First Steps Toward a Draft

Here is the beginning material for the middle of my thesis (why write sequentially?!). I'll be editing this post as I write more!

            Marya Hornbacher’s Wasted: A Memoir of Anorexia and Bulimia amounts to what she claims “cultural heresy” (5). It is through her analysis of both her eating disorder and what it takes to recover from an eating disorder that she violates long-standing ideas about femininity and wellness and embraces a clinical picture of her disorder that encourages her to say, “I will eat what I want and look as I please and laugh as loud as I like and use the wrong fork and lick my knife” (5). Much of what Hornbacher accomplishes in the memoir (or attempts to accomplish) – most notably, a clinical caricature of the eating-disordered patient and a rejection of cultural standards in favor of biological health – stems from her interchangeable usage of first-, second-, and third-person voices, all of which aim to shed light on the texture of eating disorders as both mental illness and cultural phenomenon. The memoir never settles on a distinct pronominal “I.” Rather, the text speaks to “you”, the reader(s); to “us” or “we,” the eating-disordered collective or community; “her” or “them,” the eating-disordered individual(s); or about “I,” the ostensible bearer of the narrative who only seems to surface when particular details of the life in question are too specific to be attributed to “you” or “us” or “her.”

            Because the pronominal switching occurs regularly throughout the memoir with a fairly consistent pattern, it is impractical to take the entirety of the work into close analysis. Thus, I will examine a few passages in which this pronominal switching is particularly important and apparent, and I will ask my readers to take these selected passages as evidence as to the structure of the rest of the memoir.

            My first passage of concentration occurs early in the memoir, in the introduction, to evidence just how quickly Hornbacher delves into the inherent structure of her memoir. In her first description of the cognitions and cultural influences behind eating disorders, Hornbacher writes,

[An eating disorder] is . . . an attempt to find an identity, but ultimately strips you of any sense of yourself, save the sorry identity of “sick.” It is a grotesque mockery of cultural standards of beauty that wind up mocking no one more than you. It is a protest against cultural stereotypes of women that in the end makes you seem the weakest, the most needy and neurotic of all women. It is the thing you believe is keeping you safe, alive, contained . . . An eating disorder is in many ways a rather logical elaboration on a cultural idea. While the personality of an eating-disordered person plays a huge role – we are often extreme people, highly competitive, incredibly self-critical, driven, perfectionistic, tending toward excess - . . . I do believe that the cultural environment is an equal . . . culprit in the sheer popularity of eating disorders. . .  I chose an eating disorder. I cannot help but think that, had I lived in a culture where “thinness” was not regarded as a strange state of grace, I might have sought out another means of attaining that grace, perhaps one that would not have so seriously damaged my body, and so radically distorted my sense of who I am (6-7).  

By page six, Hornbacher has already assigned herself, an eating-disordered individual, or even “you” an unsteady narrative identity. Her claim that the consequences of her eating disorder “radically distorted my sense of who I am” (7) create the space for her to oscillate between narrative identities, allowing her to become, by turns, the patient, the feminist, or the pedestrian onlooker all contained within one memoric self.

            Traditionally speaking, autobiography, and by extension, the memoir, contain the life narratives of one singular person. By using multiple pronouns to tell her narrative, Hornbacher challenges this traditional sense of memoir, embracing instead what Jelinek describes as “a multiplicity of selves” within a feminine autobiographical text. In the passage above, Hornbacher extends her experience to the reader by asking “you” to emotionally empathize with the consequences of distorted eating-disordered cognitions. Hornbacher does not write, “I felt safe in my eating disorder;” she instead couples “you” with the words, “safe,” “alive,” and “contained” (6), assuming that her audience will emotionally identify with her experience, thus supporting and extending Butler’s idea of precarity – that personal identity hinges upon the identities of others. By creating emotionality as a shared experience and emphasizing emotional identification between individuals (here, between “I” and “you,” the supposed reader), Hornbacher allows emotionality itself to become a shared narrative, thus inviting multiple identities – her identities and those of her readers – into her work in an act defiant of the tradition of her genre.

