Introduction

Disordered Eating Confronting the Dance Aesthetic

L. M. Vincent, M.D.

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

4 Journal of Dance Medicine & Science Volume 2, Number 1 1998 5 exclusive. Dancers can be slender, but slenderness is a matter aesthetic grounds, on the distraction of a too thin body line? of degree, and what may represent an appropriate weight in What if grant money for the arts were contingent on health a naturally thin dancer may represent an unrealistic weight concerns and physiologic weights? What if dance publica- for another. tions presented youngsters with a variety of legitimate body What cannot be denied as a reality in classical ballet is that types in their glossy photos instead of an ideal unhealthy for the thin body provides a competitive advantage for selection, most young women? and the thinner the better, health consequences be damned. A younger and less cynical version of myself once believed Does any justification for self-deprivation and self-destructive that if dancers, parents, teacher, and choreographers were behavior give me pause? “If realizing my dream of becoming simply made aware of the eating problems in dancers and a great and famous dance artist entails the sacrifice of my their profound negative health ramifications, they would do health, isn’t the sacrifice worth it, and my choice to make?” I something about them. I was wrong. Perhaps, then, the solu- stumble over that one, since so many artists historically have tion was one of patience. If history is our guide, eventually set such a precedent. But from the perspective of a physi- we will cycle through our “thin” era as we have in the past, cian, the cost remains hard to justify, the sacrifice a needless the fashion smoldering and eventually burning out on its one. And in the broader sense, how long does the casualty own. But the cycle in the larger society has lasted longer than list of not-so-great artists have to be? To what extent should anticipated, baby ballerinas evolving into Twiggy evolving these consequences be tolerated among a distressingly large into heroin chic. The aesthetic may be patently offensive and number of girls, adolescents, and women? The dancers who still widely and mindlessly accepted as a cultural norm. survive the selection process are most often the naturally thin Our collective deference and timidity puzzles me. If we ones; the ones who don’t make it through the schools and are serious about the health of dancers, we must challenge perhaps never end up dancing are much more likely to be the aesthetic. Yet few seem willing to even question the aes- damaged. But why should there be a choice between health thetic in a meaningful way. Are we content to investigate the and art, anyway? pathophysiology and surgical and medical therapies for lung I offer additional realities of classical dance that are not cancer, and yet not be concerned with cigarette smoking? specious. The world of classical ballet is conservative and Is there any fundamental difference between performance traditional, and decidedly anti-feminist. The traditionalists enhancing drugs and an unrealistic body ideal? I would in classical ballet have trouble with the notion that any suggest not. Both are potentially quite harmful to health, concept of beauty is cultural, and may in fact be arbitrary. and both may bestow a competitive edge (for dancers, the Despite the fact that most dancers are women, the hierarchy competitive edge is conforming to the desired “look,” not of dance continues to be male-dominated. In 1998, women true enhancement of performance). Yet the sports medical are still conforming to what is by and large a male ideal, just establishment does not shy from random drug testing or as they have throughout the centuries. An unrealistic body disqualifying from competition athletes guilty of transgres- ideal in dance is an invisible corset, and young women in sions. But do we ever see company physicians “benching” classical dance continue to be victimized by fashion today non-compliant dancers who are prone to injury from fatigue in much the same manner as their predecessors in tight stays because of inadequate energy reserves, or are at risk for stress and crinolines. fracture from diminished bone density? In this light, let us change our orientation, view the problem The dance establishment is poorly equipped to recognize as a women’s issue (not unreasonably, since eating disorders or face the problems of disordered eating and inadequate overwhelmingly are confined to women), and construct a energy states. This void must be filled by health professionals parallel situation for males. If a particular dance belt for men forcing the issue. Realistically, I do not envision exercise- were all the fashion rage, for example, and if it were learned that associated menstrual dysfunction going away in elite female wearing this devise lowered testosterone levels, caused infertility, athletes. To some extent, it will remain a given, and will have and predisposed one to career threatening fractures and long- to be dealt with therapeutically or tolerated within certain term bone loss, how long would they be worn? Would female limits (and by itself should not be used to discourage young costumers and choreographers still insist on it? women from engaging in competitive sports or dance). But The Position Statement of the American College of Sports energy deficits to the degree seen in student or professional Medicine is a welcome one, but I fear it will have less impact dancers or other athletes, whatever their origins, should not in the ballet world than in college athletics (strikingly odd be a fact of the competitive life. The scientific investigations to anyone in dance, the position statement refers to dance presented in this journal must continue, but the problems as a “sport,” an awkward fit at best). Professional ballet must be approached from all fronts. Then, perhaps, we will companies and the schools that are associated with them are be able to conclude an issue such as this one with a review outliers, far removed from college sports programs, coaches, article documenting the decreasing incidence of eating dis- and trainers. Besides, academic dance programs have little orders in dancing as well as non-dancing females. to do with the establishment or perpetuation of a body ideal for classical ballet. Other actions might have more profound L. M. Vincent, M.D. is a radiologist practicing outside and desired effects. What if dance critics had the audacity of Seattle, Washington and the author of Competing with to challenge choreographers or company directors on true the Sylph.