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Bodies, By Susie Orbach

It's been almost 30 years since Susie Orbach, as a young psychotherapist, picked up on the problems with eating and body image she was encountering in her work, and declared to the world that Fat is a Feminist Issue. Her argument was that "tucked into notions of thinness and fatness, were complex social and psychological ideas and feelings that were having difficulty being expressed directly".

This notion has been absorbed into the mainstream. People who have never read a word of Orbach talk knowledgably about "comfort eating" or a diet that makes them feel "in control".

In Bodies, Orbach rails against "the myth of obesity" and warns that "this so-called crisis" is misunderstood. Such assertions seem like a huge challenge to orthodox ideas. But really, all Orbach is pleading for is context. She is concerned that the current mantra, that fat is bad and thin is good, masks many of those "complex social and psychological ideas and feelings", and actually bolsters, even sanctifies, some of the bodily hang-ups about which there should be very great concern.

Most women, Orbach says, now display "a constant fretfulness almost natural and invisible" about their food intake and weight. Many men and children have joined them. She is concerned that other cultures have embraced the west's obsessions, and asserts that: "The attempts by young people in Japan or Fiji, Saudi Arabia or Kenya to refashion their bodies reveal the sorrow of troubled bodies around the world."

Orbach starts out by discussing some of the most extreme expressions of bodily dissatisfaction that have fascinated her. She talks about Andrew, an "amputee wannabe" who was so desperate to have his legs surgically removed that he eventually packed his lower body in dry ice until there was a medical need for amputations. She mentions the men she met at the city prisons of New York, who spoke of being trapped in the wrong body, and longed for surgery to reassign their gender.

It is interesting that Orbach seems to acquiesce to the logic here of altering the body to fit with the notion of the body that exists in the mind. She strongly disapproves of the mass resort to cosmetic surgery.

Even Orbach admits that some of her case studies describing success in tackling body issues might seem "quite bizarre". She talks of "wildcat countertransference", and introduces Colette, a perfectly groomed beauty who makes Orbach feel uncharacteristically inadequate about her own looks. The "breakthrough" comes when Orbach's usual feeling of post-session scruffy inferiority is replaced by an intense burning sensation. Colette's brother, it turned out, had died by burning. The other children had subconsciously learned to sooth their mother by presenting her with undamaged physical perfection.

Orbach's diagnosis is that Colette's unhappiness was the result of her construction of a "false body", much like the psychological false self that Winnicott identified a child as developing "when his or her need for recognition goes unheeded". Colette's mind and the physical self she presented to the world were at odds, as is reported by sufferers from gender dysmorphia.

Now, whether or not one is sceptical about this almost mystical ability Orbach claims, whereby she sits in a consulting room, divining like a shaman the hidden traumas of her patients, the practicalities are incontestable. If, as Orbach rather persuasively argues, the psychological problems caused by childhood development of a "false body" are running at epidemic levels, there is little chance that they can be addressed through the long, intensive, one-to-one process of psychoanalysis.

She argues that "orthodox psychoanalytic theory about the mind's ability to commandeer the body has fallen short" and calls for "a more fully psychosomatic theory of human development".

Essentially, Orbach's argument is that human bodies have never been merely the products of the genetic imprints they inherit, but are shaped by upbringing. In a simple developmental context, we don't just inherit our gait from our parents, we also learn it from them. In a more complex context, we don't just inherit our skin colour from our parents, we also inherit the limitations of caste, class and aspiration that it confers in our society.

A terrible paradox has emerged because modernity has seemingly freed people, to a greater or lesser extent, from the idea that birth is destiny. But it has also delivered technological advances that invite us to see our bodies as negotiable works-in-progress that can be transformed into easily, even irresistibly, communicable ideals.

The commercial (and medical, and even governmental) clamour that sells us the possibility of a bodily ideal, persuades us that our bodies don't have to be viewed as stable or acceptable. That destabilisation of our bodies, Orbach's clinical experience has persuaded her, can destabilise our minds. We need to be more robust, Orbach warns, in defending ourselves, and our children, against such balefully disruptive psychological pressures.

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