Durham E-Theses

Consuming the Body: The Church and Eating

Disorders
KENT, ELIZABETH,ANNE

How to cite:

KENT, ELIZABETH,ANNE (2013)

Consuming the Body: The Church and Eating Disorders

, Durham

theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/6905/

Use policy

The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or
charge, for personal research or study, educational, or not-for-prot purposes provided that:
a full bibliographic reference is made to the original source

a link is made to the metadata record in Durham E-Theses

the full-text is not changed in any way

The full-text must not be sold in any format or medium without the formal permission of the copyright holders.

Please consult the full Durham E-Theses policy for further details.

Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP
e-mail: [email protected] Tel: +44 0191 334 6107
http://etheses.dur.ac.uk

Elizabeth Anne Kent

Consuming the Body: The Church and Eating Disorders
Abstract
The aim of this thesis is to suggest that through practical means based on a cohesive theological
engagement with the issues, the Christian church has a unique contribution to offer those affected
by disordered eating. Taking a canonical narrative approach to Scripture and using the
methodology of the pastoral cycle the thesis examines how the Church might understand the
relationship between eating, identity, food and the body. After an exploration of the nature of
eating disorders from the perspectives of physiology, psychology, history and sociology, this thesis
examines how the Churchs practices of baptism and eucharist, confessing and being accountable,
and the doctrine of Christian Perfection relate to disordered eating.

The argument advanced is that there are particular contributions the Church can make by living in
the light of Gods revelation in Christ, demonstrated through a rediscovery of particular practices.
These seek to address the societal context in which disordered eating flourishes, the underlying
issues generating and sustaining disordered eating, and its impact upon individual and communal
life.

In re-interpreting ancient practices of the Church it is hoped that the body of Christ in the present
age may be equipped to engage with disordered eating and be a conduit of Gods healing and hope
for those who long to know freedom and release.

Consuming the Body:

The Church and Eating Disorders

Elizabeth Anne Kent

Department of Theology and Religion

Durham University
Doctor of Philosophy

2013

Thesis Word Count: 91380

This research is the product of my own work, and the work of others has been properly
acknowledged throughout.

The copyright of this thesis rests with the author. No quotation from it should be published
without the prior written consent and information derived from it should be acknowledged.

ii

Table of Contents
Abstract..i

Title Page...ii
Table of Contents .iii
Acknowledgements ...v
1.Introduction .................................................................................................................................. 1
1.0 Introduction ................................................................................................................................. 1
1.1 Background context .................................................................................................................... 3
1.2 The need for this research .5
1.3 Thesis aim, location and approach..11
1.4 Framing the questions .... 12
1.5 Mapping the way forward . 17
1.6 Methodology ..20
1.7 Conclusion .23
2. What are Eating Disorders? ..24
2.0 Introduction 24
2.1 Defining anorexia nervosa 27
2.2 Defining bulimia nervosa ...61
2.3 Defining atypical eating disorders . 65
2.4 Current opinion . 67
2.5 Conclusion .68
3. Towards a theological response to Eating Disorders ..72
3.1 Inadequacy of pastoral support.. 75
3.2 The inadequacy of CBT and other clinical and self- help approaches as a sufficient church
response .. .78
3.3 Inadequacy of other practical theology approaches ... 83
3.4 Practices of the church 86
3.5 How are the practices within this thesis selected? ..93
3.6 Baptism & Eucharist ...96
3.7 Summary. 100
4. Baptism & Eucharist 101
4.0 Introduction . 101
4.1 Methodology .104
4.2 Baptism .106
4.3 Eucharist ...130
4.4 Conclusion 151
5. Confessing & Accountability. ..152
5.0 Introduction...152
5.1 What has been the Churchs historical understanding and practice of confessing and being
accountable?................................................................................................................................... 157

iii

5.2 What is the role and significance of Confessing and Accountability in relation to disordered
eating?............................................................................................................................................. 183
5.3 Conclusion 197
6. Perfection & Perfectionism.. 198
6.0 Introduction . 198
6.1 Perfection Theological and Philosophical Foundations.. 200
6.2 What is perfectionism? .219
6.3 Rediscovering Christian Perfection for the Present Age ..227
6.4 Conclusion 237
7. Conclusion .239
7.0 Introduction . 239
7.1 A context in which to discern ...240
7.2 An Identity to Explore: Counter-Cultural Communities of Transformation ....242
7.3 A Community in which to Belong: Counter-Cultural Communities of Transformation, Part 2
.245
7.4 A Purpose to Re-imagine Life after Perfectionism 246
7.5 Conclusion 248
Appendix 251
Bibliography... 253

iv

Acknowledgements
There are many people without whose support and encouragement I would never have
completed this thesis and I would like to take this opportunity to thank them.

To all who have shared the story of their own personal experience of eating disorders,
thank you for your honesty and courage. To Spoor and Fellside Methodist Churches and
my Circuit colleagues who have been generous in allowing me time away from Circuit
ministry to study, thank you for being understanding.

To the friends who have encouraged me to persevere: Sarah Charlton, Jennifer Gane,
Elaine Lindridge, Kathryn Stephens, and Alison Wilkinson, thank you for keeping faith.

My supervisor Robert Song has been patient beyond measure and a constant source of
guidance, encouragement and help. Thank you so much.

I would also like to thank my parents, James and Ann Powell for their unfailing support
and wisdom and my wonderful husband Ian who has travelled this long journey every step
of the way and has always encouraged me to keep going.

Dedication
This thesis is dedicated to my daughters Ruth and Bethany

and to the memory of

Rev Dr Sarah Charlton,
Encourager, theologian, friend.

Chapter 1
Introduction
1.0 Introduction
1.0.1 In their own words
Christines Story Anorexia Nervosa
I never actually intended to lose weight. It began simply as a resolution to eat more
healthily. I was 14 and had become aware of the start of my natural teenage weight gain.
But within weeks it had spiralled into an obsession and I gradually became afraid of eating
anything. Each mouthful made me terrified of the weight it would make me put on. I
started to feel freezing cold and exhausted all the time. I could barely concentrate at all and
passed out a few times.

Eventually it went too far, and I have vague memories of a blur of doctors, nurses and
scary phrases such as risk of heart failure and hospitalisation. In the end I was told I had a
few days in which to begin my weight gain otherwise I would be put into a paediatric ward.
I was taken out of school, given a daunting meal plan and told to get on with it. Looking
back the most terrifying thing about it was that I genuinely had no idea that I was so
underweight I was convinced I was larger than most of my friends. 1

Christine underwent an outpatient treatment programme until she was seventeen years old and
classes recovery as one of the hardest things Ive ever done. She feels that at a deep level her

Youth Matters Lifeline Autumn 2009, 9.

recovery is still ongoing but in terms of her eating behaviour now describes herself as eating
disorder free.2

Philippas Story Bulimia Nervosa

When I went to university, I was about 15st 5lb but it never ever bothered me. Then after I
came back I was out drinking and this bloke just shouted at me and called me fat and it
basically started from then.

Something clicked. I was having fish and chips with my mum and I thought, theres a lot of
batter on that. So I made myself sick and saw it all come up. I thought it looked a good way
to lose all the calories and it just started from there. It was a nightmare. After absolutely
everything I had eaten, I would make myself sick. Even an apple. Id only eat anything
with less than two grams of fat. One day I went to the toilet at work and passed out. But it
didnt put me off.3

Philippa lost six stone in less than two years and having suffered with bulimia nervosa throughout
her mid-twenties she is now in recovery and able to eat without purging.

Margarets Story Compulsive Eating/ Binge Eating Disorder

Margaret Bullitt-Jonas came from an educated, high-achieving but emotionally repressive family.
To the outside world she was a gifted academic and a dutiful daughter but her diary entries reveal
how food binges belonged to a secret part of her life where she struggled to communicate or
conceal her needs and desires.

23 March 1982: Yesterday was worse than its ever been. Near despair, I ate cheese and
half a grapefruit in the morning. Before a friend came over for lunch, I went to the bakery

2
3

Ibid.
Philippa Tait, Mums Bulimia Victory Gateshead Herald & Post March 21 2007, 1.

and bought an apricot pie and two cookies. I ate the pie very fast, standing at the kitchen
counter. I ate a light lunch with my friend how discreet I am in public, how normal, how
apparently sane. After she left, I went out and bought more food: a coconut custard pie, a
loaf of bread, and a box of English muffins. I ate them all.

