Trigger Warning: Eating Disorders

Jess Woollard examines what is considered an eating disorder, deconstructing what has previously been labelled as disordered eating versus eating disorders.

When people make the point that having disordered eating is ‘not the same as having an eating disorder’, what are they hoping to achieve? The issue of psychiatric diagnosis is sensitive, and I want to make it clear that the criticisms of Mad Pride activists and myself come from a very different place to those of the ‘young people with ADHD are a load of self-victimising snowflakes’ camp. But if we’re going to call individual outlooks on diagnosis ‘personal’, we have to keep in mind that questions around mental health and the ways in which we model our distress are hugely political too.

Chatting with a friend about our histories with eating disorders, I once mentioned that I thought most people our age had probably struggled with food. I was surprised when she replied with ‘yes, but not so badly that they had to go to hospital’, wondering how someone could voice so bluntly their belief that essentially they’d had it worse. As a teenager I was in and out of inpatient units for years and, although us eating disorder patients made a point of appearing to validate one another – decrying the glamorisation of NG tubes and the flaunting of underweight bodies online – there was still a sense of exclusivity when we talked about disordered eating in the wider world. We were more than ready to recite that it wasn’t a low BMI or a number of hospital admissions that made any of us worthy of recovery, that there was ‘no such thing as not sick enough’, yet when we talked about people we’d met outside of clinical settings we were deeply hypocritical. Almost everyone had a story involving someone at school trying to relate to them by saying that they’d had a phase of skipping breakfast, and the story was supposed to be funny – because of course, that just ‘wasn’t the same’. People get nastily competitive in hospital, but by sidelining our peers whose presentations were ‘subclinical’, we were able to reassure ourselves of the significance of our struggles with minimal risk to in-ward relations.

It’s now generally accepted that physical emaciation is a poor measure of emotional suffering; rightfully, mental health advocates are angry that BMI is still included in the DSM’s scale of severity for anorexia, and I can well sympathise with the demand that this be changed. But with weight out of the equation, the psychiatric definition of ‘anorexia nervosa’ starts to look less like a medically-describable disorder, and more like something that will be familiar to the vast majority of people (especially younger, non-male individuals) in the Western-influenced world: a ‘simple’ case of body insecurity, anxiety around food, and the translation of the stresses of everyday life into disruptive eating patterns. Where the undiagnosed compete with the diagnosed and the diagnosed compete with each other, our energies are directed away from addressing the sources of our discomfort. Instead of campaigning to broaden diagnostic categories, bargaining with medical authority to draw the line between ‘sick’ and ‘well’ a little bit more liberally, I’d rather we were done with diagnosis altogether.

Our fascination with named psychiatric ‘conditions’ and who does and does not ‘have’ them distracts us from the root causes of so many of our problems. On the whole, the concept of ‘mental illness’ depends upon the idea that individual people have ‘faulty’ ways of thinking – it is the anorexic or bulimic who is ‘sick’, and the problem lies within them rather than with, say, misogyny, racialised fatphobia, or the health and beauty industries bent on abusing both workers and consumers for maximum profit. The ‘eating disorders vs. disordered eating’ divide frames one set of problems as medical in nature (pertaining to biology; brain chemistry and genetics) while the other is a more likely a product of our social conditions, discouraging a political understanding of the former whilst ensuring the latter’s insecurity in how ‘real’ their problems are. As long as we make a distinction between those we deem distressed or disordered to a ‘normal’ degree and those whose experiences warrant a formal diagnosis, surely we are expanding the same stigmas that we claim to want to end.

There is no way of labelling some people as psychiatrically ‘sick’ without implicitly diminishing the issues of everyone else, alienating the majority (or perhaps not, given the psychiatric tendency to increasingly label our various responses to our terrifying world as symptomatic) and in turn discouraging conversations that could help us to better understand our pain in context. People who knew me in my teens will say things like ‘but I’ve never had an eating disorder so I can’t imagine what you went through’, despite many aspects of our stories being actually quite similar. I’ll listen to someone go on about how worried they used to be about carbs or having a thigh gap or spending however many minutes working out each week, only for them to backtrack and claim (trying to be respectful of my ‘illness’) that they ‘obviously can’t relate’ to my diagnosed problem, as if we have nothing in common – not self-criticism, nor the background of the Euro-centric beauty standards that we’ve all been conditioned to strive for. The differentiation between ‘disorder’ and ‘disordered’ neglects the reality of the harmful environments we share, shutting down discussions between the two artificially-erected groups before they have even begun.

Exemplifying this semantic crisis, the ‘check if you have an eating disorder’ section on the NHS website states that ‘If you or people around you are worried that you have an unhealthy relationship with food, you could have an eating disorder’. This is entirely and ironically (given that this is messaging from a ‘Health Service’) missing the point: an ‘unhealthy relationship with food’ should be a concern in itself, yet by asking that we ‘check’ this very clear sign of suffering to see if its conclusion is an ‘eating disorder’ or not, the page seems to imply otherwise. Without really meaning to, I think we’re raising the standards for our suffering by accepting the idea of diagnosable ‘mental illness’; each and every one of us has learned to ‘check’ our behaviours against the medical reference points and criteria of psychiatric ‘conditions’, and if we feel that we fall short, we end up either in complete denial or wildly self-conscious about how valid we are. From either of these highly probable outcomes, the only way is down.

Establishment psychiatry is of course the architect of the idea that ‘mental disorders’ exist as objective, classifiable entities that you either ‘have’ or don’t. But perhaps we each have a responsibility to interrogate how useful it is to exceptionalise the experiences of the diagnosed, and ask whether our increasingly medicalised view of human suffering might not be depoliticising the issues at hand (with eating disorders here being a good example). Broadly, I think people are more nuanced than I’ve given them credit for when it comes to recognising whether or not something is a problem, but it makes sense that nonetheless our biases – favouring ideas of ‘disorder’, pitting one person’s problem against another’s on a hierarchy of pain – can creep in to our analyses of our own and others’ struggles. Scenarios like that between myself and my friend are the logical consequence of using an ‘illness’ framework – put in place by the very institutions that claim to be there to help us – to interpret breakdowns in eating behaviours and body image, and I don’t believe that this will be solved by any amount of destigmatisation or ‘advocacy’.

Psychiatric abolitionists don’t believe that anyone is ‘making up’ their problems, and I won’t argue that all pain is created equally – there are blatantly degrees to which different people (and the same people at different points in their lives) struggle, and no two individuals’ experiences will ever be identical. Questioning the psycho-sciences should not mean bringing down the people whose lives it has tried to define and describe, but asking how we can work collectively to better comprehend what hurts us all, and in turn what is to be done to raise us up together.