A body to die for

Debashis Singh interviews TV presenter Caryn Franklin

Being backstage at a fashion show is rather a surreal experience. Within a few seconds more gaggingly gorgeous models pass by me than I had previously seen in my entire life. Preventing myself drooling proved to be a task of Herculean proportions, and I had to keep reminding myself that this was not reality--it was fashion. A dressing room door opened, and I was greeted by heavily pregnant Caryn Franklin, fashion writer, lecturer, television presenter, and patron of the Eating Disorders Association. I am struck by the irony of the situation--here we are, discussing the seriousness of eating disorders, when we are surrounded by the chaos of bubble bath superficiality such as air kissing, constantly ringing mobiles, and fashion slang. We are interrupted by a male model in a skirt, and I can't help but give a look of sheer incredulity.

Caryn presented the UK television series The cloths show (BBC)

Industry to blame

"The reason I got interested in it [eating disorders] was because my sister had anorexia as a teenager," she began. "At the time I had no knowledge or understanding of what was going on, so it was not like I was any use to my sister when she was suffering." The disease had an enormous effect on the family, who had to stand by and watch a loved one slowly die through starvation. That was the beginning of what was to become a personal mission to raise awareness and debate of eating disorders within the fashion industry, in the hope that the industry would accept some responsibility. "The thing that people in the fashion industry don't grasp is that they are barometers for cultural change. They can flag up dynamic marketing campaigns that would influence cultural taste around weight and therefore make a very positive change if they chose to ... no one chooses to."

It was fascinating to watch her talk with such passion and eloquence about a subject I admittedly knew little about. I thought it must be difficult for Caryn to work in an industry that promotes the emaciated look as the ideal to such an extent that all other body shapes are considered abnormal. "I am much more use inside--talking to people, creating campaigns, writing about it, than I am as a mad lady with a placard outside going 'Oh! This is terribly wrong, I don't know anything about it, and I don't know the people involved.' I personally will not make an enormous change in my time in the industry. But when I teach students about it, I am actually saying, you are the next generation of image makers, consider whether you want to have any responsibility, you have a choice. So for me it is very rewarding being here, doing a job that I enjoy, but also wanting to make changes."

A punishing culture

I wonder how easy it would be to make changes in such a brutal, body fascist, industry. She tells of how one tall thin model went to a casting and found her garment was too tight for her. As a punishment she was made to walk down the Milan catwalk in only her underwear holding the offending garment. "It was like a public humiliation because she couldn't wear it. And young women go through that, so they are very susceptible to thinking that they must lose half a stone to get ahead in modelling, as though it was some sort of qualification." It is not surprising that the highest incidence of anorexia is found among models.

Eating disorders are a complex problem. On the one hand, there is the use of the disorder as a way of controlling the chaos of everyday life: "Anyone with a full blown eating disorder has the biggest fear that someone will take it away from them and make them live life without it." On the other hand, there are all sorts of problems that form the underlying cause of the disorder in the first place, from environmental problems to personality types. "They [people with eating disorders] are often perfectionists--they work twice as hard as anyone else; they have much higher expectations of themselves than anyone else. And they have this constant psychological battle which takes place hourly where they are torturing themselves with the fact that they want to eat but can't. It is not a case where they get any pleasure out of having the eating disorder. It is like a psychological torture that they create for themselves. It takes a lot of bravery to get up to face that every day."

Eating disorders, like deliberate self harm or misuse of drugs and alcohol, are often physical manifestations of people displaying their emotional distress. "They have chosen to have an issue with food from all of the messages they have understood from their own environment." Treating people with eating disorders is notoriously difficult. However, through counselling, the things that the disorder is offering or replacing in people can be discussed as well as possible changes in behaviour. "The hardest thing about an eating disorder, especially anorexia, is that once it begins to interfere with the electrolyte balance within the brain it triggers off a strange kind of euphoria when you are actually not eating. I don't fully understand that, but when they reach that state it is actually very hard to reach them. Quite often people have no intention of killing themselves but have no idea how to climb out of this state, but a large proportion of eating disorders ends in death or suicide."

Time for change

She must get ready to present the show. I wonder if things are going to change in a society so endemically obsessed with physical appearance. Perhaps the fashion industry could begin to make the changes by ceasing to use exclusively emaciated models. "There is nothing wrong with thin women, but when being thin is prioritised so exclusively, women of other shapes and sizes begin to think that there is something wrong not being thin." It is quite frightening to think that even children at primary school are influenced by the "thin is beautiful" dictum. One day Caryn's four year old daughter came home from school and said "Mum, Shanaz says my tummy's fat." She makes her way to the stage, we say our goodbyes, and I get ready to return to the comfort of reality. She turns to me and says, her voice heavy with concern: "I am quite anxious about the fact that she [her daughter] will deliberately try to lose weight for none other than aesthetic reasons." The show begins.

The Eating Disorders Association estimates that about 90 000 people in the United Kingdom have an eating disorder, and 9000 of those are male.

Debashis Singh, fourth year medical student, University of Leicester

Eating Disorders Association helpline: 01603 621414 - Mon-Fri 9 am-6.30 pm

Caryn presented the UK television series The Clothes Show

studentBMJ 2000;08:175-216 June ISSN 0966-6494

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