            Hornbacher’s “you” serves not only to further multiplicity in her work, however. Here, the “you” also extends the “disabling” cognitions of having an eating disorder to the  “non-disabled” majority. In the above passage, “you” is used empathetically. The pronoun is meant to allow readers to step into the shoes of an eating-disordered individual, to explore the cognitions and the unarticulated emotions that come with those cognitions. Here, it is not Hornbacher or a woman in inpatient treatment who seems the “most weakest” (6) – it is “you.” The reader is asked to become an anoretic, to adopt the “sorry identity of ‘sick’ ” (6). Further, by paralleling this implicit request of the reader to become eating-disordered (or to at least empathize with an eating-disordered individual) with a brief mention of the “cultural standards of beauty” (6) that reinforce eating-disordered behavior, Hornbacher implies what McDermott and Varenne argue in “Culture as Disability” – that culture, in its constructed-ness, creates room for the social construction of disability to exist. Because Hornbacher invites her audience to identify with disability by using “you,” she indicates that because her readers are ostensibly of the same society with similar disabling features of that society in their lives, they thus have the ability to experience disability in the same way.

            Though Hornbacher invites her readers into disability with “you,” she simultaneously turns and pushes them away with her use of “we.” Throughout her memoir, she draws the picture of an eating-disordered community – in her words, a group of “extreme people” (6) whose intensity feeds not only into their athletic, creative, occupational, and academic lives, but into “perfecting” their eating disorder. Professor Amy Neeren of Haverford College says that in her clinical practice, she sees a tendency of eating-disordered individuals to compete with each other. They want to be the “best” at having the eating disorders. They want to be the thinnest, eat the least, and, most notably, they want to exclude others from their community. As Hornbacher implies, outsiders (those without eating disorders) cannot understand “us.” Outsiders do not combine self-criticism and perfectionism with self-starvation or purgation. Outsiders do not “[attain] grace” (7) in the self-destructive and difficult-to-maintain way that “true” eating-disordered individuals can. In using “we,” Hornbacher pushes against her own idea of empathy with her readers, excluding outsiders from her elite community, and clearly drawing a line between those with her disability and those without. Eating disorders, by use of “we,” are then treated as an abnormal response to the collective culture in which “you all” live. “You” might be affected by the disabling cultural ideals that catalyze disordered eating, but “you” do not have something – the personality, the family climate, the sheer drive – that maintains eating disorders. Thus, “you” are excluded from “we.”

            As the passage continues, Hornbacher narrows the experiential component of her narrative even more, finally settling momentarily on “I” to describe her own particular experience. Though the “I” of this passage stands in contrast to the “I” in the majority of the memoir, it is worth analyzing the agency that the “I” gives her here, at the start of the memoir. Here, the “I” denotes the kind of agency that, clinically, is not supposed to be present in the development of an eating disorder. By stating, “I chose an eating disorder” (6), Hornbacher implicitly indicates an active choice, as if she had surveyed the field of vices from which she could choose and found an eating disorder to be the most suitable. (It is worth noting that Hornbacher reports experimenting with a plethora of negative behaviors in her adolescent years, including but not limited to promiscuity, illicit drug use, and self-mutilating behaviors.) Though it is indeed possible that Hornbacher actively rejected other vices in favor of an eating disorder, it is unlikely given clinical evidence that individuals slowly fall into patterns conducive to eating disorders. Thus, Hornbacher’s “I” here may represent the irrational sense of control associated with eating disorders. By using an irrational “I” and following the declaration of that flawed “I” with stating that her eating disorder “radically distorted my sense of who I am” (7), Hornbacher constructs the effects of her “rather logical elaboration on a cultural idea” (6) as pathological and disabling. A causal relationship between culture (in which “you” live) and a delusional, disabled “I” is established, thus linking the “you” to “I” and connecting her pronouns circularly.

