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Determined, intoxicating, resourceful and stereotypically middle-class – you only need to spend a matter of minutes at medical school before you meet an ‘Ana’ or a ‘Mia’. Romantic and feminine these names may be, but things aren’t what they seem – a significant minority of ladies who appear successful and talented amidst our incestuous fishbowl are keeping a very dirty secret. Their secret commands and compels out of choice; the choice to equate weightlessness with godliness. 

Welcome to the darkly exclusive web called pro-active anorexia. Preferring to be seen as a social movement which serves to define anorexia as a lifestyle choice, the movement concentrates on self-control and discipline in order to better the self. Providing a sharp contrast to the professional view of the condition as a disease or a disorder, ‘Pro-Ana’ defines itself as a proactive ‘choice’, differing from the reactionary behaviour of eating disorder anorectics. Followers are inspired to initiate from within themselves, without needing to maintain ‘internal control’ as a psychological coping device in response to some external event or stimulus. They thrive on the challenge of getting the human body to respond to will; a task they feel must be completed before turning their iron will to better the rest of the world. Pro-Ana’s see themselves as a power to be reckoned with. ‘Victim’ is a dirty word.  

Websites such as the Grotto, provide invaluable support to Pro-Ana’s battling against victimisation. Inspirationally grotesque pictures of celebrity skinnies, such as Nicole Richie and Calista Flockhart are categorised as ‘thinspiration’ nestled amongst quotes from luminaries such as Eleanor Roosevelt and Catherine de Medici. These writings are used liberally to battle against the ‘victim’ mentality despised by the movement. After all, ‘no one can make you feel inferior without your consent’. Practical support is also offered, delineating foods as ‘good’ and ‘bad’, whilst teaching the reader how to deceive outsiders into thinking they’ve not ‘avoided that plate’. What is especially striking is the perceived thought of society as the ‘enemy’.  

Viewed as a victim culture, society and its peons are out to inspire conformity to pre-determined biological standards. The conspiracy of conformity is an interesting one – are the people who ‘give in’ to natural hunger impulses weakened by their desire to satiate nature? Are the very same people eager to silence ‘pro-Ana’ voices in order to hide their insecurities about the way the Ana lifestyle exposes their weakness? What about the perceived selfishness where the masses aren’t allowed to ‘throw off the chains of nature and exist self-directed’? These are well worth considering in an increasingly individualistic world where the principles of deontology are fighting against decisions taken for the ‘greater good’.

Whilst individualism may attempt to provide a theoretical basis for getting the body one wishes for, the libertarian argument to have the right to create said body falls flat when the attitude of pro-Ana’s towards their opposition are concerned. Unsurprisingly, feedees, feeders, sumo wrestlers and squashers are castigated for being weak in spite of their single-mindedness to look and feel as they please. Their pictures make a presence in the ‘reverse trigger’ section, amidst sensationalist articles on ‘fat acceptance’ and the perils of obesity. 

It is evident that the desire to be thin stems from a more expansive area of the psyche. Historically speaking, anorexic behaviour was relatively confined to ascetic types. Greek philosophers observed the body, to be part of the material world, considering it evil in contrast to the ‘holy’ soul imprisoned within.  This depreciation of the body was not confined to male recluses, with wealthy Roman ladies and princesses taking part in self-imposed fasting in order to prove altruistic enough to survive on their faith alone. ‘St Jerome’ was the first of many young ladies canonised for trying to beat the biological block, the second being a princess who fasted when her father promised her in marriage to a Saracen king of Sicily. The princess, who wished to serve only Christ, managed to make her sufficiently unattractive for her suitor to call off the wedding. Her father had her crucified, resulting in her canonisation for her alleged ability to communicate with Christ.  

Consequently, the ‘martyr’ complex has placed a psychological premium on female physical stamina and procreative capability. Renaissance anorexics were praised for their ethereal devotion to helping the sick and the poor at the expense of their own health and appearance. Sex was seen as the end to all dreams and desires by a significant minority of women with the implications of motherhood and an adult life being intimidating enough to instigate fasting in those who felt threatened by this.  

Interestingly, the complex is swept aside in economically poor times, such as the Dark Ages, where populations had more pressing concerns of recurrent famines, plagues, and attack by marauding armies – similar to modern day trends in the developed world and the middle classes of the developing world.  

The recent history of anorexia stems from the 1960’s. Increasingly skeletal societal notions of beauty, in addition to the equation of ‘thin’ as powerful are arguably more responsible for the all-pervasive ‘fear of fatness’ versus altruism or insecurity regarding responsibility.  

Surveys have shown that present day beauty standards are 23% lighter than the average UK female of reproductive age, in comparison to just 8% lighter in the 1960’s. Thin women are portrayed as paragons of virtue and femininity, acting as muses for the most sought-after clothes and products. Without doubt, they capture the most successful men. The media glamourise this, equating the thin girlfriend to masculinity and success. Ordinary men alter their expectations, since a bought pair of breasts and buttocks looks just as good as a natural one. Add a new obesity scare-story at will and it’s unsurprising that sixty percent of UK females are on a diet at any one time.  

Even the clothing industry is in on the act – witness the fuss Kookai made over resizing their UK lines to be larger than their French equivalents and the success of books such as ‘French Women Don’t Get Fat’. By downsizing the amount of material required to cover a diminished female body, the companies can keep their prices static and increase profit margins. Whoever said insecurity didn’t pay?  

As medical professionals, it is our responsibility to be empathetic whilst working in a patient’s best interests. A mentally competent patient is within their rights to refuse treatment, with advanced informed consent directives issued in the state of mental competence standing firm if the patient is presently incapacitated to do so. The legal and political implications which make failing to deliver care equivalent to negligence mean the murky world of ‘Pro-Ana’ is one that must be seen and heard.

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