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Johnson, Lynda Dunn
Feminist Theories Revolutionize Our Understanding of
Eating Disorders as a Cultural Disease.

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Anorexia Nervosa; *Counseling; Counselors; *Cultural
Context; *Eating Disorders; Eating Habits; FamilyCounseling; Family Life; *Females; *Feminism;Physical Health; Psychological Patterns; Psychology;
Sex Bias; Sex Discrimination
Patriarchal Societies

ABSTRACTThe increasing prevalence of eating disorders,
especially in women, has motivated feminist theorists to evaluate thesocial, cultural, and historical roots of these illnesses. This paperargues that traditional models of psychology are embedded in apatriarchal, individualistic society where the impact of culture on
eating disorders is largely ignored. Counter to traditional
psychology, feminist psychology views eating disorders as a reaction
to the oppression of women in western culture. This point of viewsuggests that eating disorders are one way women protest against theobjectification of women and the expectation that they embrace
patriarchal values while rejecting their own femaleness. The
influence of individualism and body-mind dvalism on traditionalmodels of psychology and eating disorders are also reviewed. It issuggested that family therapy has broken ground and created aneffective contextual framework for treating eating disorders, but it
is imperative that a model of psychology includes not just thefamilial context but also the larger cultural context. Indeed,feminist psychology suggests that eating disorders are a culturaldisease. Contains 24 references. (Author/JBJ)

Reproductions supplied by EDRS are the best that can be madefrom the original document.

Eating Disorders as a Cultural Disease

Feminist Theories Revolutionize

Our Understanding of Eating Disorders as a Cultural Disease
Lynda Dunn Johnson
Antioch New England Graduate School

PERMISSION TO REPRODUCE THIS
MATERIAL HAS BEEN GRANTED BY

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Running Head: EATING DISORDERS AS A CULTURAL DISEASEBEST COPY AVAILABLE

Eating Disorders as a Cultural Disease2

Abstract
This paper argues that traditional models of psychology are embedded

in a patriarchal, individualistic society where the impact of culture on
eating disorders is largely ignored. Counter to traditional psychology is
an astute and novel approach, feminist psychology, where eating

disorders are viewed as a reaction to the oppression of women in our

culture. This point of view suggests that eating disorders are one waythat women protest against the objectification of women and the

expectation that they embrace patriarchal values while rejecting theirown femaleness. The influence of individualism and body-mind
dualism on traditional models of psychology and eating disorders also

are reviewed. It is suggested that family therapy has broken groundand created an effective contextual framework for treating eating
disorders, but it is imperative that a model of psychology includes notjust the familial context but also the larger cultural context . Indeed,feminist psychology suggests that eating disorders are a culturaldisease.

Eating Disorders as a Cultural Disease3

Introduction
Eating disorders plague the lives of many women today. Thesefrightening and consuming illnesses prevent women from experiencing

normal, healthy development as well as a fulfilling and balanced

lifestyle. Unfortunately, women who struggle with eating disorders
are not given much hope about prognosis or recovery, and during

therapy they often experience a continued misunderstanding of whothey are as people. Recently, the refreshing and insightful vision offeminist theorists has rejuvenated the hope for these women who havefelt misunderstood, isolated, and disconnected from their bodies andrespective social arenas.
The increasing prevalence of eating disorders, especially inwomen, has motivated feminist theorists to evaluate the social,
cultural, and historical rootedness of these illnesses (Thompson, 1994).

Eating disorders, although prevalent in the 1920's, have increased toepidemic proportions since the ending of World War II (Per lick &Silverstein, 1994; Bruch, 1985; Lewis & Blair, 1991). Brumberg (1989)

projected that between 90 to 95 percent of anorexics are female. Lewis& Blair (1991) claim that cluTently, 1 in every 100 in the UK will

experience anorexia nervosa at some time in her life, and that 5 ormore females in every 100 will fulfill the diagnostic criteria for bulimia.

Given the magnitude of the problem it is imperative that we begin tounderstand why this disease is afflicting women now, and begin toEating Disorders as a Cultural Disease4

understand how we can intervene more effectively (Per lick &Silverstein, 1994).

