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At What Price Slenderness?

By Cynthia Griggins

Food is central in every culture, and ours is no exception. What celebration or important event can you think of in which food is not a part? Look at the amounts of your budget and time that are spent on food and dining out. And consider what was the center of your life as an infant.

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Some aspects of 20th Century Western Society, however, are peculiar regarding food. Look first at the ubiquity and relentless power of advertising, constantly telling us to eat more-"Aren't you hungry for Burger King now?"! And look at the foods pressed upon us that before available-ready-to-eat, high sugar, high caloric-Twinkies, Ho-Ho's, potato chips, Whoppers, etc. Now look at the images of people in that advertising, especially the women-stick thin. I needn't go into this issue, as much has been written about it. I only want to point out the cruel conflict in the juxtaposition of these two messages with which we are constantly bombarded day and night: "Eat" (especially high calorie foods) and "stay thin." The result can only be what we have today: a society obsessed with dieting. It has to be in order to follow both directives and counteract the effects of the foods pushed upon us. This is also a society from which hard physical labor has virtually vanished (which doesn't help). No wonder that at any given time, 25 percent of the adult population of the U.S. is on a diet!

Now, multiply if you will the pressure to be thin for the women in the population. For we all know that the real pressure is on us. We are the ones valued most for what we look like, not who we are. Does all this silly dieting start to make some sense?

Now consider a few physical realities to contrast with these cultural norms. Adult female bodies are not supposed to look like adolescent males'. They are supposed to be higher in percent of fat than men's (to support reproduction). They are supposed to be rounded and wider in the hips, thighs and belly. And they are supposed to be of different sizes, not all size 5, 110 pounds as the media would have us believe. Kim Charnin in her book Reflections on Obsession: The Tyranny of Slenderness develops powerfully the theme that women are being told to look not like mature, ripe adult females, but like adolescent boys. Just the other day a woman dancercize instructor exclaimed in front of her class, "Oh, I wish I had hips like Michael Jackson's!" The women in the class agreed with the ultimate desirability of this image. One class member, however, freaked: "No wonder I'm crazy! I don't know if I should want to look like a man!"

With all these pressures, combined with our society's clear abhorrence for obesity, it's a wonder to me that more people are not disturbed in their eating. Yet some people express surprise when they hear that we at the Free Clinic are turning our attention to treating eating disorders (anorexia nervosa, bulimia, bingeing and vomiting). To those with some knowledge it seems inappropriate: "Isn't that a disease for upper class girls? Why do they need free treatment?” To others it sounds exotic and rare: "There can't be that many of them. Why are you focussing on this?" And finally to others it just seems silly and super-

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ficial: "Big deal. Everybody overeats at times, and who doesn't want to be skinny? Pay attention to real problems."

After spending many hours working with adolescents and young women with eating disorders, my initially apologetic attitude has changed considerably. I have come to realize that we are not struggling with a rare, superficial or irrelevant phenomenon. When I work with these women I am aware of being in contact with just the tip of the iceberg. These are women who are reacting to powerful and universal political and cultural norms which affect us all, although perhaps not so drastically. In studying the relation between women, food and their bodies, I realize I am delving into powerful, uncharted areas in women's psychology.

The importance of understanding eating disorders is certainly not just theoretical. Anorexia nervosa (the voluntary starvation and fear of gaining weight which usually occurs in adolescent girls) appears to be on the rise, and moving from the rich into other social classes. Even more prevalent seems to be bulimia (uncontrolled bingeing, with or without subsequent purging, usually by vomiting). This latter syndrome has only recently been identified because it can be hidden so well, and the victim can maintain a normal weight while bingeing and vomiting eight or ten times a day! The numbers of women involved are not small. And when one considers the links between these two disorders and obesity, one realizes that eating problems are affecting millions of people's lives.

While obesity seems to be more normally distributed between the sexes, the eating disorders anorexia and bulimia are overwhelmingly confined to

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clinicians to study, especially those who are willing to ask why this affects women 95 percent of the time. What are the political and social forces interacting with psychological vulnerabilities?

Rather than go into the detailed medical definitions of anorexia nervosa and bulimia, I'll explain only briefly what they involve. In both, young women become obsessed with controlling and losing weight, usually because of inner conflicts, fears and low self-esteem (which I will examine further later). Basically the central theme is: "I'll be valued more, be more adequate and competent if I can just become thin." Anorexics, either by totally starving themselves or by severe dieting and purging, lose more and more weight. Each time they reach a goal weight, they find that it doesn't give them what they had hoped for, so they believe they just have to lose a little more. These are the girls and women who get down to 60 or 70 pounds and risk death, plus a myriad of physical problems that accompany starvation.

Bulimics share common themes with anorexics, but they don't reach those dangerously low weights. However, repeated vomiting either once or ten times a day over the years wreaks destruction on the digestive system. Also, teeth rot away as a result of exposure to stomach acid, leaving women in their 20's wearing dentures. Most severe, however, are the resulting electrolyte imbalances which can even be fatal. Bulimics hinge and vomit, using the vomiting as a weight control tactic. What both anorexics and bulimics fail to see is that their constant restricting of their eating percipitates their other most abhorred problem, the constant urge to binge. That is a pure physical reality, seen universally with starvation victims: restricting food intake will produce irritability, depression, obsession with food and a constant urge to binge. So a vicious circle becomes established. I must diet and lose weight, but all I want to do (and end up doing) is eat. Depression, guilt and hopelessness follow.

These are common stories I hear:

Mary discovered vomiting as a weight control technique twelve years ago when she was pregnant and her doctor told her she was gaining too much weight. It was so convenient-being able to eat whatever she wanted and not having to "pay the con-

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young women in their teens and 20's-women who are struggling to become independent, struggling with their educations, their first jobs, their first homes away from parents. These are not women with much money; these are women who can't afford $60 per hour for treatment. They are the kind of people the Free Clinic has always sought to help.

Finally, as I will describe later, we are not talking about women who occasionally overeat. We're talking about women whose lives have been disrupted, physically and emotionally, by food. Anyone who still feels this is a silly or irrelevant area should consider what Dr. Susan Wooley told her colleagues at a national conference on all eating disorders: "What if it were young men's educations and careers that were being disrupted by these syndromes? What would our attitude be then?" This is an important area for

sequences" that she became "addicted." She had been vomiting up to six times a day when she came into treatment.

Carol is 17, athletic, conscientious and a good student, at normal weight. She is terrified of becoming fat, and every day pledges "not to eat." She can't keep to this pledge, of course, breaks into a binge in the late afternoon, and then hates herself. She is frustrated and depressed all the time now. She hasn't menstruated in over two years.

Donna is 24 and has had problems with drugs, alcohol and food. She has conquered the first two, but when she binged in her halfway house, her counselors got angry and told her not to. Donna got to the point where she was vomiting into plastic bags.

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