[Content note: eating disorders]

Anorexia has a cultural component. I'm usually reluctant to assume anything is cultural – every mediocre social scientist's first instinct is always to come up with a cultural explanation which is simple, seductive, flattering to all our existing prejudices, and wrong. But after seeing enough ballerinas and cheerleaders who became anorexic after pressure to lose weight for the big competition, even I have to throw up my hands and admit anorexia has a cultural component.

But nobody ever tells you the sequel. That ballerina who's losing weight for the big competition at age 16? At age 26, she's long since quit ballet, worried it would exacerbate her anorexia. She's been in therapy for ten years; for eight of them she's admitted she has a problem, that her anorexia is destroying her life. Her romantic partners – the ones she was trying to get thin to impress – have long since left her because she looks skeletal and weird. She understands this and would do anything to cure her anorexia and be a normal weight again. But she finds she isn't hungry. She hasn't eaten in two days and she isn't hungry. In fact, the thought of food sickens her. She goes to increasingly expert therapists and dieticians, asking them to help her eat more. They recommend all the usual indulgences: ice cream, french fries, cookies. She tries all of them and finds them inexplicably disgusting. Sometimes with a prodigious effort of will she will manage to finish one cookie, and congratulate herself, but the next day she finds the task of eating dessert as daunting as ever. Finally, after many years of hard work, she is scraping the bottom end of normal weight by keeping to a diet so regimented it would make a Prussian general blush.

And nobody ever tells you about all the people who weren't ballerinas. The young man who stops eating because it gives him a thrill of virtue and superiority to be able to demonstrate such willpower. The young woman who stops eating in order to show her family how much their neglect hurts her. If they pursue their lack of appetite far enough, they end up the same way as the ballerina – admitting they have a problem, admitting they need to eat more, hiring all sorts of doctors and dieticians to find them a way to eat more, but discovering themselves incapable of doing so.