Size Doesn't Matter

British psychoanalyst Susie Orbach wrote a landmark bestseller on weight and treated Princess Diana’s eating disorders. In Bodies, she takes on Freud and says physical perfection is overrated.

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“I read the new Joan Rivers’ on the plane over here,” says Susie Orbach, the British psychoanalyst who is in New York to promote her 11th book, Bodies. She is referring to Rivers’ cosmetic surgery tell-all, Men Are Stupid . . . And They Like Big Boobs: A Woman's Guide to Beauty. “I pride myself on my knowledge of plastic surgery, but some of those procedures I’d never even heard of. She’s a woman in her seventies and her body is just so incongruous.”

“I recently heard that brides are now offering their bridesmaids plastic surgery a year before the wedding so that it’s all settled by the time they accompany her down the aisle.”

Orbach is the anti-Rivers: At 62, she’s an attractive woman with crow’s feet and a forehead that wrinkles when she’s perplexed. The V-neck of the black T-shirt that she is wearing underscores her unenhanced cleavage, yet she is not looking to go under knife or needle, notwithstanding her recent separation from her husband of 30 years or the fact that for millions, as Rivers will tell you, nipping, tucking, filling or suctioning is as basic a part of a beauty regime as using toner. “I recently heard that brides are now offering their bridesmaids plastic surgery a year before the wedding so that it’s all settled by the time they accompany her down the aisle. I mean, hello!” says Orbach, widening her eyes. “We now see our body as something we can, must, and should perfect.”

The author of Fat Is a Feminist Issue and a professor at the London School of Economics, Orbach is the psychoanalyst who treated Princess Diana for her eating disorders (although due to the confidentiality of the analyst-patient relationship, this is not something that she will ever confirm). She describes her own body as “hardly thin and hardly fat—I’m a small person,” even though her 1978 bestseller introduced women to the idea that fat was “a way of saying 'no' to powerlessness and denial."

Thirty-one years on, she writes that “the postmodern body is in crisis.” Therapists are seeing cases of eating disorders and body dysmorphias “mushroom.” And so her focus has moved from the mind to below the neck to focus in on what the body itself is trying to tell us when it is suffering from anorexia, bulimia, unrelenting desires for plastic surgery or self-mutilation. “When I wrote Fifi [ Fat Is a Feminist Issue], I saw mental problems or social issues being acted out on the body, but I now think that every act of cutting, every eating problem or extreme surgical procedure can be seen as the body attempting to let its presence and the difficulties around it be known,” she explains.

Who doesn’t fret about their body? Even the genetically blessed can’t escape self-scrutiny. But what Orbach is attempting to draw attention to is the fact that we don’t question where this massive discontent stems from and why the numbers are epidemic. “Millions, literally millions, struggle on a daily basis about troubled and shaming feelings about the way their bodies appear,” she writes, adding, “for an increasing number of younger people it is almost as though the body is something that is so much a trouble to them that they are wracked with anguish about it and they feel they have to transform it.”

In Bodies, Orbach relies on her now-familiar style of presenting mostly anonymous, deeply voyeuristic case studies to illustrate her ideas and build her argument. But in this book—the third in Picador’s “Big Ideas Small Books” series—she abandons that method halfway through to consider the body in a myriad of fascinating ways. Along with Korean girls having plastic surgery to “Westernize” their eyelids and Chinese girls having a rod inserted into their upper thighs to reach Western ideals of height, she discusses the body in terms of visual culture, looking at how the constant stream of digitally manipulated images we are exposed to affects our body image. She scrutinizes the tyranny of the celebrity, fashion, beauty, and diet industries (it is her dream to sue Weight Watchers International). She even goes into cyberspace in an attempt to understand the appeal of becoming “disembodied” (and it is hilarious and just a tiny bit sad to read how on the website Second Life other avatars float away from her or ignore her because her avatar is a facsimile of her real self: a 62-year-old woman).

But Bodies becomes unputdownable when Orbach dismantles Freud’s take on the mind-body connection—that repressed emotions could negatively impinge on physical functioning, creating what he called "psychosomatic" symptoms. The theory she posits is that the body experiences as much difficulty as the mind and, until recently, therapists haven’t realized that it is able to “speak” its own problems. “Yes, I agree it sounds mad to separate the mind from the body,” she says, “but it’s necessary to do to shine the light on the body itself. You don’t just have this pristine body that you dump your problems on. The body’s problems are forcing themselves into consciousness and they may be undermining our feelings of safety.”

Orbach points to the immense amount of research that has been done around the development of the personality and the psyche and asks why “nobody ever asks what the hell touching, or not being touched, being swaddled or not being held” means to the development of a baby’s body. “I’ve taken a risk here to say let’s not take our bodies for granted and what I’m also trying to argue is that because mothers’ bodies have been so under assault, the body that they bring to parenting is often a body that is itself so fraught it doesn’t have a coherence and a consistency [to pass on to the child].”

For Freud and for most therapists, the quality of the interaction between baby and caregiver will determine brain and nervous-system development, but Orbach considers that an insufficient account. “If we begin to ask ‘How do we get a body?’ we will see that it’s as complicated as the questions that researchers are captivated by like ‘How do we get a mind?’ or ‘How do we get a sense of self?’ We haven’t even begun to think about how appropriation of the body happens.”

Just as Freud saw the pathologies of the mind, what we can see at the moment, says Orbach, is all the things that can go wrong with the body: obesity or anorexia, only eating one food, or running compulsively. “What I’m trying to say in this book is that the body doesn’t just unfold from your DNA. Everything about it is structured as a result of the parental relationship and culture,” she says. Orbach suggests that, like learning a language, perhaps there is a critical period for what she terms “the acquisition of the body.” “If what you are bequeathed in the parental relationship is a stable body, that is going to stand you in pretty good stead, but if what you get is an unstable body, that instability, just like the language frame, is going to be there for a very long time.”

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So would the late Lady Di have benefited from this new thinking in her treatment for eating disorders? “A therapist can never know how an individual will respond to any particular set of ideas. If only we could! Then we could just convey them and that would be that,” is Orbach’s diplomatic answer. “But what I think you may be asking is, if Bodies is highlighting the madness we have in relation to our bodies, could knowing this and raising awareness help things for individuals? To that I say, I really hope so, so much.”

Nadine Rubin is the former editor in chief of ELLE South Africa. She moved to New York five years ago and has written for Harper's Bazaar and the New York Times. She is currently completing her MA in arts journalism at Columbia University's Graduate School of Journalism.