Investigations into these illnesses are not new. Cases ofanorexia nervosa had been cited as early as 1689 by Dr. Richard

Morton, describing what he called 'nervous consumption'. In the late1800's a couple of cases of anorexia nervosa had been cited by E.C.
Laseque and W. W. Gull, however anorexia nervosa did not comeprominently to the public's attention until the 1960's and 1970's (Lewis& Blair, 1991). Anorexia nervosa is characterized by extreme weight
loss, self-starvation, a dread of becoming fat, and verY frequently adistortion of body size (Perlick & Silverstein, 1994; Lewis & Blair,1991). The anorexic does not maintain normal body weight, often
exercises excessively, and may invoke rituals around the consumptionof food. Vomiting, laxatives, and diuretics may be used to facilitate
weight loss (Perlick & Silverstein, 1994, p.90). Anorexia is understoodas a hunger fast (Chernin, 1981) or a hunger strike where theindividual uses one's body to conform to, as well as protest against, thedemands of one's culture.

Bulimia is characterized by binge-eating and ending the bingeby purging through vomiting, use of laxatives, diuretics, or exercise(Kinoy & Holman, 1992). Abdominal pain, sleep distizbance, andsocial interruption very often accompany this illness. A criticalcomponent of this disease is a feeling that eating is out of one's control,Eating Disorders as a Cultural Disease5

accompanied by self-deprecating thoughts and depression (Lewis &Blair, 1991).

Bulimarexia, another form of eating disorders, is used todescribe the overlap of bulimia and anorexia nervosa. An individual
who binge eats, vomits, and engages in self-starvation with severe
weight loss typifies bulimarexia (Waldinger, 1984). While bulimia

nervosa and bulimarexia are significant, for the purposes of clarity
anorexia nervosa will be the focus of this paper.
This paper will review how eating disorders, specificallyanorexia nervosa, have been understood by predominant schools of

psychology over the past century. Traditional models such as
psychoanalytic, object relations, and self psychology reveal that

Western culture has emphasized internal conflicts and deficits ofindividuals with eating disorders, while overlooking and de-emphasizing the importance of culture and society. In contrast,

feminist theories begin to take into account the significant role that
culture and society has had on the development and maintenance of
eating disorders. Included in this discussion will be a review of how
individualism has significantly influenced traditional models of

psychology resulting in a less culturally-sensitive understanding ofeating disorders. Furthermore, it will be argued that individualism set
the stage for a more socioculturally-sensitive point of view throughfeminism. Feminist perspectives revealed how culture has had atremendous impact on the etiology of eating disorders and ultimately

Eating Disorders as a Cultural Disease6

revolutionized our understanding of eating disorders as a culturaldisease.

Traditional models of psychology overemphasize internal

conflicts, the unconscious, sexual and aggressive drives, thefragmented self, and the empty self, while minimizing external forcesthat are working in people's everyday lives. These more traditionalmodels of psychotherapy have been noted for understanding thepsychological complexity of the "internal hydraulics" of an individual'sfunctioning while minimizing events and stressors in one's life. Hi lde
Bruch (1985), a pioneer in the field of eating disorders, worked from a

psychoanalytic perspective. Initially she focused on the "oralcomponent; a form of conversion hysteria that symbolically expressed
repudiation of sexuality, specifically of oral impregnation fantasies"(Bruch, 1985, p. 8). This understanding of anorexia nervosa views thecore of the self as dangerous and destructive, one that needs to becontrolled and socialized (Cushman, 1992). Culture plays a very
insignificant role in the etiology, duration or treatment of the illness.

The psychoanalytic approach to eating disorders suggests that
pathology occurs when internal drives, desires or wishes are

insufficiently monitored and controlled. Society is only peripherally
connected to one's psychological functioning. Psychoanalytic theory

clearly evolved out of a culture that was embedded in stoic

individualism. Even Freud articulated, in Civilization and its
Discontent , civilization is only possible through the individual learningEating Disorders as a Cultural Disease7

to control and contain one's aggressive and egoistic self-satisfaction(Freud, 1930/1961).

Similarly, Object Relations theory and Self Psychology

subscribed to this individualism where the role of culture in one's
psychological well being was held at bay. Object Relations theorists
expanded the psychological world of the individual to include a'primary caregiver' as critical to the development of the persona (Eagle& Wolitzky, 1992). The work of therapy often "focuses on issues andgoals of separation and individuation to the exclusion of connection andrelationship" (Mirkin, 1990, p.101). On the contrary, Gilligan (1982), a

feminist theorist, asserts that separation, individuation, and autonomy
without connection to others is not central to female development.
Nevertheless, in Object Relations and Self Psychology, this is thefocus. The etiology of eating disorders are understood as dependentneeds stemming from incomplete 'self development or interrupted
separation-individuation (Steiger, Goldstein, Mongrain & Van derFeen, 1990; Chelton & Bonney, 1987).

