Author: Irina Samsonova has a BA from the University of Adelaide and BA (Hons) from ANU. She is currently an anthropology PhD student at the Research School of Humanities and Arts, ANU. While her research interests are broad, Irina’s PhD research focuses on digital Indigenous art and its link to Indigenous self-representation and contemporary identity.
‘People think eating disorders are solely based on body image
that is warped by the media and it’s all about body size; . . .
it has to do with that, but it’s only a small piece of the pie
so to speak — using a food metaphor’
(Warin 2009)
From screens and tabloids, we are fed images of slender bodies. For decades sleek and angular silhouettes were said to be icons of style, fashion, beauty, youth, and desire. This trend is often blamed to be the source of anorexia. But is anorexia nervosa as simple as that? In her book Abject relations: everyday worlds of anorexia (2009), Megan Warin takes us on a journey to find the answer.
Anorexia nervosa is a psychological eating disorder that is commonly referred to as self-starvation. For decades there has been little to no improvement in the recovery rates despite the efforts of psychiatrists and the available treatment programs and services. Moreover, by the time this book was released there was surprisingly little research on the treatment of anorexia or alternative ways to understand it beyond the medicalised discourse of ‘disorder’. Megan Warin’s ethnography offers a look into something that is often missing in literature on anorexia – the daily experiences of anorexic people. Warin challenges common assumptions and popular discourses around eating disorders/anorexia, as well as the assumptions made by medical professionals, as being far from the lived reality of anorexia.
The ethnography consists of preface, acknowledgements, and eight chapters, where the first chapter serves as an introduction and the last one as a conclusion:
- Introduction: a description of the research process, methodology, key themes, and the author’s arguments featured in the book.
- Steering a Course between Fields: a reflection on Warin’s fieldwork experience, an exploration of public representation of anorexia, and an analysis of anorexia through the theory of fields and habitus.
- Knowing through the Body: a reflection on relationships between the researcher and the researched.
- The Complexities of Being Anorexic: an exploration of the concept of ‘relatedness’ and the power of the medical diagnosis.
- Abject relations with Food: an investigation of the notion of ‘abjection’ and its relation to food.
- ‘Me and My Disgusting Body’: an analysis of the interconnectedness of dirt, disgust, and cleanliness to anorexic practices.
- Be-coming Clean: an exploration of the anorexic desire to sanitise the body and the mind.
- Reimagining Anorexia: suggestions of alternative approaches to treating anorexia and directions for future research.
Warin lays out her theory and findings in the early chapters. The middle sections combines her theoretic findings with empirical data and fragments of the interviews with participants, and the concluding chapter adds a new level of analysis – an insight into the role of media, which reduces anorexia to merely an extreme desire for slimness, and ends with future directions for research on this topic.
Warin worked with 44 women and 3 men of various age groups and social backgrounds. Warin’s ethnographic fieldwork was conducted in three major cities on three continents (Vancouver, Canada; Edinburgh, Scotland; and Adelaide, Australia) in the late 1990s to the early 2000s. She investigated medical institutions and wards specialising in eating disorders, interviewed medical staff, and studied the social environment of the participants. The author visited houses of some of the participants, accompanied them to the grocery stores, met them in cafeterias, and spent time with them while they had medical procedures.
Warin refutes the assumption that anorexia is simply a desire of being thin or a biological disorder. Such surface-level ways of viewing anorexia miss an important side of anorexia — relations with social life, psychological traumas, hygiene habitus, embodiment, and informants’ self-esteem. Anorexia represents a disorder in people’s daily practices of relatedness.
‘Anorexia was more than a medical diagnosis;
it was, among many things, an empowering state of being,
… a way of life’.
(Warin 2009)
Warin explains the limited efficiency of the forced treatment of anorexia by pointing to the misunderstanding and struggle for power between the health professionals and the anorexic community. The author proves that the former subjectivist medical approach that sees anorexia as a disorder, through symptoms such as loss of self-care and ability for food intake, is inconsistent with the real experiences of anorexic people. The ethnographer found out that the opposite is true. Instead of being victims of the loss of self-control, anorexic people view themselves as ‘survivors’ and ‘warriors’ possessing extreme self-control. Warin’s research participants were talking about having anorexia as if belonging to a persuasive and powerful group – ‘a religion,’ ‘a competitive sporting team,’ or part of ‘a game.’
‘It’s like the Olympics —
whoever is the thinnest has won the gold medal.
‘The best,’ Amanda reiterated, ‘is dead — that’s when you win.’
(Warin 2009)
Warin based her analysis on Bourdieu’s (1977) theory of practice to argue that practices of anorexia, as any other daily practices, are rooted in the interplay of habitus and fields. Bourdieu explains habitus in his book Structures, habitus, practices (1990) as a ‘system of durable, transposable dispositions’, or in other words, socially ingrained habits. Field here stands for an ‘arena’ of social positions, or an ‘environment’ defined by specific rules and customs. Warin analyses houses, medical institutions, grocery stores and even the diagnosis of anorexia itself as fields; people with anorexia represent agents in these fields; and doctors, nurses, and psychiatrists play the roles of field authorities. Instead of using psychiatric terminology, Warin sees practices of anorexia at a routine level as habitus.
