Distinct and Untamed: Articulating Bulimic Identities
Abstract
Bulimia nervosa and anorexia nervosa are inextricably linked, with substantial clinical and epidemiological overlaps. Yet, while anorexia has been analyzed extensively in medical anthropology, bulimia remains under-theorized. This is, perhaps, because, compared to self-starvation, binge eating presents a logic of practice that is difficult to reconcile with culturally reified notions of self-control, transcendence, and hard work. Thus, although anthropologists have analyzed anorexic subjectivities as imbued with a sense of cleanliness and purity, moral superiority, and heroics, similar analyses have not been extended to bulimic subjectivities; instead, bulimia has been subsumed, as a tangential disorder, into analyses of anorexia. In this paper, I aim to move bulimic identities from the margins to the centre of anthropological analysis. Based on participant narratives, I analyze bulimic identity as articulated by six Israeli women who identified as bulimic and received treatment for bulimia. The women’s narratives show that bulimic identity is aligned with concepts of distinct selfhood. For these women, to be bulimic was to be framed as ‘abnormal’; but this ‘abnormality’, albeit a source of social stigma and shame, held meanings that went beyond pathology. Through the claiming of bulimic identity, the women positioned themselves as untamed, non-conforming subjects, who acted against gendered and classed expectations—and even against the limitations of the body. Their constructions of bulimic distinction highlight the need for anthropological work that situates bulimia not as a footnote to anorexia, but as a structurally and culturally meaningful condition in its own right.
Keywords
Bulimia nervosa Eating disorders Illness narratives Israel Medical anthropologyNotes
Funding
The 2011 phase of the study was funded by the Oxford University Press John Fell Research Fund.
Compliance with Ethical Standards
Conflicts of interest
The author declares that she has no conflict of interest.
Ethical Standards
The study received ethics approval from the University of Oxford’s Social Sciences and Humanities Inter-Divisional Research Ethics Committee (under the auspices of the University of Oxford’s Central University Research Ethics Committee) in 2005 and 2011, and ethics approval from an Israeli Kupat Holim (health care) fund Helsinki ethics committee in 2005 (Helsinki ethics approval was not needed in 2011). Informed consent was obtained from all individual participants included in the study. All procedures performed in the study were in accordance with the ethical standards of the University of Oxford’s Central University Research Ethics Committee and the Kupat Holim Helsinki ethics committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
References
- Alpers, Georg W., and Brunna Tuschen-Caffier 2002 Negative Feelings and the Desire to Eat in Bulimia Nervosa. Eating Behaviors 2(4): 339–352.CrossRefGoogle Scholar
- American Psychiatric Association 1987 Diagnostic and statistical manual of mental disorders, third edition, revised (DSM-III-R). Washington, D.C.: American Psychiatric Publications, Incorporated.Google Scholar
- American Psychiatric Association 2013 Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Washington, D.C.: American Psychiatric Publications, Incorporated.CrossRefGoogle Scholar
- Birenbaum-Carmeli, Daphna 2001 Between Individualism and Collectivism: The Case of a Middle Class Neighbourhood in Israel. International Journal of Sociology and Social Policy 21(11/12): 1–25.CrossRefGoogle Scholar
- Bordo, Susan 2003 Unbearable Weight: Feminism, Western Culture, and the Body. London: University of California Press.Google Scholar
- Bourdieu, Pierre 1984 Distinction: A Social Critique of the Judgement of Taste. Harvard, Harvard University Press.Google Scholar
