Fiona Wright is an acclaimed writer from Sydney who is recovering from anorexia nervosa. In 2016, Wright was awarded the prestigious Kibble Literary Award for her semi-autobiographical essay collection, Small Acts of Disappearance: Essays on Hunger. I was curious about its success and wanted to see what it could teach a psychiatry trainee about the internal world of a person suffering from an eating disorder.
The collection consists of ten essays, in mostly chronological order, and progresses through the phases of Wright recognising she has a disorder, identifying its precipitating and maintaining factors, and starting the recovery process. The majority of the essays are Wright's reflections on her own illness, which lasted over 8 years. Wright also reviews the existing scientific and literary research on eating disorders, which provides an interesting and informative interlude while also illustrating her own intellectualisation of her disorder.
Small Acts explores how anorexia maintains its grip on an individual, beyond the textbook fear of fatness. Wright, interestingly, never uses terms such as ‘fat’ in reference to herself. Instead, she addresses two drives that maintained her illness: the sensation of hunger and the need to be small. From her opening lines onwards, we learn how hunger can be experienced as a positive internal sensation. The importance of being small is frequently referred to and has its own essay, ‘In Miniature’, which weaves the history and philosophy of miniature objects with Wright's reflections on why this was such a stronghold, or as it might appear to us, an overvalued idea.
Wright's essays permit a reasonable psychiatric formulation but they are not a full psychiatric history. She has, of course, chosen what not to publicise. Her family relationships, for example, are not explored in great depth. Her rumination disorder and anorexia are difficult to disentangle, both for herself and the reader, particularly as the narrative indicates that the rumination disorder leads to anorexia, yet Wright alludes to anorectic cognitions before the disorder developed. Regardless, the book highlights the complex psychopathology and the importance of exploring the patient's narrative of their symptoms.
Small Acts gives a valuable insight into a disorder that thrives on secrecy and is presumably difficult to discuss in public. It addresses the tyranny of an eating disorder from multiple perspectives, with beautiful poetic prose and wide-ranging historical insights, and is recommended to anyone interested in the complex relationship people can develop with food and with themselves.
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