders. Weil is one of Clein’s many “sisters”—women, girls and, indeed, “anyone who’s ever hurt themselves hoping to become beautiful”—whom Clein quotes by their first names. “I feel like I know them,” Clein says. “I wish Simone put mayo on a chunk of baguette instead of dying.” Clein takes it for granted that Weil had anorexia. Unlike other commentators, though, Clein doesn’t see the diagnosis as draining Weil’s fasting of political or spiritual significance. Rather, Clein wants to make legible the political and spiritual stakes within “ordinary” eating disorders—eating disorders of the sort that 13 percent of American girls will suffer symptoms of before they are twenty, and which (besides opiate addiction) cause more deaths than any other mental health condition.
The politics of disordered eating are also a central concern for the Cornell philosopher Kate Manne, whose third book, Unshrinking, has a critique of diet culture and fatphobia as its centerpiece. Like Dead Weight, Unshrinking is confessionally anchored cultural criticism, and the two books share many preoccupations. Both Clein and Manne stress the porous boundaries between “normal” diets and clinical eating disorders. Both authors argue against simplistic equations of fatness with unhealthiness. “Many of the studies connecting fatness to heart disease and death have confounding factors,” writes Clein; she has in mind, in particular, the health risks of weight-cycling—repeatedly losing and gaining weight—which has been linked to cardiovascular disease, strokes, metabolic conditions, diabetes and worsened immune function. Manne stresses that fat people—“fat” is her preferred nomenclature—may be reluctant to seek treatment from a biased medical establishment. When fat people do seek treatment, they are often treated incompetently. (Manne tells the story of a 38-year-old woman who went to see a kidney specialist after receiving some worrying lab results. The specialist advised her to lose weight and eat less salt—totally missing the bone marrow cancer that was ravaging her body.)
Despite these similarities, though, the books read very differently. Clein’s prose is self-consciously lyrical—at times cloyingly so. (“To people who binge, the trash can is a cipher and a kaleidoscope, a mirror and a camouflage, an altar and a site of utter abjection, a confessional.”) Manne, by contrast, mixes her pared-back philosopher’s prose with clichéd social media affirmations. (“Fuck beauty culture, along with diet culture,” she writes toward the end of her book. “Burn it down.”) Clein’s book is ambitious, a little chaotic and wide-ranging in its cultural and historical reference points. Manne’s book is a far more controlled effort, but it also makes for duller reading. Both books have some argumentative weak spots. Clein’s poetical instincts sometimes overwhelm her analytical chops; meanwhile, much of Manne’s rather one-note analysis—fatness is inappropriately moralized, the health risks of fatness are overstated, diets are ineffective—will be familiar to many readers.
The clearest point of contrast between the two books, though, lies in the authors’ competing visions of the self. Like Weil, both Clein and Manne understand that food—which is, after all, something that we pluck from the world and envelop into ourselves—is intimately bound up with the human project of demarcating the “I.” Feminist analyses of disordered eating have long centered this insight. (Anorexia and bulimia are both more prevalent among girls and women than boys and men.) Many feminists have argued that an independent, bounded ego is the proper goal of human development, with the problem being that social conditions make female selfhood a fraught and elusive aspiration: girls are too closely identified with their bodies, and too attuned to the needs of others at the expense of their own. Manne’s analysis sits squarely within this broad tradition. Clein is more revisionary. Like Weil before her, she questions the value of a stable, bounded “I.” Unlike Weil, though, Clein doesn’t want to hollow the self out. Rather, she wants to reconfigure it: to conceptualize self-making as something we do with and alongside others—as a project whose key task is not demarcation, but something more like harmonization.
The bounded self, though, might turn out to be an indispensable fiction. The ideals of self-governance and self-authorship are deeply woven into our political vernacular. (“My body, my choice!”) But if we can draw no clear line between me and you—if all authorship is co-authorship—then these ideals might seem to falter. (Our body? Our choice?) Can a feminist politics do without them? I’ve come to think that’s the wrong question. A better one would be: What should we use instead?
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Manne’s Unshrinking makes for an instructive case study as to the limits of this fiction. “Since my early twenties,” Manne writes, “I have been on every fad diet. I have tried every weight-loss pill.” She can tell you what she weighed “on any significant occasion from the age of sixteen onward”: her wedding day, the day of her Ph.D. defense, the birth of her daughter. When she moved to Boston from Australia to do graduate work in philosophy, her toothbrush was the only thing she unpacked before her set of scales. Eventually, her obsession with weight loss led to periods of self-starvation:
Sometimes I wound up eating nothing whatsoever. At first I would go one day and feel cold and a little foggy. I felt hungry, of course, and was consumed by thoughts of food. But at that point, on day one, I was still relatively clearheaded. That would change on day two or three, by which time I wasn’t thinking well enough to decide to resume eating. By day four or five, when I lasted that long, I wasn’t thinking at all. I would cease to be an agent. … The hunger gnawed away at me—determined, relentless. It felt like not an emptiness but an active, sapping mandate. My body was telling me to eat. And, churlishly, I ignored it. Then I lost the capacity to listen altogether.
Manne’s trajectory—from diet to eating disorder—is not unusual. But diets are routinely prescribed, despite the high risk-to-reward ratio: a 2007 meta-analysis suggests that diets seldom lead to long-term weight loss; indeed, there’s evidence that dieters’ weights will increase more, over the long term, than will non-dieters. And a 2020 study showed that lifestyle changes tended to produce—at best—very small improvements in health measures like cholesterol and blood pressure. Strikingly, where these markers did improve, there was no correlation with the amount of weight lost.
Why, then, the fixation on dieting? Manne’s answer is fatphobia—an ideology that moralizes weight and ranks fat people as inferior to thin. Per fatphobia, fat people are disgusting, stupid and wanton. Against this backdrop, diets seem less like a public-health intervention and more like a punitive measure: a spiked cilice for the sinful fat body.
It does not seem to be well understood why it is so difficult to maintain significant weight loss over the long term. But, one might think, the more difficult it is to sustain weight loss, the more important it is to prevent people from becoming fat in the first place. Manne is skeptical. Even if dieting were effective and costless, she would oppose it as a social practice, seeing it as of a piece with skin-lightening creams and Botox: interventions that “flatten out” a valuable form of human diversity.
Manne’s template, in thinking through the politics of fatness, is what we might call a politics of recognition: a politics that contests a society’s status orderings and representational codes but sidelines questions of production and distribution. Sometimes such a politics is apt. Heterosexism, for example, is at its heart a cultural phenomenon (albeit one with economic spillovers); accordingly, its dismantling requires the imaginative revaluation of despised queer identities. But Manne’s paradigm risks obscuring as much as it reveals. She is right that fat people are unjustly reviled. But fatness is also the product of a profit-driven food system, in which food is engineered to be hyper-palatable and overconsumed. Manne stresses that fatness can be the result of a rational life plan—one might, she argues, permissibly decide to prioritize gustatory pleasure over health, just as base jumpers value thrills over safety. One might. But for many people, fatness does not feel chosen. It feels like an imposed burden, not part of an epicurean project.