            We see a shift in the nature of Hornbacher’s “I” as the memoir continues, though. No longer is the “I” decisive and forceful. Instead, it is momentary and visceral, cataloguing what are usually the more mundane moments of the life the memoir is supposedly chronicling. In the passage that follows, Hornbacher again uses pronouns interchangeably yet skillfully, but does so with slightly different effects than in the previously-analyzed passage:

You go insane about now. You understand, it just happens. Crazy isn’t always what they say it is. It’s not always the old woman wearing sneakers and a skirt and a scarf, wandering around with a shopping cart, hollering at no one, nothing, tumbling through years in her head . . . No. Sometimes it is a girl wearing boots and jeans and a sweater, arms crossed in front of her, shivering, wandering through the streets at night, all night, murmuring to no one, nothing, tumbling through the strange unreal dimensions in her head. . . Bedtime, and the house falls darker still. I sit at the window, waiting for the mutterings and shufflings to stop. . . I hold the back of the chair with one hand, do exercises endlessly, waiting for one o’clock. Only four hours till morning, I think. (171-172).

A Brief Introduction to the Wondrous Field of Medical Humanities (Not to Be Confused With Disabilities Studies)

I'm going to begin this post with a description of "the medical humanities" put out by the NYU School of Medicine: 


"We define the term "medical humanities" broadly to include an interdisciplinary field of humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. The humanities and arts provide insight into the human condition, suffering, personhood, our responsibility to each other, and offer a historical perspective on medical practice. Attention to literature and the arts helps to develop and nurture skills of observation, analysis, empathy, and self-reflection -- skills that are essential for humane medical care. The social sciences help us to understand how bioscience and medicine take place within cultural and social contexts and how culture interacts with the individual experience of illness and the way medicine is practiced."


Though there doesn't seem to be any one-stop shop for a concrete definition of "medical humanities" (Wikipedia agrees with me), after perusing the medical humanities (heretofore referred to as "MH") sections of various medical school websites and from the Association for the Medical Humanities blog, I've come to conceptualize the field in the following ways:

- MH tries to introduce a new kind of critical thinking to medical cases. It situates them in a sociocultural context and looks beyond pure physiology (and individual psychology) in searching for a diagnosis. MH asks, "What's going on in the larger community? In the world? How might that impact not only this particular patient's diagnosis, but his interpretation of his illness and his outlook on the same?

- On a larger scale, MH asks what will happen to the practice of medicine in the context of developing political and cultural issues.

-MH is concerned with patient identity before, during, and after illness. How does illness change a person? And how might a physician be sensitive to that change?

- MH seems more willing to explore alternative therapies for illnesses.

-MH looks toward greater physician empathy through deep analysis of a patient's condition and mental status.

- MH considers the representation of illness in narratives, art, etc. How does such representation affect how we define an illness and, more importantly, how we define those affected with that particular illness?

- Finally, and perhaps most prominently, MH is concerned with the ethics of healthcare - what do providers, as humans, owe to their fellow humans? how should patients be treated not only on a political level, but an emotional one? how great of an understanding must a care provider have of both patient and illness before, during, and after treatment?

MH tries to change our attitudes towards healthcare from within the medical community. The field isn't necessarily trying to change the classification or practice of healthcare itself - it's trying to reconstruct how we go about giving care in a humane way and how we narratively describe that care and the patients it affects. MH isn't so much concerned with challenging the given definitions of illness - to it, breast cancer is breast cancer is an illness is a disability - but rather how illness is represented. Illness, and by extension, disability is a given, and the social constructions that give rise to disabilities aren't questioned - they are simply and implicitly accepted as present.

And this is where MH deviates from DS. DS questions the structures that give rise to disability. It asks us to reform our definitions of illnesses where MH only asks us to represent them in a more empathetic way. DS isn't looking to change things from within the medical field - it is looking to challenge the roots of disability as we know it, asking the larger population and the medical population to consider redefinition - not reframing.

I'm wondering now if Hornbacher's memoir is swinging between two representations of illness and women - the MH representation and the DS representation. The MH representation seems to lie in the plethora of clinical literature used to describe the eating disorder, and in how that clinical literature is twisted to fit one particular case study. The DS representation, by contrast, seems to be situated in the multiple selves of Jelinek. These "selves" say, "Here's another way of looking at eating disorders. Here's something that doesn't fit. And, most importantly, here's a way that we've constructed the feminine condition as a disability and that, perhaps, eating disorders are just extensions of the disabled feminine ideal."

I think it will be interesting to further examine where feminist studies, women's autobiography, DS, and MH all fit together. I don't have the greatest grasp on the connection between these fields now, but hopefully in my next posts, I'll be able to fit the puzzle together.

