In 2004, Hilary Mantel wrote an article in which she suggested that modern-day anorexia provided a means for sufferers to opt out of the demands placed on the “ideal woman.” The latter, she wrote, “has the earning powers of a CEO, breasts like an inflatable doll, no hips at all and the tidy, hairless labia of an unviolated six-year-old.” For women,“The world gets harder and harder. There’s no pleasing it. No wonder some girls want out.”
When I first read the article, not long recovered from anorexia myself, it did not make sense to me. “Anorexia,” Mantel argued, “seems like mad behaviour, but I don’t think it is madness. It is a way of shrinking back, of reserving, preserving the self, fighting free of sexual and emotional entanglements.” Anorexia might seem like self-preservation from the outside, but much of what I recalled—the obsession with timing meals, the sheer panic at any deviation from routine, the hoarding of rotting fruit, the belief that the oil from cosmetic products would sink through my pores and make me fat—seemed pretty insane. Spending an entire day imagining the packet of Skips (13.1g, 71 calories) I’d have for tea did not feel like a form of resistance. As fellow sufferer Jan Wienpahl wrote in her 1993 piece Fourteen Days in the High Sierra, “if my ‘struggle’ is, as Susie Orbach would have it, a ‘metaphor for our age’, all I can say is what a pathetic age.”
Years later, I came back to Mantel’s piece and found it read differently. While I had not experienced illness as a conscious “wanting out” of the impossible demands of femininity, illness had granted me exile all the same, and I had valued it. Like so many former anorexia sufferers, I mourned the loss of my illness. I did not miss the suffering or the boredom, but wellness—“healthy, normal womanhood”—felt like something into which I’d been tricked, a state with countless conditions and expectations about which I had not been warned. “The general consensus,” wrote Orbach in 1986’s Hunger Strike, “is that the [anorexic] patient has recovered when the normal weight is reached and appropriate sex role functioning is achieved.” “Being well” felt like capitulation to an idea of womanhood that failed to represent me, but which my larger, healthier body signified all the same.
I did not want to be ill again, but for a long time—maybe even now, as I write this—I wanted people to know that I had been ill. I wanted them to think I could have been a contender in the fight against “normal weight” and “appropriate sex role functioning.” I wanted to retain a little of what Mantel calls “a certain personality structure which has always been problematical for women … a type which is withdrawn, thoughtful, reserved, self-contained and judgmental, naturally more cerebral than emotional,” more prone to starvation and opting out. I think this is why I had many “recovered” years which might more accurately be described as to-and-fro, dabbling, not-quite-deciding years. I wanted to remain on the periphery of healthy and normal, both of which symbolised consent to feminine norms I did not feel prepared to embrace.
In short, “ill woman” can be a desirable identity. I am conscious of the risks of that statement. So many young women with depression and eating disorders have been called vain, attention-seeking manipulators that it is tempting to steer clear of the topic entirely. Yet, ultimately, I think we must address this dynamic honestly. Strange as it may sound, this is the only way to show women that wellness—health, strength, recovery—is a safe and good goal, a state that they may seek and embrace without fear or regret.
For too long, sickness has been a site of fake rebellion for women, allowing them to avoid confronting the restrictive gender stereotypes that falsely constrain our shared conception of what “healthy womanhood” looks like. In the age of diagnosis—which is also the age of porn—I worry that this dynamic is worsening. While embracing a medical or psychiatric label might feel freeing to an individual woman, at the societal scale, the trend has the opposite effect, reinforcing the belief that women who do not fit the regressive stereotypes of pop gender ideology and tradwifery are somehow deviant or defective as women.
“Healthy Womanhood” in the Age of Diagnosis
Far more people are being diagnosed with mental disorders now than when I became ill. This is especially true of young women, for whom rates of diagnosis can be twice as high as for young men.
