Literary anorexics such as Marya Hornbacher turn a narcissistic rage on the insular, immature society that bred them. Joan Smith diagnoses a modern malaise
Kafka's short story "A Fasting-Artist" is about a circus performer whose act consists of setting records for the number of days he can go without food. As he grows more feeble, visitors lose interest and a passer- by even accuses him of fraud. The irony is that, far from being an act, the fasting-artist feels compelled to starve. It is his only means of drawing attention to himself, he explains, just before he expires in a heap of rags and bones.

His almost-last-words, "I always wanted you to admire my fasting", could be an epigraph for Marya Hornbacher's book Wasted: a memoir of anorexia and bulimia (Flamingo, pounds 12.99). Hornbacher is 23, American, and traces her history of eating disorders back to the age of five. Her story is a progress from bulimia through experiments with drugs and casual sex to a state of anorexia so severe it almost killed her. Even now, she believes, its consequences are etched into her body. She wakes in the night, next to her sleeping husband, and fears she is having a heart attack. She has told him he will outlive her and all they can be sure of is the fact that, for the moment at least, she is still alive.

"See? I'm here," she writes, endlessly seeking reassurance. "See? See? See? Look at me. Look at me." It is this desperate plea, right at the end of Hornbacher's book, when she has been institutionalised and brought back to life for the third or fourth time, which connects so closely to Kafka's fasting-artist. "It's never over," she concludes. "Not really, not when you stay down there as long as I did, not when you've lived in the netherworld longer than you've lived in this material one, where things are very bright and large and make such strange noises."

It could be a description of the fasting-artist, looking through the bars at a world he fears. Engagement in that world is beyond him, as it appears to be for Hornbacher, so the point of living becomes something else: to be noticed. Wasted recognises this state of dissociation, so familiar there is no release. "Always, there is an odd distance between you and the people you love and the people you meet, a barrier, thin as the glass of a mirror." Glass, the bars of a cage: it doesn't matter what the barrier consists of, only that it cannot be dismantled. It represents a state of deprivation so intractable that what is missing resists definition. "I've never been able to find the kind of nourishment I like," explains Kafka's fasting-artist apologetically.

In this condition of perpetual frustration, smaller goals substitute themselves. Kafka's circus act settles for admiration; Hornbacher wants to be seen. Her book is, in a sense, another way of making that demand now that the original strategy, starvation, has become too costly. Description has taken the place of experience but the route chosen marks a change of register, not an escape.

If this sounds harsh, it is because Wasted excites such contradictory emotions. On the one hand, Hornbacher's account of bingeing, throwing up, starving and collapsing, her ghastly descriptions of what it is like to have a four-stone body, leave the reader reeling. Stick-like, vomiting blood, she resembles a torture victim, tottering through her own narrative like the concentration camp survivor in Marguerite Duras's fictionalised fragment of autobiography, La Douleur.

On the other, these horrors are self-inflicted and all the more terrible because Hornbacher is able to analyse them so dispassionately. "Many of us came from less-than-grounded families," she observes, describing women with eating disorders. "We were living inside a pressure cooker, competition tough, stakes very high..."

Young women, in the late 20th century, do seem to have a tendency to suffer eating disorders, and to write books about them. Many, though not all, come from the US and the adolescence they describe (usually of a white girl growing up in a wealthy area) is similar. The most impassioned sections of Naomi Wolf's The Beauty Myth are about her experience as an anorexic. At 13, "not a teacher or a principal or guidance counsellor confronted me with any objection to my evident deportation in stages from the land of the living." "Look at me. Look at me," says Hornbacher. No one noticed how I was suffering, says Wolf. And this brings us to the heart of the phenomenon. There are plenty of theories about the tyranny of slenderness, about the dire effects of elevating emaciated models into icons, but eating disorders are more convincing as a desperate assertion of control, acted out on the only body the sufferer feels able to affect. Her own.

The most powerful emotion to emerge from these accounts is fury. When Hornbacher writes that "I was born in Walnut Creek, California, to a pair of exceptionally intelligent, funny, wonderful people who were perhaps less than ideal candidates for parenthood," the anger is already there. By the end, it is a rage which, inflicting only glancing blows on its real target, has very nearly consumed her instead.

Bulimia and anorexia, no matter how punishing their physical symptoms, have other, more ambiguous effects. One is an intense, narcissistic relationship with the self. Hornbacher uses Freud's formulation, "lack of affect", to describe her long-standing inability to form ties with other people. A recurring feature of Wasted is the way in which parents, friends and boyfriends are described in terms of psychoanalytic jargon or their responses to Hornbacher herself.

Her story is, in essence, an account of desperate behaviour accompanied by a long wait for the people around her to respond. She vacillates between congratulating herself on her self-control and her ability to conceal her bingeing, and absolute incomprehension that conduct so bizarre has not inspired someone to intervene. But, like the fasting-artist, it is always her relation to others that she seeks, in a roundabout way, to alter.

What emerges from Wasted is the sense that eating disorders represent a peculiarly perverted form of narcissism. We are only now beginning to recognise that it is the form of the disease, rather than its origins, that is culturally determined. Girls turn aggression on themselves, boys on others, which is why more boys end up in court.

Why have these diseases affected so many young women in the most affluent society on earth? As long ago as 1963, in The Feminine Mystique, Betty Friedan compared the lives of women in American suburbs to a "comfortable concentration camp". The daughters of that uniquely discontented generation appear to have taken the metaphor a step further, inflicting camp conditions on themselves. The literature of eating disorders describes these conditions, without explaining the underlying malaise. Wasted does not provide much elucidation, apart from anecdotal evidence that Marya Hornbacher, like other sufferers, is the product of an affluent, insular, self-obsessed culture that shows little sign of maturity.