Wednesday, April 11, 2012

I'm backing up some edited work so that, in the case of disaster, I don't lose it!


“The words are purposes.
The words are maps.
I came to see the damage that was done
and the treasures that prevail.”
- “Diving into the Wreck,” Adrienne Rich, 1973

I am interested in stories. It is a longstanding interest, one that has combined with other interests – psychology, medicine, nonfiction – to produce a professional trajectory that aims toward medicine, but which resists science as the only means to get there. When I began to conceptualize my senior thesis, I was certain only of two things: I wanted to work with memoir – with a narrative by which an identity may be formed – , and I wanted to combine my interest in mental health with my training in reading English literature. From the beginning, my thesis was an interdisciplinary project. I wanted it to be an experiment – an experiment in how literature represents illness, in how psychology explains prose, in how a text might resist linearity and other traditional devices to, as David Shields writes, “dissolve a genre or invent one.” I wanted to see what resulted when the lines between genres are erased. I wanted to consider the broader readership that might result from such a move and the practical implications of using a medicalized narrative to tell a personal life story. In short, I had lofty ideas about what I wanted to produce, but then I took a step back and realized I had no primary text.
So I began reading, using my own interests and abstract ideas about what I wanted to write as a guide to my memoir purchases. Though I read about schizophrenia and depression, bipolar disorder and substance abuse, no illness seemed to reach beyond its medicalized self quite like an eating disorder. Eating disorders were wrapped not only in the individual and her diagnosis, but in our sociopolitical climate and culture. I read Wasted: A Memoir of Anorexia and Bulimia by Marya Hornbacher and was taken with the complexity of her narrative – how she accounts for her eating disorder in nontraditional terms and paints a picture of mental illness that stretches the boundaries of the clinical narrative. Though initially hesitant to work with a memoir that detailed an area of mental health that I knew precious little about, the complexity in Hornbacher’s memoir begged to be unraveled, and I decided to take on Hornbacher’s most-famous chronicle of eating disorders.
As I began to reread Hornbacher’s text, the English major in me was struck by her wide-ranging pronominal choices. She was “I”, “we,” “she.” At times, she was “you.” What is a memoir without a concrete “I”? Questions surfaced from my training in psychology. How does the prognosis of an eating disorder change when its bearer resists pronominal identity? How do popular culture and diagnostic culture clash in the telling of such a narrative? How might both of my disciplines be helpful in untangling the maze of pronouns scattered throughout Wasted?
Through a drawn-out process of theory-reading, which began somewhere within narrative psychological theory and passed through the clinical literature on eating disorders, I settled on three areas among which I will situate myself in order to understand how Hornbacher represents eating disorders and to explain how, by extension, the humanities can help the medical field understand its patients. Eating disorders are inherently complex, with etiological roots in neurobiology, social surroundings, individual temperament, and the family climate; a comprehensive view of an eating disorder is complex, requiring seemingly contradictory theories to explain its layers.
Hornbacher’s clinical explanations of her illness – an enmeshed family pattern, a history of mental illness, a personality that errs impulsive – prompted me to begin looking at Rita Charon’s work in narrative medicine: she trains physicians to attend to the ways in which patients tell their stories and how those stories can be used to contribute to more accurate diagnoses and treatments as well as greater empathy.  Narrative medicine offered me an entre into the field of medical humanities, which enlarges the scope from stories of individual patients to include the story of medicine itself, looking to offer the most comprehensive healthcare through reformed thought about diagnosis and treatment.
Because medical humanities is primarily focused upon reform from within the traditional medical structures and because Hornbacher’s text not only addresses medicalized representations of her illness, but the sociopolitical dimensions of it as well, I saw it necessary to widen the scope of my theoretical lens by considering both the tradition of women’s life writing and the field of disabilities studies. Disabilities studies is concerned with the social and political implications of our cultural construction of illness and explores the ways in which culture provides access to some while disabling those with physical and mental differences. Disabilities studies moves beyond the medical institutions, resisting medicalization as a way of categorizing and coping with difference. The field borrows from the framework of feminist theory, and it is towards theories about women’s life writing that I will also use in my analysis of Hornbacher’s memoir. Like disabilities studies, theories about women’s life writing consider the oppression that results from inhabiting a disadvantaged body and examines how this oppression (and resistance to this oppression) is represented in the narrative female voice.
The following project seeks to follow Rich’s words – to use words as “maps” and “purposes” to uncover the “treasures that prevail.” By situating myself within these theoretical orientations, I will ultimately suggest that texts like Hornbacher’s are maps not only to individual lives, not only to women’s stories, not only to the particularity of genre in which those stories are told, but to diagnosis and communication between patients and physicians, so that diagnostic categories might be more comprehensive – taking into account sociopolitical, familial, and like climates in addition to traditional symptoms – to offer a more accurate view of, in this case, eating disorders.
 I. 