- Braun, Virginia and Victoria Clarke 2006 Using Thematic Analysis in Psychology. Qualitative Research in Psychology 3(2): 77-101.CrossRefGoogle Scholar
- Brooks, Anna, Amanda LeCouteur, and Julie Hepworth 1998 Accounts of Experiences of Bulimia: A Discourse Analytic Study. International Journal of Eating Disorders 24(2): 193–205.CrossRefGoogle Scholar
- Broussard, Brenda B. 2005 Women’s Experiences of Bulimia Nervosa. Journal of Advanced Nursing 49(1): 43–50.CrossRefGoogle Scholar
- Burns, Maree 2004 Eating like an Ox: Femininity and Dualistic Constructions of Bulimia and Anorexia. Feminism & Psychology 14(2): 269–295.CrossRefGoogle Scholar
- Churruca, Kate, Jane M. Ussher, and Janette Perz 2016 Just Desserts? Exploring Constructions of Food in Women’s Experiences of Bulimia. Qualitative Health Research: 1049732316672644.Google Scholar
- Dias, Karen 2003. The Ana Sanctuary: Women’s Pro-Anorexia Narratives in Cyberspace. Journal of International Women’s Studies 4(2): 31-45.Google Scholar
- Eddy, Kamryn T., David J. Dorer, Debra L. Franko, Kavita Tahilani, Healther Thompson-Brenner, and David B. Herzog. 2008 Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa: Implications for DSM-V. American Journal of Psychiatry 165(2): 245-250.CrossRefGoogle Scholar
- Eddy, Kamryn T., Pamela K. Keel, David J. Dorer, Sherrie S. Delinsky, Debra L. Frando, and David B. Herzog. 2002 Longitudinal Comparison of Anorexia Nervosa Subtypes. International Journal of Eating Disorders 31(2): 191–201.CrossRefGoogle Scholar
- Eli, Karin 2014 An Embodied Belonging: Amenorrhea and Anorexic Subjectivities. Medicine Anthropology Theory 1(1): 53-80.Google Scholar
- Eli, Karin 2015 Binge Eating as a Meaningful Experience in Bulimia Nervosa and Anorexia Nervosa: A Qualitative Analysis. Journal of Mental Health 24(6): 363-368.CrossRefGoogle Scholar
- Eli, Karin 2016 ‘The Body Remembers’: Narrating Embodied Reconciliations of Eating Disorder and Recovery. Anthropology & Medicine 23(1): 71-85.CrossRefGoogle Scholar
- Eli, Karin forthcoming Striving for Liminality: Eating Disorders and Social Suffering. Transcultural Psychiatry.Google Scholar
- Elran-Barak, Roni, Maya Sztainer, Andrea B. Goldschmidt, Scott J. Crow, Carol B. Peterson, Laura L. Hill, Ross D. Crosby, Pauline Powers, James E. Mitchell, and Daniel Le Grange 2015 Dietary Restriction Behaviors and Binge Eating in Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder: Trans-Diagnostic Examination of the Restraint Model. Eating Behaviors 18: 192–196.CrossRefGoogle Scholar
- Fairburn, Christopher G., Zafra Cooper, and Roz Shafran 2003 Cognitive Behaviour Therapy for Eating Disorders: A “Transdiagnostic” Theory and Treatment. Behaviour Research and Therapy 41(5): 509–528.CrossRefGoogle Scholar
- Fox, Nick, Katie Ward, and Alan Orourke 2005 Pro‐Anorexia, Weight‐loss Drugs and the Internet: An ‘Anti‐Recovery’ Explanatory Model of Anorexia. Sociology of Health & Illness 27(7): 944–971.CrossRefGoogle Scholar
- Gooldin, Sigal 2008 Being Anorexic. Medical Anthropology Quarterly 22(3): 274–296.CrossRefGoogle Scholar
- Gremillion, Helen 2003 Feeding Anorexia: Gender and Power at a Treatment Center. London: Duke University Press.CrossRefGoogle Scholar
- Guilfoyle, Michael 2001 Problematizing Psychotherapy: The Discursive Production of a Bulimic. Culture & Psychology 7(2): 151-179.CrossRefGoogle Scholar
- Hepworth, Julie 1999 The Social Construction of Anorexia Nervosa. London: Sage.Google Scholar
- Heywood, Leslie 1996 Dedication to Hunger: The Anorexic Aesthetic in Modern Culture. London: University of California Press.Google Scholar
- Katriel, Tamar 1988 Gibush: A Study in Israeli Cultural Semantics. Anthropological Linguistics 30(2): 199–213.Google Scholar