Furthermore, it is believedthat "failures in parenting prevent the child from properlyinternalizing mental functions that are necessary for both a stablesense of 'self and 'others' " (Steiger & Houle, 1991, p. 147).

Theoretically, the individual compensates for these difficulties by
gaining control over his or her body to acquire a sense of personaladequacy, and by using the powerful sensations of starving to regulate
his or her affect (Steiger & Houle, 1991; Chelton & Bonney, 1987)).

Eating Disorders as a Cultural Disease
8

The goal of treatment is to assist one in moving through separationindividuation and to promote a cohesive, autonomous sense of self
(Chelton & Bonney, 1987). As a result, Object Relations and Self
Psychology theorists almost solely focus on an individualistic maleoriented developmental model (Mirkin, 1990) of the self where theculture is still largely ignored.

Bruch (1985) described dissatisfaction with the traditional

interpretive psychoanalysis in the treatment of anorexia nervosa. Shechanged her approach so that instead of searching for definite"underlying unconscious conflicts", the focus prompted a fact finding

approach where she asked clients to reconstruct what really happened

during the patient's early development. She suggests that thisapproach was accompanied by better treatment results because it
created a greater reliance on the client's thinking which had been
deficient in his or her early development. This development in Bruch's
work is critical because even through this highly individualistic

approach to psychotherapy she discovered that it was essential to take
into account the patient's social and cultural circumstances toeffectively treat eating disorders.

Indeed, Bruch (1985) believed that changing status andexpectations of society played a role in the development of eating

disorders. She described little girls who were socialized to become"clinging vine" wives suddenly expecting to prove themselves as womenof achievement in adolescence and adulthood. She believes that

Eating Disorders as a Cultural Disease
9

women "choose the fashionable dictum to be slim as a way of proving

themselves as deserving respect" (Bruch, 1985, p.9). Bruch seemed torecognize and incorporate a more comprehensive way of looking at

individual's with eating disorders which included a cultural

understanding.
Equally important to understanding how feminist theories have
revolutionized our understanding of eating disorders as a culturaldisease, is to understand how individualism centralized andinternalized our understanding of personhood (Sampson, 1985).

Individualism upholds the ideal that character is designed to control

and master internal states which results in an egocentric culture(Sampson, 1985). This ideal is contrasted with a feminist
understanding that the self is organized in relation and connection toothers (Sampson, 1985; Mirkin, 1990).

The self-contained individualism of Western culture promotes a

psychology that understands the conception of the self as independent,
unique, and with an internal locus of control (Ramachandran, 1994).

Individualism locates the personality as something interior to persons
and core characteristics as stable over time. Psychoanalytic theory,

originated by Freud, clearly reflected the individualistic standards of

his time. "Foucault argued that Freud's belief that society by nature
had to control sexuality and aggression was a history-bound conceptthat held a great deal of utility for the modern state" (Cushman, 1992,
p. 27). Foucault (as cited in Cushman, 1992) suggested that Freud'sEating Disorders as a Cultural Disease10

theories were really no more than a social artifact, a clear
interpretation of the culture of his time.
Individualism continued to dominate the social movement which
was coupled with an ever-increasing emphasis on the self-contained
individual, unencumbered by community ties, ideological allegiances,moral traditions and geographical boundaries (Cushman, 1992).
Object Relation theorists and Self Psychology began to emphasize thecritical nature of the parent-child relationship in the development of anautonomous and independent entity (Cushman, 1992). These theorists
argue that with the opportunity for healthy and normal development achild eventually becomes autonomous, achievement oriented,

competitive and self-motivated. Anorexia nervosa is viewed by these
two schools as a way to remain dependent, as a way to remain childlike

thus preventing healthy individuation and separation. This view isvery different from the feminist perspective because it excludes thesignificance of this individual's need to remain in connection andrelationship to others.
Another important philosophical influence to the belief that one
needs to gain control of his or her body was Descartes' claim that "ourminds are somehow essential to our identity and to our existence but
our bodies are not" (Flanagan, 1991, p. 9). This body-mind dualism
instilled the belief that our bodies were something that could becontrolled by our minds. It contributed to the understanding that theself was observing itself and that the body was split off from the mind

11

Eating Disorders as a Cultural Disease
11(Cushman, 1992). This body-mind split created fertile ground foreating disorders by promoting control over one's body with one's mind.