            As Ilora et al. highlights in their book, Medical Humanities: A Practical Introduction, beginning in the 1960s, a “perception” of a “crisis” rose in western medicine that questioned the “underlying authority of modern scientific medicine” (3), which at the time was grounded in “biomedicine,” or “the overall trend . . . for the patient narrative gradually to disappear in favor of technical investigation, for symptoms to give way to disease entity, and for treatment to become non-negotible” (11). This crisis was fed by
the emergence of the anti-psychiatry movement; the inability of science and technology to deal effectively with many chronic and disabling conditions, despite escalating levels of public expenditure on healthcare; and an awareness of the personal insensitivity of much of modern medicine and its failure to take account of the patient’s perspective (13)
These phenomena all contributed to a growing movement toward reform of medical practice, which catalyzed the development of the field of medical humanities. David Greaves, in his chapter entitled, “The Nature and Role of the Medical Humanities” in Ilora et al.’s book defines the field as “a humanistic perspective . . . [that] embodies a mode of enquiry which is typical of philosophy in particular, but can also be discerned in every subject in its relationship with medicine” (16). Greaves presents four possible definitions of the humanities; the one I find most useful to my project is the fourth, “subjects concerned with the uniqueness of individuals rather than generalization” (15), as this definition of the humanities, in a medicalized context, challenges the institutionalization of diagnosis and begs for a return of attention to individual narratives. Stepping off from this definition, Greaves negotiates the definitions of the medical humanities by situating a narrower conception within a broader one. The first  “equates” the field “with the medical arts” (18), by identifying science and technology as “arts” and then subordinating those practices to the “art of medicine” (14). This narrower view depicts the medical arts as being a counterbalance to biomedicine, and conceptualizes medical practice as a balance of  art and science (18). The second broader view
focuses on the human as relevant to the whole of medicine and so cuts across the traditional formulation of western medicine as comprising separate realms of art and science, with the human aspects restricted mainly, if not exclusively, to the former (18).
Greaves’ broad definition defies the binary between the sciences and the arts, allowing for “an innovative and unified approach” (19) to medicine that reconsiders medical theory and urges “practitioners to develop a more rounded and humane attitude to their practice” (19). In this paper, I will use Greaves’ definition of the medical humanities to inform the work I will do on Hornbacher’s memoir because Greaves considers both the macro- and microscopic implications of involving the humanities in science just as Hornbacher’s text allows me to consider the implications of a reformed medical narrative on both an individual and a societal level.
 In “The Humanities’ Role in Improving Health and Clinical Care,” Richard Edwards identifies the medical humanities as responding to generalized and impersonal theories of medicine. Edwards points out that evidence-based medicine leads to generalizations that do not necessarily match the needs or situation of the individual, and that “even in ideal circumstances” (238), when the individual does meet a generalized clinical picture of an illness, “it remains imperative to address and respond sympathetically to the emotional consequences of diagnosis and treatment” (238). Medical humanities aims to remedy such problems arising from clinical generalization.
            Edwards reports a variety of ways the medical humanities works to reform the existing structure of medicine. Firs they provide a language for patients to communicate more effectively with their physicians, allowing them both to verbalize their emotions concerning diagnosis and treatment and to create fictional narratives exploring possible courses of action (241). These fictional narratives and emotive depictions of disease both provide a framework for evidence-based theory, allowing physicians to reassure patients by exploring the benefits and drawbacks of a treatment from  both theoretical and emotional perspectives. The medical humanities build upon “problem-based learning” (245); they beg for a “questioning,” critical approach that “promote[s] reflective practice and learning” (242). Such a complete evaluation is conducive to the exploration of alternative and complementary therapies for illness, including treatments not as often empirically validated, such as those associated with eastern medicine (242). Edwards also argues that it is useful
to employ published narratives or artistic representations of ill health as qualitative input alongside actual patients’ narrative, to widen perspective and facilitate a more sympathetic understanding of the ‘human condition’ (237).
Published narratives of illness work, on a grander scale than oral, unpublished patients’ narratives, to promote change within western medicine. In publishing such narratives, patients develop a voice apart from medical generalizations, fitting their personalized medical stories into the existing clinical literature, thus allowing for clinical language to expand beyond the textbook. The field of medical humanities is apparent in published personal discourses of illness through this combination of clinical and personal narrative. It is in this space that I situate my own analysis of such a narrative.
                         When disabilities studies scholar Margaret Price visited the Bryn Mawr College campus in February, she explained to several of us over lunch the difference between the fields of medical humanities and disability studies; while the medical humanities arose from within medical schools and thus look to reform medicine from the inside, disabilities studies is the academic branch of a social activist movement that both nodels itself on past movements (such as those for civil and women’s rights) and positions itself uniquely, and primarily, as a critique of the “medical model” of disability medicine. As Lennard Davis elaborates, disabilities studies is “both an academic field of inquiry and an area of political activity” that “aims to challenge the received in its most simple form – the body – and in its most complex form – the construction of the body” (xv-xvii). Even more broadly, Susan Wendell explains, the field critiques the belief that “the world [is] structure[d] for people who have no weaknesses” (243); it posits, instead, that weakness is a socially constructed paradigm, based upon an unspoken, implicit archetype of the “perfect” body that all humans strive to achieve.