More on Judith Butler, More of Me Resisting Judith Butler

Given my general reluctance to read straight theory, my thesis advisor kindly found a handout called "Butler for Beginners" that neatly sums what Judith Butler has to say about gender performativity without all of the lofty academic-speak. I'm not going to get deeply into Butler's theory, but let it suffice to say that Butler basically says that a) gender and sex are constructed and b) it is through repetition and performance that we take on a gender role. Obviously, Hornbacher, by attempting to conform to cultural standards of femaleness by starving and binging/purging, constructed herself as female by her behaviors, but I'm reluctant to say that that fact is significant in the context of my thesis. I don't think Hornbacher's eating disorder or life story has so much to do with engendering herself as it has to do with being engendered. Because she was treated "female", she acted female, and an eating disorder ultimately resulted (I'm simplifying things too much here). I'm not sure that by repeatedly performing as female she constructed herself as a woman and, as a woman, then performed a traditionally female illness by having an eating disorder.

Maybe I'm being too resistant to the thought that gender performativity could cause eating disorders (or maybe I'm misinterpreting things), but I just don't think the hows and whys about how gender develops in the first place have much to do with the work I'm trying to do (what work is that?).

Disabling Culture, Multidimensional Disorder?

I just finished reading an article by McDermott and Varenne that my advisor has been trying to get me to read since before winter break and that I, in my inherent pseudo-laziness, have failed (until now) to look up. The title of the article is "Culture as Disability," and it goes on to argue that culture, in its constructed-ness, creates both opportunity (able-ing) and disability (disabling). When a culture decides something is "good" or "favored" it also implicitly identifies whatever is opposite of that "good" or "favorable" thing as un-useful, unnecessary, or even disadvantageous.

The article mainly focuses on disability as what happens when one doesn't conform to culture. For example, a person in a wheelchair isn't considered disabled until he is unable to surmount a curb. Similarly, a child who is dyslexic is considered disabled only when he cannot engage in the culturally constructed practice of reading text. What the article fails to consider (and what I am most interested in), however, is what happens when culture has it so that extreme conformation is also labeled disability. Hornbacher writes of a social etiology of her eating disorder. She talks about how we've developed a culture that worships thinness as a sign of beauty, intelligence, positive personality, and self-control. But what happens when, in an effort to conform, we surpass the line between beautiful and enter into the realm of emaciation? It would here seem that for eating disorders, culture reinforces negative behaviors and only when those negative behaviors reach a certain point (determined by what? - degree of malnutrition? medical problems? destroyed interpersonal relationships?) are they collectively labeled "disabling."

Eating disorders oppose what McDermott and Varenne argue. In "Culture and Disability," difference exists and then culture pathologizes it. With eating disorders, as Hornbacher points out, culture reinforces conformation and then pathologizes its own "ideal" for being too extreme. So what do we do when culture itself is disability - when it does not simply create disability by exclusion? Perhaps the idea that "cultures actively organize ways for persons to be disabled"(see subsection, "Culture as Disability Approach") is more accurate than talking about how culture creates disability by exclusion. If culture creates ways by which we may find disability - whether that disability arise from exclusion, like learning disabilities, or inclusion, like an eating disorder - perhaps thinking as culture itself as disabling is useful.

I'm not sure where McDermott and Varenne fit in with Price, Butler, Jelinek, and Nereen, but I'm also not sure if they necessarily need to fit in with my other theorists. If, like Jelinek points out, women are multidimensional, can't I view an eating disorder as multidimensional? Maybe I'll view the woman with the disorder in a multidimensional way, and I'll also think of the eating disorder itself (since clinical literature shows that ED's have been personified, e.g. "ana" and "mia") in a multidimensional way as well. ED's are the result of a combination of factors, and perhaps one lens through which to view them (apart from the psychological lenses and the pseudo-literary lenses with which I've been working) is through McDermott and Varenne's anthropological lens.