25 March 1982: Im groggy with sleep. Stuffed with binge foods. From one bakery I
bought a loaf of cheese bread and a small roll; from another, two brownies and a loathsome
banana cream pie. I peeled the whipped topping away with my fork and flipped it into the
sink. Finally, late at night, I cooked and ate a whole box of wheat pilaf. The dimensions of
a binge are increasing. Its scary. I dont dare look at my body.4

Margaret eventually joined Overeaters Anonymous and in the remainder of her autobiographical
reflection recounts her recovery from binge eating. She describes the process of learning to
understand and express her emotions and desires in a way which does not destroy her body.

These stories were selected from a collection of many accounts, some published, others recounted
to me anecdotally, describing life with an eating disorder. Each story is as unique as the person
telling it, yet all have similar themes and bear witness to the destructive nature of eating disorders.
These accounts form the context for the thesis and acknowledge the practical and painful
experiences of those who live with disordered eating in its various forms.

1.1 Background Context

Over the past two decades the incidence and awareness of eating disorders has grown in western
culture, and in non-western cultures exposed to western images and values. 5 Eating disorders are

Margaret Bullitt-Jonas, Holy Hunger (Oxford: Lion, 1998), 97-8.

See for example the case of Fiji, where, according to research conducted by Dr Anne Becker, the
introduction of television programmes produced in the USA caused a change in desired body shape among
the indigenous population. Paper presented to the American Psychiatric Association, May 19th 1999
(referenced in Joan Jacobs Brumberg, Fasting Girls (New York: Vintage Books, 2000), xv).
5

currently clinically classified in three ways: Anorexia Nervosa, Bulimia Nervosa and Atypical
Eating Disorders/ Eating Disorders Not Otherwise Specified. 6 They cover the spectrum of eating
behaviours from those who will not eat, in the case of anorexia nervosa, to those who struggle to
stop eating in the case of Binge Eating Disorder or Compulsive Eating (both of which are
categorised under the heading of EDNOS). As well as those who satisfy the medical criteria for the
eating disorders above, there is a growing awareness among health professionals that there are a
large number of sub-clinical cases whose behaviour is not severe enough to meet diagnostic criteria
but whose eating is nonetheless disordered in some way. This would include the vast numbers of
people who deliberately restrict food intake for non-medical or health related reasons, commonly
known as dieting. Not all those who are dieting would be classified as disordered in their eating.
The boundaries between eating healthily or dieting to lose a few pounds and developing a
disordered relationship with food are not always clear, but the pressure to eat and stay thin appears
to be producing a culture among some where dieting for non-medical reasons is becoming a way of
life.

Disordered eating at both ends of the spectrum has become a public issue. Media images of
anorexic celebrities appear regularly in magazines, shaping public perception about what is
normal or desirable and yet public health campaigns are investing heavily in preventing an obesity
crisis among those whose problem is over-consumption of particular foods.7 Whilst obesity can be
viewed as the opposite of anorexia nervosa, some have interpreted them as two halves of the same
problem, namely a maladaptive response to hunger. 8 There are various features of obesity which
distinguish it from anorexia nervosa, bulimia nervosa and EDNOS which cause it to be addressed

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders IV, Revised,
(DSM R) (Washington DC: American Psychiatric Association, 4th ed. 1994); World Health Organisation,
The ICD-10 Classification of Mental and Behavioural Disorders (Geneva: WHO, 1993). This seemingly neat
categorisation needs to be considered in light of various psychology articles which are beginning to contest
the usefulness of rigid boundaries in some forms of categorisation.
7
Cross-Government Obesity Unit, Department of Health and Department of Children, Schools and Families,
Healthy Weight, Healthy Lives: A Cross-Government Strategy for England, (London: Department for Health
& Department of Children, Schools and Families 23rd January 2008).
8
Hilde Bruch, Eating Disorders: Obesity, Anorexia Nervosa and the Person Within, (London: Routledge &
Kegan Paul, 1974).

outside the established categorisation of Eating Disorders and for this reason, obesity will only be
discussed in this thesis as far as it relates to the eating disorders identified in Chapter 2. Whilst the
public impact of disordered eating is acknowledged, for those whose experience of eating disorders
is in the private realm of personal or familial experience, the debilitating effect on human
functioning cannot be underestimated.9

1.2 The need for this research

It is into this context that the church has sought to offer a variety of responses to disordered eating.
This has included a breadth of initiatives from a range of perspectives, reflected in a diverse body
of literature which will be identified below. This will establish the areas within which the Church is
already seeking to engage with this issue and demonstrate that there is a need for this particular
thesis in bridging a gap which exists in the current Church approach.

1.2.1 Institutional Response

Responding as an Institution Consultations and Cathedrals
The place of the Church within public life in the UK has enabled it to make what may be termed an
institutional response to disordered eating. This is particularly true of the Church of England as
the Established church, affording it opportunities to engage with consultations on government
legislation relevant to disordered eating10 and to host the national Service of Remembrance for
those who have died from eating disorders. 11

In response to the Labour Governments Support for All: The Families and Relationships Green
Paper, the Church of England noted the increase in eating disorders as a worrying social
9

Grainne Smith, Anorexia and Bulimia in the Family (Chichester: Wiley, 2004).
Such as Department for Children, Schools and Families, Support for All: The Families and Relationships
Green Paper (London: TSO, 2010); see also Church of England Board of Social Responsibility, Response to
The Draft Mental Health Bill June 2002 (London: Church House, 2002).
11
Held at Southwark Cathedral on 28th September 2010, the service, promoted by Eating Disorder charity
Beat and led by Canon Ian Ainsworth-Smith, aimed to raise awareness of the mortality rates of eating
disorders and to provide a forum for friends and families affected by loss through eating disorders to
remember their loved ones.
10

problem.12 The Church suggested that the way to address disordered eating and other social
problems went beyond providing additional government funding and involved a holistic approach
which also tackles family inequalities13 as well as attention [being] given to players other than the
state and the family,14 indicating the role the Church can play in building community and
resolving social problems. At this institutional level, the Church makes two important
contributions. Firstly, in speaking out it acknowledges that eating disorders are a real problem and
the Church is not willing to ignore their existence. Secondly, it indicates that the Church may have
a perspective on responding to eating disorders which is different from that of the State or the
medical profession and may be complementary to both.

Responding within an institution Policies and Publications

Most mainline denominations within the UK have developed their own policies in relation to
safeguarding children and vulnerable adults 15 and also with regard to addressing mental health. 16
Within many of these publications, eating disorders are recognised as a problem and set in the
broader context of the Churchs response to mental health, work with adolescents and safeguarding
the vulnerable. 17 It is clear that eating disorders feature on the denominational agenda but often
appear at the fringes of areas such as care of the mentally ill or at the intersection between
ministries such as youth-work and healing. Whilst these publications acknowledge the existence of
eating disorders, that appears to be the extent of their engagement with the issue and no theological
reflection upon the issue is articulated.

Responding within an Institution Schools and Support

12

Mission and Public Affairs Council of the Church of England, Support for All: The Families and
Relationships Green Paper (London: Church House, 2010).
13
Support for All, 2.
14
Ibid.
15
The Methodist Church, Safeguarding Children and Young People (London: Methodist Church House,
2010). The Church of England , Protecting All Gods Children (London: Church House, 4th ed. 2010).
Baptist Union of Great Britain Safe to Grow (Didcot: Baptist House, 6th ed. 2011)
16
Archbishops Council of the Church of England, Promoting Mental health: A Resource for Spiritual and
Pastoral Care (London: Church House, 2005).
17
Timothy Bradshaw, Judy Jarvis, Michael Jebson and Wendy Ross-Barker, Worth Doing Well- Guidance
and Good Practice for Churches and Other Organisations (Peterborough: Methodist Publishing, 2002), 63-4.

Part of the ministry of the Church in regard to children and young people has been through the
provision of church schools. In view of the fact that children as young as 5 are developing anxiety
about their weight and body image,18 some church schools have deemed it appropriate to adopt
school food policies to try and engender a positive relationship between food, health, relationships
and socialising.19 Other schools with a Christian ethos have considered it necessary to adopt
policies on eating disorders to identify signs of disordered eating early, prevent their onset and
support pupils who develop an eating disorder.20 These are the exception rather than the rule in
paying specific attention to eating disorders, but are notable in their existence.

