feminism

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Brown et al.
WOMEN’S BODY TALK:
A FEMINIST NARRATIVE APPROACH
CATRINA G. BROWN, PH.D.
SHELLY WEBER, B.A., M.S.W., R.S.W.
SERENA ALI, M.S.W., R.S.W.
School of Social Work, Dalhousie University, Halifax
The cultural discourse of self-management is arguably a significant influence on women’s efforts to control and manage their bodies. Within it, selfrestraint and control are considered definitive of personal success and are
enacted through the body by strict eating and exercise practices. It is argued
that these cultural influences not only shape eating disorders, they also paradoxically shape their treatment. This article argues that traditional treatments
and theories, which rely upon an individualistic self-management discourse,
perpetuate women’s existing problematic focus on these behaviors. We propose that feminist and narrative therapy can be combined as an alternative
approach to understanding and working with eating disorders. From a feminist approach we emphasize women’s conformity and resistance to gender
scripts of self-regulation alongside the narrative postmodern sensibility of
living storied lives.
In North American and Western society thinness is a beauty ideal often associated
with a disciplined lifestyle (Dyrenforth, Wooley, & Wooley, 1980). For many women
this discipline takes the form of extreme eating behavior and exercise practices,
perpetuating women’s focus on weight. Today, culturally desirable notions of selfidentity are inseparable from a discourse of self-management, which ties individual
value and self-esteem to the power associated with self-restraint, self-denial, and
self-control. Indeed, such culturally valued traits are central ingredients of eating
disorders themselves. Gremillion (2003) argues that the same cultural influences
shape eating disorders and conventional treatment, thus suggesting the importance
of finding new ways to understand and treat eating disorders.
This article will argue that traditional medical theories and treatment of eating
problems among women are embedded in dominant self-management discourse
Address correspondence to Dr. Catrina Brown, School of Social Work, Dalhousie University, 6414
Coburg Road, Halifax, Nova Scotia B3H 3J5; E-mail: Catrina.Brown@Dal.Ca.
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and that their focus on body weight management and food intake perpetuate
women’s existing problematic focus on weight and eating. We propose that feminist and narrative therapy can be combined to offer an alternative approach to
understanding and working with the continuum of eating problems women experience. It will be argued that this alternative approach shifts the focus from preoccupation with the body to exploration of the meaning of women’s struggles with
their bodies and assists in the creation of new stories of identity which are not
dependent on self-restraint, denial, and control. We begin by offering our framework for contextualizing eating disorders, which serves as a lens for our critique
of medical treatment. We then outline a treatment model for eating disorders that
blends feminist and narrative therapy and conclude with a clinical case to illustrate this blended approach.
CONTEXTUALIZING EATING DISORDERS
Current understandings of the role of social factors in the development of weight
preoccupation and eating disorders are often “[s]hallow and unsystematic” and
their primary focus on aesthetics denotes women as products of culture, rather
than active agents (Bordo, 1993, p. 45). Missing have been personal accounts (see
Hosking, 2001) and explorations of the imperative of the thin body ideal as a culturally and historically formed phenomenon that tells a story about women in culture. Drawing on Foucault (1995), eating disorders are historically and culturally
specific: they “emit signs.” Women who struggle with eating disorders are but “[t]he
bearers of very distressing tidings about our culture” (Bordo, 1993, p. 60).
When we recognize the ways in which the body is in the grip of culture, women’s
struggles with their bodies make sense (Foucault, 1980). Feminists such as Bordo
(1993), Brown and Jasper (1993), Lawrence (1979), and Orbach (1986) believe
that women control their bodies as a way in which to achieve a sense of agency in
their lives. Gremillion (2003) and Brown (2007a) suggest that feminist therapy
needs to address how women’s struggles with their bodies are both cultural forms
of compliance and resistance. Gremillion writes that women who struggle with
eating disorders “[a]ppropriate powerful social norms about feminine autonomy
and self-control and challenge these norms by enacting them through eating disorder behaviours” (2003, pp. 194–195).