Ouch My Head Hurts From Thinking, but I Think This is Productive

A couple of months ago (before break), I examined a chapter in Jelinek's book, Women's Autobiography, which explored the idea that nonlinear, fragmented narratives give a more accurate picture of a progressive, multidimensional woman "in the context of a fragmented political world" (source: Me, about two months ago). Thus, following Jelinek's logic, the "we" - a pronoun that I took, in the context of Hornbacher's work, to reflect dis-ownership of one's experience and an overall unhealthy, un-recovered worldview - could actually accurately represent the female condition, and could allow a woman using the pronoun "we" to describe her own unique experience to explore all of the facets of her multidimensional self. This would seem a productive lens through which to examine Hornbacher - she has a distinctly feminist bend in her memoir, and memoir, as Jelinek pointed out, is the way in which women's autobiography is headed (it tells one's story as it progresses; it doesn't tell a narrative in retrospect) - but given that Hornbacher's memoir cannot be examined without an eye to the psychiatric condition with which she wrestles (or, at least I'm not keen on ignoring the clinical lens through which her memoir can be interpreted), I'm not sure that labeling her "we" as productive and healthy is something I'm willing to do. 

On the flip side of Jelinek's "we" is the "we" delineated by my abnormal psychology professor, Amy Nereen. Nereen's "we" is totally clinical and totally non-positive. Here, the "we" more closely resembles what I initially thought when I came across it when first reading Hornbacher's memoir - that "we" represents an unhealthy way of pushing other people out, closing oneself to empathy, resisting developing an integrated, functional personal identity. Nereen pointed out that "we" may be representative of an ingrained behavior (in this case, an eating disorder) that the individual validates through a collective community and that, because it is validated, is not open to outside change. Thus, the feminist "we" of Jelinek's female autobiographers may instead, in the context of mental illness memoir, be a pathological "we", evidencing not multidimensionality, but pathology. 

I'm wondering if it would be useful to take a step away from the memoir itself now - get a little "meta" as us liberal arts students love to do - and put the work in context with the facts of Hornbacher's life. Hornbacher is an author, successful journalist, (at the time) married to her first husband, and prone to relapse and dysfunctional thinking as a result of years of battling mental illness. When viewing her life in its whole (as presented with the memoir, but not the focus of the memoir), it seems that Jelinek's multidimensional "we" might be an accurate way of describing Hornbacher, and that in constructing herself as a "we", Hornbacher creates the space in which she might extend discrete attributes of her person. (Because the "we" implies fracture, there may be room to stretch Jelinek's "we" by stating that a fractured "I' ("we") may represent separate characteristics or opportunities which can  be pursued independent of one another and none of which claim a total forefront in defining a woman.) So Hornbacher's "we", in context with her diverse attributes, talents, and interests, may be a liberating move away from characterizing and defining herself as an eating-disordered "I". The "we" may be a way of pushing against definition by illness. 

But then again, the fact that Hornbacher's "we" almost exclusively focuses on her eating disorder and does not, in fact, describe other areas of her life is where Jelinek's "we" falls out of place and Nereen's "we" gains credibility. Hornbacher's "we" is focused on cultivating a sense of community in which eating-disordered individuals exist and are validated by other eating-disordered individuals (sounds like Butler's idea precarity - that all personal identities are interdependent and derived from a greater collective). Because her "we" is so focused on eating disorders to the neglect of every other facet of her life, Nereen's "we", which denotes pathology, may be more useful for interpreting Hornbacher than Jelinek's. 

However, can I really say that Hornbacher's we is totally exclusive? Hornbacher makes it clear that every facet of her life - interpersonal, educational, romantic, professional, medical, etc. - was affected by her eating disorder. Her eating disorder became a predominant self-definition - she "became an anoretic" (not "anorexic"; she was the noun - she didn't have the adjective) - on which all other self-definitions relied. So perhaps hybridizing Jelinek's and Nereen's seemingly antithetical "we"s may be beneficial (perhaps with Butler as a higher theoretical framework). Let me see if I can lay this out: Butler says all identities are interdependent and do not exist on their own. Jelinek says that nonlinear, fragmented narratives evidence a multidimensional self. What if these multidimensional selves were dependent on each other, much like Butler's discrete selves in other people are interdependent? Further, in the context of Hornbacher's eating disorder, what if the "we" as proposed by Nereen created the space for other aspects of the self to exist within it. In that case, what would happen in the absence of the integrated, yet pathological "we"?