Local Church Professional and Popular literature

In 2000, a survey of 754 local church pastors in UK churches affiliated to the Evangelical Alliance
identified eating disorders as a low priority pastoral issue. 21 The reflections of the reports authors
were that this may suggest that certain problems are being concealed in the local area rather than
faced by the local church and that pastors may not be listening carefully enough to some of the
issues of pastoral concern which are of growing importance in todays society. 22 Within the
literature surveyed, there are several volumes aimed at church leaders who may be seeking to
counsel those with eating disorders from a Christian perspective. 23 With the exception of
Grossoehme, these works require a level of competence in understanding psychology and theology
which may be beyond many clergy but they are clearly written with a readership of professional
counsellors in mind.

18

All Party Parliamentary Group on Body Image and Central YMCA, Reflections on Body Image Report,
May 2012.
19
Cannington C of E Primary School, School Food Policy.
20
The Newcastle upon Tyne Church High School, Eating Disorders Policy, revised February 2012.
21
This means that fewer than 10% of the respondents to the questionnaire identified eating disorders as a
pastoral issue they encounter.
22
Leslie J. Francis, Pastoral Care Today (Farnham: CWR, 2000) 14.
23
Edward J. Cumella, Marian C. Eberly and A. David Wall, Eating Disorders- A Handbook of Christian
Treatment (Wickenburg, Az: Remuda Ranch, 2008); Raymond E. Vath, Counselling those with Eating
Disorders (Waco, Tx: Word Books, 1986); Daniel H. Grossoehme, The Pastoral Care of Children
(Birmingham: Haworth Pastoral Press, 1999), 95-7.

In contrast, Christian literature on eating disorders addressing the popular market is readily
available and covers a number of areas. Works originating from the USA have commented on the
cultural and sociological context in which eating disorders arise and seek to integrate theological
reflection into that analysis.24 Another genre of popular literature on the subject of eating disorders
and Christian faith includes what may be termed testimony or recovery narrative. 25 Some of
these accounts, written from personal experience seek to draw out insights or principles which may
help others.26 These autobiographically inspired reflections differ in tone from the self-help books
written by those who are perceived to be experts in Christian leadership27 or work with people
with eating disorders. 28

It would appear that the increasing prominence of eating disorders within general public perception
and within the church has had an impact over the decade since the interviews in Pastoral Care
Today were conducted. One of the largest Anglican churches in the UK has now produced a 6
week course for those struggling with eating disorders 29 which is being run in local churches from
Aberdeen30 to Bristol,31 though it will take time to assess the value and success of these courses,
which have only begun in 2012.

1.2.2 Para-Church Response

ABC
Whilst the institutional framework of the Church has made possible a public dialogue on issues
surrounding disordered eating and at some level the Church has woven an awareness of eating
disorders into its own policies, the work with those actually diagnosed with an eating disorder has

24

Michelle Mary Lelwica, Starving for Salvation (Oxford: Oxford University Press, 1999); R. Marie Griffith,
Born Again Bodies (London: University of California Press, 2004).
25
Margaret Bullitt-Jonas, Holy Hunger (Oxford: Lion, 1998).
26
Catherine S. Boyle, Hungry Souls: What the Bible Says about Eating Disorders (New Look Press, 2010).
27
Joyce Meyer, Eat and Stay Thin: Simple, Spiritual, Satisfying Weight Control (New York: Warner, 1999)
28
Kate Middleton, Eating Disorders: The Path to Recovery (Oxford: Lion, 2007); Deborah Newman, Loving
Your Body (Wheaton, Illinois: Tyndale House, 2002); Nancy Alcorn, Starved (Winepress, 2007).
29
New ID course, Holy Trinity Brompton.
30
City Church Aberdeen.
31
Christ Church, Clifton, Bristol.

been undertaken mainly by para-church organisations. These charities, set up specifically to

provide help, support, information and advice have been at the front line of the Churchs
engagement with disordered eating as it is experienced by individuals and their families.
Anorexiabulimiacare, otherwise known as ABC, was formed in 1989 through the amalgamation of
two Christian initiatives seeking to help those suffering from eating disorders.

32

The work of ABC includes providing information for those with eating disorders, their families,
friends and church leaders via its website and print media. 33 It also runs a telephone helpline for
sufferers and a separate helpline for parents of sufferers as well as a web-based support forum for
those with eating disorders. ABC have established a befriending scheme whereby those who are
struggling with an eating disorder are linked with someone who has recovered and can offer
friendship and encouragement on the road to recovery. Other aspects of ABC include a prayer
support network, training and conferences, a referral service to accredited counsellors and a
quarterly e-newsletter for those supporting individuals with eating disorders. Through its website
ABC seeks to make available to the Church a range of resources to engage with eating disorders.

The work of ABC is acknowledged to be a leader in the field and as such, other Christian
agencies34 who encounter those suffering from eating disorders refer enquiries on to ABC.

Mercy Ministries UK
Mercy Ministries UK is a Christian charity who have established a 6 month residential programme
for young women suffering from life-controlling issues such as eating disorders and published a
number of resources related to this programme. Starved, Beyond Starved and Mirror Image

35

32

One was a support group in the north of England called Anorexia and Bulimia Care, the other was a
national organisation called There is an Answer based in East Anglia.
33
This includes a range of booklets as well as a number of books.
34
Such as Christian family support charity Care for the Family.
35
Nancy Alcorn, Starved (WinePress, 2007); Nancy Alcorn, Beyond Starved (WinePress, 2009) and Arianna
Walker, Mirror Image (Presence Books, 2011).

are books which have emerged from the programme and address eating disorders and body image
in a style and at a level for popular readership.

Mind and Soul

Mind and Soul is a non-denominational organisation exploring Christianity and Mental Health.
Overseen by a board of directors including a consultant psychiatrist, an Anglican vicar and an
academic psychologist who was previously director of ABC, Mind and Soul provides a credible
and reliable repository of information about spirituality and mental health, including a number of
articles and books on the subject of eating disorders. Within the wider context of mental health
many of the articles on eating disorders can be categorised under the same headings noted above;
academic psychology, popular information, popular self-help or popular testimony.

Summary
As has been demonstrated above, the Church has attempted to engage with eating disorders from a
variety of perspectives and many have been successful in raising awareness and supporting
sufferers. Within the Church, however, there is very little literature written from an academic
theology perspective directly addressing disordered eating. There are several volumes for those
with a background in psychiatry or counselling seeking to bring a professionalism and faith basis to
the subject and there is a range of books on eating disorders from a Christian perspective written
for a popular audience, either seeking to inform or advise or provide support to sufferers and their
families. A further genre of literature incorporates the materials for self-help or practical courses.

It is into this multiplicity of approaches that I believe this present research offers a unique and
necessary contribution. Whilst grounded in academic theology and having an awareness of the
other forms of Christian and non-Christian literature on eating disorders it seeks to fill the gap
which currently exists.

10

1.3 Thesis aim, location and approach

1.3.0 Thesis Aim
The aim of this thesis is to explore what contribution the Church has to offer those affected by
disordered eating. In a rediscovery of ecclesial practices, theoretical and practical knowledge come
together to enable faithfulness 36 to God and witness to a way of living which may provide
protection from some cultural factors which promote disordered eating and offer hope to those
suffering with eating disorders.

1.3.1. Locating the thesis

It has already been established that the Church has responded to eating disorders in three key ways;
through institutional publications; through popular Christian literature and through practical
initiatives.37 A work which engages with academic theology, the insights of medical professionals
and offers a way for the Church to embody a theologically rich, practical response to eating
disorders is currently absent. It is into this gap that I offer this thesis in an attempt to demonstrate
an integrated approach to the subject.

1.3.2. Approach
An underlying question behind this thesis is: how do churches understand and relate to eating,
identity and the relationship of food to the body? This is a thesis written primarily for those within
the Church who aspire to witness faithfully to Christ in the way they live with regard to the way
they relate to food and body image. In that sense this is not confined to those with a particular
interest in eating disorders, but to all who seek to orientate every aspect of their lives around the
risen Christ. The insights offered may be of help those relating particularly to those under the age

36

David Willows and John Swinton, Spiritual Dimensions of Pastoral Care: Practical Theology in a
Multidisciplinary Context (London: Jessica Kingsley, 2000), xxi.
37
Such as the befriender network of ABC or the Mercy Ministries programme.