Women’s communication through their bodies or “body talk” reveals hidden
struggles about who they believe they should be as “women” within society. Femininity is shaped by the prevailing discourse of self-management and the gendered
expectation of self-restraint is played out through women’s dieting and weight
control. Further, women struggle with the contradictory social messages of a
bulimic culture (Bordo, 1993). One message dictates the imperatives of consumer
culture—to consume endlessly, to capitulate to temptation, and desire—and
another, the imperative of self-management which demands the restriction of
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excess, temptation, or desire. These contradictory messages of excess and restraint
associate slenderness with control, power, and success and fatness with loss of
control and personal inadequacy (Bordo, 1993; Brown, 2005).
Gremillion’s (2003) research demonstrates that not only are women with eating disorders recruited into culturally based self-management practices of continual evaluations and comparisons, strict self-surveillance, and denial of personal
desires, but that these same patterns are reproduced within treatment itself. Treatment that focuses on behavioral strategies serves to reinforce the logic behind
eating disorders. Within this logic the body is an object that needs to be resourced
to create a certain kind of self (Gremillion, 2003). Typically, medically based treatment programs involve a highly structured environment that focuses primarily on
monitoring and managing women’s behavior. This creates a situation in which
individuals develop strategies to avoid eating or weight gain in an attempt to gain
back some control (Gremillion, 2003). In response to these behaviors, medical
treatment programs have created their own strategies for individuals viewed as
“noncompliant.” While these medical practices are meant to be deterrents to eating disorder behavior, they fail to acknowledge and undermine the way women
resource their bodies to maintain a sense of autonomy and self-control (Gremillion,
2003). In turn this may inadvertently exacerbate women’s anxieties and perceived
lack of control over their lives and intensify their subsequent efforts to achieve
control through the body.
FORMULATING AN ALTERNATIVE APPROACH
An alternative treatment approach blends feminist and narrative therapy, drawing on both modern and postmodern theory. It recognizes that women’s experiences of the body, expressed as eating disorders, reflect gender socialization and
the cultural practices and discourses of self-management. Within this blended
approach the therapist is politically positioned, working collaboratively with
women to challenge dominant social narratives and help reconceptualize how
women resource or use their bodies. Women’s use of their bodies or “body talk”
is a form of expression that both resists and reflects culture (Brown, 2007b). From
this perspective, eating disorders and weight preoccupation are not contextualized
simply as individual problems located within the person, but rather as a distinct
reflection of contradictory social and cultural discourses.
Feminist Therapy
Feminist therapy developed as a critique to traditional androcentric forms of intervention, which individualized and pathologized women’s experiences, and as
a challenge to falsely universalized and privileged male norms. Feminist ap-
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proaches have recognized eating problems as gendered and emphasized a nonpathologizing and socially contextualized approach to understanding and treating the continuum of weight preoccupation and eating disorders among women
(Bloom et al, 1994; Brown, L., 1989; Brown & Forgay, 1987; Chernin, 1981;
Dyrenforth, Wooley, & Wooley, 1980; Fallon, Katzman, & Wooley, 1994;
Lawrence, 1984, 1987; Lawrence & Dana, 1990; Orbach, 1978, 1986; Root &
Fallon, 1989; Wooley & Wooley, 1986a, 1986b).
Medical approaches perpetuate the doctor as expert and the power differentials
between doctors and patients, producing struggles over issues of bodily control
(Brown, 1993a; Gremillion, 2003; Lawrence, 1984). In contrast, feminist approaches to working with eating disorders and weight preoccupation emphasize
empowerment, social change, and self-direction. They also recognize that the
problem itself is an extension of the experiences many women have with their
bodies and eating. The goal of feminist intervention is to work collaboratively
with women struggling within the continuum of eating problems, not only to
understand the meaning of these struggles, but to develop alternative ways of
communicating them and to create preferred stories that challenge the dominant
self-management discourse.
Feminist therapists have identified that a “control paradox” is often central to
eating disorders and weight preoccupation (Brown, 1993a, 1993b; Lawrence, 1979,
1984). While a woman with an eating disorder may feel out of control, her efforts
at self-regulation and controlling her eating and body weight often offer her a strong
sense of mastery (Brown, 1993a). The thought of giving up the power achieved
through self-restraint is often terrifying. Feminist therapy seeks to establish a therapeutic alliance that fosters an important sense of power, control, and emotional
safety for women. This approach recognizes the positive intentions and effects
associated with controlling and regulating the body.
