Eating Disorder Treatment is Broken, and Only Abolition Can Fix It

With a reported increase in eating disorders during the coronavirus pandemic coinciding with the recent Black Lives Matter rebellions bringing abolition into the spotlight, could one be the key to the other?

In 1973, two IRA volunteers began a hunger strike to protest their treatment by the British state, which was to end 208 days later after sustained forced tube feeding by prison authorities. Whilst there were many hunger strikers during the Irish war against British occupation, these two sisters are of particular interest. The hunger strike that they embarked on led to their development of anorexia nervosa, a restrictive eating disorder that leaves sufferers obsessed with food, hunger and weight loss. The experience of the Price sisters seems to unearth a strong and rarely examined link between eating disorders and the carceral state.

It is often said that eating disorders are a way of exerting control over a life that feels uncontrollable, one of the many reasons why there are such high rates of the illness during this time of economic and social precarity. Mirroring the role of policing in society, eating disorders act as an occupying force in the psyche — hypervigilant, menacing and unwelcome. With manifestations of excessive punishment, restriction and isolation, anorexia sufferers are subjugated by their own minds. It is in this respect that the illness can be seen as an internalisation of the complex methods of incarceration, surveillance and policing that constitute the carceral state. This link is not just theoretical — whilst research is scant, one study in the UK found people in women’s prisons twice as likely to develop an eating disorder as other groups. This makes sense when we recognise the eating disorder as a means of control and punishment — perhaps subconsciously it is understood that being in control of your own punishment is preferable to leaving it in the hands of the so-called ‘justice’ system.

None of this is to equate individual eating disorders with the very real violence marginalised communities face at the hands of the state, but instead to demonstrate how our cultural hegemony of punishment pervades all aspects of our lives, including our subconscious. The rise in eating disorders can be strongly linked to racial capitalism’s ability to glorify the very suffering that it creates, seen in the glamorisation of sleep and food deprivation as honourable sacrifices for career progression or the ‘perfect body’. A society that encourages self-flagellation and associates pain with achievement is fertile ground for a mental illness that thrives off of punishment and restriction.

A patient at the infamous Bedlam ‘lunatic asylum’ in a restraining device

My introduction into the similarities between the prison industrial complex and eating disorders was my time in a psychiatric hospital for anorexia. Psychiatric institutions have always been another arm of incarceration under the guise of healthcare, something I was to find out very shortly after admission. With features such as having only 15 minutes outside a day, brutal restraints of patients, a constant echo of screams and head-banging, regimented mealtimes, urinating into a jug, being told when you can defecate and shower — the concept of autonomy or dignity is merely a pipedream. With such hopeless conditions, is it any wonder that these institutions don’t work? Just as ‘we don’t fight fire with fire, we fight fire with water’, we can’t fight a punitive disease with punishment, we must fight it with abolition.

But what is abolition? This is a question I find myself pondering often — a few years ago, I would have said it was the abolition of prisons and police, but the more I understand, the more I realise that it is so much wider than that. Abolition is many different things to many different people, a rich tapestry of different world views and experiences coalescing under the shared belief in the value of human life. Abolition is everything. It is a new form of social life that values humans over any amount of property, profit or power. It is international solidarity, reparations, anti-imperialism, community, compassion, liberation, justice, equality and an end to exploitation. It is the understanding that illegality and immorality are not the same, that criminal is a word only ever reserved for society’s most downtrodden. It is red for the workers and green for the planet. It is material, not just theoretical — every niche crevice of life can be seen through an abolitionist lens. Abolition is not some far flung fantasy but a politics we can practice in our everyday lives, our communities and even our eating disorder recoveries. Abolition really is everything.

So, with that being said, we cannot talk about prison and police abolition without understanding the ways in which carceral methods have permeated all areas of our lives. Mass incarceration has paved the way for a hegemony of penalisation, where schools, social workers, mental health nurses and welfare systems maintain a constant air of distrust and retribution. Eating disorders and their treatment models are no different. If we can apply the carceral state’s logic to eating disorders, why not apply an abolitionist approach to eating disorder recovery?

The first step in this is to understand that no one can recover from an eating disorder without abolition. To be truly well again, we must eradicate all aspects of disordered thinking from our diets, minds and lives. However, abolition, as Ruth Wilson Gilmore teaches us, is not just an absence, but a presence. We cannot rely on getting rid of an eating disorder whilst coping with the same circumstances that enabled the illness to develop in the first place. We must also build a treatment model that centres the patient and their complex experiences.