Moreover, it provided a new rationale for these disorders. Clearly,
anorexia nervosa is the ultimate control one places over his or her
body. Traditional models of psychology missed the cultural relevanceof one using his or her body as a protest or as a political statement, andinstead viewed this as a deficit within the self. Traditional psychology
in it's purest form stripped one's context from the individual so as togain a clearer picture of the problem.
As Bruch (1985) discovered these approaches were not only

unsuccessful, they were reinforcing the damage that culture hadalready done. For example, anorexics may be protesting against thedemands to become autonomous and live the isolated life that theydread, yet in traditional psychology, the goal of therapy is to help them
become independent instead of helping them find ways in which they

can connect and live in relation to others.
Individualism created the environment for feminism to evolve.
The heavy emphasis on individualism as well as male dominance havecreated an atmosphere where feminists question the validity of sciencein understanding women's issues (Riger, 1992). Feminism "refers to asystem of values that challenges male dominance and advocates social,political, and economic equity of women and men in society" (Riger,

1992, p. 731). Feminist theorists view the individual as integrally
connected to his or her social context, the self as defined in relationshipEating Disorders as a Cultural Disease12

to others (Gilligan, 1992; Mirkin, 1990). What has evolved out of thefeminist perspective is a science that aims at understanding women(Riger, 1992).

The internal focus of eating disorders that resulted from thisindividualistic understanding of psychopathology is incomplete because
it did not give enough credence or credit to more dominant andcontributing factors in one's social context. The individualistic culture

created an atmosphere that at best was non-conducive and, at worst,

hostile to women. Feminist theorists would argue that eating
disorders were a symptom and perhaps even a protest against this
disconnected, achievement- oriented society. It is vital to understandthat individualism created the exact atmosphere where feminist
theories could flourish.

Feminist theorists began to argue that eating disorders were one
way that women protested against the exclusion and rejection of what

was normally feminine in science and culture. Feminist theories
demonstrate how culture has contributed to, if not soley created, eating
disorders through this rejection of what is feminine. It inevitably
rejected what was feminine by the mere promotion of what was

masculine as was illustrated in the assumption that normal andhealthy development for women is through individuation andseparation, rather than through connection and relation.
In addition to the rejection of what was feminine an importantelement of social control over women's appearance was in effect3

Eating Disorders as a Cultural Disease
13(Rothblum, 1994). "Everything about our socialization as females in apatriarchai culture leads us to value ourselves in terms of our bodies -as objects of love, as child-bearers, as nurturers, and as ornaments formen" (Hutchinson, 1994, p. 153). Throughout history women havebeen expected to conform their bodies to the demands of culture. In
China, for 1,000 years women have broken and deformed their feet tocreate a 3-inch "lotus hook" which is required for a woman to be

marriageable. This 3-inch foot is considered the height of erotica for
Chinese men. Additionally, in cultures across the world, women are

expected to mutilate their genitals, to remove their clitoris leaving ahole only the size of a matchstick for urination and menstruation.

Women in their natural form are not considered marriageable(Rothblum, 1994). "There is a long history of women being objectified

and viewed, interpreted, and judged like works of art" (Berger as citedin Woo ley, 1994, P. 40). Feminist theorists argue that eating disorders
are one way that women have learned to cope with the objectification of

women and the rejection of femininity. Some claim that anorexia is ahunger strike, a protest against the pressure to conform. Descartes
body-mind dualism may have contributed to this illness by promoting
control over one's body with one's mind. Anorexia nervosa serves as

the ultimate protest against the social and cultural demands placed on
the individual (Chernin, 1981).
Additionally, new messages have been given to women to not

only be nurturing, maternal and beautiful, but also to achieve in14

Eating Disorders as a Cultural Disease14

educational arenas and in the workplace. "Females today receive
contradictory messages focused, on the [sic] one hand, on creating,raising and caring for a family and, on the other hand, developing andmaintaining a career" (Lewis & Blair, 1991, P. 26). Eating disorders
are viewed as a paradoxical solution for women. "Anorexia nervosa canbe viewed as a reactive attempt by females to impose control over a

crucial area of their lives, particularly when other aspects of their lives
feel out of their control" (Lewis & Blair, 1991, p. 26).

The options for women are to conform to society and lead highly

isolated and individualized lives or to rebel and embrace their own

need for nurturance, relationships, and interconnectedness. Mirkin(1990) suggests that there is a solution in eating disorders to thecontradictory expectations of women in our culture. Our culture does

not value the relational, nurturing and interconnectedness of womenand expects independent and isolated achievement instead (SteinerAdair, 1994). There is a double standard for the white, AngloAmerican woman where she is expected to climb the corporate ladder,but remain subordinate to men. If a woman hangs on to her need forconnectedness and nurturance she will not function effectively in thecompetitive, capitalist world.