Manne, of course, might retort that this is merely a product of fatphobia. Fatness feels like a burden because it is socially reviled. Ideology prevents us from affirming ends with which we might otherwise identify. That’s true, but it’s also a non sequitur. My relation to my body is distorted by ideology. But the bad ideology doesn’t sit atop some politically neutral structure. An unjust structure creates the ideology’s objects. A politics of fatness that takes the identity as a given—and ignores the political economies that undergird the identity’s production—will always be incomplete.
Manne is probably right that the health risks of fatness are overstated. But the health risks of fatness might be both overstated and considerable. A 2018 study in the Lancet showed that there are significant losses in disease-free years of life for both overweight men and women compared to those with a “normal” weight; crucially, this was observed “across all categories of physical activity, smoking and socioeconomic status.” To be sure, many of Manne’s key claims are unaffected by such findings: there is no duty to be thin; fat people deserve our care and respect. Still, they show how cramped the horizons of Manne’s political imagination are: her moral energies might be more productively channeled toward the food conglomerates that got Congress to classify pizza as a vegetable.
Unshrinking contains two really novel ideas. Manne’s first innovation is to tie her critique of diet culture to her favored meta-ethics (that is, to her preferred account of why and how our ethical claims have authority). Manne locates the authority of ethics within the body. “Pain and suffering are bad,” Manne thinks. “Pleasure and enjoyment” are good. Bodily states like hunger and pain “speak to us, almost literally”: “Pain whispers—or shouts—in our ear, ‘Get off that limb! You are injured.’ Hunger similarly bids us to eat, to assuage its characteristic gnawing. ‘Eat something! Do it,’ it urges us firmly.” On this picture, the body gives us orders; we are obliged to obey. Surely, though, one might think: pain can sometimes be good. Grief, after all, is pain. Grief says: “Make it stop!” But it is good to feel grief when a loved one dies. It is a fitting response to loss—a way for us to honor the beloved. Similarly, pleasure can be evil. Suppose that I feel delight at your suffering. If I feel joy when I pull out your fingernails, my pleasure is not good. It is depraved. Bodily states, then, do not have any native authority. It matters—deeply—whether a given bodily state is orienting us to goodness or numbing us to it.
This suggests that obsessive dieting might be wrong not because it makes us hungry, but because that hunger monopolizes our attention. Self-inflicted hunger is bad not because our bodily desires have so much moral weight, but, rather, because they have so little. When Simone Weil visited Solesmes Abbey, she wanted to find “a pure and perfect joy” in the Gregorian chanting, to stand outside her needy body. But can a really hungry person fully lose themselves in gorgeous music, or a mountainous vista, or the eyes of their beloved? I’ve never been able to manage it. The hungry person doesn’t unravel the “I.” Rather, their world contracts, collapses: there is nothing outside the hunger, no longer a not-self for the self to be stuck on to.
Manne’s second innovation is the idea of “body reflexivity.” Manne presents “body reflexivity” as an alternative to “body positivity” and “body neutrality,” both of which make substantive recommendations as to how we should aim to affectively relate to our bodies—recommendations that, Manne worries, can be difficult to follow, and easily transfigured into disciplinary rhetoric. “Body reflexivity” has a more proceduralist flavor. It does not prescribe any particular attitude but suggests a new style of thinking—one in which our attitudes to our bodies are shaped by our own needs and values, rather than by others’ demands and preferences. “My body is for me. Your body is for you,” says Manne.
But is my body just for me? Can I separate out my own wants from others’ preferences? I want to be desired. I want to be needed. What those others need and desire, then, will always be threaded into what I need and desire. And if we insist upon drawing a line between us? Well, there’s no guarantee that “your own” needs and values will be kinder to you than others’. When I suffered from anorexia as an adolescent, it was my parents who wanted me to eat. I wanted to be thin, no matter what. “My” needs and values had not been displaced by impostors. There was nothing more authentically mine than my terror of eating. I had built my personality around it. Manne’s ideal of self-governance and self-authorship couldn’t save me, because—far from being anathema to my illness—they were its engine and its fuel. “Autonomy of the will,” wrote Kant, “is the property the will has of being a law unto itself.” Well, I was legislating for myself, and I was ecstatic.
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This might seem counterintuitive. Anorexia is readily conceptualized as an autonomy deficit. We like to imagine the anorexic as a hostage, seized by patriarchal culture, hijacked by unrealistic beauty ideals. You know the story. Cover girls are too thin; Photoshop makes us hate our cellulite. Clein’s Dead Weight flirts with this easy narrative. “The spores of sickness get planted in our brains early,” she writes, by women’s magazines and “the billboards we see out car windows, the mannequins in the mall.” But in its better moments, Dead Weight suggests a far more nuanced understanding of how disordered eating takes hold.
It might seem dim-witted to ask why women and girls succumb to anorexia. Anorexic women dread eating. We assume that the fear of food expresses a fear of fatness: women stop eating because they want to be thin. But why do they want to be thin? The desire for thinness is practically culturally mandatory—so readily intelligible that it’s almost a joke to ask why. But anorexics, of course, become too thin. They go beyond—indeed, they almost seem to parody—our aesthetic ideals. The idea that thinness is self-evidently desirable—and that anorexia is its rational pursuit gone too far—masks anorexia’s true psychodynamics. It makes the anorexic comprehensible, but perverse. The anorexic is superficial, narcissistic and vain; the anorexic girl wants, too badly, to be hot, but ends up ugly. So we warn her that her hair will fall out, that she will be grotesque: covered in lanugo like a newborn. We say: this is not a path to beauty. The warnings, though, don’t seem to work. Why not?
The obvious answer is that looking good is not what the anorexic is after. But if anorexia is not a pathological overinvestment in beauty norms—a diagnosis that Clein sometimes seems to endorse—what is it?
Clein’s anorexia developed as she prepared for her bat mitzvah. In bed at night, Clein would fantasize about having sex with women, before begging God, “Please don’t let me be gay.” My own eating disorder—which, unlike Clein’s, was never formally diagnosed—developed when I was around eleven. I remember my own mother, frantic and distressed, trying to understand what was happening to me. “Is this about your looks? Is it about getting boys to like you?” (She was very embarrassed to ask me these questions.) I remember being confused. I didn’t know how to answer, because beauty was a part of it, but not in the way my mother thought. Thinness felt to me then, and for many years thereafter, like a kind of safety. I had a keen, inarticulate sense that there was something pathetic and repulsive in my desires—desires that were, at that stage, still childish; I wanted friends, not boyfriends, but I wanted them with all the desperation and intensity of lust. Other girls my own age had started to slide, more easily than me, into adolescent femininity—a world with a brocade of rules so rich that I could never keep track of them. I was always tripping, stumbling, trying to keep up and failing. I’d become a hanger-on; I could feel their desire to set me aside, like the games that they had outgrown, but that I still hankered to play.
Anorexia’s typical age of onset is between twelve and 25; as a result, it is often understood as a refusal of sexual maturity. “Anorexia,” writes the psychotherapist Susie Orbach, “reflects an ambivalence about femininity, a rebellion against feminization.” But I wasn’t ambivalent about adult femininity. I was repulsed by it. I despised all the adult women I knew. None of them had lives I could imagine wanting for myself; still, puberty was sucking me into a body like theirs. Like many tomboyish girls, I experienced my adolescence as a kind of crisis. Gender had never really impressed itself upon me before; then, suddenly, I was caged by it. A refusal of adult womanhood was, then, à la Orbach, certainly a part of why I stopped eating.