11

of twenty-five38 and also those working with women.39 In pursuit of its aim, the thesis looks to
name and engage the cultural forces which form the background to disordered eating and to adopt
practices to address them. It is hoped that those who do not consider the Church a place they would
look to find help regarding disordered eating may discover through the witness of the Church a
community aspiring to reach out to the broken and oppressed and offer hope and transformation.

This introductory chapter will establish the rationale for the thesis and frame the questions which
drive it. The specific areas addressed by the thesis will be identified and the arguments proposed
will be introduced. Subsequent sections of this chapter will articulate the methods used in
answering the questions raised within the thesis.

It is acknowledged in both the structure and content of the research that at times Christian doctrines
have been interpreted in such a way as to potentially encourage eating disorders. 40 Despite this, I
will argue that a Christian understanding of food, body and identity, integrated with and shaping
the practices of Christian community can make a positive contribution in the sphere of disordered
eating.

1.4 Framing the Questions

At the outset, it is necessary to frame the questions which lie behind this thesis in order to
understand the argument which flows through subsequent chapters. The initial question concerns
why the issue of disordered eating is of relevance to the Church and a valid topic for theological
engagement. Subsequent questions which will be addressed are: How does the Church understand
disordered eating? How does it seek to help those whose eating is disordered? What does the

38

The majority of clinical diagnoses of eating disorders are to those in the 14-25 age group, though cases are
increasingly being seen in those younger than 14 (website of B-eat, (formerly the Eating Disorder
Association)).
http://www.b-eat.co.uk/Home/PressMediaInformation/Somestatistics (30th October 2010).
39
The gendered nature of eating disorders is recognised in literature such as Sharlene Hesse-Biber, Am I Thin
Enough Yet? (New York: Oxford University Press, 1996) and discussed within this thesis in Chapter 2.
40
See discussion in Chapter 2 about extreme food asceticism in medieval women.

12

existence of disordered eating mean for a faith whose central act of worship involves eating and
drinking? How might disordered eating among Christians affect their participation in the Church as
the Body of Christ?

1.4.1 A Valid Theological Topic?

Some within the church may consider theological engagement with disordered eating a frivolous
pursuit, seemingly pandering to the preoccupations of popular culture. Others see it as having little
to do with church and merely an issue affecting a small minority of people. I argue that, as food
and eating are essential to human existence and the purpose of the Christian church includes being
the clear manifestation of a people who have learned to be at peace with themselves, one another,
the stranger, and of course, most of all, God41 it is imperative that the Church is a place where
food, eating and identity is correctly orientated in relation to God. To allow the issue of disordered
eating to challenge the Church to look critically at whether it has adopted prevailing cultural
understandings and practices regarding eating is a valuable consideration in itself.

I argue that theologically engaging with the issues raised by disordered eating presents an
opportunity for the Church to re-examine its own practices in the light of biblical and historical
models. In so doing the Church may rediscover practices which offer a distinctive way of living in
the face of a culture driven by consumption, and may be a witness to the world and a beacon of
hope to those affected by disordered eating. Without such theological engagement, it is argued the
church will conform to cultural norms and be incapable of offering a distinctive witness. As noted
by Elaine Graham, Heather Walton and Frances Ward, Theological systems that are established
upon cultural norms which are so ingrained as to become invisible are difficult to contest on their
own terms.42

41

Stanley Hauerwas, The Servant Community: Christian Social Ethics, in John Berkman and Michael
Cartwright (eds.), The Hauerwas Reader (Durham N.C: Duke University Press, 2001), 372.
42
Elaine Graham, Heather Walton and Frances Ward, Theological Reflection: Methods (London: SCM Press
2005), 93.

13

It is also important to acknowledge that the Church is not exempt from those who suffer from
disordered eating. Experience of eating disorders within the Christian community often arises
through the individual encounter. It may be the pastoral conversation between clergy and a church
member seeking help, or the youth leader concerned about the weight or eating habits of one of the
young people. Despite public awareness of eating disorders, Christian engagement with the issues
around them rarely goes beyond the individual pastoral encounter and yet this is a faith where the
central act of communion is one of eating and drinking.

It is therefore surprising that, despite the specific areas of focus identified above, the Church in
general appears to have only really engaged with disordered eating in a non-distinctive or
uninterested way if it has engaged at all. It is argued that this may be because the terms presented in
popular literature do not correlate with the Churchs perception of the situation. A common
misconception, despite the many church members who actually know someone with a diagnosed
eating disorder, is that this is something for doctors or counsellors to treat. The notion that this is
an individual illness which has nothing to do with the Church, rather than being a reflection of a
society which has become disordered in its relationship with food, body and identity, is widely
accepted.

The rationale behind this thesis is that the existence and impact of eating disorders in society
cannot be ignored by the Church but needs to be appropriately and theologically addressed. The
ministry of the Church in the pastoral care it offers to those within it will be significantly improved
with a greater understanding of the factors contributing to and sustaining disordered eating, as will
the mission of the Church to those outside it. The role and mission of the Church in offering
healing to the sick and proclaiming liberation to the captive and oppressed takes its cue from Jesus
ministry. It is argued that in learning to imitate Christ through practical means the Church may
indeed be a conduit of Gods healing and liberating grace.

14

1.4.2 How does the Church understand disordered eating?

In a society where disordered eating exists, the implications for the Church are many and varied.
From the perspective of the Church, particular questions and challenges are raised about how it
relates to those whose eating is disordered.

The first challenge is to be able to articulate why disordered eating is a problem. From a Christian
perspective, it is intolerable that healthy people starve themselves to death, or rid their bodies of
nourishing food, or eat to such excess that they suffer debilitating health problems. For the majority
of people in the Church this conclusion is arrived at almost instinctively. The questions
surrounding ethical eating in the face of a world where many thousands of people are starving are
questions beyond the scope of this thesis, but the awareness of global starvation forms part of the
context of the discussion. This thesis will identify what understandings and practices form and
shape the Church to believe that disordered eating is not what humanity was intended for. From
this basis it will be possible to recognise that the Church, health professionals and the general
public may differ in the way they perceive disordered eating.

1.4.3 What does the existence of disordered eating mean for a faith whose central act of
worship involves eating and drinking?
For the Church, its engagement with the world of disordered eating generates a number of issues
about how it operates. The practice of hospitality and Christian table fellowship, which invariably
involves food, may need thoughtful consideration and adaptation if it is not to be exclusive of those
suffering from disordered eating. The extent to which the Church accommodates the needs of
members out of pastoral concern43 or challenges particular behaviour44 is a difficult judgment to
make and it is hoped that the content of this thesis may assist the Church in making those decisions.

43

See for example 1 Cor. 8:9-13, where Pauls pastoral concern causes him to advise a change of practice in
spite of the principle, in order that eating does not become the cause of other people falling into sin.
44
Joan Jacobs Brumberg suggests that women could combat the linking of physical beauty and self-worth by
challenging the social convention of greeting one another by complementing appearance and instead focus on
asking about interests, activities or work.

15

1.4.4 How does the Church seek to help those affected by disordered eating?
There is also the question of whether disordered eating is a hidden problem within the Christian
community in the sense of not being openly spoken about. The sense of shame felt by many
sufferers and the secretive nature of anorexia nervosa and bulimia nervosa leave many sufferers
and their families isolated and silenced. How the Church may become a safe and supportive place
where those with eating disorders find help, and hope rather than condemnation and rejection, is a
challenge to be addressed.

1.4.5 How might disordered eating among Christians affect their participation in the Church
as the Body of Christ?
Far reaching questions extending beyond immediate food practice include the consideration of
whether the age, class and gender profile of those with eating disorders coincides with the next
generation of female45 Christian leaders, hindering their participation in the Body of Christ. An
examination of history identifies a number of periods where extreme restriction of food,
particularly by women, was venerated in the life of the Church. This raises the question of whether
disordered eating is a new problem or an old problem manifested in a new way.