Feminist therapy acknowledges that therapy is not neutral, thus the therapist
must ensure she is aware of and accountable for her use of power in the therapeutic relationship. Therapeutic methods such as feminist contracting offer a collaborative process in which the goals, expectations, and pace of therapy are negotiated
between therapist and client (Brown, 1993b). Through feminist contracting client empowerment and self-determination are emphasized and a safe therapeutic
environment is established (Brown, 1993b). An example of feminist contracting
is a negotiation between the therapist and client about a minimum weight and health
status, allowing for the therapeutic work to proceed without over-focusing on
physical symptoms (see Brown, 1993a). Importantly, feminist contracting honors the positive intentions and effects associated with anorexia and bulimia while
also reducing the harm associated with negative effects. Further, shifting the focus
of intervention away from weight preoccupation and eating behavior leaves room
to explore how these preoccupations distract women from the meaning of their
struggles.
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Narrative Therapy
Central to narrative therapy is the belief that we live storied lives and that people
organize and assign meaning to their lived experiences through stories about them
(White & Epston, 1990). Narrative therapy assumes that the meaning ascribed to
stories will change, depending on the context. It also presupposes a person’s life
is multi-storied, that no story is free of uncertainty or contradictions, and that stories often disguise dynamics of power and control (White, 1991). In narrative
therapy, clients and therapists work collaboratively to deconstruct old narratives
and coauthor new narratives, recognizing that each bring their own knowledge to
the process (Brown, 2003). An understanding of the problem is achieved by focusing on language, power relations, and the ways in which people interpret and
assign meaning to their experiences (White, 1991).
According to White (1991) stories are never neutral, thus they need to be told,
deconstructed, and reconstructed. The unpacking of people’s experiences involves
exploring how aspects of stories have been disqualified or rendered invisible
(White & Epston, 1990). The act of resurrecting subjugated knowledge disrupts
the idea that there is one objective truth universal to all people and reveals the
“political” or non-neutral nature of the ideas (Brown, 2003). This process can help
challenge the dominant discourse that people internalize as truth in their stories
about themselves.
A central technique of narrative therapy is the process of “externalization.” The
aim of externalizing is to separate the individual from the problem and to create
alternative stories that include subjugated knowledge and unique outcomes which,
in turn, facilitate the construction and performance of new stories (White & Epston,
1990). Unique outcomes “[i]llustrate that other stories exist, that dominant discourse does not always prevail, and offers rich alternatives that can begin to form
reconstructed stories” (Brown, 2003, p. 236). As alternative narratives emerge,
clients can separate themselves from their unhelpful dominant stories and experience agency and a capacity to “[i]ntervene in their own lives and relationships”
(White & Epston, 1990, p. 16).
In externalizing eating disorders, narrative therapy acknowledges the social
pressure to be thin (Grieves, 1998; Kraner & Ingram, 1998; Madigan & Goldner,
1998; Maisel, Epston, & Borden, 2004; Nylund, 2002). Narrative therapy conceptualizes eating disorders as the highest level of achievement or mastery in the
processes of self-regulation (Gremillion, 2003). However, within this narrative
process some regard women primarily as victims of social pressures to be thin
and the subsequent therapeutic intervention focuses on assisting women to claim
their power by “fighting back” against the enemy of the eating disorder (Brown,
2005, 2007b). There may be a number of significant risks associated with totalizing eating disorders as negative (White, 2007). According to White (2007) “totalizing can obscure the broader context of the problems that people bring to therapy
and can invalidate what people give value to and what might be sustaining”
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(p. 35). When the focus of externalization is on creating an “anti-anorexic” or “antibulimic” stance, the important content of women’s struggle and their efforts to
talk through the body is rendered invisible. If women are positioned solely as
victims or products of culture therapy may negate the agency and resistance women
often express through their bodies (Brown, 2007b). Consequently, the process of
externalizing within narrative therapy may create and reinforce a dichotomy between the individual and the problem, in which the problem is portrayed as entirely pathological and the individual as helpless victim or courageous resistor
(Gremillion, 2003; White, 2007).
