HE ZHANG
Professor Linying Li
Beijing Institute of Technology, School of Humanities and Social Sciences
China Women’s Health Network
No. 5 Zhongguancun South Street, Haidian District, Beijing, 100081
Dear Professor Li,
It is my pleasure to write to you.
I am a Chinese student studying for the degree of Master of Arts in Health Humanities at UCL. This term, a course named Applied Medical Anthropology used anthropological knowledge to unravel the veil woven by medical science discourse and lead me step by step to delve deeper into the socialised causes of global health issues and think of more integrated solutions. The learning process was fun and challenging, but it was compounded by a combination of perfectionist personality traits, constant peer pressure and loneliness in a foreign country, which triggered another flare-up of my recurring binge eating disorder that began six years ago. Countless evenings and weekends after high-intensity study, I turned down invitations from friends, holed up alone in my tiny student flat, and ate all the high fat, sugar, and calorie snacks I had bought. The mechanical munching allowed me to escape from the reality of my mixed emotions, but the photos of fit bloggers and celebrities on social media forced me to fight my fears of obesity with intense exercise as I suffered from the pain of food stuck in my throat and stomach. This has been my daily struggle with food and beauty for six years and a similar experience that millions of Chinese girls feel and are ashamed to speak about.
In 2017, a year after repeated binge eating and dieting, I happened to learn from an article that this state belonged to Eating Disorders (EDs). In addition to my Binge Eating Disorder(BED), there are other EDs, Anorexia Nervosa (AN) and Bulimia Nervosa (BN) (Dakanalis et al.,2017, p.721; APA, 2013). Yet, that life-changing article had not been read by more than a hundred people at that time. However, according to the Shanghai Mental Health Centre’s statistics published in 2020, the number of ED emergency department visits in the last five years was approximately three times higher than in the previous five years (Chen et al., 2021, p.102). At the same time, the restricted daily activities and high social network usage caused by the COVID-19 pandemic were affecting people’s emotional health, further increasing the risk of developing EDs (Rodgers et al., 2020, pp.1167-1168). As a significant health threat to women, with a much higher mortality rate than other mental disorders (Arcelus et al., 2011, p.729), EDs warrant our attention. How can we help those who cry out for help or struggle silently? Perhaps the first step is to uncover the real causes of eating disorders.
As a typical representative of a non-Western country, China’s rapid development in recent years has attracted worldwide attention. However, Western culture constantly influences its economic and cultural modernisation, placing a high value on individualism and emphasising personal responsibility in everyday life through methods such as weight control and health management (Klaczynski, Goold & Mudry, 2004, p.308). Meanwhile, the use of media has promoted ideal images of thinness and the negative stereotype of fatness (Greenhalgh, 2016, pp.548-549), which has encouraged individuals to internalise cultural standards of beauty, further influencing the development of EDs (Hausenblas, H.A. et al., 2013, p.179). Diverse body types are dissolving under this uniform division of size and shape of slender appearance. And women’s body practices of becoming thinner are not only a desire to conform to socially constructed gender roles but also a process of the body being re-sculpted to meet today’s narrow aesthetic (Chrisler, 2011, p.609). In conjunction with various social forces, the body becomes a critical element in the maintenance of social inequality (Shilling, 2003, p.111). In the grip of this structural violence, women surrender themselves to a “panopticon” (Foucault, 1979a, cited in Shilling, 2003, p.67) constructed by the intellectual discourse of “thin equals healthy” and the social aesthetic of “women should be thin and beautiful”, fulfilling both social and self-discipline. It is a tyranny of slenderness (Rodgers, 2012, p.29) imposed on women by the patriarchal society, like a noose tied around women (Farmer, 2004, p.315), which in the process of tightening is a way of oppressing them.
In addition, the mainstream media’s complicity with consumerism has always been keenly interested in the forces that shape the experience of the female body (Burke, 2006, p.316). In 1994, when the sudden death of a 14-year-old girl on the street of Hong Kong was dramatised by the media (Watters, 2010, p.58), Anorexia Nervosa, causing death due to losing weight, entered the public sight and was popularised throughout Hong Kong. Since then, the number of people suffering from AN had increased exponentially. The symptoms were becoming closer and closer to the standard Western version of “diet-driven”, opposed to the small number of cases before that could not be explained by distorted self-images of the body. It is no coincidence that 20 years later in mainland China, with its burgeoning media platforms, Bilibili (Zhou, 2019, p.7) and RED (Zhang et al., 2021, p.2), the number of bloggers sharing their experiences of diet-driven Binge Eating Disorders and the science of EDs has grown exponentially, gaining a high volume of views, and the comments sections have been filled with users who claim to have similar symptoms. This does not suggest that people are faking illness, but rather that once an illness is widely recognised and its symbolic meaning is accepted and understood, people can adopt this culturally licensed form of behaviour to express their inner pain that may not yet be clear. EDs are like fast-acting psychotropic ‘opiate’ that allows them to temporarily hide in their private space and time, away from the real pain of life (Eli, 2018, pp.489-490). This lifestyle disease is highly contagious (Seeberg & Meinert, 2020, p. 60) and has infiltrated females through online platforms. Humans are meaning-making creatures, and when we feel tired, frustrated, and powerless, we need an outlet to name and express our emotional experiences. EDs are one such outlet; in other words, disease diagnostic criteria create a pool of illnesses with recognised expressions, and people struggle to recognise that their pain is entitled to be counted as pain and will subconsciously affix those symptoms that can express these purposes. This means that it is even more important to hear the voice that the pain is trying to spill out and understand the signals that the call signs are trying to convey while relieving the symptoms and treating the illness.