1.4.6 Is the Church part of the problem or part of the solution?

Discussions surrounding the subject of Christianity and eating disorders will often raise the subject
of asceticism and suggest that the Church may be part of the problem rather than the solution.
Whether there is historical precedent for eating disorders in the life of the Church is explored in
chapter 2. This thesis argues that the Church can be part of overcoming eating disorders and whilst
it is a work of theology it raises a number of issues which empirical experience has a bearing on. It

45

Whist disordered eating affects both men and women, it is acknowledged that women are
disproportionately affected by anorexia and bulimia nervosa with their socially debilitating consequences.
(B-eat, http://www.b-eat.co.uk/Home/PressMediaInformation/Somestatistics (30th October 2010)).

16

is not possible to assess here whether the benefits argued for in this thesis are borne out in practice,
but it would be the work of future research to test such claims.46

1.5 Mapping the way forward

In setting forth these questions at this introductory stage, beginning with the theological rather than
medical issues, this thesis takes an approach which asks: with regard to eating disorders, what if the
Body of Christ set the agenda? This involves an intentional raising of the theological questions
above, prior to exploring the medical research on disordered eating, rather than having the medical
issues determine the course of the thesis.

In addressing the questions via the methods referred to below, Chapter 2 of the thesis argues for an
overall account of disordered eating as a biopsychosocial phenomenon of multifactorial causes.
This is based on the research of clinicians in physiology and psychology as well as the observations
of sociologists and anthropologists. It is an acknowledgement that the aspects of disordered eating
affect the individual as a biological and psychological affliction but happen within the context of
familial and cultural influences. It is argued that the Churchs practices may have a simple but
profound witness in being distinctive in relation to the prevailing culture, thus addressing the wider
context, but may also form a pattern of life sustaining to the individual.

In the light of this, Chapter 3 sets forth the methodology pursued in the thesis, arguing that an
approach based on practices of the Church addresses inadequacies in current Church responses to
disordered eating and allows for a richer theological engagement with the issue.

46

It would be possible to conduct empirical research into whether participation in a small group which
practices confessing and accountability reduces the frequency of binging those suffering from bulimia
nervosa. The benefits argued for in the chapter on Baptism and Eucharist could be tested by a study on body
image dissatisfaction to see whether practices undertaken as the Church help people assess their value less by
their appearance and more by other factors.

17

The thesis then moves to consider particular practices of the Church, beginning with the shaping
and forming of Christian identity through the practices of Baptism and Eucharist in Chapter 4. The
impact on the identity of the individual body as it participates in the Body of Christ is discussed,
suggesting that this may have a potentially liberating effect on those whose identity, body image
and eating is distorted. It is not insignificant that disordered eating has become more common at a
time when communities have broken down and pressure on individuals to achieve has increased.
The argument that the Church provides a loving and supportive community which looks beyond
individual achievement or appearance is advanced as a contribution the Church can make to those
vulnerable to developing eating disorders.

The chapter continues by examining the central act of the Churchs worship eating and drinking
at the Eucharist. The later part of the chapter considers what significance the Eucharist has for
disordered eating where the practice of eating and drinking, literally consuming belief, is central to
faith and shaping identity.

The forming of character through the practice of confessing and accountability is explored in
Chapter 5. The first section identifies the biblical origins of confessing and also the exhortation to
be accountable to other believers. The significance of the Church as a place for openness, sharing,
confessing and accountability is articulated and affirmed. Confession is explored in the broader
sense of speaking out rather than the narrower focus of telling another of ones sins. It is argued
that in contrast with the individualism and isolation of much of contemporary society, mutual
accountability within the Church enables a rediscovery of community as a place to be real and to be
formed, to be loved and forgiven despite failings, and it holds out the hope of transformation and
redemption.

Ironically, the importance of mutual accountability has been harnessed by those outside the
Church whilst many within the Church have neglected it. Groups promoted by the dieting industry,
such as Weight Watchers, operate on a group model not unlike the early Methodist class meetings.

18

Those groups seeking to help others recover from disordered eating also focus on mutual
accountability. This section considers the case study of a twelve-step eating disorder group in the
USA modelling a rediscovery of accountability as a way to combat disordered eating. It is argued
that this may be one of the practical ways in which the Church can respond to the challenge of
disordered eating.

The three chapters focussing on key practices are supplemented by a further chapter addressing the
themes of perfection and perfectionism. It is acknowledged that whilst these are not single
practices, they are attitudes and aspirations which permeate the preceding discussion and can be
manifest through a variety of practices. Throughout its history the Church has both embraced and
rejected the pursuit of what has been described as Christian perfection or holiness, and this is of
course a central theme in Methodism. This chapter considers the biblical and historical precedents
for Christian perfection, what a rediscovery of it today may look like and what relevance it has to
disordered eating.

This is considered in the knowledge that one of the strongest drives of the anorectic is the quest for
perfection. Often extreme restriction of food through dieting can be perceived as a means to the
perfect body or, in the mind of the anorectic, not eating becomes an exhibition of perfect self
control. This section of the thesis also considers the pressure, particularly felt by many women, to
achieve unattainable physical perfection. I argue that a return to living and speaking of the grace of
God offers a hope which extends beyond a works righteousness perfectionism based on perfect
self-control, perfect eating or perfect body shape.

In this thesis therefore I propose an approach which engages theologically with the issues raised by
eating disorders and considers the practical implications for how the Church responds. This thesis
takes the view that the Church striving to develop new ideas to address disordered eating is less
significant a contribution than a re-engagement with existing Christian practices. Such practices

19

form the character of those who participate in them by creating a way of being which is determined
by different values from the prevailing culture.

1.6 Methodology
Having established the grounds for examining disordered eating, the next question is one of
methodology regarding how the Church identifies the issues raised by disordered eating. The
consideration of theological approach is implicit in the structure of the thesis. This introduction
begins with the theological questions and the purpose and call of the church, looking to what a
Christian ethic might look like. This is the setting of context and all questions which follow are
framed within this overarching understanding.

1.6.1 Wesleyan Pragmatism and the Pastoral Cycle

As someone located within Methodism, my denominational heritage contains within it certain
emphases which work their way through the thesis in both the practices examined but also in the
methods used to undertake the research. Though much of John Wesleys theology was underpinned
by his formal theological studies at Oxford, it was in his pragmatic theology directed at addressing
an evolving movement with new issues and questions that he became notable. In a similar vein, this
thesis looks to the practical theological tool of the pastoral cycle 47 as an overarching structure for
the thesis, but not its detailed methodology. As with Wesley, the underlying concern is how, in
responding to this issue, the church may be more fully equipped to reflect Christ, nurture disciples
and live out its mission in acts of mercy and piety.

The choice of the pastoral cycle as methodological tool is influenced by the capacity it has to
relate faith (or doctrine) with practice (or life) and to do so in ways that are relevant and useful. 48

47

Paul Ballard and John Pritchard, Practical Theology in Action (London: SPCK, 1996).
Emmanuel Lartey, Practical Theology as a Theological Form, in David Willows and John Swinton,
Spiritual Dimensions of Pastoral Care: Practical Theology in a Multidisciplinary Context (London: Jessica
Kingsley, 2000). 72.
48

20

In dealing with the practical impact of disordered eating, a methodology which moves from
experience to an analysis of that experience, and then to theological praxis is an obvious and fitting
choice.

Other methodologies which also integrate reflexive practice and theology such as the see, judge,
act model pioneered by Cardinal Joseph Cardijn49 were considered as means by which this subject
might be addressed. It was however the scope within the pastoral cycle to bring experience,
theology and analysis together that most suited to my approach to the issue. Within the model of
the pastoral cycle itself, a number of variations have been proposed, each taking a slightly different
approach.50 The model used as the overarching methodology for this thesis is a pastoral cycle
which involves; immersion/experience, exploration/analysis, theological reflection,
response/pastoral planning.51 In a departure from a strict application of the four stages my approach
integrates the theology and response within an understanding of practices, which will be explored
further in chapter 3. The practices themselves are both the theology and the response, so rather than
considering eucharistic theology and concluding that in response the Church should share bread
and wine, it is in the sharing of bread and wine that the theology of eucharist is declared and
enacted.

This introductory chapter has already raised the issue of disordered eating and begun asking
questions about how it is experienced and how it may be understood. This marks the insertion point
into the cycle, beginning with the issue as it is encountered. The second chapter marks a transition
to multi-disciplinary analysis, wrestling with the questions surrounding the amount of influence
given to each discipline and the extent to which each discipline is appropriate in analysing the
issue. It is in this second chapter that disordered eating is defined in such a way to be able to move
on to relate it to practices of the Church.