‘Experiences of anorexia draw directly from people’s habitus,
from their everyday relationships with people, places,
food, bodies, sexuality, and gender relations’
(Warin 2009)
Forced feeding in the heavily policed eating disorder wards has proven ineffective as a treatment, as demonstrated by the lack of significant progress over the last 50 years. Warin argues that the shortcoming of the mainstream approach in treating anorexia is that it regards it as a biological disorder, which misses the mark. Psychological aspects of anorexia are immensely important for its understanding and treatment. Anorexia is a way of living and a struggle for extreme self-control. The author writes about the hierarchical relationships among the ‘anorexia club’ that encourage replication of anorexia practices and resistance to the health professionals. Struggle takes place in daily life in the world of anorexia: with hunger, doctors, general people, and so on. This struggle occurs in people’s homes, in the media, and in the public idea of anorexia. Hence, instead of pushing doctor-patient submission, treatment should probably involve negotiation with anorexic patients and their integration back into society and socialisation. It is also important to treat patients individually and never unite them into groups, because anorexic practices are built around hierarchy and can be reproduced by the patients. This would interfere significantly with the recovery process.
want to get rid of anorexia,
but I don’t know who I’d be’.
(Warin 2009)
As an alternative way of treating anorexic patients, Warin suggests a recognition of their agency rather than the strict authoritarian controls imposed on patients. Warin provides the example of Monica, the head of a small hospital eating disorder program, as one alternative approach to anorexia patient care. Monica chose to reject the ‘authoritarian’ way of treating patients, instead choosing to blur the hierarchy between patients and doctors: she takes her clients for dinners, hugs them, and cries with them. As for the treatment plans, Monica lets her patients make decisions on meal plans and encourages them to modify their behaviours rather than completely change them. Even though Monica’s approach is experimental, it could be a good start to developing better treatments of anorexia.
Key themes of the book are the ideas of relatedness and abjection.
- Abjection is a concept described by Julia Kristeva in her book Powers of horror: an essay on abjection (1982) as something that is cast off and separated from conventional norms and rules, something that causes subjective horror. According to Warin, ‘abjection played a central role in people’s experiences of anorexia’. She found out that abjection, in forms of food, fat, places, relationships, and so on, was avoided, rejected, and washed away by anorexic people to feel safe. Therefore, abjection includes the relationship between itself and a person. Warin implements Douglas’ (1966) idea of ‘matter out of place’ to explore abject relations through the notion of disgust. This notion is described in Douglas’ book Purity and danger (1966) and it explains that anything that does not fit into our idea of classification or categorisation is perceived as contaminated, thus driving us to avoid it. Similarly, Warin claims that ambiguous relationships, which simultaneously cause desire and disgust among anorexic people, are the basis for abjection.
‘The place where anorexia is, it’s a very narrow space, and there is a little room for anything else’ while ‘you were having a relationship with anorexia’.
(Warin 2009)
- Relatedness resides at the very core of abjection because ‘in being cast out, one moves away from relationships with people, oneself, and objects and creates a different kind of relatedness’ (Warin 2009). Respondents said that anorexia is their friend and enemy at the same time, as well as ‘a shining angel’, ‘a fiancé’, ‘an abusive partner’, and even ‘a grim reaper’. Many participants told Warin that relatedness at all the levels is extremely problematic for people with anorexia, who attempt to escape it through anorexic practices. Relationships with anorexia interfere with people’s relationships with the rest of the world. Emphasising the importance of relatedness, Warin goes further to show that anorexia is not in individual practices and experiences, but rather in communal activities. People with anorexia use pro-anorexia websites, eating disorder medical wards and other fields of socialisation to reproduce anorexic practices of secrecy and purging, to share tips on how to be more efficient in these practices, to encourage and motivate each other, and to build hierarchies and prove ‘who is the best anorexic’.
Warin concludes her ethnography with the suggestion of future research directions. She points that research needs to target the development of new methods of treatments that take into account the importance of integrating anorexic people back into society via practices of relatedness and the need of anorexic people to feel in control over their own bodies.
To conclude, Warin’s research opens the door for our understanding of people’s everyday experiences of an eating disorder that is so difficult to cure — anorexia nervosa.
References
Bourdieu, P 1990, ‘Structures, habitus, practices’, in P Bourdieu (eds), The logic of practice, Stanford University Press, Stanford.
Bourdieu, P 1977, Outline of a theory of practice, trans. R Nice, Cambridge University Press, Cambridge & New York.
Douglas, M 1966, Purity and danger: an analysis of the concepts of pollution and taboo, ARK Paperbacks, London.
Kristeva, J 1982, Powers of horror: an essay on abjection, trans. LS Roudiez, Columbia University Press, New York.
Warin, M 2009, Abject relations: everyday words of anorexia, Rutgers University Press, New Brunswick, New Jersey & London.
[Image of a person with a calendar sourced from https://www.spectrumnews.org/ provided by the author].
[Image of a woman turning away from a dinner table sourced from https://www.science.org/ provided by the author.]
[Image of a woman walking a tight rope between cutleries by Jens Magnusson, sourced from https://ki.se/en/research/a-disease-with-many-faces provided by the author.]