Merging Feminist and Narrative Therapies
Through a blended approach, therapists attempt to understand women’s body talk
without pathologizing their experiences (Brown, 2005). Both feminist and narrative approaches acknowledge that therapy is an interpretive process. By focusing
on the cultural context which shapes women’s experiences of their bodies, feminist therapy avoids reinforcing “[t]he existing displacement of a client’s emotional
struggles onto the body and obscuring the larger and more substantial issues”
(Brown, 1993a, p. 192). Furthermore, feminist therapy emphasizes the need to
explore the multiple meanings of eating problems and weight preoccupation for
the women experiencing them, including their positive intent and effects, and
potential negative effects. Similarly, narrative therapy offers a nonblaming stance
by discussing experiences with eating disorders in a manner that separates it from
women’s identities (Gremillion, 2003). Such a separation is vital, as most women
enter therapy with the message that they “are” anorexic or bulimic. As the eating
disorder experiences are externalized and located within their cultural context,
“[t]he ongoing cultural work involved in the construction of illness becomes visible” (Gremillion, 2003, p. 195).
A narrative approach helps women begin to understand how discourses in the
wider social context support the problem description they have of themselves and
aims to help externalize the problem from the person. This is consistent with
feminism’s efforts at empowerment through consciousness raising and contextualizing women’s experiences (Worell & Remer, 1992). A combined feminist and
narrative approach may help acknowledge the critical role of women’s agency in
their lived experiences and may be useful in moving away from therapeutic constructions of women as passive victims of either eating disorders or culture (Brown,
2005). The therapeutic goal of this process is to help women explore the meaning
of their body talk and the ways that it may communicate both conformance and
resistance to gendered subjectivities (Brown, 2005). Feminist therapy brings to
narrative therapy an emphasis on women’s agency within therapeutic processes
of contextualizing gendered stories. Conversely, narrative therapy offers feminist
therapy a way to move past the deconstruction of problem stories through the idea
of reconstructing or rewriting alternative more helpful stories of identity. Therapy
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needs to take into account that life context and experience shape individual’s
particular engagement with the dominant discourse of self-management and how
individual stories of self-regulating through the body are played out.
SHAYNA
Shayna is a 23 year old Jewish Canadian woman who is episodically bulimic, as
well as a restrictive eater with a low but stable body weight of 90 pounds. She
shares that she began to focus on her weight at age 16 and describes often feeling
out of control. While she has begun to go out socially on occasion, she is generally quite isolated. When we began to work together Shayna often said “I don’t
know” when asked a question. Shayna is currently completing a theater degree at
university and has received feedback in her program that she needs to learn to
“let go” or express herself more. Shayna reports feeling stressed out and anxious
about her studies as she never feels good enough. The more stressed out and anxious Shayna feels the more self-critical she is and it is at these times that she is
very likely to binge and purge. Following periods of bingeing and purging she
returns to very restrictive eating. Shayna exercises daily and observes that she feels
more in control, confident, and better about herself when she does. Weekly individual therapy sessions continued for about 18 months. By the end of these sessions Shayna had a greater understanding of the meanings she associated with
bingeing and purging and her desire to be thin. This understanding led her to challenge the dominant discourse which ties self-regulation to a sense of control and
self-worth. She no longer said “I don’t know” when asked a question and risked
being more expressive. She continued to maintain a stable low body weight and
was able to limit her bingeing and purging to periods of heightened stress.
EXTERNALIZING STORIES OF CONTROL
Our feminist narrative approach to externalizing Shayna’s story focuses on three
areas of exploration. First, we begin the process of externalization by honoring
and exploring the positive intentions behind Shayna’s eating problems. The second aspect of externalization emphasizes the complexity and contradictions in her
story. This involves exploring both the positive and negative effects of the anorexia and bulimia. The third focus of externalization we discuss is centered on
creating alternative stories which support alternative ways of managing positive
intentions.