49

See Graham, Walton and Ward, Theological Reflection: Methods, 183.

Lartey, Practical Theology as a Theological Form, gives three variations.
51
See either Lartey, Practical Theology as a Theological Form,73, or Graham, Walton and Ward,
Theological Reflection: Methods, 188, for a visual representation of the cycle.
50

21

Chapter 3 explores the methodology employed in later chapters. It considers current Church
approaches to the issue of disordered eating and having noted their strengths and weaknesses
argues for a methodology based upon ecclesial practices. Particular questions surrounding the
choice, content and theological approach to these practices are addressed within Chapter 3.

The main body of the thesis, Chapters 4 to 6, are what may be termed theological reflection as the
relationship between the issue of disordered eating, as defined in Chapter 2, and theology is
explored. Within the overarching methodology of the pastoral cycle, the methods of canonical
narrative engagement with scripture and attention to practices of the church are used within the
theological reflection element of the thesis; these are more fully articulated below.

Chapter 6 marks a transition point between the move from theological reflection to outcome or
responsive action, though within each chapter the focus on practices leads to an outcome as the
chapter conclusion. In drawing together the tendency for the practices discussed in the preceding
chapters to collapse into perfectionism or works-righteousness this chapter becomes a bridge in
the structure of the thesis between theology and outcomes, seeking to temper a mechanistic link
between issue and solution. The exploration of the call to perfect love or holiness in Chapter
6 emphasises the significance of grace. The effect of this upon the structure of the thesis is to
prevent it from suggesting that a simple rediscovery of particular practices will automatically result
in the outcomes which appear in the concluding chapter. It is hoped that in passing through this
transitional stage on the cycle that the outcomes proposed in the concluding chapter (ch. 7) may not
appear as a series of disjointed actions but a genuine step on the way to the Church becoming what
it is called to be, with particular reference to relating to disordered eating.

22

1.6.2 Other Methodologies Observational Ethnography

Within particular chapters and sections there will be reference to non-theological methodologies,52
whilst the empirical work on accountability and Church community will combine both
observational ethnography and narrative reporting of interviews conducted. This is most
particularly the case in Chapter 5, the case study of a 12 Step eating disorder group in the USA who
are rediscovering accountability as a way to combat disordered eating. 53

1.7 Conclusion
The Church cannot ignore disordered eating or pass it off as a fad or a minority interest. Within
western culture which is exposed to particular images of beauty, disordered eating has become a
firmly established phenomenon, crossing generational 54 and social class boundaries. 55 Instead the
Church must engage with the fact that to be the Church is to live in a way which challenges those
powers within the culture which drive disordered eating in its various and complex forms and
witnesses to the narrative of a God who offers redemption and hope.

52

Such as the questionnaire- based and interview- based research of much of the psychological literature
reviewed in Chapter 2.
53
Details of the context and conducting of this particular element of research are contained within the
exploration of methodology in chapter 3 and in relation to the subject of perfection in Chapter 6.
54
See increase in geriatric anorexia which is attributed to different causes to the form of anorexia nervosa
affecting younger people. Website of B-eat, (formerly the Eating Disorder Association)
http://www.b-eat.co.uk/Home/PressMediaInformation/Somestatistics (30th October 2010).
55
For an increase in non-middle-class anorexia, see Maisie C. E. Gard and Chris P. Freeman, The
Dismantling of a Myth: A Review of Eating Disorders and Socioeconomic Status, International Journal of
Eating Disorders 20, no. 1 (1996), 112.

23

Chapter 2
What are Eating Disorders?
Eating disorders are of great interest to the public, of perplexity to researchers, and a challenge to
clinicians.1

2.0 Introduction
The purpose of this chapter is to explore the nature and origins of eating disorders from the point of
view of medical, sociological, psychological and cultural studies. In order to engage theologically
with the issue of disordered eating it is necessary to do so in an informed and credible way and to
this end, the research of those working in the field of eating disorders will be examined and
evaluated. This chapter will establish the definitions of and understandings about disordered eating
upon which the rest of the thesis will proceed.

The nature of eating disorders is such that they have been discussed in the academic disciplines of
medicine (including physiology, 2 neurobiology and pharmacology3), sociology, philosophy,4
anthropology, feminist theory, and psychology. The multifaceted nature of eating disorders has also
generated much research that is multi-disciplinary in approach.

This chapter aims to identify the primary sources and major issues in this field and give attention to
key theories, concepts and ideas at work within the discussions as they occur outside theological
discourse. There will be reference to the central questions around which the debate is structured
and a tracing of the origins of the field and attention to changing definitions within it.

Christopher G. Fairburn and Paul J. Harrison, Eating Disorders, The Lancet 361 (2003), 407-416.
Diane Alix Klein and B. Timothy Walsh, Eating Disorders: Clinical Features and Pathophysiology,
Physiology & Behavior 81, ( 2004), 359-74.
3
Claire Advokat and Vesna Kutlesic, Pharmacotherapy of the Eating Disorders: A Commentary,
Neuroscience & Biobehavioral Reviews 19, (1995), 59-66.
4
Susan Bordo, Unbearable Weight (Los Angeles: University of California Press, 2nd ed. 2003).
2

24

The approach taken is to work through hypotheses suggested in various disciplines about what
eating disorders are, taking theories in a broadly historical development. This necessitates initially
treating anorexia nervosa, bulimia nervosa and atypical eating disorders (including Binge Eating
Disorder) as separate entities, due to the historical emergence of their differing diagnoses. The first
part of the chapter considers anorexia nervosa and the questions surrounding its definition and
diagnosis. Reference will also be made to assertions made regarding its aetiology. A second section
will chart the emergence of bulimia nervosa as a separate and distinct entity within the spectrum of
eating disorders. This will consider how the literature on anorexia nervosa and bulimia nervosa
altered from the late 1970s to the present day as a new definition and a new disorder became
accepted. The third part of the chapter will discuss the most recent development of atypical eating
disorders5 and the difficulties expressed in the literature surrounding redrawing the boundaries of
eating disorders once again to account for new classification. Also within this latter section will be
reference to diagnoses of Binge Eating Disorder and attention to the debate around disordered
eating which includes sub-clinical cases.

Within the literature, the dominant perspective is that of psychology, for historically it was
physicians specialising in the area which later emerged as psychology who claim to have
discovered eating disorders. Whether they discovered eating disorders or merely medicalised
something which had not previously been categorised in medical terms is one of the issues
commonly discussed in the sociology of psychology.6 As will be more fully discussed later, the
early medical accounts of eating disorders are closely linked with cases of hysteria 7 and
agoraphobia where problems of the mind manifested themselves in physiological symptoms.8 From

Referred to as Eating Disorders - Not Otherwise Specified in American literature. See American
Psychiatric Association (APA), Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (Washington
DC: APA, 1994).
6
Joan Jacobs Brumberg, Fasting Girls (New York: Vintage Books, 2000), 45.
7
Stephen Mackenzie, On a Case of Anorexia Nervosa vel Hysterica, The Lancet 131, no. 3370, 613.
8
C.H. Lasgue, On Hysterical Anorexia, Medical Times and Gazette 2 (1873b), 265- 6.

25

earliest times questions of aetiology, diagnosis and treatment have been prominent in the debate
around eating disorders and these themes are consistent throughout the psychological literature.

Before exploring the content and boundaries of the eating disorders discussed in this chapter, the
use of terminology needs to be established. Anorexia nervosa will be used to refer to the
condition which results in restrictive eating causing body mass being reduced to levels which
impair normal bodily functioning. 9 Bulimia nervosa will be used to refer to the cases where a
person purges themselves of the food they have eaten; it will be treated as distinct from binge
eating disorder, where food is not subsequently purged. It should be recognised at this stage that the
behaviour of purging which is used as one of the key the criteria to differentiate bulimia nervosa
from anorexia nervosa, can also be part of a diagnosis of anorexia nervosa. 10 The high rates of
crossover between anorexia nervosa and bulimia nervosa as currently defined has cast doubt on
the usefulness of the current diagnostic criteria to accurately reflect the clinical picture, which is
not as clear cut as the distinction above suggests. 11

A third category encapsulating eating behaviours not otherwise specified, clinically falls under the
heading of EDNOS.12 All the above mentioned disorders will be referred to under the generic term
eating disorders throughout the thesis, which I use to denote all the clinically identified disorders
above. Also included in this definition of eating disorders are orthorexia, an obsession with
eating only right foods, and compulsive eating. Whilst elements of excessive exercise can also be
found in anorexia nervosa and other disorders related to body image, they will not be addressed
within the scope of this thesis, which concerns itself with behaviours to do with eating. Throughout
this thesis, unless otherwise specified, the term disordered eating will be used as a broader term
than eating disorders. Whereas eating disorders will refer to clinically defined behaviour,
9

A definition in line with DSM IV, although difficulties with defining anorexia will be discussed more fully
below.
10
See Anorexia nervosa (purging type) diagnostic criteria at section 2.1.3.5.
11
Kamryn T. Eddy, David J. Dorer, Debra L. Franko, Kavita Tahilani, Heather Thompson-Brenner, David
B.Herzog, Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa: Implications for DSM-V,
American Journal of Psychiatry 165 no.2 (2008), 245-50.
12
American Psychiatric Association DSM IV.

