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An interview with two eating disorder specialists

From Radiance Winter 1992

The information that follows was compiled by Radiance senior editor Catherine Taylor from telephone conversations with Debby Burgard, Ph.D., and Michael Horne, M.D., on the topics of food, self-esteem, body image, and the movie Eating.

Debby Burgard, Ph.D.

DEBBY BURGARD, Ph.D.,is the co-author (with Pat Lyons) of Great Shape: The First Fitness Guide for Large Women. She works as a therapist in Palo Alto, California.

As a therapist who sees people with eating disorders, I'm used to hearing women talk about their problems with food. But seeing the women in the movie Eating, who supposedly represent everyday women in their everyday struggles, made me sad. There is a great deal of pain out there.

The women in the film speak in a confessional way about feeling out of control with food. Most people seem to focus on the bingeing phase of the binge-restrict cycle as the problem. Perhaps this is because our culture values the illusion of being "in control." But the restriction phase is just as much the problem. Some women in the film feel so driven to get food that they even sleepwalk and eat in the middle of the night. This is seen as an emotional problem, but it may actually be the physiological result of struggling to stay below one's genetic weight. This was suggested by the Keys study during World War II, which found that when psychologically healthy men were forced to eat half their usual rations and lose 25 percent of their body weight, they behaved much like the characters in Eating. They were miserable and obsessed with food.

The obsession with food may be a normal, healthy response to starvation. The question then becomes, Why is it so important to so many people that women starve? When you ask people what they associate with being thin, they talk about feeling "together," "in control," "emotionally self-sufficient," not being "needy." When a woman wakes up and looks in the mirror and says she feels "fat," other women know exactly what she means, even though "fat" is not a feeling. It means she feels vulnerable, unattractive, depressed. Even though we all feel that way sometimes, women are told that if we just melt or carve away every last bit of that offending substance, fat, we'll be free of our negative feelings.

As a therapist, I see what happens between some women and men struggling with these issues as an enactment of a self-fulfilling prophecy. Some women fear that their needs are "too much" and will overwhelm the men in their lives. And some men do feel overwhelmed. Therefore a woman may keep her needs private. She may not be clear about how to get her needs met, or may be pessimistic about her partner's ability to satisfy her needs. Food can become a substitute, a reliable short-term way of being soothed. But because the need is not really for food, it doesn't work. No amount of food can satisfy a hunger for connection with another person.

Therefore the woman remains unsatisfied, confirming the fear that she can never be satisfied, and that her neediness and appetites are dangerous and about to fly out of control.

If instead of keeping her needs hidden in the kitchen, she brought them to the relationship, she might find that her partner would not be overwhelmed and that in fact, interdependence between people creates the opportunity for intimacy. But she'd have to risk disappointment to do this. Whatever happened would be genuine, instead of being a drama about eating.

I believe that most people want intimacy. But it can happen only when a person is her authentic self. When women try to make themselves what they think men want (a thin, controlled, undemanding partner), men who want real intimacy are stymied. Neither person is satisfied, and the woman often ends up thinking she just didn't control herself well enough.

All of this is about the tension between being yourself and being connected with other people. I like that the movie ends with one woman saying she needs to be by herself and the other saying she is ready to share with others. There's no pat answer about how to work this out. Some of us will need to clear the decks of distractions to be able to see who we really are, and some of us are going to learn about ourselves only through making connections with others.

For political reasons, we in the size acceptance movement have avoided the subject of food, partly in order to break the mistaken association of fat with overeating. It's one of the most tenacious myths around, a "data-resistant" belief. Research shows us that fat people do not eat differently from thin people, but fat women are often assumed to have eating disorders, whether it is true or not. The I'dea is that if one eats "healthfully," one will have a culturally approved body size and shape. But this is rarely a body's agenda.

All women are bombarded by the demand to be thin. This makes us vulnerable to the weight-loss industry's products. We'd give up on other products if they didn't work, but we keep buying weight-loss products because we blame ourselves when diets don't work. But some women are breaking out of this trap. My own research (see Radiance, Fall 1991) shows that fat women can accept themselves as they are, and that a woman's weight doesn't have to determine her level of self-esteem.

