BY JESS MELVIN
Eating disorders now rank as Australia's third worst health problem for women under 18 years old. A recent survey conducted from June 2002 to June 2003 by the Australian Paediatric Surveillance Unit, which involved all Australian paediatricians, has found that one in every 250 women under the age of 18 is affected.
"These are people that place inordinate pressure upon themselves", adolescent specialist Dr Michael Cohen, who worked on the study, said. "It's a pattern to cope with stress."
Eating disorders come second to schizophrenia in fatality rates associated with mental illness.
During a 12-year study of 103 people with anorexia nervosa treated at one US hospital, 15% died.
The causes of death included suicide, infection, gastrointestinal complications and severe emanciation. Thirty-five per cent of survivors had an associated medical disorder.
"Anorexia nervosa affects mainly young women", B. Bennetts wrote for volume seven of Molecular Psychiatry in 2002. "The sufferers become obsessed with the importance of losing weight to the point where they become skeletal ... To decrease their weight, sufferers either restrict their eating, or vomit what they eat."
Eating disorders have been described as "slow motion suicide".
But where does this First World famine come from? Why is it overwhelmingly women who are affected, and what can be done about it?
Most medical specialists conceive of the disorder as Cohen does: as a person placing "inordinate pressure upon themselves". This is an individual approach to the disorder, suggesting that it is a maladjusted way that an individual may cope with their circumstances.
However, eating disorders treated in this way have a terribly low success rate. About 60% of people with anorexia and about 40% of bulimia nervosa sufferers will remain chronically unwell.
Eating disorders are a social problem. They are the result of living in a sexist and unjust society.
Naomi Wolf, in her landmark book the The Beauty Myth, suggested: "Food still means power, historically how much you received acts as a physical affirmation of how much of the tribe's resources you are thought to be worth."
In order to justify unequal distribution of food, Wolf argues, "weight [control] became its rationale once natural inferiority went off the cards."
That men and women are "worth" different amounts in our society is no deeply concealed secret.
Women still perform the majority of unpaid domestic labour and provide the majority of care for children, the sick and the elderly. When performing paid labour, they get on average 66% of what men earn.
As lower-paid, part-time and temporary workers, women provider a cheaper and more "flexible" workforce for employers. The fact that many women will take casual or permanent work in order to juggle the vast amount of domestic work and child-care required of them, has helped the massive drive towards casualisation in the last two decades.
The concentration of women into poorly paid casual work has been justified by the claim that women naturally "want" to "nurture" and therefore spend more time at home. It is also justified by the argument that women's natural work is therefore different, and they take paid work less seriously than men.
However, this argument has been under sustained attack as increasing numbers of women are working full-time alongside men as equals.
Food deprivation, like low self esteem, can act as a mechanism of social control.
In the 1976 volume 85 of the Journal of Abnormal Psychiatry, J. Polivy and P. Herman explained that, "prolonged and periodic" calorie deprivation resulted in a distinctive personality whose traits are "passivity, anxiety and emotionality".
"It is those traits, and not thinness for its own sake", they wrote, "that the dominant culture wants to create in the private sense of the self of recently liberated women in order to cancel out the dangers of their liberation."
In other words, the exhaustion and anxiety that come with being hungry can prevent seemingly "liberated" and "equal" women from participating fully in society.
Even women not actually hungry often suffer a debilitating fear that they do not look attractive, that they are fat, and, therefore, worth less.
These fears are almost impossible to avoid in a society obsessed with "good-looking girls" — with "good looking" including thin.
Women of roughly the same size and general physical appearance are often all you see in the corporate media. From advertisements, to movies, television shows, internet sites and magazines we are bombarded with an unnatural world where all "normal" women are thin with unblemished skin, and most are white.
The insecurities that are generated by this bombardment are a source of considerable profits — from fashion to cosmetics to diet foods and binge foods. Women's insecurity with their self-image is one of the biggest retail drivers around.
Women are paralysed by insecurity: it makes them less likely to leave abusive relationships, stand up to abusive bosses or refuse to clean up after others.
The concept of "fat" in western culture has changed dramatically in a relatively short period of time.
Although much of the media's obsession with being thin is justified in health terms, fat only becomes a health risk when a person becomes obese. And, being obese is less imminently life threatening than being severely emaciated.
Being underweight adversely affects women's reproductive ability. Malnutrition caused by restricted eating leads to reduced sex-drive and loss of menstruation. Rose Frisch in the March 1988 edition of Scientific American argues that the "historical linking of fatness and fertility actually makes biological sense" as fat regulates reproduction.
As Wolfe explains, "Fat tissues store sex hormones, so low fat reserves are linked with weak estrogens and low levels of all the other important sex hormones, as low fat reserves are linked with inactive ovaries .... Underweight women double their risk of low-birth-weight babies."
In 19th century Europe, fat was viewed as a physical manifestation of social status. For a woman to be underweight meant that she, or more accurately her husband, did not have the economic ability to gain access to enough food, worked too hard and was not well-off enough to have someone else to work for her.
But today, for women to achieve thinness becomes a statement of worthiness. Fat is associated with lazy, unproductive and sloppy.
The first waves of the feminist movement won formal equality for women. They, however, have not yet won real equality.
Real liberation for women will be impossible without socially run domestic services that can replace the enormous amount of domestic work that women carry out in the home. While women are still required to do this, a host of sexist ideas, including ideas about how women should look, will continue to plague women's lives.
Therapy will help some women face and defeat their eating disorders. Likewise, hospitalisation of some women may save lives. Neither of these, however, will make the underlying cause of eating disorders go away. They may treat the symptom, but not the cause. They will not stop more women from falling victim.
We cannot simply aid those who are worst affected — we must together fight against sexist ideas and practices.
[Jess Melvin is a member of the socialist youth organisation Resistance.]
From Green Left Weekly, September 24, 2003.
Visit the Green Left Weekly home page.