But I wasn’t stupid. I knew that I could not remain a child. More important, I think, was my disavowal of neediness. I craved the attention of friends whose gaze was drifting. I needed them; they did not need me back. Very well: I would wall myself off from others. I would make myself anew, and become pure will, unconditioned by appetite or inclination. It is natural that the desire to appear—that the desire to be—invulnerable should find its sensuous articulation in thinness. Food and desire are fused together in our metaphors; the rejection of one can easily serve as a proxy for the refusal of the other.
For my eleven-year-old self, then, Manne’s ideal of body reflexivity would not merely have proved otiose. It would have made things worse. My problem was not that I had mindlessly absorbed a set of mores that I would not, when spurred to reflection, endorse. My problem was that I wanted to hive myself off from others, to seal and store myself off and up, safe and fierce and proud in a cell. Like Simone Weil, I wanted to stand outside need. But unlike Weil, that tenacious critic of modernity, I was engaged in that most modern of projects—that of fashioning a self. The last thing I needed was a reason—one more reason—to trace the boundaries between me and my mother, or between me and my friends. What I needed was not more autonomy—more separateness—but less.
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The “hostage” model of anorexia has deep cultural roots. In medieval Europe, women used fasting, alongside other forms of self-mortification, to authenticate a personal connection to Christ. Though many of these “holy anorexics” were later canonized, their behavior often threatened contemporary religious and familial authorities, because they bypassed the sacerdotal hierarchy and refused to marry. Catherine of Siena—who, like Weil, died in her early thirties—cut off her blond hair, determined to thwart her parents and brothers by remaining a virgin. When Catherine began to fast, she was ordered to eat by her confessor, Tommaso, who suspected that a demon—the original hostage-taker—was behind her abstention. Eventually Tommaso accepted that Catherine should “do as the Holy Spirit suggest[ed].” She drank only water and chewed bitter herbs, before spitting them out. If traces of the herbs did go into her stomach, she would force herself to vomit by sticking stalks of fennel down her throat.
Standard diagnostic categories draw a sharp distinction between anorexia mirabilis—Catherine’s disease—and anorexia nervosa (or “modern” anorexia). The nervosa/mirabilis split maps on to a familiar cultural dualism. Women with anorexia nervosa are obsessed with the body, with surface, with looks. Holy anorexics, by contrast, are too high-minded to want to be fuckable. In fact, they want to be pure. But the mind and the body cannot be held apart for long, even in imagination. Fasting mystics’ relation to Jesus was often erotic. In one of her ecstatic visions, Catherine was married to Jesus, who gave her a ring of his foreskin. And modern anorexics articulate their goals in a markedly spiritual register: anorexia is understood as “a higher purpose,” as producing a new, purified and sexless self. On Tumblr, Clein used female saints as her thinspo; online, she learned “[her] own kashrut”: “a system of fasting and ritualistic rules cobbled together from magazines, diet books, blogs, eating disorder novels, and Google searches.” Perhaps anorexias nervosa and mirabilis, then, should not be thought of as two separate pathologies, but culturally specific manifestations of a more-or-less unified underlying kind.
In Holy Anorexia, Rudolph Bell’s study of medieval Italian anorexics, Bell reports seeing a pattern emerge in his research. A “superficially obedient but deeply strong-willed child” is brought up intensely religious, usually by her mother. In her early teens, the girl’s father gets involved: he pressures her to marry. The girl resists, and “comes to display the classic anorexic syndrome; ultimately she runs away to a convent.” When the girl is a novice, she still cannot eat; she is depressed and tormented by demons. But gradually, the girl recovers, by becoming active in the life of her convent; often, she would become the abbess, or the mother superior. The convent, Bell thinks, facilitated recovery because it was a place where a woman could exercise agency: where female ambition could be channeled outwards, into the world, rather than cooped, with only the body to claw at. “When you are isolated,” observed Hilary Mantel in an essay about mystics and anorexia in the London Review of Books, “control over your own ingestion and excretion is all you have left.” What Mantel misses is that isolation may be partly self-imposed, a crucial stratagem in the project of control. Anorexia is a will to power, twisted into a pretense at its absence. This pretense, perhaps—the anorexic mimics feminine diffidence—is part of why we find it so hard to recognize that anorexia is not an autonomy deficit, but rather a peculiarly uncompromising articulation of the desire to self-legislate.
In some ways, the modern eating-disorder clinic is strikingly reminiscent of a medieval nunnery. Both are tightly controlled, cloistered, highly regimented environments, populated almost entirely by females. Inside both, women are supposed to guard themselves from the “temptations” of the outside world. Within the clinic, though, there’s no way for the patient to become the abbess. Friendships between patients are discouraged; instead, they are taught to personify their diseases. Therapists, Clein writes, insist that the eating disorder is “a second self … capable of mind control.” The modern treatment paradigm is shadowed by Tommaso, and his insistence that Catherine of Siena was possessed by a demon. Doctors would say, “‘this is the eating disorder talking,’ when you try to describe desires or moods,” one patient recalls. “She was praised when she was able to parse an ‘ED thought’ from a supposedly genuine thought,” Clein writes, “and applauded when she narrated her illness in external terms, casting it as a bad friend or an abusive lover.” Anorexia’s treatment thus reinscribes the disease’s own logic: the anorexic self is separate from the “true” self, who must be recovered; threats to the true self must be identified, quarantined and locked away—exorcised, even—rather than, as Clein puts it, “endured” and integrated. Clein, then, calls for a mode of treatment that teaches the patient to recognize the ways in which her agency has been scaffolded by and complicit in her disease. But she avoids any real confrontation with the problems that beset such a suggestion. The autonomy-deficit model has its attractions. In particular, it seeds an easy justification for why we must sometimes treat anorexics against their will. If anorexics are autonomous, shouldn’t they be left to get on with their diets?
This question’s high stakes become clear in Dead Weight’s fifth chapter, in which Clein takes a close look at the case of Alyssa: a patient who entered hospice after suffering from anorexia for more than a decade, and applied for medical assistance in dying (MAID). Before dying, Alyssa co-authored a paper with the doctor who prescribed her MAID drugs, arguing for a new diagnostic category, terminal anorexia nervosa. Alyssa and her co-authors envisage the category as facilitating patient access to hospice (rather than cure-oriented) care. Clein fears—justly—that terminal anorexia nervosa would become an aspirational diagnosis, the object of fevered identification.
Many women with eating disorders, Clein notes, cycle through a range of diagnoses: anorexia, bulimia, binge-eating disorder (BED), eating disorder not otherwise specified (EDNOS). When she was first diagnosed with EDNOS, Clein writes, it felt like a “fucking dare”: being placed at the bottom of the diagnostic hierarchy just made her want to climb it. Anorexia has a cachet—a glamour, even—that binge-and-purge disorders do not. When Clein was still suffering from eating disorders, she found it easy to tell her friends about blacking out from hunger, or obsessively counting her steps. She never told them about the laxatives she kept in her jewelry box. “Eating disorders,” Clein concludes, “are notoriously competitive diseases, and the existing diagnostic hierarchy inspires shame.”