- Katz, Gideon 2009 The Secular Hero: The Spirit of Individualism in the Israeli Discourse about Secularism. Journal of Modern Jewish Studies 8(2): 133–149.CrossRefGoogle Scholar
- Lafrance, Michelle N., and Suzanne McKenzie-Mohr 2013 The DSM and its Lure of Legitimacy. Feminism & Psychology 23(1): 119-140.CrossRefGoogle Scholar
- Lavis, Anna 2011 The Boundaries of a Good Anorexic: Exploring pro-Anorexia on the Internet and in the Clinic. Unpublished doctoral dissertation. Goldsmiths, University of London.Google Scholar
- Lavis, Anna 2014 Alarming Engagements? Exploring Pro-Anorexia Websites in/and the Media. In Obesity, Eating Disorders and the Media. Karin Eli and Stanley Ulijaszek, Eds. Farnham: Ashgate, 11-36.Google Scholar
- Lavis, Anna 2016 A Desire for Anorexia: Living through Distress. Medicine Anthropology Theory 3(1): 68-76.Google Scholar
- LeBesco, Kathleen 2004 Revolting bodies?: The struggle to redefine fat identity. Amherst, University of Massachusetts Press.Google Scholar
- Lester, Rebecca 1997 The (Dis) Embodied Self in Anorexia Nervosa. Social Science & Medicine 44(4): 479–489.CrossRefGoogle Scholar
- Lester, Rebecca 2007 Critical Therapeutics: Cultural Politics and Clinical Reality in Two Eating Disorder Treatment Centers. Medical Anthropology Quarterly 21(4): 369–387.CrossRefGoogle Scholar
- Lester, Rebecca 2014 Health as Moral Failing: Medication Restriction among Women with Eating Disorders. Anthropology & Medicine 21(2): 241–250.CrossRefGoogle Scholar
- Mitchell, Allyson 2005 Pissed off. In Fat: The Anthropology of an Obsession. Kulick, Don and Meneley, Anne, Eds. New York: Penguin: 211–225.Google Scholar
- Murphy, Rebecca, Suzanne Straebler, Zafra Cooper, and Christopher G. Fairburn 2010 Cognitive Behavioral Therapy for Eating Disorders. Psychiatric Clinics of North America 33(3): 611-627.CrossRefGoogle Scholar
- Musolino, Connie, Megan Warin, Tracey Wade, and Peter Gilchrist 2015 “Healthy Anorexia”: The Complexity of Care in Disordered Eating. Social Science & Medicine 139: 18-25.CrossRefGoogle Scholar
- Noy, Chaim 2004 This Trip Really Changed Me: Backpackers’ Narratives of Self-Change. Annals of Tourism Research 31(1): 78–102.CrossRefGoogle Scholar
- O’Connor, Richard A., and Penny Van Esterik 2015 From Virtue to Vice: Negotiating Anorexia. Oxford: Berghahn Books.Google Scholar
- Owen, Lesleigh J. 2015 Monstrous Freedom: Charting Fat Ambivalence. Fat Studies 4(1): 1-13.CrossRefGoogle Scholar
- Oyserman, Daphna 1993 The Lens of Personhood: Viewing the Self and Others in a Multicultural Society. Journal of Personality and Social Psychology 65(5): 993.CrossRefGoogle Scholar
- Pausé, Cat 2012 Live to tell: Coming Out as Fat. Somatechnics 2(1): 42-56.CrossRefGoogle Scholar
- Sasson-Levy, Orna 2008 Individual Bodies, Collective State Interests: The Case of Israeli Combat Soldiers. Men and Masculinities 10(3): 296–321.CrossRefGoogle Scholar
- Scheper-Hughes, Nancy, and Margaret M. Lock 1987 The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology. Medical Anthropology Quarterly 1(1): 6–41.CrossRefGoogle Scholar
- Shohet, Merav 2007 Narrating Anorexia: “Full” and “Struggling” genres of Recovery. Ethos 35(3): 344–382.CrossRefGoogle Scholar
- Squire, Sarah 2002 The Personal and the Political: Writing the Theorist’s Body. Australian Feminist Studies 17(37): 55-64.CrossRefGoogle Scholar
- Squire, Sarah 2003 Anorexia and Bulimia: Purity and Danger. Australian Feminist Studies 18(40): 17–26.CrossRefGoogle Scholar
- Thompson, Becky Wangsgaard 1992 “A Way Outa No Way”: Eating Problems among African-American, Latina, and White Women. Gender & Society 6(4): 546–561.CrossRefGoogle Scholar
- Warin, Megan 2010 Abject Relations: Everyday Worlds of Anorexia. London: Rutgers University Press.Google Scholar
- World Health Organisation 1992 The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.Google Scholar