Attached is an article from the sunday times that gives on pause for thought.
A different kind of community of practice?
I do not think one has to pay for daily perusing, Nate, but I could be wrong.
This came up in connection with revision of text materials on adolescence.
mike
This article from NYTimes.com
has been sent to you by jessica.bayne who-is-at verizon.net.
A Secret Society of the Starving
September 8, 2002
By MIM UDOVITCH
Claire is 18. She is a pretty teenager, with long
strawberry-blond hair, and she is almost abnormally
self-possessed for a girl from a small town who has
suddenly been descended upon by a big-city reporter who is
there to talk to her, in secret, about her secret life. She
is sitting on the track that runs around the field of her
high school's football stadium, wearing running shorts and
a T-shirt and shivering a little because even though we are
in Florida -- in the kind of town where, according to
Claire, during ''season'' when you see yet another car with
New York plates, you just feel like running it down --
there's an evening chill.
Claire's is also the kind of town where how the local high
school does in sports matters. Claire herself plays two
sports. Practice and team fund-raisers are a regular part
of her life, along with the typical small-town-Florida
teenage occupations -- going to ''some hick party,''
hanging out with friends in the parking lot of the Taco
Bell, bowling, going to the beach.
Another regular part of her life, also a common teenage
occupation, is anorexia -- refusal to eat enough to
maintain a minimally healthy weight. So she is possibly
shivering because she hasn't consumed enough calories for
her body to keep itself warm. Claire first got into eating
disorders when she was 14 or 15 and a bulimic friend
introduced her to them. But she was already kind of on the
lookout for something: ''I was gonna do it on my own,
basically. Just because, like, exercise can only take you
so far, you know? And I don't know, I just started to
wonder if there was another way. Because they made it seem
like, 'You do drugs, you die; be anorexic and you're gonna
die in a year.' I knew that they kind of overplayed it and
tried to frighten you away. So I always thought it can't be
that bad for you.''
Bulimia -- binge eating followed by purging through
vomiting or laxatives -- didn't suit her, however, so after
a little while she moved onto anorexia. But she is not, by
her own lights, anorexic. And her name isn't Claire. She
is, in her terms, ''an ana'' or ''pro-ana'' (shortened from
pro-anorexia), and Claire is a variation of Clairegirl, the
name she uses on the Web sites that are the fulcrum of the
pro-ana community, which also includes people who are
pro-mia (for bulimia) or simply pro-E.D., for eating
disorder.
About one in 200 American women suffers from anorexia; two
or three in 100 suffer from bulimia. Arguably, these
disorders have the highest fatality rates of any mental
illness, through suicide as well as
the obvious health problems. But because they are not
threatening to the passer-by, as psychotic disorders are,
or likely to render people unemployable or criminal, as
alcoholism and addiction are, and perhaps also because they
are disorders that primarily afflict girls and women, they
are not a proportionately imperative social priority.
They have been, however, topics of almost prurient media
fascination for more than 20 years -- regularly the subject
of articles in magazines that have a sizable young female
readership. In these forums, eating disorders are generally
depicted as fundamentally body-image disorders, very
extreme versions of the non-eating-disordered woman's
desire to be thin, which just happen, rivetingly, to carry
the risk of the ultimate consequence. ''So many women who
don't have the disorder say to me: 'Well, what's the big
deal? It's like a diet gone bad,''' says Ellen Davis, the
clinical director of the Renfrew Center of Philadelphia, an
eating-disorder treatment facility. ''And it is so
different from that. Women with the vulnerability, they
really fall into an abyss, and they can't get out. And it's
not about, 'O.K., I want to lose the 10 pounds and go on
with my life.' It's, 'This has consumed my entire
existence.' ''
And now there's pro-ana, in many ways an almost too lucid
clarification of what it really feels like to be eating
disordered. ''Pain of mind is worse than pain of body''
reads the legend on one Web site's live-journal page, above
a picture of the Web mistress's arm, so heavily scored with
what look like razor cuts that there is more open wound
than flesh. ''I'm already disturbed,'' reads the home page
of another. ''Please don't come in.'' The wish to conform
to a certain external ideal for the external ideal's sake
is certainly a component of anorexia and bulimia. But as
they are experienced by the people who suffer from them, it
is just that: a component, a stepping-off point into the
abyss.