Clein is sympathetic to the suggestion that the DSM should eliminate any diagnostic label more fine-grained than “eating disorder.” Treatment could then be informed by clinicians’ qualitative judgments. But this would still leave us with a substantive, agonizing question. Should Alyssa have been prescribed MAID drugs? At least on the face of it, respecting Alyssa’s agency would mean allowing the prescription. Alyssa thus serves as a hard test case for Clein’s more agential vision of eating-disorder treatment. But, strikingly, Clein is reluctant to concede agency to Alyssa. Although she understands that Alyssa’s doctor was trying to lessen her suffering, she nonetheless regards the prescription as a mistake. Indeed, Clein is clearly tempted to reinstate the distinction between the “true” and the “anorexic” self that she elsewhere disavows. One might see this retreat as a regrettable loss of nerve on Clein’s part. Equally, though, it might be read as an overdue recognition that those with serious psychiatric conditions cannot responsibly be allowed to devise their own treatment plans.
After finishing Dead Weight, I read the paper that Alyssa contributed to. Alyssa is lucid, precise and determined. “In my individual case,” Alyssa wrote from hospice care, four days before she died, “death was inevitable.” Knowing that she could use the MAID drugs offered her, she writes, a “sense of ease and peace of mind in my final stage of life”; she described prescribing the drugs as “a tremendous act of love.” I don’t know whether Alyssa should have been prescribed the MAID drugs. But I am sure that she wasn’t lacking in autonomy. There was no demon lodged in Alyssa, wagging her tongue. Her voice is quite her own. The unhappy truth is that sometimes people with no agential defects will choose things that harm them. We can try to escape the hard choice between complicity on the one hand and paternalistic interference on the other by “finding” agential flaws where there are none. To read the anorexic as autonomous, then, need not mean that we stop trying to get her to eat. The anorexic governs and authors herself more fully than her peers. That doesn’t show that we should admire her discipline. It shows that we should be warier of self-governance as an ideal.
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Clein, unlike Manne, resists making the bounded female self the goal. She refers to her book as a “choral narrative.” Her own voice mingles and blends with others. “Catherine” and “Simone” feel like her friends, and her friends feel like part of her. “I used to make [collages] out of magazines on my bedroom walls,” Clein recalls, “taping one girl over another, sometimes obscuring someone’s leg with someone else’s beach waves, someone’s torso with a screaming headline.” These girls are “unnatural” and “disturbing,” but Clein has come to “like the look of a collaged girl, a girl with mismatched limbs and words written on her body, glitter nail polish painted over her pores.” That we are all of us collages, built out of parts that we borrow from and lend to others, is an insight that Manne’s autobiography attests to, cutting against the letter of her theoretical efforts:
My daughter, at twenty months, became fascinated with her belly button. At every chance she got, she began lifting her T-shirt to joyfully point it out. The inference that Mommy and Daddy had belly buttons too was not far behind, and neither were further exploration efforts. But when she lifted my shirt, I found myself instinctively sucking in my stomach. I felt shame, and ashamed of my shame. And that’s when it hit me: I had to sort my head out, regarding my body, for the sake of my daughter.
Manne’s body, she comes to realize, is not just for her—it exists partly for her daughter. These silly, playful moments are some of the scraps from which Manne’s daughter will one day build a self-image. And it’s Manne’s relation to her daughter—not a retreat from the gaze and the expectations of others—that grounds her revaluation of her body and her diets.
Women’s relationships with each other are often cast as toxic. Catherine of Siena learned how to fast from her older sister, who used it strategically, attempting to improve her ribald husband’s behavior; today, women share their weight-loss tips online. They compete to make their ribs protrude, and they feed off other women’s jealousy. But, Clein insists, sororal bonds can also “be cathartic” and “spark communion.” Her own recovery ran on solidarity, not isolation, on the “cyber sisters” who listened to her, “no matter how scary the words I spilled.” Recovery, she writes, “took love, and your hand in mine, and splitting a snack.” Perhaps, then, Clein suggests, we shouldn’t be striving after that fabled, autonomous self after all. Self-governance is a lonely, isolationist standard. What helped Clein was learning to form relationships: to bond with others rather than flee from them. Maybe we need to be willing to take more of ourselves from each other, and to give more back, in return.
Like Clein, I’m skeptical of the bounded “I.” When the Enlightenment philosopher David Hume tried to track himself down in thought, he was disappointed. “I always stumble on some particular perception or other, of heat or cold, light or shade, love or hatred, pain or pleasure.” He could introspect to discover experience and feeling, but no stable object behind or below their flux. “I never can catch myself,” he wrote, “at any time without a perception, and never can observe any thing but the perception.” If I try to catch my self, I can never come up with something properly bounded. There is Rachel-talking-to-her-students, and Rachel-laughing-at-her-husband’s-jokes. There is Rachel-frowning-in-a-philosophy-talk, trying to cook up an objection, and Rachel-reminiscing-with-her-brother. A Rachel-in-herself—a Rachel excised from these concrete relations and contexts—seems like a dead, hopeless abstraction. Rachel exists with and for others like Bach’s cello suites exist in their various performances. There isn’t a “realer” music lurking beneath the music we hear, and there’s no realer Rachel shut up behind her suits and show. Just as Bach’s cello suites need cellos and cellists, I need my students and my husband, philosophy talks and my brother. I am something they create. My anorexia was a refusal of this dependence: an attempt to create a self that could float free from her social context, as an airy self-contained substance.
I still care a lot about my weight. I want to write, “I know I shouldn’t,” or “I wish I didn’t.” But I don’t know—not really—that I shouldn’t. And I don’t wish—not fully—that I didn’t. When I read Clein’s chapter about Wellbutrin—an antidepressant with weight loss as a side effect, which is sometimes abused by those with eating disorders—I thought, briefly, about trying to wrangle a prescription. It might be comforting, in a way, to pin that daydream on a demon, or “the patriarchy.” But it was my daydream, my half plan. What, then, stopped me from pursuing it? Only that while I care about my weight—yes—I care about other things more. There are books I want to read, and seas I want to swim in, friendships I want to deepen, and ideas I want to have. When measured against these other projects, thinness loses some of its old allure. That turns out to be a way of saying that I’m less keen than I was, at eleven (or seventeen, or 24) on protecting myself from the world. That I’m keener now to reach out into the world, and to have the world reach back into me. That, aged eleven, I despised my mother. That now, I love her.
Art credit: Lauren Schiller, Confession: Pleasure, 2012. Oil on panel, 8 × 6 in. Courtesy of the artist.
Like many women, Simone Weil had a difficult relationship with food. When she was six months old, her mother fell ill; in adulthood, Weil would joke that she had been poisoned by her sick mother’s milk. Weil was weaned at eleven months old, but she stubbornly refused to eat off a spoon; her mother fed her mush, to be sucked from a bottle, until she was two. As an older child, she would go door to door with her brother, gleefully pretending parental neglect and begging for sweets, which were banned (along with toys and dolls) in the Weil household. In her teenage years, her friends report, she ate very slowly, as though it were painful to chew. She was plagued by digestive problems. Later, living in England and gravely ill with tuberculosis, she let herself starve, insisting that she would share in the suffering of those in Nazi-occupied France. After spending time in a London hospital, she was moved to a sanatorium in Kent, where she fantasized about Christmas turkey and mashed potatoes but left her meals untouched. When she died, aged just 34, she was ruled to have killed herself by refusing to eat.