Debates surrounding this phenomenon are often seen as a face-off between diagnosis deniers (older, more right-wing people yearning for the days when everyone “just got on with it”), and those seeking to end stigma and validate distress (younger, more left-wing, therapy-literate types). Feminists might be expected to side with the latter, viewing the recent rise in diagnosis not as a continuation of patriarchy’s pathologisation of femaleness, but as a corrective to women’s health being ignored overall. Yet this overlooks the way in which broadening the criteria of sickness necessarily limits our definitions of health.
If feminism is a political project that seeks to expand our understanding of what a woman can be, what impact does it have when more and more facets of her humanity—her beliefs, her feelings, her behaviours—are redefined as symptoms of deviation? What definition of “normal woman” is left behind? And whose definition is it? If the space into which one can recover has become smaller, recovery becomes harder, if not impossible.
Recent books such as Suzanne O’Sullivan’s Age of Diagnosis and Sami Timimi’s Searching for Normal question the expansion of diagnostic labels in neurology and psychiatry. O’Sullivan defines overmedicalisation as occurring “when ordinary human differences, behaviour and life stages are given medical labels, turning them into the business of doctors,” while overdetection occurs when “the dividing line between normal and abnormal slowly shifts so that, over time, people who would once have been considered healthy are drawn into the disease group.” Meanwhile, Timimi writes that “psychiatric classification of behaviours and experiences considered disordered relies on an idea that the person’s presentation sits outside an imagined normal.”
Of course, gender is also a system of “classifications of behaviours and experiences.” It is a set of ideas about what is normal or deviant for persons of one sex or the other, operating (from a radical feminist perspective) to facilitate male dominance and female subjugation. Feminism has typically sought to bring “unfeminine” or “non-compliant” women back in from “outside an imagined norm,” thereby causing disruption to the gender hierarchy. Leaving such women on the outside, even adding more to join them in “the disease group,” leaves the hierarchy intact.
Historically, feminist critiques of psychiatry, in works such as Elaine Showalter’s The Female Malady and Phyllis Chesler’s Women and Madness, have placed particular emphasis on the way in which gender non-conforming women could be defined as mad and often institutionalised against their will. But what happens when the non-conforming woman self-diagnoses as mentally ill? What if this is considered not an extension of patriarchal control but an act of self-recognition?
If “unfeminine” ways of thinking, feeling, and behaving remain acceptable only when they are captured by a diagnosis, then declaring oneself ill becomes a means of rendering oneself inoffensive by posing no challenge to regressive ideas of “healthy womanhood.” “Healthy womanhood” is left as it stands, for the walking stereotypes, for those who are assumed to lack the inner complexity to care.
The New Hysteria
There is a history to this. It is, I am sure, highly controversial to compare the current rise in young women being diagnosed and self-diagnosing as mentally ill to the late nineteenth-century cult of hysteria and invalidism amongst upper-class women. This is, in part, due to how we have come to regard “hysterics”: as posh ladies lying on the chaise-longue, demanding that less privileged women, women who have genuine problems, pass them the smelling salts. Unless their plight can be put in some directly coercive context, Yellow Wallpaper-style, a privileged woman who seems to be choosing to be ill, perhaps as part of some social contagion, is not seen as deserving of much sympathy.
Nonetheless, the manifestation of sickness as an acceptable, internalised, largely unconscious form of rebellion is instructive. Barbara Ehrenreich and Deirdre English have argued that many women “probably were using the sick role to escape their reproductive and domestic duties.” The distinction between “real illness” and flight to an acceptable space outside of oppressive feminine / reproductive norms becomes blurred:
Doctors had wanted women to be sick, but now they found themselves locked in a power struggle with the not-so-feeble patient: Was the illness a construction of the medical imagination, a figment of the patient’s imagination, or something ‘real’ that nevertheless eluded the mightiest efforts of medical science?
As Ethan Watters recounts, the medical historian Edward Shorter sees anorexia as an evolution from hysteria: “whereas in the 1950s self-starvation was a rare symptom associated with hysterics, by the end of the century the medical literature was littered with references to full-blown anorexics.” I might have done so once, but I no longer find it offensive to think of my own situation as comparable to that of a hysteric. I don’t think the expectations for female “normality,” for any era or class, are trivial. Why, then, should resistance be seen as indulgence?