As the girls (and in smaller numbers, boys) who frequent
the pro-E.D. sites know, being an ana is a state of mind --
part addiction, part obsession and part seesawing sense of
self-worth, not necessarily correlating to what you
actually weigh. ''Body image is a major deal, but it's
about not being good enough,'' says Jill M. Pollack, the
executive director of the Center for the Study of Anorexia
and Bulimia, ''and they're trying to fix everything from
the outside.'' Clairegirl, like many of the girls who
include their stats -- height, weight and goal weight --
when posting on such sites, would not receive a diagnosis
of anorexia, because she is not 15 percent under normal
weight for her height and age.
But she does have self-devised rules and restrictions
regarding eating, which, if she does not meet them, make
her feel that she has erred -- I kind of believe it is a
virtue, almost,'' she says of pro-ana. ''Like if you do
wrong and you eat, then you sin.'' If she does not meet her
goals, it makes her dislike herself, makes her feel anxiety
and a sense of danger. If she does meet them, she feels
''clean.'' She has a goal weight, lower than the weight she
is now. She plays sports for two hours a day after school
and tries to exercise at least another hour after she gets
home. She also has a touch of obsessive-compulsive disorder
regarding non-food-related things -- cleaning, laundry, the
numeral three. (''Both anorexia and bulimia are highly
O.C.D.,'' says Pollack. ''Highly.'')
And she does spend between one and three hours a day
online, in the world of pro-ana. Asked what she likes best
about the sites, Claire says: ''Just really, like at the
end of the day, it would be really nice if you could share
with the whole world how you felt, you know? Because
truthfully, you just don't feel comfortable, you can't tell
the truth. Then, like, if I don't eat lunch or something,
people will get on my case about it, and I can't just come
out and tell them I don't eat, or something like that. But
at the end of the day, I can go online and talk to them
there, and they know exactly what I'm going through and how
I feel. And I don't have to worry about them judging me for
how I feel.''
pro-ana, the basic premise of which is that an eating
disorder is not a disorder but a lifestyle choice, is very
much an ideology of the early 21st century, one that could
not exist absent the anonymity and accessibility of the
Internet, without which the only place large numbers of
anorexics and bulimics would find themselves together would
be at inpatient treatment. ''Primarily, the sites reinforce
the secretiveness and the 'specialness' of the disorder,''
Davis says. ''When young women get into the grips of this
disease, their thoughts become very distorted, and part of
it is they believe they're unique and special. The sites
are a way for them to connect with other girls and to
basically talk about how special they are. And they become
very isolated. Women with eating disorders really thrive in
a lot of ways on being very disconnected. At the same time,
of course, they have a yearning to be connected.''
Perfectionism, attention to detail and a sense of
superiority combine to make the pro-ana sites the most
meticulous and clinically fluent self-representations of a
mental disorder you could hope to find, almost checklists
of diagnostic criteria expressed in poignantly human terms.
Starving yourself, just on the basis of its sheer
difficulty, is a high-dedication ailment -- to choose to be
an ana, if choice it is, is to choose a way of life, a
hobby and a credo. And on the Web, which is both very
public and completely faceless, the aspects of the disorder
that are about attention-getting and secret-keeping are a
resolved paradox. ''I kind of want people to understand,''
Clairegirl says, ''but I also like having this little
hidden thing that only I know about, like -- this little
secret that's all yours.''
Pro-ana has its roots in various newsgroups and lists deep
inside various Internet service providers. Now there are
numerous well-known-to-those-who-know sites, plus who knows
how many dozens more that are just the lone teenager's Web
page, with names that put them beyond the scope of search
engines. And based on the two-week sign-up of 973 members
to a recent message-board adjunct to one of the older and
more established sites, the pro-ana community probably
numbers in the thousands, with girls using names like
Wannabeboney, Neverthinenuf, DiETpEpSi UhHuh! and
Afraidtolookinthemirror posting things like: ''I can't take
it anymore! I'm fasting! I'm going out, getting all diet
soda, sugar-free gum, sugar-free candy and having myself a
14-day fast. Then we'll see who is the skinny girl in the
family!''
That ana and mia are childlike nicknames, names that might
be the names of friends (one Web site that is now defunct
was even called, with girlish fondness, ''My Friend Ana''),
is indicative. The pro-ana community is largely made up of
girls or young women, most of whom are between the ages of
13 and 25. And it is a close community, close in the manner
of close friendships of girls and young women. The members
of a few sites send each other bracelets, like friendship
bracelets, as symbols of solidarity and support. And like
any ideology subscribed to by many individuals, pro-ana is
not a monolithic system of belief.