Additionally, there is an effort to keep women's physicalappearance diminutive which is symbolic of the lack of power womenexperience (Mirkin, 1990). "In the face of this dilemma, many women

have found a paradoxical solution in anorexia nervosa. By losing

13

Eating Disorders as a Cultural Disease15

weight in a way that so grotesquely changes their bodies, anorexic

women are both conforming in the ultimate manner to the standard fora diminutive presence and rebelling in an ultimate manner: 'You wantme to act like a man? Well, here's my no-longer-female body', 'You

want me to be little and childlike at the same time? Well, I'll be solittle and childlike it will be intolerable to you' " (Mirkin, 1990, pp. 103104).

It is apparent that eating disorders are perceived by feminist
theorists as a manifestation of the devaluation of the relational self
(Mirkin, 1990). Mirkin (1990) points out that young women who arevulnerable to eating disorders are typically very loyal to their families

and often view their mothers as isolated, unfulfilled and unhappy. It isdifficult for a child to leave a depressed mother but especially when

adulthood seems to be filled with rejection and unhappiness. "Whyventure out of the nest when you feel your wings have already beenclipped?"(Mirkin, 1990, p. 102). Anorexia nervosa metaphorically

represents the loss of connection that will be experienced as a young

woman moves into adulthood, it also represents the desire to stay achild and to remain connected and comfortable as she was in her
childhood (Mirkin, 1990).

It should be noted that there are clear limitations of the feminist
perspective. Just as the male-oriented scientific perspective ignored orneglected the female perspective, the feminist perspective is primarily
a white, middle-upper class Protestant claim which does not include

Eating Disorders as a Cultural Disease16

African-American, Jewish, lesbian, single, divorced, widowed, or

geriatric women to name a few (Thompson, 1994). Additionally,"ranking patriarchy, as a system of injustices, over other oppressions
also limits the current feminist framework" (Thompson, 1994, p. 359).

The future implications of this model are to expand the social context

in which eating disorders arise so that an integrated analysis, "onethat accounts for the intersecting influence of gender, race, sexuality,
nationality and class" (Thompson, 1994, p. 360) are taken into account.
Conclusion

Feminist theorists have begun to weave together a web ofcultural and social influences that have clearly contributed to women's

development of eating disorders. Some suggest that eating disorders
are a way that women handle the paradox of being female in a male-oriented culture. It may be a way to shed what is feminine so that one
can encompass what is masculine. Anorexia is viewed by some as apolitical statement that asserts not only the rejection of what is
feminine but also the acceptance of a diminutive presence. Otherssuggest that it is a hunger strike, or a protest against the demands
that are expected of women. Feminist theorists point out that thedevaluation of the relational self, the self that is nurturing, maternal
and interconnected with others led women to these illnesses.
On the contrary, traditional models of psychology such as:
psychoanalysis, object relations, and self psychology were embedded in

the cultural influences of individualism. Individualism maximized the

1 'r

Eating Disorders as a Cultural Disease17

importance of a self-contained, autonomous, capable, achievement

oriented individual that did not fall to the whims of dependence,emotionality and bodily desires. As a result, feminine characteristics
were devalued.

It is imperative to give credit where credit is due. Until now
family therapy has not been discussed but it is critical to recognize thesuccess that family therapy has had in bringing the familial context

into the treatment of eating disorders (Mirkin, 1990). Despite theindividualistic embeddedness of family therapy, , it has been

tremendously successful with the treatment of eating disorders.
Indeed, feminist theorists agree with the work of family therapy, , but
advocate moving beyond the family system to a more comprehensive

approach that involves the importance of society, cultural rules andcultural values.
The goal of this paper is not to further exacerbate the divide thatis felt between genders, but to critically examine how this divide has
contributed to the misunderstanding of women's issues, specifically as

it relates to eating disorders. It may be that many people are attune tothese issues by now, but the hope is that this point of view will help

bring the context into understanding eating disorders. Furthermore, it
is imperative that feminist theorists not maximize sexist oppression
over racism, ageism, religion, ethnicity or sexual orientation. Whatfeminism needs to do is go beyond sexism and factor in all different

cultural and social contexts for different groups. It is critical that1

Eating Disorders as a Cultural Disease18

feminist theorists not further alienate marginalized groups by only
including the white Anglo-American woman into their research.

11 j

Eating Disorders as a Cultural Disease
19

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3