Though the personal details of Hornbacher’s work mark it as autobiography, the identity of her main character, Hornbacher herself, remains ambiguous as the work draws to a close. In the final sections of her work, Hornbacher writes,
In my limbo period after leaving the hospital the last time, I was grasping at straws. . . If you do that long enough, you eventually get a hold of some, enough, anyway, to keep going. I no longer had anything that I understood or could believe in. The situation I was in then is not at all uncommon. The experts say, What did you do before your eating disorder? What were you like before? And you simply stare at them because you can remember no before, and the word you means nothing at all. Are you referring to Marya, the constellation of suicidal symptoms? Marya, the invalid? Marya, the patient, the subject, the case study, the taker of pills, the nibbler of muffins, the asexual, the encyclopedia, the pencil sketch of the human skeleton, the bearer of nightmares of hunger, the hunger itself? (279).
Here Hornbacher’s pronominal switching becomes unmasked as at attempt to negotiate fractured, often antithetical identities. Hornbacher’s narrator, to use the clinical term, is dis-integrated. She exists as several identities – some assigned to her by her disease and by medical professionals, others developed in an attempt to relate her experience in an understandable way – and it becomes apparent that the entirety of her work is the product of these interrelated narrative identities. Hornbacher uses her own first name, Marya, as the label that unifies all of her identities. “Marya” is no longer a name connected to one discrete identity. Rather, Hornbacher’s first name is evidence that her identity can no longer be referred to in the singular. The experts ask “you” what “you” were “like before” (279), and the narrator struggles to tie “you” to a name, which is often the marker of a coherent identity. But the narrator, “you,” cannot find definition in anything but a cluster of behaviors, abstract terms (“hunger”), and medical terminologies, and thus the “you,” in the narrator’s confusion, fails to become an “I.”
Hornbacher begins this paragraph, which rests after a one-sentence paragraph that reads, “There is, in fact, and incredible freedom in having nothing left to lose” (279), with the singular experience of her often transient “I”. The “I” has just left the hospital. The “I” is disoriented and “grasping at straws” (279). In contrast to the previous short paragraph, which lacks any personal identification and which reads, instead, as a declarative pseudo-philosophical statement, the beginning of this next paragraph betrays the unsteady ground on which the narrator stands. The “I” uses unsure words – “limbo,” “grasping,” a negated “believe” (279) – and an attempt to normalize her situation – “The situation I was in then is not at all uncommon” (279) – as a way of showing that her pronominal identity as “I” cannot stand by itself. Almost immediately, the “I” is traded for an empathetic “you,” functioning to both eradicate the personal details from the prose and to place the reader in the place of the narrator. The “you” handles the “I’s” uneasiness, as it is “you” who “get[s] a hold of some [straws] . . . to keep going” (279). In switching from the personal “I” to an empathetic, stronger “you,” the narrator blurs the boundaries between the “normal” population and the disabled. Because “you” can so easily fit into this situation that is “not at all uncommon” (279), the author shows that “you” are as close to disability as her “I” is and that though the specifics of her situation – for example, the recent release from inpatient treatment – may not apply to “you,” “you,” as someone whose body is constructed (Davis xvii) and who resides in a world “structure[d] for people who have no weaknesses” (243), are in a position to take on a disabled identity yourself.
Despite the apparent strength of the “you” as both a normalizing and empathetic vehicle, though, Hornbacher then places the “you” in a state of uneasiness similar to that in which she placed her “I”. Instead of the narrator controlling the “you,” deliberately projecting it onto the reader, the unquoted questions of medical professionals then step into the paragraph, drawing the “you” into a therapeutic, medicalized culture. As her “I” is subject to the uncertainty caused by external forces, so her “you” is subject to the uncertainty borne of the medical discourse in which she finds herself. Edwards writes that the traditional medicalized discourse disallows effective communication to occur between medical professionals and their patients (241), and this traditional discourse becomes apparent in the above passage. The professionals ask “you” what “you” did “before your eating disorder” (279), never considering the serious fragmentation of identity and the loss of memory that may have occurred as a result of the illness. The same medical institution that assigns identities – “invalid,” “patient,” “subject,” “case study,” “taker of pills,” “constellation of suicidal symptoms” (279) – does not then consider the fact that its own many identities may have aided in replacing an integrated one, and a disconnect then occurs between the “you” and the medical community, as the “you” stares back at the medical professionals because “the word you means nothing at all” (279).