At its most militant, the ideology is something along the
lines of, as the opening page of one site puts it:
''Volitional, proactive anorexia is not a disease or a
disorder. . . . There are no victims here. It is a
lifestyle that begins and ends with a particular faculty
human beings seem in drastically short supply of today: the
will. . . . Contrary to popular misconception, anorectics
possess the most iron-cored, indomitable wills of all. Our
way is not that of the weak. . . . If we ever completely
tapped that potential in our midst . . . we could change
the world. Completely. Maybe we could even rule it.''
Mostly, though, the philosophical underpinnings of pro-ana
thought are not quite so Nietzschean. The ''Thin
Commandments'' on one site, which appear under a picture of
Bugs Bunny smiling his toothy open-mouthed smile, leaning
against a mailbox and holding a carrot with one bite taken
out of it, include: ''If thou aren't thin, thou aren't
attractive''; ''Being thin is more important than being
healthy''; ''Thou shall not eat without feeling guilty'';
''Thou shall not eat fattening food without punishing
thyself afterward''; and ''Being thin and not eating are
signs of true willpower and success.''
The ''Ana Creed'' from the same site begins: ''I believe in
Control, the only force mighty enough to bring order into
the chaos that is my world. I believe that I am the most
vile, worthless and useless person ever to have existed on
this planet.''
In fact, to those truly ''in the disorder'' -- a phrase one
anonymous ana used to describe it, just as an anonymous
alcoholic might describe being in A.A. as being ''in the
rooms'' -- pro-ana is something of a misnomer. It suggests
the promotion of something, rather than its defense, for
reasons either sad or militant. That it is generally
understood otherwise and even exploited (''Anorexia: Not
just for suicidal teenage white girls anymore'' read the
home page of Anorexic Nation, now a disabled site, the real
purpose of which was to push diet drugs) is a source of
both resentment and secret satisfaction to the true pro-ana
community. Its adherents might be vile and worthless, but
they are the elite.
The usual elements of most sites are pretty much the same,
although the presentation is variable enough to suggest Web
mistresses ranging from young women with a fair amount of
programming know-how and editorial judgment to angry little
girls who want to assert their right to protect an
unhealthy behavior in the face of parental opposition and
who happen to know a little HTML. But there are usually
''tips'' and ''techniques'' -- on the face of it, the
scariest aspect of pro-ana, but in reality, pretty much the
same things that both dieters and anorexics have been
figuring out on their own for decades. There are
''thinspirational'' quotes -- You can never be too rich or
too thin''; ''Hunger hurts but starving works''; ''Nothing
tastes as good as thin feels''; ''The thinner, the
winner!'' There are ''thinspirational'' photo galleries,
usually pretty much the same group of very thin models,
actresses and singers -- Jodie Kidd, Kate Moss, Calista
Flockhart, Fiona Apple. And at pro-ana's saddest extreme,
balancing the militance on the scales of the double-digit
goal weight, there are warnings of such severity that they
might as well be the beginning of the third canto of
Dante's ''Inferno'': ''I am the way into the city of woe. I
am the way to a forsaken people. I am the way into eternal
sorrow.'' The pro-ana version of which, from one site, is:
PLEASE NOTE: anorexia is NOT a diet. Bulimia is NOT a
weight-loss plan. These are dangerous, potentially
life-threatening DISORDERS that you cannot choose, catch or
learn. If you do not already have an eating disorder,
that's wonderful! If you're looking for a new diet, if you
want to drop a few pounds to be slimmer or more popular or
whatever, if you're generally content with yourself and
just want to look a bit better in a bikini, GO AWAY. Find a
Weight Watchers meeting. Better yet, eat moderate portions
of healthy food and go for a walk.
However.
If you are half as emotionally scarred as I am, if you look
in the mirror and truly loathe what you see, if your
relationships with food and your body are already beyond
''normal'' parameters no matter what you weigh, then come
inside. If you're already too far into this to quit, come
in and have a look around. I won't tell you to give up what
I need to keep hold of myself.
Most of the pro-ana sites also explicitly discourage people
under 18 from entering, partly for moral and partly for
self-interested reasons. Under pressure from the National
Eating Disorders Association, a number of servers shut down
the pro-ana sites they were hosting last fall. But
obviously, pretty much anyone who wanted to find her way to
these sites and into them could do so, irrespective of age.