Food, hunger and eating are recurrent preoccupations in Weil’s writing; they serve as the props and symbols through which she articulates her harsh ethical vision. Weil wanted to devote herself to the world—to fully attend to its beauty. But, she thought, she could only be swallowed up by the world—“eaten and digested by God”—if she made herself empty. Love, for Weil, was not a relation that a self can stand in, but a steady, merciless undoing of the “I.” To refuse food when one is starving, Weil wrote with stern approval in her notebooks, is “to tear the eternal part of the soul violently away from the self and fix it to the not-self.” Hunger destroys the personality, collapses it into a pure, howling need. And in that experience of need, we encounter something real: our wretchedness. Because the wretchedness is real, we must love it.
Was Simone Weil anorexic? Her refusal of food is often read as an empathetic impulse—as an expression of what one biographer calls her “pathological need to share the sufferings of others.” (Aged six, after all, she refused to eat sugar, because French soldiers at the front had none.)
Such readings locate Weil’s fasting in a political, rather than in a mystical, context. But toward the end of her life, Weil was writing prayers in her notebooks: pleading with the Father to “rend this body … away from me … let nothing remain of me, forever, except this rending itself, or else nothingness.” In 1938, she spent ten days at Solesmes Abbey, a Benedictine monastery. She wanted to immerse herself in the liturgy; but, she later wrote, “I was suffering from splitting headaches; each sound hurt me like a blow.” By effort of will, she reports, she was able “to rise above this wretched flesh, to leave it to suffer by itself, heaped up in a corner, and to find a pure and perfect joy in the unimaginable beauty of the chanting and the words.” To be oriented toward the good, Weil thought, the soul must be unpicked from the body’s false demands. Weil’s insistent fasting, then, should be read as an attempt at discarnation. She didn’t want to understand the lives of the needy so much as she wanted to stand outside need altogether.
Simone Weil is just “Simone” for Emmeline Clein in her first book, Dead Weight, a memoir-laced study of eating disorders. Weil is one of Clein’s many “sisters”—women, girls and, indeed, “anyone who’s ever hurt themselves hoping to become beautiful”—whom Clein quotes by their first names. “I feel like I know them,” Clein says. “I wish Simone put mayo on a chunk of baguette instead of dying.” Clein takes it for granted that Weil had anorexia. Unlike other commentators, though, Clein doesn’t see the diagnosis as draining Weil’s fasting of political or spiritual significance. Rather, Clein wants to make legible the political and spiritual stakes within “ordinary” eating disorders—eating disorders of the sort that 13 percent of American girls will suffer symptoms of before they are twenty, and which (besides opiate addiction) cause more deaths than any other mental health condition.
The politics of disordered eating are also a central concern for the Cornell philosopher Kate Manne, whose third book, Unshrinking, has a critique of diet culture and fatphobia as its centerpiece. Like Dead Weight, Unshrinking is confessionally anchored cultural criticism, and the two books share many preoccupations. Both Clein and Manne stress the porous boundaries between “normal” diets and clinical eating disorders. Both authors argue against simplistic equations of fatness with unhealthiness. “Many of the studies connecting fatness to heart disease and death have confounding factors,” writes Clein; she has in mind, in particular, the health risks of weight-cycling—repeatedly losing and gaining weight—which has been linked to cardiovascular disease, strokes, metabolic conditions, diabetes and worsened immune function. Manne stresses that fat people—“fat” is her preferred nomenclature—may be reluctant to seek treatment from a biased medical establishment. When fat people do seek treatment, they are often treated incompetently. (Manne tells the story of a 38-year-old woman who went to see a kidney specialist after receiving some worrying lab results. The specialist advised her to lose weight and eat less salt—totally missing the bone marrow cancer that was ravaging her body.)
Despite these similarities, though, the books read very differently. Clein’s prose is self-consciously lyrical—at times cloyingly so. (“To people who binge, the trash can is a cipher and a kaleidoscope, a mirror and a camouflage, an altar and a site of utter abjection, a confessional.”) Manne, by contrast, mixes her pared-back philosopher’s prose with clichéd social media affirmations. (“Fuck beauty culture, along with diet culture,” she writes toward the end of her book. “Burn it down.”) Clein’s book is ambitious, a little chaotic and wide-ranging in its cultural and historical reference points. Manne’s book is a far more controlled effort, but it also makes for duller reading. Both books have some argumentative weak spots. Clein’s poetical instincts sometimes overwhelm her analytical chops; meanwhile, much of Manne’s rather one-note analysis—fatness is inappropriately moralized, the health risks of fatness are overstated, diets are ineffective—will be familiar to many readers.
The clearest point of contrast between the two books, though, lies in the authors’ competing visions of the self. Like Weil, both Clein and Manne understand that food—which is, after all, something that we pluck from the world and envelop into ourselves—is intimately bound up with the human project of demarcating the “I.” Feminist analyses of disordered eating have long centered this insight. (Anorexia and bulimia are both more prevalent among girls and women than boys and men.) Many feminists have argued that an independent, bounded ego is the proper goal of human development, with the problem being that social conditions make female selfhood a fraught and elusive aspiration: girls are too closely identified with their bodies, and too attuned to the needs of others at the expense of their own. Manne’s analysis sits squarely within this broad tradition. Clein is more revisionary. Like Weil before her, she questions the value of a stable, bounded “I.” Unlike Weil, though, Clein doesn’t want to hollow the self out. Rather, she wants to reconfigure it: to conceptualize self-making as something we do with and alongside others—as a project whose key task is not demarcation, but something more like harmonization.
The bounded self, though, might turn out to be an indispensable fiction. The ideals of self-governance and self-authorship are deeply woven into our political vernacular. (“My body, my choice!”) But if we can draw no clear line between me and you—if all authorship is co-authorship—then these ideals might seem to falter. (Our body? Our choice?) Can a feminist politics do without them? I’ve come to think that’s the wrong question. A better one would be: What should we use instead?
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Manne’s Unshrinking makes for an instructive case study as to the limits of this fiction. “Since my early twenties,” Manne writes, “I have been on every fad diet. I have tried every weight-loss pill.” She can tell you what she weighed “on any significant occasion from the age of sixteen onward”: her wedding day, the day of her Ph.D. defense, the birth of her daughter. When she moved to Boston from Australia to do graduate work in philosophy, her toothbrush was the only thing she unpacked before her set of scales. Eventually, her obsession with weight loss led to periods of self-starvation:
Manne’s trajectory—from diet to eating disorder—is not unusual. But diets are routinely prescribed, despite the high risk-to-reward ratio: a 2007 meta-analysis suggests that diets seldom lead to long-term weight loss; indeed, there’s evidence that dieters’ weights will increase more, over the long term, than will non-dieters. And a 2020 study showed that lifestyle changes tended to produce—at best—very small improvements in health measures like cholesterol and blood pressure. Strikingly, where these markers did improve, there was no correlation with the amount of weight lost.
Why, then, the fixation on dieting? Manne’s answer is fatphobia—an ideology that moralizes weight and ranks fat people as inferior to thin. Per fatphobia, fat people are disgusting, stupid and wanton. Against this backdrop, diets seem less like a public-health intervention and more like a punitive measure: a spiked cilice for the sinful fat body.