Although it is often assumed that fear of obesity is the core cause of EDs, a study of 141 Hong Kong patients with AN showed that it is not the only reason (Lee et al., 2012, pp.691-692). Different individuals with EDs which are used to relieve stress and anxiety, may be influenced by their personalised stressors (BEARDS et al., 2013, p.746). Studies have shown that young women tend to relieve excessive stress by consuming sweet and high-fat foods（Hou et al., 2013, p.64）and that severe negative emotions can also lead to a more pronounced decrease in appetites, such as when dealing with the loss of a loved one or the sickness of a family member(Bennette et al., 2013, p.191). In addition to the effects of emotions, it has been found in studies as early as 10 years ago that the onset of atypical EDs patients is often not caused by a thinness-driven fear of weight or obesity. For example, a report by Lee et al. (1993, cited in Ramacciotti et al., 2002, p. 211), showed that 59% of Chinese patients with anorexia nervosa tended to somatise the expression of non-fat-phobic reasons for food refusal, such as flatulence, loss of appetite, stomach pain, and inability to feel hunger, which may lurk behind cultural differences. The traditional Chinese culture that does not emphasise the explicit expression of personal sensations, preferring instead to choose somatic symptoms that are more socially acceptable as an indirect expression of internal feelings. The unique expression of the same disease in different cultural contexts requires the involvement of anthropological research to reveal the social, cultural, and local causes behind the appearance of such symptoms.
From an anthropological perspective, patients are never isolated, biological individuals. Eli (2016, pp. 80-81) concluded, following an embodied memory analysis of five women with eating disorders, that patients’ narratives of their experiences of illness as a disorder-associated practice, embodied feelings, and reactions, influenced not only by biomedical models but also by the social milieu in which they lived (Lester, 2007, cited in Eli, 2016, p. 80). Thus, anthropologists’ analyses of patients’ identities and embodied experiences can reveal a deeper cultural logic that could lead to EDs, related to socially shared systems of perception and action, unspokenly, and intuitively embedded in patients’ daily practices (Eli & Warin, 2018, p. 447). Sigal Gooldin (2002, cited in Eli, 2016, p. 81) indicates the unique manifestation of the globalised EDs among Israeli adolescents – adhering to the Western culturally-influenced goal of thinness while continuing to make being a ‘responsible’ mother-to-be. Motherhood is considered a symbol of ‘good’ female citizenship in Israeli society and culture (Berkovitch, 1997, cited in Eli, 2016, p. 81), and therefore these patients’ expressions of their feelings about their eating disorders follow the ” logic of practice” (Bourdieu, 1990, cited in Eli & Warin, 2018, p. 447) that embeds the local culture. Bourdieu (1990, pp. 92-93) sees this kind of logic as the result of the interaction of social agents’ perceptions and judgments of the world with the actions and dispositions of agents formed under the influence of the world. It is the anthropological study of listening to patients’ narratives and understanding the experience of illness that can answer the question of how EDs practices and experiences are implicated as a means of long-term survival in cultural values and socio-political processes that transcend the individual patient’s world, and how the structural vulnerabilities that underpin EDs help patients to survive oppressive familial, institutional, and social conditions, not just for pathological reasons.
We want to be seen and understood, to rely on our subjective experiences and reflections to construct everything about ourselves, and now exact physical interventions are trying to replace introspection and meditation, to deconstruct the story of ‘I’ into a bunch of elements: neurotransmitters, chemical elements, molecules, genes. Helping these patients find meaning requires the addition of anthropology to find a more integrated treatment model over and above the existing medical model or the purely psychological model. Biology is fascinating, but it may never explain what psychological conflict feels like, how to deal with the anxieties of one’s existence, much less touch on essential spiritual elements such as freedom and dignity. How can the human tragedy and comedy, those of love, pain, and choice, be merely chemical?
Modern society is moving so fast that we cannot tell if our desires are real. Is the desire for thinness in a thousand different forms of women an inner desire, or is it society’s mainstream value and goal? China’s rapid modernisation process has neglected to examine the structural violence of modern civilisation, and unthinking emulation only turns into cultural self-colonisation. We should embrace everyone in her individuality, not regulate people by gender differences. The struggle of women continues, and counterculture itself is a process of creating a new culture.
Food is neither love nor salvation. Everyone who is struggling with EDs maybe not be perfect, but be unique and deserved to be loved and cherished. We are not to become “men” as defined by male authority, or “patients” as constructed by medical knowledge, or “beauty” as portrayed by the Western media, but Women as defined only by ourselves.
I look forward to your response.
Yours sincerely,
HE ZHANG
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