Only been recently have disabled individuals organized themselves politically; a major accomplishment of the movement was the passage of the Americans with Disabilities Act in 1990 (xvi). Emerging work in disabilities studies drew both on this social movement and on academic work that had been done in feminist studies, sociology, and philosophy, by scholars such as Jacques Derrida, Judith Butler, Susan Bordo, Erving Goffman, and David Rothman (Davis xvii). As Davis explains, the “work of a newer generation of writers and scholars looks toward feminist, Marxist, postmodern, and cultural studies models for understanding the relation between the body and power” (xvii).
But this next generation of writing is also distinct in that it “tends to be created from within the boundaries of disability” (xvii). It does not attempt to “share” the disabled experience by showing audiences what it is like to be, deaf, blind, etc., but rather refuses to write for normative audiences, shunning the inherently unequal balance between disabled and able-bodied that occurs when works are “sensitized” in such a way (xvii). By upending this power dynamic, disabilities avoids the advocacy trap that promotes emotive, sympathetic understanding and, in doing so, reinforces cultural conceptions of disability as weakness and as disadvantage. It thereby creates room for critical inquiry into difference
Davis explains that disability has traditionally “been seen as eccentric, therapeutically oriented, out-of-the-mainstream, and certainly not representative of the human condition” (xv); it has been treated much in the way that “race, class, and gender have been theorized” (xvi), by being placed in a unique sociopolitical cultural context and understood as a request for special needs. The field considers individual difference in social and political context, identifying oppression as a social construction that needs to be de-institutionalized. The field focuses on the power dynamic between the social norms of ability and individuals unable to meet those norms, whoa re thus exposed “to inspection, interrogation, interpretation, and violation of privacy”; “people with anomalous bodies are often called upon to account for them, sometimes quite explicitly: they may be asked, ‘What happened to you?’ ” (Couser 400).
            The United Nations defines disability as “[a]ny restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being” (244). Handicap, which refers to the social disadvantage resulting from disability, is “the loss or limitation of opportunities to take part in the life of the community on an equal level with others” (24s4). Thus, social function is inextricably linked to social constructs, like disability, that allow for “normative” experiences of society. In “Toward a Feminist Theory of Disability,” Susan Wendell points out that the given definitions of “disability” and “handicap” are dependent on recognition of the normative (245), and that “[p]aradigms of health and ideas about appropriate kinds and levels of performance are culturally dependent” (245). Wendell explains that because social conceptions of disability are so dependent on context, “we might eliminate the category of the ‘disabled’ altogether, and simply talk about individuals’ physical abilities in their social context” (245). Disabilities studies examines functionality within cultural confines and asks how degrees of functionality may contribute to a given culture.
            In “Culture as Disability” McDermott and Varenne show how culture is both able-ing and dis-abling when selects certain features, such as academic achievement, that it values. For example, the advent of the radio presumed that the normative, able-to-hear majority would benefit from receiving information in this manner – and thus excluded those who were deaf from a new source of news and entertainment. McDermott and Varenne argue that such social inventions, which enable one portion of the population, disable others by denying them some degree of social functionality.
            According to other disability studies scholars, the field of medicine is particularly egregious in this regard. Wendell shows how contemporary medicine “plays into and conforms to our cultural myth that the body can be controlled” (249). Doctors are “trained to do something to control the body” (250) – the body must bend, under various therapies, to the will of the physician, who aims to return the body to a cultural norm. Wendell labels this “heroic approach to medicine” (250) a method in which “[m]edical professionals have been given the power to describe and validate everyone’s experience of the body” (253).
Feminist disability theory has been particularly crucial in advancing this argument. As Rosemarie Garland-Thompson explains, “The fundamental premise of Disability Studies is that disability is a culturally fabricated narrative of the body, a system that produces subjects by differentiating and marking bodies” (1). Her analysis of the field draws together feminist rejection of the cultural narrative of the female identity and body and disabilities studies’ rejection of the narrative of the disabled identity and body:  both force us “to realize that other people have more social authority than you do to describe the experience of your own body” (254). Combining the two fields into what she refers to as “feminist disability critical theory,” Garland-Thompson outlines a methodology for reading the narratives of disabled women, which draws on these fundamental premises:
that representation structures reality; that the margins define the center; that gender and disability are ways of signifying relationships of power; that human identity is multiple and unstable; and that all analysis and evaluation has political implications (6).
It is this approach to the disabled female condition – that society has constructed gender as a disability, and that a disabling gender and a traditional disability are inseparable when criitically viewing a disabled woman – with which I will be concerned in my examination of Hornbacher’s memoir. In my reading of Wasted, I will draw on disabilities studies as a reflective field that sheds light on the constructions that either name or cause disability. For the purposes of my paper, disabilities studies will be a means of explaining eating disorders outside of the clinical literature – of answering how culture is constructed in such a way as to facilitate the development of these disorders and of exploring how society might cope with these disorders in non-clinical ways.
