Upon waking up this morning, I quickly became aware of Joan Bakewell’s ridiculous comments about anorexia in The Sunday Times (£ — paywall). In a nutshell, Bakewell said:
I am alarmed by anorexia among young people, which arises presumably because they are preoccupied with being beautiful and healthy and thin. No one has anorexia in societies where there is not enough food. They do not have anorexia in the camps in Syria. I think it’s possible anorexia could be about narcissism.
To be unhappy because you are the wrong weight is a sign of the overindulgence of our society, over-introspection, narcissism, really.
She has followed up by claiming on Twitter that her opinion has been misrepresented by the ST, and that she didn’t want them to print her (completely ignorant, foolish, dangerous) opinion. But presumably Bakewell is relatively au fait with how interviews work — so if she didn’t want her opinion — no more than ill-informed guesswork — printed in the newspaper, why offer it? There’s no harm in the words “I don’t know”. There’s every possibility of harm in making wild stabs in the dark.
I’ve already tweeted about this quite a bit this morning, generally and directly to Bakewell. She responded, taking a predictably defensive stance — suggesting I, and other commentators, are attacking her right to an opinion per se, rather than her propriety in broadcasting that opinion in the national press, on the back of her platform a) as a member of the House of Lords and b) as a member of the judging panel for the Wellcome Book Prize.
Bakewell has been insisting all morning today on Twitter that it’s “simply an opinion”.
I don’t really understand why Bakewell is persisting in trying to paint her critics as unreasonable by asking of them goading questions that suggest their primary challenge is to her right to speak at all, not to the content and effect of her speech.
I also don’t understand why she hasn’t now, having read what people like me have been saying to her and about her article more generally, issued a subsequent statement something along the lines of “You’re right. I shouldn’t have spoken up on an issue about which I know less than nothing. It was wrong and, moreover, irresponsible of me to speculate in the national press about this topic, especially since my views, whatever my intention in expressing them was, embarrassingly and dangerously reinforce false perceptions of eating disorders and the people who have them”.
These harmful effects are already apparent in some of the responses to tweets about this issue.
I’ve written elsewhere about eating disorder stigma, but I think it’s important to elaborate on why exactly Bakewell’s narcissim idea is so dangerous.
Bakewell’s view is symptomatic of a broader misunderstanding of eating disorders. And her presentation of her opinion in the national press is part of a media trend propelling pervasive beliefs about the influence of mass media on anorexia incidence or on ‘prospective’ anorexia patients (i.e. teenaged girls, in the main): the view, as Crisafulli and colleagues put it, that anorexia nervosa is “a purely sociocultural phenomenon in which young girls succumb to the image of ideal beauty put forth in fashion magazines”. Thus anorexia patients are, roundaboutly, blamed for having become ill. And the illness is also seen a sort of inevitable product of visual culture — making anorexia seem both volitional and trivial.
Research suggests that this view of anorexia as volitional is quite common, and that it contributes directly to stigma and real harm to people with eating disorders. Several studies highlight the negative attitudes healthcare professionals hold towards anorexia patients, reporting, for instance, that anorexia patients are less liked and that the prevailing opinion among caregivers is that patients “have only themselves to blame”. Similar opinions have been found among the general public — that patients should “pull themselves together”. Research by Crisp, for example, found feelings of blame towards anorexia patients far exceeded those for depression or schizophrenia (which we know are still heavily stigmatised) and approached levels directed at those with drug and alcohol dependence.
Bakewell’s position, portraying anorexia as narcissism, or as a product of narcissism, or as a result of too much focus on looks, or as a so-called slimmer’s disease or as a celebrity copycat phenomenon among teens, is harmful in other ways. It’s not just about stigma: portraying anorexia as the looks-based, narcissistic domain of teenage girls means that anorexia is increasingly not recognized when it presents differently. For instance:
Recent work has found a large portion of anorexia cases emerge totally absent volitional weight loss or any attempt at dieting. In these cases (15% of cases studied, research indicates), patients develop anorexia nervosa having unintentionally lost weight (thanks to a parasitic infection, say, or cancer treatment). For these sort of patients, and those who challenge the predominant view in other ways — for example, boys and men, older women, people of colour— their illness becomes invisible. Anorectics whose eating disorders are not accommodated by the prevailing narrative are less likely to seek help and are less likely to have their problems recognised as such if they do. Delays in diagnosis and treatment have well known negative consequences for illness duration and recovery trajectory. And knowing that the prevailing narrative — of narcissism, vanity, Barbie dolls and models — is false, only makes the facts sadder.
Finally, Bakewell’s assessment of anorexia as a “looks” phenomenon or product of teenage “narcissism” requires a troubling and enduring focus on the bodily elements of the condition. Bakewell seems to have been suggesting on Twitter this morning that this focus is misplaced, but doesn’t seem to grasp that her position very much depends on, and sustains, that focus. When Bakewell asks “Does our culture’s focus on the body help?” the implied answer is “no”. And I have to agree.
But Bakewell really isn’t helping matters. Seeing anorexia as narcissism, or as the pursuit of normative beauty standards or idealised health or thinness yields treatment narratives which focus on correcting extreme thinness, holding reversal of emaciation as the primary marker of health.
Using weight as the main measure of illness severity leads to enormous gaps in care provision (and patients often needing to lose weight in order to qualify for treatment). Helen Gremillion has further criticized this microscopic focus on the body, arguing that the “constant surveillance and manipulation of the body on a very intimate scale” (for instance, daily weight monitoring to 100-gram precision), could very well make hospitalizations longer and more harmful and contribute to increasing illness chronicity in anorexia nervosa.
Basically, in all ways, Joan Bakewell has made a grave, foolish, and (for me and others who work in this field) frustrating misstep. But the bell can’t be un-rung now. So I can only hope that she will listen to her critics graciously and gratefully (which, to be fair, I have seem some evidence of so far this morning on Twitter) and use her platform as a Labour peer, Wellcome book prize judge and public figure now to correct her mistake, promote the voices of others who (to be frank) actually know about which they speak, and try to undo the damage that this sort of negative media attention on anorexia and other eating disorders does.
References (where not hyperlinked)
Brandenburg, B. M. P., and A. E. Andersen. “Unintentional onset of anorexia nervosa.” Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity 12 no. 2 (2007): 97–100.
Crisafulli, Michele A., Anne Von Holle and Cynthia M. Bulik, “Attitudes Towards Anorexia Nervosa: The Impact of Framing on Blame and Stigma” International Journal of Eating Disorders 41, no. 4 (2008): 333–339.
Crisp, Arthur. “Stigmatization of and Discrimination Against People with Eating Disorders Including a Report of Two Nationwide Surveys” European Eating. Disorders Review 13, no. 3 (2005): 147–152.
Gremillion, Helen. Feeding Anorexia: Gender and Power at a Treatment Center. Durham and London: Duke University Press, 2003.