Initially, a blend of feminist and narrative therapy will shift the focus away from
dominant social discourses which pathologize eating disorders and focus on managing behavior. Instead the conversation will shift toward understanding the control
paradox and the meanings associated with eating problems for Shayna. Unpacking
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Shayna’s dominant story of control involves challenging the social story of selfmanagement and appreciating the meaning that controlling her body and eating
has come to have for her. The creation of an alternative story for Shayna necessarily involves both unpacking the dominant social story that being in control “is
good” and being out of control “is bad” and differentiating between harmful and
helpful practices of self-management. This approach challenges the story that she
is only good enough when she is thin enough or when she has attained a sense of
control over her body. At the same time, it does not minimize the real sense of
power that Shayna gets from controlling her body and eating. Through a gradual
and in-depth exploration of less restrictive, oppressive, and extreme methods of
attaining a sense of control over herself and her body Shayna can begin to develop an alternative identity story that moves beyond the limitations of the dominant self-management discourse and practices.
Questions around the theme of unpacking self-management and self-control
explore what feeling out of control is like for Shayna, how it is not tolerated, and
how it is displaced onto controlling her body. While these questions provide a
kind of scaffold for therapeutic conversations, one would probe and explore the
meaning around each of these questions for Shayna in greater depth. Therapists
can begin this process by offering comments which invite women to move past a
focus on weight, eating, and control: “Sometimes when women struggle with eating
problems they talk about them as a way to cope. We can work together to try to
understand what they mean to you. In order to do this we will shift away from
only focusing on weight and eating.” These questions invite Shayna to explore a
richer story of her eating problems:
•
•
If anorexia or bulimia tell a story about you, what do you think they are
saying?
What does anorexia or bulimia say about you that most people might be surprised to know?
The following questions continue to shift Shayna’s focus away from a preoccupation with controlling weight and eating to the idea that this focus often distracts her from alternative levels of meaning. These externalizing questions address
the first task of externalizing we are focusing on by exploring and honoring the
positive intentions of Shayna’s struggles with eating and weight. Initially it is
helpful to recognize the positive intentions associated with her desire to feel more
in control.
•
•
•
•
•
Are there times when you are most likely to want to binge eat?
Do you feel more or less in control when you binge eat?
Do you feel more or less in control when you control your eating?
What are other ways or times you feel in control of yourself?
What things make you feel anxious or out of control in your life?
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•
•
Are you more or less likely to binge eat at these times? Purge? Exercise?
Does purging make you feel more in control? (If so), how does it do this?
A second task of externalizing is to move beyond positive intentions. The second task highlighted here explores how Shayna makes sense of anorexia and bulimia as resources to feel more in control and less anxious, as well as the ways
that they are not helpful to her. These kinds of questions hold onto the idea that
Shayna is her own agent and that while aspects of anorexia and bulimia are not
helpful to her, there are many aspects that are indeed meaningful in that they help
her cope with uncertainty, anxiety, and not feeling good enough. Simultaneously,
we can begin to acknowledge the importance of her finding alternative ways of
attaining a great sense of power and control in her life and of expressing disqualified stories.
•
•
•
•
•
•
•
•
•
Do you feel bingeing and purging, exercising and restrictive eating are useful to you?
What are the positive effects of these behaviors? How are they helpful to you?
What are the negative effects of these behaviors? How are they not helpful
to you?
What part of you would prefer to use anorexia and bulimia?
What part of you would prefer to not use anorexia and bulimia?
What do you think about the positive and negative effects of anorexia and
bulimia on your life?
What do these effects say to you about your struggle with anorexia and
bulimia?
If you were to imagine giving up anorexia or bulimia right now what would
you feel you are giving up?
Tell me about what would be hard about it for you.
A third role of externalizing is the creation of less oppressive, alternative stories
that encourage Shayna to express herself more directly, rather than through her body.
These new stories can help create other ways of managing positive intentions. Within
a feminist narrative process, it is important to explore the history of how she has
participated in her control story and what aspects of her life fall outside this story.
For women, the dominant gender scripts of what it means to be a “good girl” become intertwined with and reinforce the importance of self-management. Femininity involves a particular performance of “being nice” that too often involves
suppressing or disqualifying aspects of experience in order to not offend or upset
anyone else. Interestingly, despite the fact that parents, doctors, and therapists
usually want women to give up their eating disorders, women typically refuse to
comply, often maintaining, like Shayna that it is the only thing that is just for her.