I think the most productive thing to come out of a movie like Eating is that it helps women become less isolated. They may realize that this isn't just a personal problem and that it's about more than food or being thin.

I do wonder how the movie might have been different if it had been made by a woman. I sensed that the women in the movie were trying to describe something to someone who hadn't experienced it. Some people have objected to the film's portrayal of women, saying that the characters seem vain and obsessed; others have argued that it accurately shows the pain of food obsession. I know many women who have worked through this pain, and I would have liked to have seen more of the recovery process in this film. The women in the film express their pain-they act out the drama of food and eating-but most of them remain caught in the substitute world of weight and food obsession, where their true needs cannot be met. ©

Michael Horne, M.D.

MICHAEL HORNE, M.D., is a psychiatrist and the medical director of Woodside Women's Hospital in Redwood City, California.

The simplest definition of an eating disorder is a fear of being fat carried to an extreme. A bulimic person binges, becomes terrified of being fat, and throws up. An anorexic doesn't eat. Most of the women in the movie Eating weren't pathological enough to be diagnosed as having eating disorders. Most of them had food preoccupations.

Enjoying food, wanting to eat more of what is tasty, and then feeling that one has overindulged is a common experience for all of us. But the eating disorder person doesn't want the food; she wants the symbol of the food. Food symbolically fills up the emotional hole inside. When it gets filled, she then feels guilty and ashamed about it. She imagines that the food has turned into fat, and she wants to purge herself of the fat by throwing up or using diuretics or laxatives. For this person it's not just a matter of "Oh, I ate too much. I'd better not eat as much or I'd better exercise more tomorrow," but "I'm fat and that's awful." In recent years eating disorders have reached epidemic proportions. I think this is because women are experiencing a transition in gender roles in a society where the male culture is still dominant. By the broadest definition, male culture is concerned with activities involving independence and competition, and female culture is concerned with activities involving intimacy and relationships. Women are supposed to take care of everyone else. Men are socialized to be independent and selfish. It's unmanly to pay attention to other people; you have to get ahead on your own. Men have trouble with intimacy; women have trouble with their self-assertion. That's the two poles, of course. Ideally, men and women are able to be both independent and intimate. Both are human activities.

Because the male culture dominates in the work world, women are finding themselves trying to become assimilated into that culture, rather than seeing their own culture become equal. Women's values are being considered in some places, but in general, women's personal needs are not seen as legitimate. Many women are experiencing strong conflict between their needs for intimacy and connection and the requirements that they behave independently and competitively.

Food is one substitute for working through this conflict. This rash of eating disorders is a symptom that the process of integrating masculine values and feminine values into our culture is being attempted but is still not complete. Another symptom, I believe, is the backlash-in violence against women, in pornography, and in sexism in popular music-by men who are afraid of women's culture encroaching on them. The men's movement is the positive response to the gender changes that are in progress.

You might still ask why women are expressing this struggle through their relationship to food. Food and body image are intertwined with women's development from a very early age. Women use food from the minute they begin to be socialized. Women are the food preparers in society, and the food givers. Food is like a currency for women; it's something they can control. They even control it through their bodies, as mothers feeding infants. In addition, throughout history and even today, women's bodies are much more symbolic than men's bodies are. Women have been valued for their bodies: as sex objects, as mothers, and as objects of beauty. Women with eating disorders tend to put themselves down, as we could see in the movie. They are often in relationships where they have all the talents and skills in the world, but they defer to the man. They frequently are very ambivalent about men. You can see this also in the mothers of eating disorders patients. Mrs. Williams (Candice Bergen), the mother of Helene (Lisa Richards), is a classic example of the woman putting herself second. She makes statements such as, "I maintained my marriage. I knew he was philandering, but I put up with it." That's a very typical thing to hear from mothers of eating disorder women. The daughters are trying to break out of that pattern, but they haven't been able to break out completely. They still aren't comfortable being independent in their own person. In the last scene of the film Helene is starting to say, "I don't need a man." This isn't necessarily about being with a man; it's about being your own person and about learning to be independent without sacrificing intimacy. In the same scene, Martine (Nelly Alard) realizes she can have her needs for intimacy met without feeling guilty, which is the other challenge many women face. So from a therapist's point of view, this movie has a very happy ending. �

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