            My final area of interest with disabilities studies lies in its relation to theories of autobiography and representation. Couser writes that “[t]he cultural representation of disability has functioned at the expense of disabled people, in part because they have rarely controlled their own images” (399). In contrast to this historic representation, Couser states that recent life writing exemplifies a way in which “disabled people have initiated and controlled their own narratives” (399). This writing, he suggests, should be considered a “retort” to “misrepresentation of disability” in that the writing resists the cultural narratives that are “inscribed” on the bodies of the disabled (400).
 In “Her Pronouns Wax and Wane: Mental Disability, Autobiography, and Counter-Diagnosis,” Margaret Price expands Couser’s idea by describing the ways in which, by showing a multiplicity of selves through the deliberate confusion of a narrative “I,” autobiographical writing by disabled individuals creates a culture of counter-diagnosis that defies the framework that contributes to the institutionalization and oppression of individual difference. Integrated with cultural and personal narratives of disability and gender, and challenging of traditional medical structures, disabilities studies will offer some of my key insights into Hornbacher’s representation of eating disorders, which stretch beyond the clinical and the personal. Though the two arise from two different schools of thought, I will use disabilities studies as a lens that expands medical humanities to include the sociopolitical and cultural aspects of illness, situating both fields within the genre of women’s autobiographical writing in the context of Hornbacher’s memoir as an example of how medicalized narratives might be expanded to consider a larger range of diagnostic implications.
             Hornbacher’s title, Wasted: A Memoir of Anorexia and Bulimia deliberately situates her work within the larger genre of women’s life writing. Theorists of feminist autobiography cast various nonfictional forms, including memoir, letters, diaries, and autobiography as sub-categories in the overarching genre of life writing (Smith and Watson) – and they trace the history of women’s life writing far back. It first emerged in Europe as a mark of chastity and virtue (Lamb). In the Renaissance, non-fictional writing – often in the form of diaries – was the only type of writing permissible for women in good social standing, as fiction was thought to give women sexually and socially transgressive ideas (Lamb). Early women’s diaries “manifested Christian virtue [which was] an excellent thing in women” (Heilbrun 17). The earliest recognized female autobiography, published in 1656 by Margaret Lucas Cavendish, Duchess of Newcastle, exemplifies the narrow scope of self-representation available to women: Cavendish reports that “ we were bred Virtuously, Modestly, Civilly, Honorably, and on honest principles . . . we lived orderly” (Cavendish 178).
Cavendish’s autobiography, among others, represents not only the advent of the female autobiographical tradition, but also a clear continuation of the male tradition catalyzed by St. Augustine. According to Georges Gusdorf, male autobiography stresses “the defense and glorification of a man, career, a political cause, or a skillful strategy” (Benstock 8). For many centuries, female autobiography reflected a reinforcement of the “token woman” – the inevitable response to the “masculine man” as presented in male autobiography –  (Heilbrun 16) and a continuation of the “one plot” available to women, which ended either in marriage or death (17).
            Women’s autobiography was traditionally “sentimental and passive” (19), bringing out only the expected for the public to see and leaving the private – goals, hopes, anger – to private spheres (19). This disconnect between the private and the public exemplified in Jane Addams’ diaries in contrast with her published autobiography. While her autobiography demonstrates the passivity characteristic of female discourse, her unpublished, private diaries reveal the challenges and frustrations she had with establishing Hull House (19). Women were expected to speak with authority only of “family and religion” (19). Addam’s status as public businesswoman was therefore ironically relegated to her private writing.
            The tradition of women’s autobiography also, however, included another stream – that of confessional writing, which, with its emotive and tell-all nature, defied the conventional literary script within which women’s autobiography was expected to operate. Writing confessions enabled women to express their “uninhibited autobiographical impulses” (23). Such writing created a “rhetoric of uncertainty” (18) that today generally characterizes women’s life writing. Unlike male autobiographical writing, women’s life writing “has become an exploration of painful experience rather than denial of pain and struggle” (25), moving from introspection outward (24) and extending their experience to a larger population (Benstock 8).
            With the defiance of masculine autobiographical tradition, women’s life writing became inherently politicized. The act of confession, of making the private public, essentially catapulted women’s autobiography into feminist discourse, creating room in women’s life writing to integrate the political and the personal. According to Estelle Jelinek’s 1980 book, Women’s Autobiography, women’s “self-portraits” are informed by “irregularity rather than orderliness” (17), a long-standing distinguishing feature of women’s life writing in contrast to men’s. This “irregularity” is often seen in pronominal switching and disruption of chronology. In her study of “Political and Personal Autobiography Integrated: The Fusion of Kate Millet,” Jelinek indicates that “irregularity” has been expanded in women’s life writing to include writing that seems like “a jungle of fragments” (171), with truncated sentences without proper subjects and perhaps consisting only of a phrase or even a single word, resembling “the kind of shorthand writing characteristic of diaries and notebooks” (171), interrupted by passages that are “chronological, progressive, and strictly grammatical” (171). These stylistic trends of women’s life writing, Jelinek argues, politicize female text. Through the multiplicity of the singular subject, which Benstock states stands in direct contrast to the male resistance of the “discordant ‘I’ ” (8) and various other structural and stylistic choices that distinguish women’s life writing from the male tradition, women have developed a means by which their selves – coherent, fractured, and multiplied – are represented outside of the traditional prescriptive forms.