It does not seem to be well understood why it is so difficult to maintain significant weight loss over the long term. But, one might think, the more difficult it is to sustain weight loss, the more important it is to prevent people from becoming fat in the first place. Manne is skeptical. Even if dieting were effective and costless, she would oppose it as a social practice, seeing it as of a piece with skin-lightening creams and Botox: interventions that “flatten out” a valuable form of human diversity.
Manne’s template, in thinking through the politics of fatness, is what we might call a politics of recognition: a politics that contests a society’s status orderings and representational codes but sidelines questions of production and distribution. Sometimes such a politics is apt. Heterosexism, for example, is at its heart a cultural phenomenon (albeit one with economic spillovers); accordingly, its dismantling requires the imaginative revaluation of despised queer identities. But Manne’s paradigm risks obscuring as much as it reveals. She is right that fat people are unjustly reviled. But fatness is also the product of a profit-driven food system, in which food is engineered to be hyper-palatable and overconsumed. Manne stresses that fatness can be the result of a rational life plan—one might, she argues, permissibly decide to prioritize gustatory pleasure over health, just as base jumpers value thrills over safety. One might. But for many people, fatness does not feel chosen. It feels like an imposed burden, not part of an epicurean project.
Manne, of course, might retort that this is merely a product of fatphobia. Fatness feels like a burden because it is socially reviled. Ideology prevents us from affirming ends with which we might otherwise identify. That’s true, but it’s also a non sequitur. My relation to my body is distorted by ideology. But the bad ideology doesn’t sit atop some politically neutral structure. An unjust structure creates the ideology’s objects. A politics of fatness that takes the identity as a given—and ignores the political economies that undergird the identity’s production—will always be incomplete.
Manne is probably right that the health risks of fatness are overstated. But the health risks of fatness might be both overstated and considerable. A 2018 study in the Lancet showed that there are significant losses in disease-free years of life for both overweight men and women compared to those with a “normal” weight; crucially, this was observed “across all categories of physical activity, smoking and socioeconomic status.” To be sure, many of Manne’s key claims are unaffected by such findings: there is no duty to be thin; fat people deserve our care and respect. Still, they show how cramped the horizons of Manne’s political imagination are: her moral energies might be more productively channeled toward the food conglomerates that got Congress to classify pizza as a vegetable.
Unshrinking contains two really novel ideas. Manne’s first innovation is to tie her critique of diet culture to her favored meta-ethics (that is, to her preferred account of why and how our ethical claims have authority). Manne locates the authority of ethics within the body. “Pain and suffering are bad,” Manne thinks. “Pleasure and enjoyment” are good. Bodily states like hunger and pain “speak to us, almost literally”: “Pain whispers—or shouts—in our ear, ‘Get off that limb! You are injured.’ Hunger similarly bids us to eat, to assuage its characteristic gnawing. ‘Eat something! Do it,’ it urges us firmly.” On this picture, the body gives us orders; we are obliged to obey. Surely, though, one might think: pain can sometimes be good. Grief, after all, is pain. Grief says: “Make it stop!” But it is good to feel grief when a loved one dies. It is a fitting response to loss—a way for us to honor the beloved. Similarly, pleasure can be evil. Suppose that I feel delight at your suffering. If I feel joy when I pull out your fingernails, my pleasure is not good. It is depraved. Bodily states, then, do not have any native authority. It matters—deeply—whether a given bodily state is orienting us to goodness or numbing us to it.
This suggests that obsessive dieting might be wrong not because it makes us hungry, but because that hunger monopolizes our attention. Self-inflicted hunger is bad not because our bodily desires have so much moral weight, but, rather, because they have so little. When Simone Weil visited Solesmes Abbey, she wanted to find “a pure and perfect joy” in the Gregorian chanting, to stand outside her needy body. But can a really hungry person fully lose themselves in gorgeous music, or a mountainous vista, or the eyes of their beloved? I’ve never been able to manage it. The hungry person doesn’t unravel the “I.” Rather, their world contracts, collapses: there is nothing outside the hunger, no longer a not-self for the self to be stuck on to.
Manne’s second innovation is the idea of “body reflexivity.” Manne presents “body reflexivity” as an alternative to “body positivity” and “body neutrality,” both of which make substantive recommendations as to how we should aim to affectively relate to our bodies—recommendations that, Manne worries, can be difficult to follow, and easily transfigured into disciplinary rhetoric. “Body reflexivity” has a more proceduralist flavor. It does not prescribe any particular attitude but suggests a new style of thinking—one in which our attitudes to our bodies are shaped by our own needs and values, rather than by others’ demands and preferences. “My body is for me. Your body is for you,” says Manne.
But is my body just for me? Can I separate out my own wants from others’ preferences? I want to be desired. I want to be needed. What those others need and desire, then, will always be threaded into what I need and desire. And if we insist upon drawing a line between us? Well, there’s no guarantee that “your own” needs and values will be kinder to you than others’. When I suffered from anorexia as an adolescent, it was my parents who wanted me to eat. I wanted to be thin, no matter what. “My” needs and values had not been displaced by impostors. There was nothing more authentically mine than my terror of eating. I had built my personality around it. Manne’s ideal of self-governance and self-authorship couldn’t save me, because—far from being anathema to my illness—they were its engine and its fuel. “Autonomy of the will,” wrote Kant, “is the property the will has of being a law unto itself.” Well, I was legislating for myself, and I was ecstatic.
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This might seem counterintuitive. Anorexia is readily conceptualized as an autonomy deficit. We like to imagine the anorexic as a hostage, seized by patriarchal culture, hijacked by unrealistic beauty ideals. You know the story. Cover girls are too thin; Photoshop makes us hate our cellulite. Clein’s Dead Weight flirts with this easy narrative. “The spores of sickness get planted in our brains early,” she writes, by women’s magazines and “the billboards we see out car windows, the mannequins in the mall.” But in its better moments, Dead Weight suggests a far more nuanced understanding of how disordered eating takes hold.
It might seem dim-witted to ask why women and girls succumb to anorexia. Anorexic women dread eating. We assume that the fear of food expresses a fear of fatness: women stop eating because they want to be thin. But why do they want to be thin? The desire for thinness is practically culturally mandatory—so readily intelligible that it’s almost a joke to ask why. But anorexics, of course, become too thin. They go beyond—indeed, they almost seem to parody—our aesthetic ideals. The idea that thinness is self-evidently desirable—and that anorexia is its rational pursuit gone too far—masks anorexia’s true psychodynamics. It makes the anorexic comprehensible, but perverse. The anorexic is superficial, narcissistic and vain; the anorexic girl wants, too badly, to be hot, but ends up ugly. So we warn her that her hair will fall out, that she will be grotesque: covered in lanugo like a newborn. We say: this is not a path to beauty. The warnings, though, don’t seem to work. Why not?
The obvious answer is that looking good is not what the anorexic is after. But if anorexia is not a pathological overinvestment in beauty norms—a diagnosis that Clein sometimes seems to endorse—what is it?
