Disordered Eating
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Abstract
Nearly twenty years ago at a meeting of the American Psychiatric Association, Drs. Garner and Garfinkel, and Dr. Lowenkopf and myself presented papers on “anorexia” in dancers, and shared a panel chaired by Dr. Hilde Bruch. This elderly and rather unassuming woman, arguably the leading authority on anorexia nervosa, listened politely to our presentations and afterward had a single comment: “Well, these girls are very interesting, but they certainly don’t have anorexia nervosa.” No offense was taken, no argument or defense pursued. Not because we felt intimated or chastised by Dr. Bruch, but because we didn’t feel entirely comfortable with our observations in dancers and how they fit the stringent psychiatric definition of “classical” anorexia nervosa. In fact, Dr. Bruch was right. While a small percentage of our dancers met the classical description, most didn’t quite fit. Terminology and the inherent limitations of a syndromal definition were only minor stumbling blocks, in retrospect. Whether or not anorexia nervosa represents an end-point on a continuum of eating disorders or is a distinct entity has been relegated to theoretical interest for most, if it concerns them at all. However, everyone would agree that dancers exhibit more than their fair share of disordered eating, regardless of the criteria employed. Whether the eating behavior reflects severe pathology or represents only transitory dietary indiscretions, the norm for many serious dance students and professionals is a chronic energy deficit. The articles in this issue stand as testament to the progress made by many investigators across the globe in the past two decades. These articles illustrate: 1. The refinement of our previously stringent definitions of pathologic eating behavior, adopting a more inclusive and practical concept of “disordered eating”; 2. The further (though still not complete) clarification of the complex physiologic effects of the low energy state; 3. The improvements in recognition and treatment of dancers with eating problems; and 4. The establishment of dietary recommendations and the renewed emphasis on education and communication. When we take these advancements out of the realm of science, medicine, and health, and expand the context to the dance world, we have significantly less progress to applaud. Anorexia nervosa and bulimia nervosa are indeed now household words, all dancers intellectually know that it’s not healthy to be too thin, eating disorder clinics have sprung up all over the country, and business goes on as usual. Investigational progress aside, what practical progress has been made in combating a problem endemic in the dance world? I would argue that we have made scant progress in this regard. The reason, I would also argue, is our failure to confront the root of the problem, because it is a cultural and aesthetic, not a scientific or medical one. Clinicians dealing with dancers have resorted to a “patch, patch, patch” approach, accepting the dance aesthetic as a given beyond their professional domain, dealing with the consequences of an unrealistic and unphysiologic ideal rather than being proactive. Most of us are guilty of unconditionally accepting the “realities” of classical dance. These “realities” serve to justify and perpetuate the status quo in classical dance, and they are passionately argued by those who deny or fail to prioritize basic health concerns. 1. Dancers must be thin and have always been thin. “You have to have ‘the look,’” the great ballerina Alexandra Danilova once told me. Since the ever-thinner ideal has evolved gradually over the years, Danilova’s vision was blurred by the deceit of art and fashion. She failed to make the connection that at 5’ 5” she performed at a weight of 112 pounds, while her prize student at the School of American ballet two generations later, who also stood at 5’ 5”, weighed 91 pounds (and was dieting). 2. Only a thin body can master the balletic technique. This begs the question of how “thin” is “thin.” I counter with the claim that physically operating at an energy deficit does not contribute to the mastery of balletic technique in a positive way. We need only look at “mature” dancers who have achieved stature in classical ballet today and in the past to refute both of these arguments. I am not so naive as to envision a ballet troupe sponsored by Weight Watchers packing houses in cities all over the country and then having an extended run in New York. Nor do I desire it. My premise is that a physiologic weight and professional dancing — even in classical ballet — are not Disordered Eating Confronting the Dance Aesthetic