            In “Reading for the Doubled Discourse of American Women’s Autobiography,” Helen Buss argues that in the wake of the development of politicized women’s life writing, female autobiographers now face a unique challenge – they must present their autobiographical selves in a “stable, unified” (97) way in order to adhere to the conventions of a genre which begs for the “self” as subject and yet “subject as fragmented, decentered, and dominated by forces largely beyond her control” (97). In other words, the female autobiographer is challenged to negotiate between self-perception – the “I” as a unified self – and social politicization, which casts the “I” an unstable result of a history of oppression and representative of a collective larger than the singular self.
Combining Jelinek’s observation of the longstanding tradition of fragmentation in women’s writing with Buss’ description of doubled discourse in women’s life narratives, I can see that one way of negotiating the demands of double discourse would be to engage in self and structural fragmentation. The fragmentation in women’s life writing may reflect the feminized politicized self, acknowledging a history of oppression and disabling cultural forces while speaking for both the unified “I” and a larger female majority.
I will consider Hornbacher’s memoir as an example of women’s life writing, and will evaluate it within this history, as an example of and possible extension to a relatively new genre with a long historical lineage. The tradition of women’s life writing represents the theoretical capstone to my three areas on interest, as I will use it to explain how Hornbacher’s text ultimately represents an expanded form of clinical literature.
II. 
            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 – most notably, a clinical depiction 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, I will examine a few passages in which this pronominal switching is particularly important and apparent, using these passages as exemplary of the whole. 
            The first passage I want to discuss occurs early in the memoir, in the introduction, and so functions as evidence of how quickly Hornbacher delves into the unique pronominal usage of her memoir. In her first description of the cognitions and cultural influences behind eating disorders, Hornbacher begins the passage in second-person, thereby both tagging us readers as eating-disordered, and telling us what we think about “our” shared condition. 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,” who is assumed to be the reader – a layered 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 its subgenre, 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 demanding that “you” emotionally empathize with the consequences of distorted eating-disordered cognitions, which in this passage are cast as general thoughts characteristic to all eating-disordered patients. Hornbacher does not write, “I felt safe in my eating disorder;” she instead couples “you” with the words, “safe,” “alive,” and “contained” (6), forcing her audience to emotionally identify with her experience by containing the “you” within the same vocabulary as the “I.” 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 that makes explicit the multiplicity of identities that characterizes women’s life writing.
            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 force 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 explicit 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 the social construction of disability to exist. By insisting her audience identify with disability by using “you,” Hornbacher places her readers in the same society as the “I,” implying that both “you” and “I” live with the same disabling features of society and are thus able to experience disability in the same way.
            Although Hornbacher forces her readers into disability with “you,” she simultaneously turns and pushes them away, inviting “you” to become a voyeur, 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 to “perfect” their disorders. 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 with her shift to “we”, 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 by isolating the eating-disordered experience to a discrete group, and clearly drawing a line between those with her disability and those without. Using “we,” Hornbacher treats eating disorders 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 invited to behold “we,” but clearly do not participate in the thoughts and behaviors of “we.” 
            As the passage continues, Hornbacher narrows the experiential component of her narrative even more, switching from first person plural to first person singular voice, 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, here, at the start of the memoir, 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 explicitly claims tht she made 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. Though Hornbacher reports that she experimented with a plethora of negative behaviors in her adolescent years, including but not limited to promiscuity, illicit drug use, and self-mutilating behaviors, and though it is indeed possible that Hornbacher actively rejected other vices in favor of an eating disorder, it is unlikely given clinical evidence that Hornbacher presents about eating-disordered “personalities” – that they are “highly competitive, incredibly self-critical, driven, perfectionistic, tending toward excess” (6) – that with a personality so specifically predisposed to an eating disorder, Hornbacher would have chosen the illness. Thus, Hornbacher’s “I” – which explicitly claims a sense of self and agency – may here may represent the irrational sense of control associated with eating disorders. By using an “I” arguably prone to irrationality 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 disabled “I” is established, thus linking the “you” to “I,” and, since the “I” is part of the “we,” connecting Hornbacher’s pronouns circularly.

            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 – most notably, a clinical depiction 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, I will examine a few passages in which this pronominal switching is particularly important and apparent, using these passages as exemplary of the whole. 
            The first passage I want to discuss occurs early in the memoir, in the introduction, and so functions as evidence of how quickly Hornbacher delves into the unique pronominal usage of her memoir. In her first description of the cognitions and cultural influences behind eating disorders, Hornbacher begins the passage in second-person, thereby both tagging us readers as eating-disordered, and telling us what we think about “our” shared condition. 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,” who is assumed to be the reader – a layered 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 its subgenre, 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 demanding that “you” emotionally empathize with the consequences of distorted eating-disordered cognitions, which in this passage are cast as general thoughts characteristic to all eating-disordered patients. Hornbacher does not write, “I felt safe in my eating disorder;” she instead couples “you” with the words, “safe,” “alive,” and “contained” (6), forcing her audience to emotionally identify with her experience by containing the “you” within the same vocabulary as the “I.” 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 that makes explicit the multiplicity of identities that characterizes women’s life writing.