Clein’s anorexia developed as she prepared for her bat mitzvah. In bed at night, Clein would fantasize about having sex with women, before begging God, “Please don’t let me be gay.” My own eating disorder—which, unlike Clein’s, was never formally diagnosed—developed when I was around eleven. I remember my own mother, frantic and distressed, trying to understand what was happening to me. “Is this about your looks? Is it about getting boys to like you?” (She was very embarrassed to ask me these questions.) I remember being confused. I didn’t know how to answer, because beauty was a part of it, but not in the way my mother thought. Thinness felt to me then, and for many years thereafter, like a kind of safety. I had a keen, inarticulate sense that there was something pathetic and repulsive in my desires—desires that were, at that stage, still childish; I wanted friends, not boyfriends, but I wanted them with all the desperation and intensity of lust. Other girls my own age had started to slide, more easily than me, into adolescent femininity—a world with a brocade of rules so rich that I could never keep track of them. I was always tripping, stumbling, trying to keep up and failing. I’d become a hanger-on; I could feel their desire to set me aside, like the games that they had outgrown, but that I still hankered to play.
Anorexia’s typical age of onset is between twelve and 25; as a result, it is often understood as a refusal of sexual maturity. “Anorexia,” writes the psychotherapist Susie Orbach, “reflects an ambivalence about femininity, a rebellion against feminization.” But I wasn’t ambivalent about adult femininity. I was repulsed by it. I despised all the adult women I knew. None of them had lives I could imagine wanting for myself; still, puberty was sucking me into a body like theirs. Like many tomboyish girls, I experienced my adolescence as a kind of crisis. Gender had never really impressed itself upon me before; then, suddenly, I was caged by it. A refusal of adult womanhood was, then, à la Orbach, certainly a part of why I stopped eating.
But I wasn’t stupid. I knew that I could not remain a child. More important, I think, was my disavowal of neediness. I craved the attention of friends whose gaze was drifting. I needed them; they did not need me back. Very well: I would wall myself off from others. I would make myself anew, and become pure will, unconditioned by appetite or inclination. It is natural that the desire to appear—that the desire to be—invulnerable should find its sensuous articulation in thinness. Food and desire are fused together in our metaphors; the rejection of one can easily serve as a proxy for the refusal of the other.
For my eleven-year-old self, then, Manne’s ideal of body reflexivity would not merely have proved otiose. It would have made things worse. My problem was not that I had mindlessly absorbed a set of mores that I would not, when spurred to reflection, endorse. My problem was that I wanted to hive myself off from others, to seal and store myself off and up, safe and fierce and proud in a cell. Like Simone Weil, I wanted to stand outside need. But unlike Weil, that tenacious critic of modernity, I was engaged in that most modern of projects—that of fashioning a self. The last thing I needed was a reason—one more reason—to trace the boundaries between me and my mother, or between me and my friends. What I needed was not more autonomy—more separateness—but less.
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The “hostage” model of anorexia has deep cultural roots. In medieval Europe, women used fasting, alongside other forms of self-mortification, to authenticate a personal connection to Christ. Though many of these “holy anorexics” were later canonized, their behavior often threatened contemporary religious and familial authorities, because they bypassed the sacerdotal hierarchy and refused to marry. Catherine of Siena—who, like Weil, died in her early thirties—cut off her blond hair, determined to thwart her parents and brothers by remaining a virgin. When Catherine began to fast, she was ordered to eat by her confessor, Tommaso, who suspected that a demon—the original hostage-taker—was behind her abstention. Eventually Tommaso accepted that Catherine should “do as the Holy Spirit suggest[ed].” She drank only water and chewed bitter herbs, before spitting them out. If traces of the herbs did go into her stomach, she would force herself to vomit by sticking stalks of fennel down her throat.
Standard diagnostic categories draw a sharp distinction between anorexia mirabilis—Catherine’s disease—and anorexia nervosa (or “modern” anorexia). The nervosa/mirabilis split maps on to a familiar cultural dualism. Women with anorexia nervosa are obsessed with the body, with surface, with looks. Holy anorexics, by contrast, are too high-minded to want to be fuckable. In fact, they want to be pure. But the mind and the body cannot be held apart for long, even in imagination. Fasting mystics’ relation to Jesus was often erotic. In one of her ecstatic visions, Catherine was married to Jesus, who gave her a ring of his foreskin. And modern anorexics articulate their goals in a markedly spiritual register: anorexia is understood as “a higher purpose,” as producing a new, purified and sexless self. On Tumblr, Clein used female saints as her thinspo; online, she learned “[her] own kashrut”: “a system of fasting and ritualistic rules cobbled together from magazines, diet books, blogs, eating disorder novels, and Google searches.” Perhaps anorexias nervosa and mirabilis, then, should not be thought of as two separate pathologies, but culturally specific manifestations of a more-or-less unified underlying kind.
In Holy Anorexia, Rudolph Bell’s study of medieval Italian anorexics, Bell reports seeing a pattern emerge in his research. A “superficially obedient but deeply strong-willed child” is brought up intensely religious, usually by her mother. In her early teens, the girl’s father gets involved: he pressures her to marry. The girl resists, and “comes to display the classic anorexic syndrome; ultimately she runs away to a convent.” When the girl is a novice, she still cannot eat; she is depressed and tormented by demons. But gradually, the girl recovers, by becoming active in the life of her convent; often, she would become the abbess, or the mother superior. The convent, Bell thinks, facilitated recovery because it was a place where a woman could exercise agency: where female ambition could be channeled outwards, into the world, rather than cooped, with only the body to claw at. “When you are isolated,” observed Hilary Mantel in an essay about mystics and anorexia in the London Review of Books, “control over your own ingestion and excretion is all you have left.” What Mantel misses is that isolation may be partly self-imposed, a crucial stratagem in the project of control. Anorexia is a will to power, twisted into a pretense at its absence. This pretense, perhaps—the anorexic mimics feminine diffidence—is part of why we find it so hard to recognize that anorexia is not an autonomy deficit, but rather a peculiarly uncompromising articulation of the desire to self-legislate.
In some ways, the modern eating-disorder clinic is strikingly reminiscent of a medieval nunnery. Both are tightly controlled, cloistered, highly regimented environments, populated almost entirely by females. Inside both, women are supposed to guard themselves from the “temptations” of the outside world. Within the clinic, though, there’s no way for the patient to become the abbess. Friendships between patients are discouraged; instead, they are taught to personify their diseases. Therapists, Clein writes, insist that the eating disorder is “a second self … capable of mind control.” The modern treatment paradigm is shadowed by Tommaso, and his insistence that Catherine of Siena was possessed by a demon. Doctors would say, “‘this is the eating disorder talking,’ when you try to describe desires or moods,” one patient recalls. “She was praised when she was able to parse an ‘ED thought’ from a supposedly genuine thought,” Clein writes, “and applauded when she narrated her illness in external terms, casting it as a bad friend or an abusive lover.” Anorexia’s treatment thus reinscribes the disease’s own logic: the anorexic self is separate from the “true” self, who must be recovered; threats to the true self must be identified, quarantined and locked away—exorcised, even—rather than, as Clein puts it, “endured” and integrated. Clein, then, calls for a mode of treatment that teaches the patient to recognize the ways in which her agency has been scaffolded by and complicit in her disease. But she avoids any real confrontation with the problems that beset such a suggestion. The autonomy-deficit model has its attractions. In particular, it seeds an easy justification for why we must sometimes treat anorexics against their will. If anorexics are autonomous, shouldn’t they be left to get on with their diets?