This complexity includes methods of food-based punishment, which can range from food restriction and excessive exercise to binging and purging. Services often only cater to anorexics who are severely underweight (which is not the majority of anorexics), despite the fact that only 8% of eating disorder sufferers are anorexic. The disregard for less ‘desirable’ illnesses, such as binge eating disorder, is perfectly exemplified by the media’s portrayal of the illness. Anorexia has a monopoly on eating disorder representation, portrayed with morbid fascination as an exaggerated diet or desirable suffering. Binge eating disorder does not receive this glamorous treatment, despite being far more prevalent and just as punitive. With uncontrollable binges, organ damage, ignorant services and societal fatphobia, sufferers often face even more barriers to recovery, especially from a medical profession that does not view them as worthy of resources. This directly mirrors society’s view of prisoners, some of whom are deemed ‘legitimate victims’, unfairly targeted by the system, and others who do not deserve our empathy. But this contradictory exceptionalism ignores that the system was built to manufacture and perpetuate injustice. No one deserves an eating disorder, just as no one deserves incarceration.

Whilst crime is treated as the problem in and of itself, instead of as a result of poverty and state abandonment, eating disorders are similarly seen as the primary issue to solve, instead of a symptom of a wider problem. Angela Davis’ quote that ‘prisons don’t disappear social problems, they disappear people’ is only too applicable to psychiatric inpatient facilities and the cosmetic treatment they provide. By treating an eating disorder as the problem, not a symptom, treatment models ignore the complex roots and different manifestations of the illness in different identities, to the detriment in particular of patients of colour, trans patients, disabled and LGBTQ+ patients. The well-intentioned riposte ‘eating disorders don’t discriminate’ is not only meaningless but actively harmful — it is to ignore the significant burden and trauma that comes from living in a society that constantly harasses, violates and dehumanises anybody outside the realm of colonial conformity. In doing this, treatment dismisses its responsibility to cater specifically to different identities and intersections, instead choosing a ‘one size fits all approach’, akin to ‘not seeing colour’. By applying a universal approach to a complex mental illness, treatment perpetuates the very problem it professes to be solving.

On top of this, treatment methods are rooted in fatphobia (which, as Sabrina Stings points out, is a fundamentally anti-Black concept, with no link to health outcomes) and are based on research that was conducted almost entirely on white women. Eating disorders are stereotyped as a ‘woman’s illness’, the borders of that womanhood extending only to white, cisgender, thin and conforming women. This feminisation adds not only to the detriment and stigma of any sufferers who do not fit this category, but enables the dismissal of the deadliest mental-illness as frivolous, narcissistic and ultimately unserious.

Just as Black, Muslim, immigrant, queer, Roma, Traveller and other marginalised communities are made invisible by the carceral state, disappeared into prisons and detention centres, so too are eating disorder sufferers from these same backgrounds. Despite evidence that Black women have some of the highest rates of eating disorders, doctors routinely dismiss their symptoms, following a long medical tradition of undermining Black women’s pain, out of the belief that it is a ‘white woman’s illness’. This invisibility is yet another deliberate, violent manifestation of the racist carceral state.

Just as the police and prisons cannot be reformed without legitimising racist violence, eating disorder services cannot be tweaked without reinforcing current failing, discriminatory practises. If the basic model of treatment reinforces people’s fears and entrenches punishment, it is bound to fail. We need a complete overhaul of current methods, and people’s lives depend on it. We cannot continue to punish mental illness.

So how do we apply abolitionist frameworks to eating disorder treatment methods?

Just as an abolitionist society will seek to eradicate the causes of crime, it will also eliminate many of the reasons that eating disorders develop in the first place. With a transformative approach to justice, victims’ healing will be prioritised, ensuring survivors of trauma have the proper tools to recover healthily without the need for harmful coping mechanisms. A dismantling of racial capitalism will ensure that everyone is provided for, eradicating poverty, food insecurity and financial stress — all triggers of poor mental health. With a society rooted in the politics of liberation, marginalised and previously abandoned communities will be able to empower themselves, creating treatment methods that cater to the complexities and intersections of patients’ lives. In a world where we put people before profit, selective privatised treatment and the ‘diet industrial complex’ will be rendered obsolete. Above all, an abolitionist approach to society focused on community strength and support can tackle the punitive, isolating and individualistic environments in which eating disorders thrive.

Eating disorders have been present throughout history, but it is no coincidence that they are so prevalent in the age of mass incarceration. A psychological manifestation of the destructive society we live in, we can never treat them properly without tackling our collective reverence of punishment.

I invite abolitionists, people with or recovered from an eating disorder, and anyone in between to imagine a world with me where we no longer punish people for sickness or poverty, and instead foster the community care so integral to mental wellbeing. We do not have to do this on our own. Abolition is about envisioning a world beyond the violent restrictions of our everyday life. It’s about collaboration, imagination and community. It’s time we built a society that views punishment as a problem instead of the solution. Abolition, just like eating disorder recovery, starts with the understanding that we all deserve better.

Abolitionist. Twitter: @Roisinminh