            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 force 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 explicit 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 the social construction of disability to exist. By insisting her audience identify with disability by using “you,” Hornbacher places her readers in the same society as the “I,” implying that both “you” and “I” live with the same disabling features of society and are thus able to experience disability in the same way.
            Although Hornbacher forces her readers into disability with “you,” she simultaneously turns and pushes them away, inviting “you” to become a voyeur, 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 to “perfect” their disorders. 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 with her shift to “we”, 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 by isolating the eating-disordered experience to a discrete group, and clearly drawing a line between those with her disability and those without. Using “we,” Hornbacher treats eating disorders 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 invited to behold “we,” but clearly do not participate in the thoughts and behaviors of “we.” 
            As the passage continues, Hornbacher narrows the experiential component of her narrative even more, switching from first person plural to first person singular voice, 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, here, at the start of the memoir, 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 explicitly claims tht she made 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. Though Hornbacher reports that she experimented with a plethora of negative behaviors in her adolescent years, including but not limited to promiscuity, illicit drug use, and self-mutilating behaviors, and though it is indeed possible that Hornbacher actively rejected other vices in favor of an eating disorder, it is unlikely given clinical evidence that Hornbacher presents about eating-disordered “personalities” – that they are “highly competitive, incredibly self-critical, driven, perfectionistic, tending toward excess” (6) – that with a personality so specifically predisposed to an eating disorder, Hornbacher would have chosen the illness. Thus, Hornbacher’s “I” – which explicitly claims a sense of self and agency – may here may represent the irrational sense of control associated with eating disorders. By using an “I” arguably prone to irrationality 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 disabled “I” is established, thus linking the “you” to “I,” and, since the “I” is part of the “we,” connecting Hornbacher’s pronouns circularly.
The nature of Hornbacher’s “I” shifts 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 chronicling. In the passage that follows, which lies after the previous passage and in which this very personal “I” appears, Hornbacher again uses pronouns interchangeably yet skillfully, but does so with slightly different effects:
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 slow and 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).

While on one hand Hornbacher fragments her narrative self – she is “I”, “you”, and “she” – in this passage, she clearly differentiates that collective self from others, such as the woman with the stopping cart.  By first distinguishing aspects of the self from one another, then collecting them, and posing them collectively as distinct from others, Hornbacher finds a pronominal way of negotiating the dilemma articulated by Buss – that the female autobiographer must present herself as stable and unified while acknowledging herself as “fragmented [and] decentered” (97). Hornbacher creates a boundary between the narrator and the woman with the shopping cart, as well as other characters in the book, by means of a distanced perspective. Perhaps, then, Hornbacher’s collection of distinct pronouns referring to the same narrator constitute evidence of the authorial negotiation involved in female autobiography. Hornbacher as a female autobiographer presents herself as unified, and she does so by linking all three of her pronouns to the narrator, but at the same time, she also acknowledges the fragmentation of that narrator by encasing her within a plurality of distinct pronouns.
Buss’ observation of the female autobiographical dilemma is not relegated to either able-bodied or disabled women, and instead is presented as so to nonspecifically refer to all female autobiographical memoirs. While Hornbacher’s memoir seems to embody Buss’ challenge, however, her work nevertheless complicates Buss’ female autobiographical challenges, as Hornbacher’s is also a memoir of illness and represents a twist that was not considered by Buss. Couser explains that autobiographical texts about illness may be written as a “retort” to the “misrepresentation of disability” (400). Hornbacher does this explicitly by defining “crazy” as something other than the conventional conception of “crazy.” “Crazy,” for Hornbacher is not “always the old woman . . . hollering. . . tumbling. . .” (171). It is also the ‘normal’-looking girl who defies the social depiction of mental disability. In casting herself as “crazy,” Hornbacher attempts to shatter preconceived notions about the face of mental illness. Hornbacher goes further by labeling “you” crazy as well. “You” go insane. “It” happens to “you.” By starting the passage , which comes after a page break and initiates a new section, with “you,” Hornbacher completes the collection of the three pronouns – “I,” “you,” and “she” – she employs in her representation of her mental illness, thus resisting conventional social constructions distinguishing the crazy from the sane and those with eating disorders from those who do not have them. Mental illness, Hornbacher implies, can develop in a ‘normal’ girl in a sweater; it can develop in “you,” just as it enveloped the “I.”
Using these three discrete pronouns, yet intertwining them in the text, Hornbacher contributes to what Margaret Prices calls a “counter-diagnostic” culture (PAGE NUMBER), which not only challenges conventional representations of her own mental illness, but also the framework in which those representations exist. By stating that “crazy” is not only the woman with the shopping cart, Hornbacher calls into question out contemporary diagnostic culture, which only recognizes insanity within a narrow range of abnormal behaviors, specifically, foe example, those outlined within the Diagnostic and Statistical Manual of Mental Disorders. Insanity, Hornbacher’s text implies, is nondescript in that it encompasses people whose behaviors are not necessarily stereotyped as indicative of disorder.
