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Mental Disorders

by Susie Orbach
Picador, 2009
Review by Anca Gheaus, Ph.D. on Feb 23rd 2010


This is a captivating, intriguing and well-written book about the many faces of our current unhappiness with our bodies. It is an exploration of how contemporary culture creates and feeds these discontents (often for commercial reasons) and of how they are passed on from one generation to the next. "Bodies" blends psychology, critical cultural analysis and compassionate story-telling.

An experienced clinical practitioner, Orbach believes that bodily unhappiness -- in the form of eating disorders, self-harming urges or a need for excessive bodily control -- has abruptly surged over the past years. She illustrates this point with numerous stories throughout the book, connecting the increasing bodily distress to what she describes as a widespread, culturally determined, obsessive preoccupation with the body. In its most general form, this preoccupation amounts to a "concern that the body is not all right as it is" (p.89).

In this age and time, argues Orbach, our expectations from our bodies grew to an unprecedented extent. We put pressure on our bodies -- striving to get them in "perfect" shape and conserve their youth, and thus to display our strivings to take good care of ourselves. An internalized sense of responsibility to keep ourselves in good shape and to (excessively, according to Orbach), control our bodies' appetites and appearances, turn our bodies into sites of moral display. We also expect our bodies to provide us with the sexual pleasure and success we feel entitled to, and to supply us with a constant feeling of being alive. Put under such exaggerated pressure, the body "bites back". Examples of bodily distress discussed by Orbach include a patient with an enduring desire to have his legs amputated in order to feel acceptable, another man -- raised by the African Ndebele tribe, but living in England as an adult -- who cannot bear any clothes, a girl who cannot help but getting herself into escalating physical fights with her adoptive mother, and various examples of eating and sexual mis-functioning.

The current standardized culture of idealized bodily images is the main culprit in generating distressed bodies by making us focus on very few aspirational models. The wide variety of bodies one finds in reality is increasingly less reflected in the representation of the beautiful body. The combination of homogenous and overambitious bodily ideals breeds bodily hatred.

Behind this culture of aspiration to bodily perfection are the economic interests of the beauty and diet industries. At the micro-level, parents' distress with their own bodies is likely to be transmitted to their children in some form of bodily anxiety. The way babies are cared for -- held, fed, looked at, spoken to, cuddled, encouraged or discouraged to discover the world and the limits of their own bodies -- is essential for the creation of their selves, including their perception of, and relationship with, their body.

One of the most appealing features of Orbach's writing is her very fine-grained analysis of how gender expectations -- most often unconscious -- permeate relationships between parents and children, often defeating parent's conscious attempts to raise their children in gender-egalitarian ways. In her previous work, she gives examples of the differences in which baby girls and baby boys are held and spoken to, and of the different ages at which they are weaned or potty-trained. Because knowledge of children's gender shapes people's emotional and behavioral responses to them, carers have different emotional reactions to girls and boys and, indeed, train their bodies differently. In "Bodies", one example comes from Orbach's own experience of a first-time mother who was able to contain the fear that her son might harm himself, where she thinks she would not have been able to do it, had her first-born been a girl. Parents -- and undoubtedly non-parents' --  gender-sensitive responses towards children cannot but entrench and reproduce gendered expectations, stereotypes and social roles.

The author's most original, an intriguing, claim in this book is that we should resist a long Freudian tradition, and should not understand all bodily disorders as originating in mental distress, i.e. as coming from outside the body. Instead, we should understand (some) kinds of bodily disorders as direct expressions of bodily distress. However, Orbach identifies the origin of these disorders in very early relationships -- by arguing that infants and small children can and do pick up their carers' anxieties, and appropriate them. But, it seems to me, one needs to use a process of decoding, of making sense of whatever cues one is given, in order to pick up from one's caregiver any kind of bodily meaning. If this is true, then unconscious processes are, after all, necessary to explain these cases of transmission of bodily distress. Moreover, Orbach herself suggests -- as a way out of the trouble -- that we consciously resist the current idealization and excessive preoccupation with our bodies. (It is somewhat paradoxical that she writes a book about the body with the final aim of shifting the focus away from it. Perhaps, one should go about achieving this goal dialectically, by first undergoing a phase of sustained reflection of one's relationship with one's body.) This solution is itself located at the level of the mind, rather than at the level of the body itself, thus casting extra doubt on the author's original thesis. If we are to understand bodily distress in the body's own terms, rather than originating in the conscious or unconscious mind, why would we have to look for a cure outside the body itself? Orbach's book is an extensive, sophisticated application of Freud's understanding of the role of the mind in bodily functioning, rather than a rejection of it.


© 2010 Anca Gheaus


Anca Gheaus is a post-doctoral researcher at the Philosophy Faculty of the Erasmus University in Rotterdam. She works on theories of care and justice on which she has published several book chapters and articles in Raisons Politiques, Feminist Theory, Basic Income Studies and Hypatia.