Two days ago, alone with a colicky baby in arms, I was channel-surfing, when I came upon an HBO documentary called Thin. It was shot in an expensive treatment facility for eating disorders. The profiles of the women featured, with feeding tubes and suicide-attempt scars and some with the ability to vomit on demand, were devastating. At least two of the women prominently featured were from working class families that went into debt to pay for this treatment. And my impression at the end of the documentary was that the prognosis for most of these women is not very cheerful.
When I was reasearching for and writing Sex & War, a book on gendered power and imperial militarism, I began reading more about so-called eating disorders. I also have personal experience with this among my own family members. While watching this film, exclusively recorded in a "recovery-based" tratment facility, I was struck by the scrupulous avoidance of the subject of gendered power, even as it seemed to be the film's silently screaming subtext. In order to even acknowledge what was happening to them, these women had to be isolated from the rest of society.
My status as a combat veteran, and my activism with other combat veterans, has kept me right up next to the subject of another "disorder" called post-traumatic stress (PTSD). By now, discerning readers have sense my skepticism -- declared in terms like "so-called" and scare-quotes -- about the whole disease model commonly associated with psychiatry on the one hand and the "recovery movement" on the other.
Labeling these phenomena "disorders" -- and legitimating them by inclusion in the DSM-IV -- then "treating" the disorders using "recovery" orthodoxies, has not only demonstrated little long term success, seems to close off whole dimensions of investigation of these phenomena.
The fact that 50% of eating disorders are believed to be associated with early sexual abuse, the fact that the most common origin for PTSD is rape, the fact that rape and combat are situation where there are sudden and terrifying losses of control... these connections are always turned inward for resolution, approached with an individual therapeutic orientation, and medicalized with the treatments commodified... this should alert us to something. Beginning with the fact that were women not sexually abused and attacked, and socially subordinated in ways that associate their intrinsic worth with appearance, and stripped of any agency... and begining with the fact that men don't just take the wrong turn on the way to work one day and end up in combat zones, we might assume that there is a social-power dimension, and therefore a poltical dimension to all these "disorders."
Childhood sexual abuse, rape, body-image obssession cultivated for profit, and war all attack real human bodies, and they are all exercises of power. The woman who purges, as well as the veteran who self-medicates with alcohol, are both caught in the paradox that they have experienced a fundamental loss of control over their own lives, that they attempt to re-establish control in these highly circumscribed ways, and that even this "control" is lost as it becomes an obssessive ritual. Suddenly, one day, they discover that the ritual itself has become their prison.
One of the interesting things I learned as a soldier was that health (now called medicine as it has become specialized) is something most people can learn. Special Forces includes among its military occupational specialties the SF Medic. That was my specialty before I was promoted out of it. I went to school for a year to learn it. Special Forces has to operate remotely, so the SF Medic has to learn a good deal more than the average Band-Aid-and-Motrin medic. At the end of that year, I knew field sanitation, differential diagnosis, nursing modalities, trauma protocols, basic obstetrics, the prevention and treatment of a host of the most common diseases, rustic anesthesia and surgery, and a bit of veterinary medicine. I pulled teeth for chicken dinners in Honduras. I caught nine babies at Claremore Indian Hospital. I helped remove shrapnel from an abdomen in Venezuela. I saved a horse in Ferrier, Haiti. On and on... but the point is, I didn't have to attend eight years of medical training, and I never required a multi-million dollar facility to treat helminths in Panama or Shigella in East Africa.
Ivan Illich -- an Austro-Russian priest, who worked extensively in Mexico -- wrote a modest little tome in 1973, called Tools for Conviviality, in which, among other thngs, he made a scathing critique of "medicine." De Clarke, my friend and the editor for Sex & War, sent me a copy of that book a while back, and in the first chapter I found Illich articulating what I had come to feel about medicne, and the medicalization of all these "disorders."
"The year 1913," Illich begins, "marks a watershed in the history of modern medicine. Around that year a patient began to have more than a fifty-fifty chance that a graduate of a medical school would provide him with a specifically effective treatment (if, of course, he was suffering from one of the standard diseases recognized by the medical science of the time). Many shamans and herb doctors familiar with local diseases and remedies and trusted by their clients had always had equal or better results."