Hornbacher’s pronominal plurality both solves the conventional female autobiographical dilemma and also rebuffs the cultural construction of mental illness. By juxtaposing these two, Hornbacher implicitly extends the concerns of clinical diagnosis to include the political dilemmas of gender. Since one pronoun refers to a “girls wearing boots and jeans and a sweater” (171), and that since that pronoun is connected to the two others, all three pronouns are implicitly feminized. Hornbacher is thereby exploring the impact of mental disability, especially the most feminized of all mental illnesses – an eating disorder – on a female subject. Hornbacher writes that she “sit[s] at the window, waiting for the mutterings and shufflings to slow and stop” (171). She – I – You cannot leave the house until the morning. It is not permissible for her to leave the house until the morning. This nocturnal waiting makes apparent the social confines in which the narrator moves (or cannot move) are made apparent. Here, the house acts metaphorically, representing both the long history of female domestic confinement and the confinement of the mentally ill to asylums. In the morning – when it is allowed – she will emerge. Her actions are governed by what Wendell calls “cultural authority,” which strips the individual of a narrative deviating from ‘proper’ cultural representation (PAGE NUMBER).
This cultural confinement, ultimately resulting in a woman’s inability to decide a course of action for herself, is also perhaps the cause of Hornbacher’s weakened use of  “I” in this passage. In contrast to the passage I first analyzed, in “I” was extremely decisive – “I chose an eating disorder” (6) –, the “I” in this second passage is paired with sedentary verbs. Whereas the “I” in the first passage “chose,” “think[s],” “believe[s],” and “sought” (6-7), the “I” in this passage “sit[s]” and “hold[s].” It is only in waiting – in the “four hours till morning” (172) that the narrator “think[s]” (172). Confined, this “I” waits for morning as she engages in another activity lying within the scope of the cultural narrative for the female body – exercises. The confined “I” is engaging in an activity wherein she further confines her body to cultural standards. Her exercises are done on a chair; they, too, are sedentary. The “I” of this second passage follows the cultural prescriptions, bowing to the “disabling” cultural construction (cf. McDermott and Varenne) of both mental illness and the female gender.
Although Hornbacher represents her twinned condition, being both female and mentally ill, as confining and therefore undesirable, she also represents herself within a diagnostic framework that resists labeling confinement negatively. Like many anoretics, the narrator is plagued by insomnia and restlessness, medical hallmarks of malnutrition. She also compulsively exercises, which is explicitly listed in the DSM-IV symptoms of both Bulimia Nervosa and Anorexia Nervosa – Binge-purge Subtype. The “she” in this passage “tumbl[es] through the strange, unreal dimensions in her head” (171), reflecting the lack of concentration and confusion reported by many eating-disordered individuals. Hornbacher’s use of words marking temporality – “years,” “one o’clock,” “hours,” “morning” (171-2) – also references the obsessive-compulsive thinking characteristic of anoretics, who are often obsessed with various ‘counts’ – calories, minutes, times – and a belief that something ‘must’ be repeated in order to be done ‘correctly’. Hornbacher’s language, in other words, is permeated by diagnostic conventions, and so clearly situates her within the clinical literature surrounding eating disorders.
Hornbacher highlights the cultural constructions that gave rise to and defined her behaviors, and so may be said to contribute to the field of disabilities studies, which critiques the medical construction of illness. However, by describing her narrator’s behavior in clinical language, molding her narrative to reflect a medical framework, Hornbacher is also operating within the field of the medical humanities, using, in Edwards’ terms a language that allows patients to describe their experience with illness in a way that the medical community can understand (241). By situating the cultural constructions that added to her illness within clinical language, Hornbacher again exemplifies how the medical humanities might consider broader implications of illness in its diagnostic framework.
In the space of a few sentences, Hornbacher sets up a triangulation of theoretical lenses. She embraces a diagnostic framework while refusing its constriction. She is expressing several selves within one narrator, feminizing each self in the process, while maintaining a divide between the I-you-she and a woman with whom I-you-she might identify. Hornbacher straddles the line between individual and collective experience, drawing her reader (through a feminized “you”) and otherwise unnamed “shes” into a collective perception of embodying a disabled and confined gender, drawing eating-disordered individuals together into a discrete diagnostic category, and drawing disabled persons into a collective social constriction. Yet, by virtue both of the personal details of her narrative account and of her genre – memoir, Hornbacher also emphasizes the experience of her created I-you-she as individualistic. A singular individual sits in a specific house and waits for specific people to stop shuffling. A singular individual waits “four hours till morning” (172). The details of her narrative define her work as a memoir. Because these details are so specific, even if they sit within a larger discourse of collective experience, I reserve an autobiographical label for Hornbacher’s work. 

            Although the personal details Hornbacher includes in her work mark it as autobiography, the identity of her main character remains ambiguous as the memoir draws to a close. In the final sections, Hornbacher describes her “limbo period after leaving the hispital 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).