And could find there, as Clairegirl did, a kind of perverse
support group, a place where a group of for the most part
very unhappy and in some part very angry girls and women
come together to support each other in sickness rather than
in health.
Then there's chaos -- also her Web name -- who like her
friend Futurebird (ditto) runs an established and
well-respected pro-E.D. site. Chaos, whom I met in
Manhattan although that's not where she lives, is a very
smart, very winning, very attractive 23-year-old who has
been either bulimic or anorexic since she was 10. Recently
she's been bingeing and purging somewhere between 4 and 10
times a week. But when not bingeing, she also practices
''restricting'' -- she doesn't eat in front of people, or
in public, or food that isn't sealed, or food that she
hasn't prepared herself, or food that isn't one of her
''safe'' foods, which since they are a certain kind of
candy and a certain kind of sugar-free gum, is practically
all food. (''You're catching on quickly,'' she says,
laughing, when this is remarked on.) Also recently, she has
been having trouble making herself throw up. ''I think my
body's just not wanting to do it right now,'' she says.
''You have the toothbrush trick, and usually I can just hit
my stomach in the right spot, or my fingernails will gag me
in the right spot. It just depends on what I've eaten. And
if that doesn't work, laxis always do.''
Chaos, like Clairegirl, is obsessive-compulsive about a
certain number (which it would freak her out to see
printed), and when she takes laxatives she either has to
take that number of them, which is no longer enough to
work, or that number plus 10, or that number plus 20, and
so forth. The most she has ever taken is that number plus
60, and the total number she takes depends on the total
number of calories she has consumed.
While it hardly needs to be pointed out that starving
yourself is not good for you, bulimia is in its own
inexorable if less direct way also a deadly disorder.
Because of the severity of Chaos's bulimia, its
longstanding nature and the other things she does -- taking
ephedra or Xenadrine, two forms of, as she says, ''legal
speed,'' available at any health food or vitamin store;
exercising in excess; fasting -- she stands a very real
chance of dying any time.
As it is, she has been to the emergency room more than half
a dozen times with ''heart things.'' It would freak her out
to see the details of her heart things in print. But the
kinds of heart things a severe bulimic might experience
range from palpitations to cardiac arrest. And although
Chaos hasn't had her kidney function tested in the recent
past, it probably isn't great. Her spleen might also be
near the point of rupturing.
Chaos is by no means a young woman with nothing going for
her. She has a full-time job and is a full-time college
student, a double major. She can play a musical instrument
and take good photographs. She writes beautifully, well
enough to have won competitions.
But despite her many positive attributes, Chaos punishes
herself physically on a regular basis, not only through
bulimia but also through cutting -- hers is the
live-journal page with the picture of the sliced-up arm. To
be beheld is, to Chaos, so painful that after meeting me in
person, she was still vomiting and crying with fear over
the possible consequences of cooperating with this story a
week later. ''Some days,'' she says of her bulimia, ''it's
all I have.''
One thing that she does not have is health insurance, so
her treatment options are both limited and inadequate. So
with everything she has going for her, with all her
real-world dreams and aspirations, the palpitating heart of
her emotional life is in the pro-E.D. community. As another
girl I spoke with described herself as telling her doctors:
''Show me a coping mechanism that works as well as this and
I'll trade my eating disorder for it in a minute.''
And while in some moods Chaos says she would do anything to
be free of her eating disorders, in others she has more
excuses not to be than the mere lack of health insurance:
she has a job, she is in school, she doesn't deserve help.
And what she has, on all days, is her Web site, a place
where people who have only their eating disorders can
congregate, along with the people who aspire to having
eating disorders -- who for unknowable reasons of
neurochemistry and personal experience identify with the
self-lacerating worlds of anorexia and bulimia.
Futurebird, whom I also met in Manhattan, says that she has
noticed a trend, repeating itself in new member after new
member, of people who don't think they're anorexic enough
to get treatment. And it's true, very much a function of
the Internet -- its accessibility, its anonymity -- that
the pro-ana sites seem to have amplified an
almost-diagnostic category: the subclinical eating
disorder, for the girl who's anorexic on the inside, the
girl who hates herself so much that she forms a virtual
attachment to a highly traumatized body of women, in a
place where through posts and the adoption of certain
behaviors, she can make her internal state external.