In her 1961 novel The Ha-Ha, explored by Showalter in The Female Malady, Jennifer Dawson’s protagonist Josephine realises that in order to leave a mental asylum, she must learn “the rules of what to do and what to say” and have “the corners rubbed off.” “Looking into the mirror,” writes Showalter, “Josephine sees that she has become a grotesque parody of female passivity.” In response, she decides to escape and “take her chances with madness.”
Today, “taking one’s chances with madness” can merge with taking one’s chances with other diagnostic labels, neurodivergence, and/or with flight from femaleness entirely. It’s not that the feelings (the “symptoms”) are not real, but situating them within the scope of “ordinary human differences, behaviour and life stages,” as O’Sullivan puts it, requires a great degree of resilience. Diagnosis culture and increasingly restrictive gender norms make it easier to embrace an “abnormal” status. This can feel like resistance, but only because the space between diagnostic compliance and feminine compliance grows harder to find.
Wellness Is Not Consent to Misogyny
Multiple diagnoses have, for some women, become a way of signalling not just their distance from corners-rubbed-off, undifferentiated femaleness, but also their political virtue and purity. There’s an irony in this, insofar as a highly restrictive idea of “health” as purity—humanity with every difference excised—has been a feature of oppressive, far-right views. In a recent piece on why she is “glad there isn’t a cure for autism” the non-binary writer Laurie Penny tells us that “non-conformity is the opposite of fascism, and the backlash against autistic identity is already building beyond the ranks of the far right.”
While I find such arguments offensive on a fundamental level (my autistic relative who has led a far more restricted life than Penny would, I think, probably appreciate some kind of cure), I think the vague mashing together of all things “non-conforming” as virtuous is typical of adherents to queer theory and identitarianism. Wellness—all wellness—is suspect. Does one really need to add that the “sick” people who are harmed least by this are those who are in fact closest to the narrow “well” norm?
Back in 2005, Mantel asked what choices were on offer for women in the wake of raunch feminism:
Self-assertion means acting; it means denying your nature; it means embracing superficiality and coarseness. Girls may not be girls; they may be gross and sexually primed, like adolescent boys. Not every young woman wants to take the world up on this offer.
It is even more difficult now, as both left and right expect women to choose between their versions of “normal womanhood.” If the options available are the trans activist’s hyper-feminine doll or the conservative’s tradwife, what is left for the young woman with her own inner life? Who wants to seem well-adapted to de-subjectification? Sickness—anxiety, depression, anorexia, psychosomatic disorder—offers a stab at selfhood denied by wellness. Wellness risks signalling psychological satisfaction with one’s situation and the way in which one’s body is perceived. It risks signalling consent.
When we clean up the category of “well woman” by defining more and more qualities as sick, we necessarily make assumptions about those who remain in it. Radical feminists have argued that femininity punishes women, whether or not they conform to its strictures. Both Butlerian gender ideology and Trumpian gender conservatism dispute this, insisting that femininity does not hurt. Both contend that women like being reduced, as Andrea Long Chu wrote, to “an open mouth, an expectant asshole, blank, blank eyes” (they only differ on whether women need to have female anatomy).
If young women have been terrorised out of saying “women aren’t that,” sickness and diagnostic labels provide a means of saying I’m not that—even if the others are. They provide non-confrontational way of managing the fact that one is at odds with what the world wants a woman to be. One can say to the entirety of gender politics (no matter whether the misogyny one is facing comes from left or right) “it’s not you, it’s me. I’m the broken one. Please may I be excused?”
I write this now as a healthy woman, never entirely free of the feeling that this makes me some kind of sell-out. But mental wellness, health, and recovery should not be misconstrued as consent. They are a reclaiming, a rejection of endless retreat. What mental illness feels is not the same as what it means, but the two are related. It is not invalidating to want better. I think it’s time we disrupted the category from within.