Because “you” no longer has any meaning for the narrator, “you” then switches from applying to the narrator herself to referring to the medical professionals. Hornbacher asks, “Are you referring to Marya, the constellation of suicidal symptoms?” (279), thus shifting the weight of the “you” onto her medical experts. In doing so, Hornbacher conflates “you” as the narrator and “you” as the medical community, projecting the identities assigned to her by the medical community onto the medical professionals themselves. “You” means “nothing at all” (279), and because “you” means nothing, “you” can be anyone. By so closely juxtaposing her normalized, empathetic “you” with a “you” referring to the medical community, Hornbacher rebuts the identities given to her throughout treatment while simultaneously pushing those same identities onto her medical caretakers as if to ask, “How do you understand yourself in the context of these labels?” In her conflation of “you,” Hornbacher effectively highlights the kind of medicalized discourse that prevents effective, empathetic communication from taking place between patients and medical professionals. By forcing medicalzed identities back onto the professionals who assigned them, Hornbacher reflects the lack of understanding that the professionals have of her all-too-common condition. By responding to the medical professionals with a rhetorical question employing “you,” Hornbacher casts their question, “What did you do before your eating disorder?” (279), as somewhat ludicrous. If the professionals had an accurate understanding of her “not at all uncommon” (279) situation, they would not push on their original question with the follow-up, “What were you like before?” (279).
Hornbacher’s “you” not only reflects the detrimental effects of medicalized identities and lack of understanding in the medical community, however. Once again, the confusion of the “you” represents the challenge of politicized life writing for women (Buss 97). The “you” here is uncertain – it means nothing, it applies to no one in particular. The “you” is the reader, the medical professional, or the narrator, and the control of the “you” lies at the mercy of any of these three. The reader controls the “you” either by choosing to empathize or not, the medical professionals control the “you” by giving it identities, and the “I” controls the “you” by introducing its presence into the paragraph. Though the pronoun itself remains stable, ownership of and reference to the pronoun changes. The “you” is fragmented, and in its fragmentation, represents the disabling effects of a culture that politicizes both gender and the body, conflating the two so that the body, in both its perceived weaknesses and its gender, is subject to external forces – here, most notably, the forces imposed by the culture of medicine in its interpretation and treatment of a distinctly feminized illness.
Near the end of the above passage, Hornbacher refers to “Marya,” a third-person singular character whose identity never settles on any of the identities proposed by the medical community. In contrast to the previously-analyzed passages, here Hornbacher does not use a third-person pronoun – no “them” or “she” – and instead opts for a proper noun – a name. But as the “you” means nothing because the narrator cannot assign an identity to the “you,” so the name, “Marya,” means nothing. “Marya” can only be identified if “you” – the medical professionals – choose an identity for her. “Marya” can be symptoms, an invalid, a patient, an asexual, hunger (279), but until the medical professionals choose an identity through which she is to respond to their questions, “Marya” is meaningless. After the “I” emerges from the hospital, after the “you” displays confusion, after the clinical evaluations and labels, the name of the narrator is secondary to the social constructions of her illness. Through illness and treatment, the narrator lost a coherent self, though she gained weight.
In the final pages of Horbacher’s memoir, there is no resolution to the narrator’s dis-integrated identity. The narrator is at turns political, declaring that “[w]anting to be healthy is seen as really weird” (283), owning a “healed” identity (“You fix yourself. It is the hardest thing I have ever done” (284)), and unsure, as her “Present Day” section recounts the still very active struggle she has with Anorexia Nervosa. In the context of such a tumultuous disease, which has essentially seeped into every facet of the narrator’s identity, cracking it at its foundations, the narrator and her body stand as a projective surface onto which western medicine and western culture both play out power dynamics between the female and her larger society. Hornbacher ends her memoir with, “And then it [my heart] tumbles into sleep, grabbing me by the hair and pulling me down into these watery sleeps that are so terribly deep and cold” (289), showing the narrator’s ultimate loss of agency due to her illness. In the end, it is a larger discourse – one that has literally defined the workings of her body, one that has told her that her hearts beats irregular – that maintains control over “me.”