In this passage, Hornbacher unmasks her convention of pronominal switching, revealing it as an attempt to negotiate fractured, often antithetical identities. To use a clinical term, Hornbacher’s narrator is dis-integrated (Gasker PAGE NUMBER). 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 the close of her narrative makes it clear that the entirety of her work is the product of these interrelated narrative identities. Hornbacher here uses her own first name, Marya, not to mark one discrete identity, but rather as the label that unifies all of her identities. Hornbacher’s first name has no single referent, its repeated evocation functioning rather as evidence that her identity can no longer be referred to in the singular. The experts ask “you” what “you” were “like before” (279), but the narrator, struggling to find a coherent identity, can only reference a cluster of behaviors, abstract terms (‘hunger”), and medical terminologies. In her confusion, the “you” fails to become an “I.”
            This paragraph follows a single-sentence paragraph that reads, “There is, in fact, and incredible freedom in having nothing left to lose” (2790. That line lacks any personal identification and reads, instead, as a declarative pseudo-philosophical statement. The next paragraph begins by betraying the unsteady ground on which the narrator stands – 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). The “I” uses unsure words – “limbo,” “grasping,” a negated “believe” (279). “I” attempts 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 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 “you,” Hornbacher makes a stronger claim: one that potentially invites empathy, and clearly blurs the blurs the boundariesbetween the “normal” and the disabled. In fitting “you” so easily into this situation that is “not at all uncommon” (279), Hornbacher makes “you” as disabled as “I” is.
The pronoun “you” is apparently a strong one as both a normalizing and empathetic vehicle. But Hornbacher then places “you” in a state of uneasiness similar to that of “I”. Instead of the narrator deliberately projecting “you” onto the reader, and so forcing “you” to participate int eh activities described in the text, the pronoun becomes incorporated into the direct address of medical professionals who, in occupying the paragraph, draw the “you” into a medicalized, therapeutic situation. If “I” is subject to the uncertainty of external forces, “you” is subject to the uncertainty imbued in patients by the medical discourse. Edwards argues that traditional medicalized discourse disallows effective communication between medical professionals and their patients (241). Such disallowal is certainly apparent in this passage when professionals ask “you’ what “you” did “before your eating disorder” (279). But the ascription of so many identities may have contributed to the loss of an integrated one. So, a disconnect then occurs between the medical interrogator and “you,” who can only stare back because “the word you means nothing at all” (279).
“You” no longer has any meaning for the narrator, when applied to herself. She then begins to use the pronoun to refer to the medical professionals who are questioning her. Hornbacher asks, “Are you referring to Marya, the constellation of suicidal symptoms?” (279). In this move, “you” shifts its position of referent from the narrator to the medical community. “you” then switches from applying to the narrator herself to referring to the medical professionals. Does ot thereby project the identited assigned to her by the medical community unto the medical professionals themselves? If “you” means “nothing at all” (279), “you” can be anyone – or no one.
By so closely juxtaposing her normalized, empathetic “you” with a “you” applied to the medical practitioners, Hornbacher both refuses the identities ascribed to her throughout treatment and simultaneously ascribes those same identities to her medical caretakers. “How do you understand yourself in the context of these labels?” she seems to ask.  In her conflation of two ascriptions of “you,” Hornbacher forces medicalized identities back onto the professionals who assigned them, and so reflects common professional misunderstanding 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 ludicrous.
In these multiple ascriptions, the confused referent “you” represents the Buss’ political challenge of women’s life writing (97). The “you” here repeatedly shifts and is uncertain – it means nothing, or it means everything, as it applies to various people in turn. The “you” is the narrator, then the reader, then again the medical professional and its reference is variously directed by each of these in turn. “I’ introduces the presence of “you” into the paragraph. The reader may choose to empathize with “you” or not, while the medical professionals ascribe various identities to “you”. Although the pronoun itself remains stable, its ownership of and reference constantly changed. “You” is fragmented, and in its fragmentation, represents the disabling effects of a culture that politicizes and conflates gender and the body. The gendered body, in its perceived weaknesses, is subject to external forces – most notably, the medical treatment, culture, and interpretation of a distinctly feminized illness.
            Near the end of this passage, Hornbacher refers to “Marya,” a third-person singular character whose identity never settles on any one of the terms applied to her by the medical community. After the “I” emerges from the hospital, after the “you” displays confusion, after the clinical evaluations and labels, the name of the narrator means little in relation to the various social constructions of her illness. Through illness and treatment, the narrator  may have gained weight, but she lost a coherent self in the process.
           The final pages of Horbacher’s memoir offer no resolution to the dis-integration that has been so minutely described. The narrator is at turns decisive, declaring that “[w]anting to be healthy is seen as really weird” (283), “healed” (“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 its foundations, the narrator offers a projective surface, the female body, on which western medicine and culture both play out conventional power dynamics. Hornbacher ends her memoir with a testimony to her loss of agency: “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). In the end, it is this larger discourse – the one that has literally defined the workings of her body, the one that has told her that her hearts beats are irregular – that maintains control over “me.”



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