Further down, Illich notes: "Since then medicine has gone on to define what constitutes disease and its treatment. The Westernized public learned to demand effective medical practice as defined by the progress of medical science. For the first time in history doctors could measure their efficiency against scales which they themselves had devised. This progress was due to a new perspective of the origins of some ancient scourges; water could be purified and infant mortality lowered; rat control could disarm the plague; treponemas could be made visible under the microscope and Salvarsan could eliminate them with statistically defined risks of poisoning the patient; syphilis could be avoided, or recognized and cured by rather simple procedures; diabetes could be diagnosed and self-treatment with insulin could prolong the life of the patient. Paradoxically, the simpler the tools became, the more the medical profession insisted on a monopoly of their application, the longer became the training demanded before a medicine man was initiated into the legitimate use of the simplest tool, and the more the entire population felt dependent on the doctor. Hygiene turned from being a virtue into a professionally organized ritual at the altar of a science."
In a rather peculiar detour -- which would eventually be subjected to the same monopolization -- aspects of human misery that did not readily reveal themselves as a bug in the laboratory -- from alcoholism to anorexia nervosa -- were transformed into metaphorical diseases by an alcoholic medical doctor and a stock speculator in 1935; and this gave birth to the Recovery Movement. This movement has itself now become a kind of orthodoxy; but the interesting thing is that it has now gained acceptance in the medical community as part of a treatment protocol. The meetings are still free for AA, NA, OEA, and the rest; but if you are "failing," as most do, then you can escalate to the medically-monopolized, commodified model of treatment featured on Thin
The limited success of the 12-step orthodoxy seems attributable more to the sense of community it encourages than its claim that every obssesive behavior is a disease... the result of a "character defect" that has to be removed -- after petitioning through prayer -- by a higher power. God becomes the doctor. But when God isn't enough, seek treatment by professionals.
The way this invariably turns back on the individual victims to seek the etiologies of these very real phenomena, and the way it so readily lends itself to commodification, raises a lot of flags for this writer (also a veteran of the 12-Step Program).
Watching these waifish, self-starving women struggle with the paradox of control, and seeing their teatment continually focus on overcoming "character defects," I grew very agitated at the fact that not a word was uttered about patriarchy. Not a single word.
The message in this silence? Deal with it.
My own frank discussions with a number of politically-conscious women reveal that even those women who have intellectually rejected the patriarchal demand for the eroticized infantile body-type still struggle affectively with body image. The indoctrination of body-hatred begins very early, and it is completely relentless. There is nothing about our bodies that does not, according to the demand-production propaganda of commodified sexuality, require correction. Particularly if you happen to be a woman.
So if this is a problem that is that difficult to deal with by women who actually understand something about the misogyny that underwrites these socially constructed "pathologies," how is it that anyone expects the women in these commercial treatment facilities to "recover," if the deeper source of their problem -- internalized patriarchy -- is intentionally concealed from them, and avoided like the plague in Recovery Orthodoxy as an "outside issue"?
The deal-breaker for me, after admittedly learning some valuable lessons about interpersonal relationships, with the 12-Step orthodoxy was that the goal stated in our manifesto was "to become productive members of society."
What is it, then, that we were supposed to produce?
When those wounded women at the eating disorder recovery facility "succeed," what is it that is the implicit measure of success?
This brings me back to my own repeated association with PTSD. In my second book Full Spectrum Disorder (no pun intended), I wrote briefly about PTSD. I close with an excerpt, since this doesn't seem to have changed.
A friend asked me not long ago if I had ever been diagnosed with posttraumatic stress disorder (PTSD). I haven't, not officially, but I picked up a book about trauma after she asked that question. Here's what it said: "trauma destroys our fundamental assumptions about the safety of the world; trauma destroys the positive value of the self; trauma destroys the belief in a meaningful order of creation."
The Army sent me to a kind of two-decade school, and in school I learned something.
The world is not fundamentally safe.
So is it us, the combat veterans, the rape survivors, and the anorexic women, who have the disorder? If disease means dis-ease, does this means we are cured when we are at-ease with the world as it is, when we accept the power of others over us?
Only the medical professionals know for sure.