This question’s high stakes become clear in Dead Weight’s fifth chapter, in which Clein takes a close look at the case of Alyssa: a patient who entered hospice after suffering from anorexia for more than a decade, and applied for medical assistance in dying (MAID). Before dying, Alyssa co-authored a paper with the doctor who prescribed her MAID drugs, arguing for a new diagnostic category, terminal anorexia nervosa. Alyssa and her co-authors envisage the category as facilitating patient access to hospice (rather than cure-oriented) care. Clein fears—justly—that terminal anorexia nervosa would become an aspirational diagnosis, the object of fevered identification.
Many women with eating disorders, Clein notes, cycle through a range of diagnoses: anorexia, bulimia, binge-eating disorder (BED), eating disorder not otherwise specified (EDNOS). When she was first diagnosed with EDNOS, Clein writes, it felt like a “fucking dare”: being placed at the bottom of the diagnostic hierarchy just made her want to climb it. Anorexia has a cachet—a glamour, even—that binge-and-purge disorders do not. When Clein was still suffering from eating disorders, she found it easy to tell her friends about blacking out from hunger, or obsessively counting her steps. She never told them about the laxatives she kept in her jewelry box. “Eating disorders,” Clein concludes, “are notoriously competitive diseases, and the existing diagnostic hierarchy inspires shame.”
Clein is sympathetic to the suggestion that the DSM should eliminate any diagnostic label more fine-grained than “eating disorder.” Treatment could then be informed by clinicians’ qualitative judgments. But this would still leave us with a substantive, agonizing question. Should Alyssa have been prescribed MAID drugs? At least on the face of it, respecting Alyssa’s agency would mean allowing the prescription. Alyssa thus serves as a hard test case for Clein’s more agential vision of eating-disorder treatment. But, strikingly, Clein is reluctant to concede agency to Alyssa. Although she understands that Alyssa’s doctor was trying to lessen her suffering, she nonetheless regards the prescription as a mistake. Indeed, Clein is clearly tempted to reinstate the distinction between the “true” and the “anorexic” self that she elsewhere disavows. One might see this retreat as a regrettable loss of nerve on Clein’s part. Equally, though, it might be read as an overdue recognition that those with serious psychiatric conditions cannot responsibly be allowed to devise their own treatment plans.
After finishing Dead Weight, I read the paper that Alyssa contributed to. Alyssa is lucid, precise and determined. “In my individual case,” Alyssa wrote from hospice care, four days before she died, “death was inevitable.” Knowing that she could use the MAID drugs offered her, she writes, a “sense of ease and peace of mind in my final stage of life”; she described prescribing the drugs as “a tremendous act of love.” I don’t know whether Alyssa should have been prescribed the MAID drugs. But I am sure that she wasn’t lacking in autonomy. There was no demon lodged in Alyssa, wagging her tongue. Her voice is quite her own. The unhappy truth is that sometimes people with no agential defects will choose things that harm them. We can try to escape the hard choice between complicity on the one hand and paternalistic interference on the other by “finding” agential flaws where there are none. To read the anorexic as autonomous, then, need not mean that we stop trying to get her to eat. The anorexic governs and authors herself more fully than her peers. That doesn’t show that we should admire her discipline. It shows that we should be warier of self-governance as an ideal.
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Clein, unlike Manne, resists making the bounded female self the goal. She refers to her book as a “choral narrative.” Her own voice mingles and blends with others. “Catherine” and “Simone” feel like her friends, and her friends feel like part of her. “I used to make [collages] out of magazines on my bedroom walls,” Clein recalls, “taping one girl over another, sometimes obscuring someone’s leg with someone else’s beach waves, someone’s torso with a screaming headline.” These girls are “unnatural” and “disturbing,” but Clein has come to “like the look of a collaged girl, a girl with mismatched limbs and words written on her body, glitter nail polish painted over her pores.” That we are all of us collages, built out of parts that we borrow from and lend to others, is an insight that Manne’s autobiography attests to, cutting against the letter of her theoretical efforts:
Manne’s body, she comes to realize, is not just for her—it exists partly for her daughter. These silly, playful moments are some of the scraps from which Manne’s daughter will one day build a self-image. And it’s Manne’s relation to her daughter—not a retreat from the gaze and the expectations of others—that grounds her revaluation of her body and her diets.
Women’s relationships with each other are often cast as toxic. Catherine of Siena learned how to fast from her older sister, who used it strategically, attempting to improve her ribald husband’s behavior; today, women share their weight-loss tips online. They compete to make their ribs protrude, and they feed off other women’s jealousy. But, Clein insists, sororal bonds can also “be cathartic” and “spark communion.” Her own recovery ran on solidarity, not isolation, on the “cyber sisters” who listened to her, “no matter how scary the words I spilled.” Recovery, she writes, “took love, and your hand in mine, and splitting a snack.” Perhaps, then, Clein suggests, we shouldn’t be striving after that fabled, autonomous self after all. Self-governance is a lonely, isolationist standard. What helped Clein was learning to form relationships: to bond with others rather than flee from them. Maybe we need to be willing to take more of ourselves from each other, and to give more back, in return.
Like Clein, I’m skeptical of the bounded “I.” When the Enlightenment philosopher David Hume tried to track himself down in thought, he was disappointed. “I always stumble on some particular perception or other, of heat or cold, light or shade, love or hatred, pain or pleasure.” He could introspect to discover experience and feeling, but no stable object behind or below their flux. “I never can catch myself,” he wrote, “at any time without a perception, and never can observe any thing but the perception.” If I try to catch my self, I can never come up with something properly bounded. There is Rachel-talking-to-her-students, and Rachel-laughing-at-her-husband’s-jokes. There is Rachel-frowning-in-a-philosophy-talk, trying to cook up an objection, and Rachel-reminiscing-with-her-brother. A Rachel-in-herself—a Rachel excised from these concrete relations and contexts—seems like a dead, hopeless abstraction. Rachel exists with and for others like Bach’s cello suites exist in their various performances. There isn’t a “realer” music lurking beneath the music we hear, and there’s no realer Rachel shut up behind her suits and show. Just as Bach’s cello suites need cellos and cellists, I need my students and my husband, philosophy talks and my brother. I am something they create. My anorexia was a refusal of this dependence: an attempt to create a self that could float free from her social context, as an airy self-contained substance.
I still care a lot about my weight. I want to write, “I know I shouldn’t,” or “I wish I didn’t.” But I don’t know—not really—that I shouldn’t. And I don’t wish—not fully—that I didn’t. When I read Clein’s chapter about Wellbutrin—an antidepressant with weight loss as a side effect, which is sometimes abused by those with eating disorders—I thought, briefly, about trying to wrangle a prescription. It might be comforting, in a way, to pin that daydream on a demon, or “the patriarchy.” But it was my daydream, my half plan. What, then, stopped me from pursuing it? Only that while I care about my weight—yes—I care about other things more. There are books I want to read, and seas I want to swim in, friendships I want to deepen, and ideas I want to have. When measured against these other projects, thinness loses some of its old allure. That turns out to be a way of saying that I’m less keen than I was, at eleven (or seventeen, or 24) on protecting myself from the world. That I’m keener now to reach out into the world, and to have the world reach back into me. That, aged eleven, I despised my mother. That now, I love her.
Art credit: Lauren Schiller, Confession: Pleasure, 2012. Oil on panel, 8 × 6 in. Courtesy of the artist.
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