The Art of Starvation, Autobiography/Psychology

One girl's journey through adolescence and anorexia - a story of survival

First winner of the annual MIND award

Sheila MacLeod Official Website, contact e-mail: roland.t@virgin.net

The fact is that life for young girls has changed dramatically in the post-Pill age: the choices seem greater, the pressures more contradictory. Sheila MacLeod explores this uncharted territory with skill and subtlety. For her, starvation became the goal of her adolescence and she developed it into an art - her body the weapon she used to fight off helplessness in the face of the impossible demands of 'womanhood'. Basing her book on her diaries, she gives an impassioned account of anorexia as an illness and a state of mind.

INTRODUCTION

At this moment, it is estimated that in this country, 1 in every 200 adolescent girls is starving herself-possibly to death. For girls over 16 in the Private sector of education or for young women in university populations, the figure can be as high as 1 in 100. Of these, about 15 in every 100 will actually die.' Of the remainder, only half will recover to lead more or less normal lives: the rest are likely to relapse, or resort to alternating bouts of feasting and fasting, or, at best, to go through life waging a never-ceasing struggle with their own bodies in order to maintain an "ideal" weight which is barely above the danger-line. The figures, based on previous studies, are startling, but even so they probably underestimate the prevalence of the mysterious and crippling psychosomatic disorder known as anorexia nervosa. It is variously described as a food phobia, a weight phobia, "a fear of all that is involved in growing-up and achieving physical maturation,"² a death-wish, a denial of sexuality and gender, or, more popularly, "the slimming disease." Although there is some truth in some of these descriptions, others of them are misleading and none, in itself, is particularly enlightening. Certainly they do not add up to a coherent picture of the disease and, despite the fact that it is becoming more and more common,³ there is still a great deal of disagreement and confusion in the medical and psychiatric establishments as to what it actually is. With some notable exceptions, the emphasis has generally been on the negative, destructive aspects of the disease, on the "unnatural" aversion to what the rest of us like to call the good things in life-food, sex-maturity, conviviality, and so on. But, as I hope to demonstrate, this is only half the story, only one half of the total paradox which constitutes anorexia nervosa.

What is now clear are the clinical criteria for the diagnosis of the disease-at least in its most obvious, medical aspects. The most noticeable symptom is, of course, a major weight loss. By the time an anorexic gets to see a doctor or a psychiatrist, she may have lost as much as 40 to 55 pounds over a period of nine months to two years. In extreme cases she will have lost around 50 percent of her previous body weight. There will be no apparent organic reason for the loss, and so the clinician is likely to direct her/his attention to the patient's wholesale resistance to fattening foods-a category which eventually expands (or has already expanded) to include all food whatsoever. Resistance can take the form of downright refusal to eat, excuses for non-eating - such as lack of appetite or sheer inability-the secret disposal or destruction of food, self-induced vomiting or excessive purging. At the same time the patient will display an obsessive interest in food, in some cases insisting on cooking for and overfeeding her own immediate family. It has been shown that when weight has been drastically reduced, menstruation will cease, and that this generally happens when the patient's weight falls to below 98 pounds.⁴ Amenorrhoea is therefore another universal symptom of anorexia nervosa. On closer physical examination, it is likely that the anorexic will be found to be suffering from constipation, cold blue extremities, slow heart beat (bradycardia), low blood pressure (hypotension), and a low basal metabolic rate. All these symptoms can be described as general effects of starvation. A more exhaustive examination is likely to reveal some, if not all, of its secondary effects: abnormal glucose tolerance levels, high carotene and cholesterol levels in the blood, fluctuations in water balance, and a low output of sex hormones. She may also have grown some downy hair on normally hairless parts of her body. But at the same time she will have retained her pubic and armpit hair as well as the shape of her breasts, and so glandular insufficiency must be ruled out as the root cause of her symptoms. In fact, after even the most exhaustive tests, no physiological causes at all will be found to account for her extreme and seemingly inexplicable weight loss.

In spite of this overall clinical picture, she will deny that there is anything wrong with her, either physically or emotionally, insisting against all appearances to the contrary that she is well and happy and, above all, not thin to the point of emaciation. As if in proof of the superior truth of her own point of view, she may evince an unnatural brightness which will turn out to be only a part of a larger pattern of hyperactivity. Or she may be quiet and polite, at pains to give the impression that, although there is really nothing to worry about, she will do all she can to cooperate with the doctor and her parents in the attempt to restore her to her normal weight. In short, she will lie-in word or deed or in both at once. The true assertion that she could be starving herself to death will be greeted with disbelief, if not scorn, and she will assert in turn that her weight loss is only a temporary aberration which she will rectify of her own accord. It will soon become clear to the clinician that she has no intention of modifying her behavior and, if treatment proceeds, it will also become clear that, despite all assurances to the contrary, she will use every trick she can devise with the unswerving determination of an addict, to avoid any such modification. She will cling to her disease, seemingly indifferent to its possibly fatal results and to its devastating effects on others who are concerned with her health and well-being.