Although perhaps controversial, we suggest that during this externalization process it is important to explore how controlling the body conforms to self-management
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practices and how it is itself a unique outcome. Totalizing the negative aspects of
eating disorders does not permit us to see potential unique outcomes. We have
argued that it is important to look at the positive intent and both the positive and
negative effects of eating disorders. Clinically, women report that there are short
term positive effects including feeling more in control, more powerful, an increase
in self-worth, and emotional release or tension reduction. While it is important to
give voice to these experiences it is also important to explore the negative and
longer term effects on women’s lives. Shayna’s resistance is a unique outcome
because she rarely takes a stance that opposed others’ wishes or that was unequivocally about what she feels she wants or needs. While conforming to the demand
for self-management and a restrained voice, anorexia and bulimia, paradoxically
provide a self-managed and contained expression of struggle and resistance. For
Shayna, her struggle with voice is evident in her theater studies, in her anorexic
and bulimic body talk, and in her “I don’t know” stance in therapy. This conversation might begin when Shayna says “I don’t know” in a session.
•
•
•
•
•
•
•
•
When you say you “don’t know” is it hard for you to say what you are feeling or thinking?
Are there times when you feel you are able to “let go” or express yourself?
What is that like for you?
What is different about these times?
How do people react to you at these times?
What happens to your voice when you don’t express it?
Do you think anorexia and bulimia might be a way for you to express
yourself?
How do you feel when others ask you to give up your eating disorders?
The exploration of unique outcomes provides an entry point for developing an
alternative more helpful story by asking how the eating disorders do not fit within
scripts of self-management; and in fact, resist them. This means exploring how
eating disorders may express aspects of Shayna’s experiences which have been
disqualified and subsequently, her ambivalence to abandon them. By doing so
Shayna can become more aware of how unspoken and uncertain aspects of her
experiences have been rendered invisible and she can choose what she wishes to
resurrect. Feminist narrative therapy will support Shayna to express those aspects
of her experience previously disqualified. Subjugated aspects of her dominant story
of control are examined in such a way that she can deliberately choose what works
best for her. This approach allows us to explore the “both/and”: the ways that eating
problems are restrictive and self-disciplining and the ways that they are expressive and quietly resist self-restraint.
A feminist narrative approach would also involve exploring with Shayna how
she may have come to value the idea of self-restraint and self-control at the same
time that she actually finds it difficult to express herself within her theater studies,
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her relationships, and in therapy itself. Through externalizing the language “I don’t
know” alongside the idea of having difficulty “letting go” or expressing herself,
feminist narrative therapy can unpack the limitation of self-management discourse
on her voice and begin to explore how the body seems to be telling a story. By
focusing questions directly on the meaning that Shayna attaches to anorexic and
bulimic behaviors we can begin to explore how they are tied to cultural and personal beliefs about being in control, as well as how they contain and express disqualified stories.
Through these three pathways of externalizing Shayna’s story we help make
sense of the story and in doing so, provide an entry point to explore alternative
stories for her that might ultimately be more helpful.
CONCLUSION
Mainstream medical discourses have served to reinforce cultural ideals of selfmanagement by focusing on fitness and weight preoccupation to control the body
and by representing women with eating disorders as being out of, and in need of,
control (Gremillion, 2003). Feminist and narrative therapies critique the dominant medical discourses, arguing they have contributed to the maintenance of
gender inequalities and the pathologizing of the female body (Malson, 1997). By
integrating feminist and narrative therapies, eating disorders and weight preoccupation are reconceptualized from traditional discourses that cast them as individual
psychopathologies into socially and historically specific conditions (Brown,
2007b). Additionally, combined feminist and narrative therapies can assist in
externalizing experiences with eating disorders without removing a woman’s
agency in the process. Women can then make sense of their struggles with their
bodies, challenge the constraining effects of self-management discourse, and create
alternative identity stories. While we have addressed aspects of gendered selfregulation, this approach to externalizing experiences among women with eating
disorders may be used when working with other specific populations by addressing the specific elements of their stories constructed within the dominant cultural
discourse of self-management.
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