26

disordered eating will refer to both clinically defined eating disorders and sub-clinical behaviours,
such as constant or yo-yo dieting.

2.1 Defining anorexia nervosa

2.1.1 Introduction
The classification of anorexia nervosa has passed through several phases. In this century, these
phases have progressed from the view that the disorder was either entirely a form of pituitary
disease or a non-specific variant of many other psychiatric disorders to the more current view that it
13

is a specific syndrome with core clinical features that distinguish it from other states.

Since the end of the nineteenth century when anorexia nervosa was identified as disease within the
classification of modern medicine and named anorexia nervosa, confusion and debate have
surrounded attempts to understand it.

Perhaps the most pressing consideration is why a person would reject food, even to the point of
death. That a person continually and wilfully refuses food until their body becomes emaciated and
their organs begin to fail is one of the most desperate and illogical aspects of anorexia nervosa. The
desire to understand what is happening and thus be able to help reverse this process is one of the
driving forces behind clinical research, and also one of the motivating factors of this thesis, which
seeks to help those within the Church make a positive difference to those suffering from disordered
eating.

A second perplexing factor has been the fact that eating disorders have been so much more
common in females than males. Why this is so continues to be a matter of debate and will be
discussed more fully below.

13

Paul E. Garfinkel, Classification and Diagnosis of Eating Disorders in Kelly D. Brownell and Christopher
G. Fairburn (eds.), Eating Disorders and Obesity A Comprehensive Handbook (New York: Guilford Press,
1995).

27

Why disordered eating manifests itself in particular eras and in particular cultures is another factor
which is debated, particularly among those addressing the issues from a sociological and historical
perspective. The cultural issues which may or may not influence whether eating becomes
disordered to the extent that functioning is inhibited will be raised and discussed below.

The task of this chapter involves identifying which disciplines should be used to interpret the
behaviours termed anorexia nervosa and justifying the grounds on which their insights are
considered authoritative. In doing so the chapter will establish the extent to which disordered eating
can truly be said to be an individual mental disorder, a symptom of dysfunctional family life, a
product of cultural pressure to look and behave a certain way, a rejection of the accepted norms of
society, or a genetically predisposed illness.

The following paragraphs focus on the definition of anorexia nervosa, whilst bulimia nervosa is
considered subsequently as a separate entity. This can be justified from the historical perspective
that bulimia nervosa has only emerged in the medical literature as a separate entity since the
nineteen-eighties. Additionally, this also has the benefit of reflecting current medical practice in
diagnosis and recognises significant differences between anorexia nervosa and bulimia nervosa
whilst acknowledging their close relationship within the broader context of eating disorders as a
whole. Treatment of anorexia nervosa will not be explicitly addressed below even though there is
much debate about what constitutes appropriate and effective treatment. However we should
recognise at the outset that views on treatment depend heavily upon the answer to the question
what is anorexia nervosa?, for different diagnoses have produced widely varying treatments.14

Despite the popular perception that it is not difficult to tell whether a person has anorexia nervosa,
either because they are too thin or hardly eat anything, defining anorexia nervosa is more

14

See Kelly D. Brownell and Christopher G. Fairburn (eds.), Eating Disorders and Obesity, 289-374, for
discussion of a range of approaches.

28

complex than first appearances suggest. It begins with the question of whose definition is accepted
as authoritative. Each discipline which has sought to define and interpret the behaviours we term
anorexia nervosa has done so within its own framework of understanding. The following
discussion will consider the ways in which physicians, psychologists, sociologists, feminists and
historians have approached the question what is anorexia nervosa?, where the points of
convergence in understanding lie, and how the differences affect our view of a phenomenon which
is still not fully understood.15

2.1.2 Anorexia nervosa as a contested notion

Before attempting to come to an understanding of anorexia nervosa with which to work, it is
worth stating that it is an essentially contested notion.16 The dependence of the definition upon our
understandings of disease, which are themselves contested, creates a problem when trying to
answer the question what is anorexia nervosa?.

The debate about what constitutes a disease becomes particularly relevant in this context.17
Anorexia nervosa exists in psychology and medicine as a disorder.18 It has been classified by some
as a disease using the clinical-descriptive or syndromal model where there are a combination of
signs and symptoms observed to occur together so frequently and so characteristically as to
constitute a recognizable and typical clinical picture. 19 The diagnostic criteria explored in section
2.1.3.5 of this thesis are an example of this model, seeking to identify the commonly occurring
symptoms and signs which indicate the presence of anorexia nervosa.

15

A.W. Clare, The Disease Concept in Psychiatry, in Robin M. Murray, Peter Hill and Peter McGuffin, The
Essentials of Postgraduate Psychiatry (Cambridge: Cambridge University Press, 3rd ed. 1997), 41.
16
See W. B. Gallie, Essentially Contested Concepts Proceedings of the Aristotelian Society 56 (1956), 167198. Gallie identifies how concepts such as art or democracy are subject to endless disputes about their
proper use on the part of their users, and I argue in the following sections that the same is true of the term
anorexia.
17
See Clare, The Disease Concept.
18
See diagnostic classifications discussed at 2.3.5.1.2.
19
Clare, The Disease Concept, 42.

29

A more difficult enterprise is classifying anorexia nervosa as a disease when using the disease-aslesion model, where disease is understood as an abnormality20 differing from the usual pattern. As
Anthony Clare observes, this model of articulating disease becomes problematic when there is no
clear dividing line between variation within normal boundaries and that which is abnormal. 21
The disease-as-lesion model cannot determine whether anorexia nervosa or obesity are diseases as
there is no means of defining the point on the spectrum at which weight ceases to be normal and
becomes abnormal. The greater problem in trying to define anorexia nervosa as a disease under
the disease-as-lesion model is the absence of any lesion or underlying physical pathology. This is
not problematic if the psychologically abnormal refusal to eat in anorexia nervosa can be attributed
to chemical or physiological changes occurring in the body due to lack of food, or as was once
thought, pituitary deficiency. Classifying anorexia nervosa as a disease under this model becomes
more difficult if the psychological fear of eating precedes any physical change or abnormality. The
medical response in such circumstances is a drive to discover a pathological abnormality which can
then be identified as the disease which causes abnormal mental states. The psychological
symptoms are therefore not seen as disease themselves but epiphenomena of underlying physical
disturbances22.

The use of the statistical model of disease, where deviation from normal is the criterion for disease,
incorporates the anorectic as one who refuses to maintain normal body weight. The subjective
nature of what constitutes normal body weight is recognised by Orbach, 23 noting how the
boundaries of normal are liable to change from decade to decade and country to country. This
raises the issue of cultural and social influences as determinants of what is deemed desirable or
acceptable and what is not. What may have been considered abnormal a generation ago may now
be considered normal, or vice versa, with the consequence that our view of what constitutes a
disease changes over time.

20

The abnormality is usually understood as having an established organic pathology.

