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Since 1980, eating disorders have been a public health problem in post-industrial society. The sociological literature intends to explain what is at stake in the medical and social success of a new psychiatric category like anorexia nervosa : a contemporary form of hysteria? A medicalization of a female deviance? a social and transient production of modernity? A social construction of a new sensibility about women 's bodies?
Despite active and spreading social sciences studies on this subject, there is a highly popular thesis about the sociogenesis of anorexia nervosa. I would coin it "the causality media thesis", a tragedic variant of the ironic and iconic "fashion victim" thesis. The main victims would be the weak young girls. Some European countries, as Spain and France, have recently enforced a new law to control the women media representation. The ideal and thin body of top models published in magazine, podium and luxury advertising would be the best way to convey anorexia nervosa. The thesis is becoming more strident and popular yet when some "pro-ana" websites try to show anorexia as a lifestyle and not as a mental disorder which may end up to death.
In her very interesting book inspired from a Foucaldian framework as archeology of self and genealogy of anorexia nervosa, Paula Saukko, a senior lecturer in sociology at Loughborough University (Leicestershire, UK), aims at challenging this reductionist "causality media thesis" which implicated the idea that women as victim would have a "weak self" in lacking autonomy or in refusing femininity. On the contrary, in a way that sociologist Charles Wright Mills would probably appreciate, she proposes to understand the more complex link between private troubles and the public sphere. Indeed, the experience of anorexic self is informed by specific political agendas and contexts.
Saukko features the diversity of women' experiences from four local contexts to analyze this complex link and break down with univocal and global explanation (as sexism, capitalism, media, etc.).
In the first context, she tells her own experience of psychiatric discourse as a "critical archeology of the self". When she was a young girl in Finnish country, she was hospitalized because she lost appetite. Stigmatized by this experience, she escaped from the hospital. Here and in the others chapters, Paula Saukko highlights very well the contradictions between the norms of psychiatric diagnosis (the conformism or weakness of anorexic) and the lifeworld of people labeled as anorexic (their rebellion or perfectionism).
In the second context, the genealogy of psychiatric discourse at such, she analyses how the loss of appetite is becoming in U.S.A a disease as the German psychiatrist Hilde Bruch reported it. This medicalization paradoxically accompanied the Freudian anti-repressive agenda.
The third context, related to the media, deals with two iconic figures (Karen Carpenter and Princess Diana) mobilized political values (US neoconservative and British new labor) to tell moral stories about ideal femininity.
The fourth context is based on four women interviews whose moral and political interpretations of anorexia nervosa is quite divergent, in tension between conservatism and progressivism, oppressive and emancipatory norms.
The last chapter is referring on narrative therapy, as technology of self, which would be more free normative and polyvocal than others therapies.
It seems, however, that another important context would be missing. Anorexia nervosa is one aspect of a wider social fact only that it would have been of interest to explore. Adolescence and its psychopathologies (distress, self injuries, addictions, eating disorders, suicide) is indeed an old concern and a contemporary stake beyond the gender issue.
The book has clearly reached its goal: understanding the moral and political complexity of an experience without stigmatizing it. That is great. But the methodological eclectism and the moral relativism, heavily present in the text, are mere politically correct forms. Unfortunately, results of sociology (or psychiatry) are sometimes counter-intuitive with regards to the individual experience.
The point is definitively not here, because the methodological framework of Saukko, behind the postmodern rhetoric, is in fact very coherent, a coherence which comes from a strong Foucaldian perspective. And her sociological problem was certainly more effortlessly formulated by Ian Hacking some years ago: psychiatric classifications of people studies point out how classified people would be affected, and how the effects on people in turn change the classifications. Saukko has a similar program without really knowing it.
© 2009 Samuel Lézé
Samuel Lézé is social anthropologist, posdoctoral research fellow at the CNRS and member of IRIS, EHESS, Paris, France. His research, from a political anthropology of mental health perspective, is on contemporary stakes of psychoanalyst's authority in France, emotional deviance and personal problem's management, forensic psychiatry and adolescent's psychopathology. Website: www.sleze.fr