The anorexic's behavior is puzzling and eventually becomes infuriating to those around her, who are reduced to helplessness in the face of her intransigence. She wounds those nearest her by rejecting all they have to offer her. To them, her persistent refusal to eat seems like the epitome of perversity: she is choosing death rather than life, sickness rather than health or, at best, a narrow existence in preference to a full one. They can see no reasons for her behavior. But of course there are reasons, many of them too close to home to he seen by those involved. I think I know what some of those reasons are. I suffered myself from anorexia nervosa for some eighteen months just over twenty years ago when I was sixteen to seventeen years old, and I have had two minor relapses since. Because the disease was rarer (and certainly more rarely mentioned) in those days, it was not recognized for what it was by any of the adults-parents, teachers, even doctors-who had reason to question why I was losing weight so rapidly, and I received no treatment, although I was scolded a great deal and frequently told to "snap out of it." At the onset of the disease I weighed 117 pounds, and was five feet two-and-a-half inches tall. Like the majority of anorexics, I was not exactly obese but only slightly and quite suddenly overweight. However, I made no conscious decision to diet and, although I did not particularly like the way I looked-a common enough attitude in adolescent girls-it did not worry me unduly. I never connected my refusal of food with the desire to be slim and, by definition, sexually attractive. I didn't know what I was doing: I just felt compelled to do it. All the same, when I had lost 14 pounds I felt I had achieved something and was determined to go on to greater heights of achievement. Eventually, my weight dropped to 78 pounds. It was at this point that my spontaneous recovery began. But it wasn't until two years later that I first heard the phrase "anorexia nervosa," when it was applied to a fellow-student in whom I recognized-with some horror-the image of my former self: a pathetically emaciated creature whose head seemed too large for her body, and who seemed to be in a permanent state of shivering and shrinking away from everything. Until then I could have been, for all I knew, the only person in the world ever to have behaved as I had behaved or felt as I had felt. And it was many years later still that I discovered not only my physical symptoms but also my state of mind to have been almost entirely typical of the syndrome of primary anorexia nervosa.

It was only then that I began to question the whole phenomenon in depth. In doing so I have found myself in frequent disagreement with others who have written on the subject. The relevant literature is all based on clinical experience and written from the point of view of the clinician or therapist who has necessarily been forced into making generalizations from the available data. My aim in this book is to particularize, to tell my own story, and at the same time relate it to the findings of those who have dealt with anorexics as patients. In my experience, anorexia nervosa is not a matter of slimming which has somehow or other got out of hand and beyond the control of the anorexic herself. Neither does it signify an urge towards suicide, nor yet an aversion from sexuality. On the contrary, it is, like most other psychoneurotic syndromes, a positive strategy aimed at establishing autonomy and resolving what would otherwise be unbearable conflicts in the life of the sufferer. These conflicts are partially related to and arising from the anorexic's individual history and personality structure -that is, they are intrapsychic. But they are also existential, that is, related to being-in-the-world, which for human beings necessarily means being-in-a-body, and for women, being-in-a-female-body.

I have decided to meet the phenomenon in meeting my former self and attempting to recall what was actually going on both before the onset of the disease and during the time that it was taking its course. I was trying to resolve something, trying to prove something and, through the language of my symptoms, to say something. Whether she knows it or not, and however obliquely metaphorical the language of her symptoms may appear, the anorexic is trying to tell us something, and something quite specific about herself and the context in which she exists. We know, from the outside, that it is something of tremendous importance because some anorexics would rather die than stop saying it. We know too, that it concerns being a girl and being a woman, and the passage from the one to the other, because anorexia nervosa is typically confined to teenage girls and young women. And because the disease is becoming more common, extending itself through all strata of society instead of being largely confined to the upper- and middle- classes, we must assume that what is being said is becoming increasingly important to increasing numbers of people. After a brief outline of the documented history of the disease, I should like to explore and try to explain, from the inside, what I believe this something to be.

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CRITICS

Written from one woman's first-hand experience, The Art of Starvation addresses the reader who is personally involved and needs to know more about how family relationships - mother-daughter relationships in particular - affect the course of the disease. MacLeod describes her early confrontation with anorexia, her 18 months of compulsive starvation, her later relapses, and her ultimate recovery and self-understanding. Woven through the story of her battle is a review of the literature by such prominent psychologists as R. D. Laing, Hilde Bruch, Erik Erikson, Rollo May, and G. G. Jung. The Art of Starvation also delves into the deeper implications of the phenomenon, touching on questions of identity, powerlessness, sexuality, parental relationships, and growing up female in our society.

A Story of Anorexia and Survival SHEILA MACLEOD, First American edition published by Schocken Books 1982, Copyright Ó Sheila MacLeod 1981, Published by agreement with Virago Ltd., London, The art of starvation. A story of anorexia and survival, Includes bibliographical references. 1. Anorexia nervosa-Patients-United States-Biography. 2. MacLeod, Sheila. 1. Title. RG552.A5M3 1982 616.85'2 81-16597, AACR2, ISBN 0-8052-3803-4, Psychology/Autobiography ISBN 0 86068 169 6, United Kingdom