Futurebird and Chaos are sitting in a little plaza just to
the south of Washington Square Park, with the sun behind
them. Futurebird is a small African-American woman. As she
notes, and as she has experienced when being taken to the
hospital, it is a big help being African-American if you
don't want people to think you have anorexia, which is
generally and inaccurately considered to be solely an
affliction of the white middle class. Futurebird has had an
eating disorder since she was in junior high school and is
now, at 22, looking for a way to become what you might call
a maintenance anorexic -- eating a little bit more
healthily, restricting to foods like fruits and whole-grain
cereal and compensating for the extra calories with
excessive exercising.
Like Chaos, she is opposed, in principle, to eating
disorders in general and says that she hates anorexia with
a blind and burning hatred. Although she also says she
thinks she's fat, which she so emphatically is not that in
the interest of not sounding illogical and irrational, she
almost immediately amends this to: she's not as thin as
she'd like to be.
Both she and Chaos would vigorously dispute the assertion
that the sites can give anyone an eating disorder. You
certainly can't give anyone without the vulnerability to it
an eating disorder. But many adolescent girls teeter on the
edge of vulnerability. And the sites certainly might give
those girls the suggestion to . . . hey, what the hell,
give it a try.
''What I'd like people to understand,'' Futurebird says,
''is that it is very difficult for people who have an
eating disorder to ask for help. What a lot of people are
able to do is to say, well, I can't go to a recovery site
and ask for help. I can't go to a doctor or a friend and
ask for help. I can't tell anyone. But I can go to this
site because it's going to quote-unquote make me worse. And
instead what I hope they find is people who share their
experience and that they're able to just simply talk. And
I've actually tested this. I've posted the same thing that
I've posted on my site on some recovery sites, and I've
read the reactions, and in a lot of ways it's more
helpful.''
In what ways?
''The main difference is that if you post -- if someone's
feeling really bad, like, I'm so fat, et cetera, on a
recovery site, they'll say, that's not recovery talk. You
have to speak recovery-speak.''
''Fat is not a feeling,'' Chaos says, in tones that
indicate she is echoing a recovery truism.
''And they'll use this language of recovery,'' Futurebird
continues. ''Which does work at some point in the negative
thinking patterns that you have. But one tiny thing that I
wish they would do is validate that the feeling does exist.
To say, yes, I understand that you might feel that way. And
you get not as much of that. A lot of times people just
need to know that they aren't reacting in a completely
crazy way.''
The problem is that by and large, the people posting on
these sites are reacting in a completely crazy way. There
are many, many more discussions answering questions like,
''What do you guys do about starvation headaches?'' than
there are questions like, ''I am feeling really down; can
you help me?'' And in no case, in answering the former
question, does anyone say, ''Um . . . stop starving
yourself.'' A site like Futurebird's, or like the message
board of Chaos's, are designed with the best intentions.
But as everybody knows, that is what the way into the city
of woe, the way to a forsaken people and the way into
eternal sorrow are paved with.
What Clairegirl, sitting shivering on the running track,
would say today is that when she reaches her current goal
weight, she will stay there. But she can't ever really see
herself giving ana up altogether. ''I don't think I could
ever stop, like, wanting to not eat. Like, I could keep
myself from eating below 300 calories a day. But I could
never see myself eating more than 1,000,'' she says,
wrapping her arms around her knees. ''I consider myself to
be one of the extreme dieters. Like, I could never want to
be -- I mean, it would be so awesome to be able to say a
double-digit number as your weight, but it would look sick,
you know?'' (Clairegirl is 5 feet 7 inches.)
And what about the people on the pro-ana sites who are not
so happy, who describe the disorder as a living hell, who
are in very bad shape? ''Those girls have been going at it
a lot longer than me. But you can't ever really say that
ana isn't a form of self-hatred, even though I try to say
that. If I was truthfully happy with myself, then I would
allow myself to eat. But I don't. And it's kind of like a
strive for perfection, and for making myself better. So I
can't honestly say there's no. . . . ''
She trails off, and gazes up, as if the answer were written
in the night sky, waiting to be decoded. ''Like, you can't
say that every ana loves herself and that she doesn't think
anything is wrong with her at all,'' she says. ''Or else
she wouldn't be ana in the first place.''
Mim Udovitch is a contributing editor at Rolling
Stone.
http://www.nytimes.com/2002/09/08/magazine/08ANOREXIA.html?ex=1032588325&ei=1&en=07d658f34e4dd4e2
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