Eating Disorders are a Political Issue: Bulimia Nervosa and Advanced Capitalism

If you know me even a little bit, you can imagine my glee at coming across a paper entitled “The Political Economy of Bulimia Nervosa.” YES! I exclaimed. Let’s explore the ways in which our systems of food production are linked to eating disorders. Let’s complicate the idea of “the social” as it relates to eating disorders and do an analysis of the complex socio-political and economic forces that govern our world.

So, let’s get right into it, shall we?

The Article

Pirie (2011) argues that it is important to understand eating disorders from a political economic perspective so that we can look beyond an equation of the “cultural” and media representations of femininity. The way in, he suggests, is through a look at how food systems have shifted since the time at which bulimia nervosa was introduced as a psychiatric diagnosis, around 1970.

The article is not the kind of research study I usually write about for this blog. It is more of a theoretical exploration. So, there were not participants and “method,” per se. Instead, the author presents a historical, sociological analysis of food systems, eating disorders, and consumer culture, building to his ultimate argument: in order to understand why there seems to has been an increase in diagnoses of bulimia over the past 40 years, we need to take into account both how bodies and gender are positioned in society and how our food systems have changed under advanced capitalism.

Now, you might be wondering what I mean by “advanced capitalism.” What’s different between capitalism and advanced capitalism? Put simply, advanced capitalism means that capitalism is entrenched in society to such a degree that it is a part of everyday life; it infuses social systems from the “overtly” economic to the day to day. It has morphed and not dissolved in the way that Marx anticipated. Evidently, this is a very, very simplistic analysis of advanced capitalism- if you’re interested, I recommend reading some Gramsci or Gramsci-inspired work on hegemony and counter-hegemony.

Getting back to the meat of the article, Pirie argues that 2 things need to be present in order for cases of bulimia nervosa (and binge eating disorder, though I have to say this seems to be tacked on as an additive, and the delineation between BN and BED is not well articulated in the article) to increase in a widespread way:

1. Changes in food systems
2. A set of social structures that governs bodies and bodily behaviours in a way that leads to hierarchies and moralizing constructions of bodies

Medicalization and Eating Disorders

The author reviews the literature on medicalization and eating disorders, drawing on critical feminist work on eating disorders, in particular work by Helen Malson and Julie Hepworth. The main points from this perspective include:

• It is challenging to distinguish what kind of eating is “normal” and what is “pathological”
• People with eating disorders tend to be treated as though they are passive sponges for cultural imagery in a way that ignores the reasons why people might engage in behaviours that get coded as pathological
• Medicalization has led to very individual-oriented explanations for eating disorders, which inappropriately blame the person (and/or their mothers) for the disorder
• To understand eating disorders we need to understand how (particularly feminine but increasingly also masculine) bodies are treated in society
• This is not about blaming medical professionals for somehow producing eating disorders or victim blaming; it is about how binaries are constructed that separate person from environment in a way that overly reduces complexity

Pirie presents a sensitive analysis of eating disorders as based in biology and in environmental factors, importantly including political economic structures, particularly food systems.

While the author identifies an uptick in bulimia nervosa over the past 40 years, he is also critical of how this increase has been measured and reported: the numbers we have to indicate eating disorder prevalence obviously rest on recognizing certain things as eating disordered and other things as not eating disordered; they are colored by assumptions and stereotypes and diagnostic criteria that have come into question and that change with new iterations of the DSM.

Bulimia: Accelerated Consumption

Pirie describes the cycle of binging and purging in BN as “accelerated consumption” that “represents the antithesis of a temporally well-defined eating regime based upon ritualized social events (meals) linked to biological need” (p. 327). While Pirie also presents quite an interesting analysis of constructions of femininity in relation to consumption, I’ll focus here on this idea that bulimia might represent a different version of a type of consumption. To briefly comment on this review, we’ve seen, with the growth of capitalism, a simultaneous increase in the need to demonstrate how “in control” one can be of one’s body in order to prove oneself a good, productive citizen.

To explore the relationship between food systems and eating disorders, Pirie begins by exploring how food is marketed to women (drawing on a book by Kilbourne, 1999):

• As something to develop an emotional attachment to
• As a way to compensate for things not going well in life
• In a cyclical way; that is, “mainstream” food followed by “diet” food to compensate
• “Naughty” and “nice” foods are marketed in a way that makes them co-dependent: they depend on each other and also on the social norms that urge us to consume, but not too much, to exercise restraint, but not to an extent that we become “disordered”

Drawing on a book by Fine (1998), Pirie similarly describes how:

• Food (all sorts of food) has become more readily available
• An “anti-eating complex” has emerged, which explicitly contains bodies through fear tactics linked to anti-obesity efforts etc.

Neoliberalism, then, places conflicting expectations on bodies by:

• Offering seemingly endless choices for consumption
• Expecting people to make the right choices; those that will maintain their status as healthy, productive citizen

Pirie highlights specific links to bulimia by emphasizing what the drive to consume looks like in advanced capitalist societies, again going back to the exploration of time. Bulimia is described as “a manifestation of a wider move towards more chaotic eating” (p. 338).

Since 1970:

• Commercialized (prepared/semi-prepared) food has exploded onto the scene
• Food preparation time has decreased
• “Eating events” are more frequently grazing-style and meals have become less ritualized and less often done as a group
• Eating patterns have become more sporadic; it is more common to see people skip some meals and eat more at others
• Snack foods have been aggressively marketed
• The delineation between “eating” and “not eating” has blurred and is often less tied to hunger; people eat for all kinds of reasons, which are not always linked to a biological need
• “Low level” binging has become more normal; for example, an increase in quick consumption at fast food restaurants and all-you-can-eat buffets

Pirie writes: “what would technically be defined as binge eating is not an activity confined to the celebration of particular feasts or the preserve of a small elite, but a regular mass activity” (p. 341). Of course, “low level binging” is not the same as bulimia or BED; there is a different psychological drive and relationship to the binge.

It is perhaps for this reason that Pirie is careful to note that we need to acknowledge individual vulnerability to eating disorders; as we all know, not everyone who diets develops an eating disorder. This is a similar idea: not everyone who is faced with this system or pattern of consumption will develop bulimia (or binge eating disorder). It is interesting, though, to look at the systems of eating that in our social worlds, and how these might be conducive to certain types of disordered behaviour. I also think this makes a great jumping off point for exploring how challenging it might then be to recover from BN, in the face of normative “abnormal eating.”

Would I say this article takes the political economic perspective on BN to its fullest extent? No, I expected a little more in terms of “where do we go from here.” After all, dominant paradigms are necessarily accompanied by strains of resistance (paging Foucault…). What I did like, however, was that the author suggested, related to my note that it would be hard to recover from BN in this context, that if we really want to support recovery from BN we need to look not only at disordered people but disordered systems. The how remains elusive.

Reference

Pirie, I. (2011). The Political Economy of Bulimia Nervosa. New Political Economy, 16 (3), 323-346 DOI: 10.1080/13563467.2011.519020