Clare, The Disease Concept, 43.
22
Clare, The Disease Concept, 44.
23
Orbach, Bodies, 15 - 16.
21

30

There are however those who contest the view that anorexia nervosa is a disease and see it rather as
a social construction. 24 The assertion that disease as a concept, and mental disease in particular,
permits a bewildering number of interpretations [and] seems inordinately sensitive to
personal, social and political influence 25 will be discussed further in later sections, which consider
the possibility that anorexia nervosa may not be a disease but a response to patriarchy.26

Another problem in defining anorexia nervosa is that each discipline has its own understanding of
the causes of anorexia nervosa and reference to these causes in turn shapes what constitutes
anorexia nervosa for the purposes of discussion within that field. Literature in one field may refer
to anorexia nervosa as wholly distinct from bulimia nervosa 27 whereas in a different field
anorexia nervosa and bulimia nervosa may be treated as part of the same phenomenon and concept.
In much sociological and feminist literature concerned with aetiology there is a greater likelihood
of broader categorisation, combining anorexia nervosa, bulimia nervosa and binge eating disorder
under the banner of eating disorders as a psychosocial phenomenon. Within some interpretations
bulimia nervosa is considered, not as synonymous with, but as a feature of anorexia nervosa. Other
professionals, even within the same discipline, may treat anorexia nervosa and bulimia nervosa as
discrete entities with different causal factors.28

The first section of this chapter traces the historical development of anorexia nervosa from the
earliest medical definition of particular behaviours as anorexia nervosa to the current medical
scene. Later sections will discuss the ways in which anorexia nervosa has been perceived in terms

24

Julie Hepworth, The Social Construction of Anorexia Nervosa (London: Sage 1999); Sharlene HesseBiber, Am I Thin Enough Yet? (New York: Oxford University Press, 1996).
25
Clare, The Disease Concept, 41.
26
See sections 2.1.7 and 2.1.8, particularly the debate surrounding fasting female saints and whether their
inedia was a disease or theology.
27
For example, medical texts concerned with treating eating disorders separate anorexia nervosa and bulimia
nervosa as requiring different types of treatment.
28
Recent definitions of anorexia have separated it into restricting-type and bingeing-type. Though bingeingtype anorexia may appear to be bulimia, most definitions distinguish them on the basis that binge-type
anorexia is often a lapse from rigorous restriction of calorie intake (i.e. restricting-type anorexia) whereas
bulimia nervosa involves a recurring pattern of bingeing and purging.

31

of non-medical understanding. These include the criteria of definition which are not related to
physical or psychological symptoms but which address by means of statistical definition the
anorexic type. Many of these long-held presumptions are now being challenged, resulting in a
lack of confidence in the more established definitions and an ongoing redefinition in response to
the question what is anorexia nervosa? The discussion of non-medical interpretations of anorexia
nervosa will look briefly at the wider context of the phenomenon termed anorexia nervosa. It will
consider the socio-historical understanding of food, eating, identity, self-control and power, themes
prevalent across all disciplines discussing anorexia nervosa. Attention will be given to whether
anorexia nervosa existed before the modern medical definition and was synonymous with the
eating/non-eating patterns of medieval ascetics as well as a consideration of the literature on the
contemporary situation of women, society, food and what Sharlene Hesse-Biber terms The Cult of
Thinness.29

The solution proposed in this thesis to the contested nature of anorexia nervosa and other forms of
disordered eating is to appeal to a concept of family resemblance. The eating disorders which are
clinically defined share a number of features which bring them within the categorisation of eating
disorders. These family resemblances include such things as the sufferers attitude toward food,
the preoccupations of the sufferer surrounding weight and body image and particular behaviours
such as restricting, bingeing and purging. This gives recognition to the similarities which exist in
the context, pattern and interpretations of disordered eating, whilst allowing for different strands of
individual disorders to be taken into account. In this way it is possible to acknowledge, for
example, the common theme of control existing within anorexia nervosa and binge eating disorder
but give credence to the very different ways in which it is expressed within each disorder.

This thesis argues that the family of disorders, termed eating disorders30 are a medical
categorisation of what is actually a biopsychosocial phenomenon of multifactorial origins. In this

29
30

Hesse-Biber, Am I Thin Enough Yet?.

See above.

32

way I endeavour to establish that there is necessarily a biological element to disordered eating, due
to physiological changes which occur when non-eating or excessive eating take place. The
possibilities of there being a genetic predisposition toward developing an eating disorder is the
subject of research which is in its infancy upon which I wish to keep an open mind. The
psychological element of disordered eating is well documented and it is argued that the thought
processes underlying disordered eating are an essential component of the variety of disorders
explored. However we also need to recognise that there is a cultural context to disordered eating
and the argument that there is a social aspect to disordered eating recognises the cultural context in
which eating disorders appear to develop, taking on some of the observations made by sociologists
and feminist writers.

2.1.3 Anorexia nervosa as a medical condition

Having acknowledged the variety of factors which influence disordered eating, I will argue that
disordered eating deserves to be recognised as a medical condition. This is not only because
historically it has been defined as such, but because the impact of anorexia nervosa, bulimia
nervosa or other disordered eating strikes at the biological functioning of the body with which
medical science concerns itself.

2.1.3.1 Historical medical origin

The origin of anorexia nervosa is a subject of great debate among historians31 and will be addressed
in relation to social and religious history in a later in this chapter.32 In the psychological and
biomedical literature, it is Richard Morton who is credited as the first to identify and describe
anorexia nervosa in his published work of 1689.34 His identification of physiological symptoms of
extreme thinness, amenorrhoea and failure to eat, combined with the psychological features of a

31

Joan Jacobs Brumberg, Fasting Girls (New York: Vintage Books, 2000); Rudolph Bell, Holy Anorexia
(London: University of Chicago Press, 1985); W. Ll. Parry-Jones, Archival Exploration of Anorexia
Nervosa, Journal of Psychiatric Research, 19 (1985), 95.
32
Section 2.1.8.
34
Richard Morton, Phthisiologia, seu Exercitationes, de Phithisi (London: Smith, 1689).

33

multitude of Cares and Passions of [the] Mind35 qualify him, in the opinion of Silverman, as the
first medical classifier of anorexia nervosa. 36 Though most histories of anorexia nervosa give a
passing reference to Morton, the levels of seriousness with which his diagnosis is treated differ. His
patient appears to be an isolated case and though the symptoms are consistent with contemporary
anorexia nervosa there are some who would dispute the validity of his classification. One reason
for this is an aversion to the methodology of correlating what we now call anorexia nervosa with a
seventeenth century case, seemingly overlaying a contemporary concept upon earlier medicine.
Others would disregard Mortons diagnosis on the basis that a specific component of anorexia
nervosa is its existence in societies influenced by particular cultural features. 37

If anorexia nervosa is a culture-bound syndrome, as many authors suggest, 38 then its appearance in
1689 is problematic. Either the Morton case is not anorexia nervosa because it does not fit the
diagnostic criteria in terms of cultural location, or the assumptions about situations where anorexia
nervosa occurs need to be re-evaluated. In defence of Morton, Silverman notes that the
circumstances in which Morton made his diagnosis were extremely primitive in comparison to the
resources available to contemporary science. Despite this, Silverman claims, Morton identified
anorexia nervosa, a disease which has confounded physicians for 300 years and has also reached
epidemic proportions as the 20th century draws to a close. 39 Silvermans inference is that Morton
should be applauded for his observations and for laying foundations for later discoveries, not
criticised in the light of modern psychology. In agreement with Silverman, I concur that the
seventeenth century physician cannot possibly be expected to have interpreted symptoms in the
same way as they would be today, but it is reasonable to suppose that the identification of the

35

R. Morton, Phthisiologia: or a Treatise of Consumptions, (London: Smith and Walford, 1694), 8-9, quoted
in J. A. Silverman, Richard Morton, 1637 1698, Limner of Anorexia Nervosa: His Life and Times,
Journal of Psychiatric Research 19 (1985), 83.
36
J. A. Silverman, Richard Morton, 83.
37
Joan Jacobs Brumberg, Fasting Girls, 44.
38
Joan Jacobs Brumberg, Fasting Girls. See the later discussion on relationship between culture and
individual psychopathology.
39
J. A. Silverman, Richard Morton, 87.

34

behaviours Morton encountered sets the precedent for acknowledging disordered eating as a matter
of medical concern.

The debate about Morton brings into focus the debate surrounding the extent to which anorexia
nervosa is culturally conditioned. Two opposing extremes exist. One states that anorexia nervosa is
entirely confined to oppressive patriarchal cultures which aggressively promote thin ideals of
female beauty or which give women no other means of achievement than self-starvation. The other
approach suggests there are reasons for anorexia nervosa which exist regardless of the culture and
that there is a universal element to the disease which means it can occur in any place in any era. My
own view is that between these extremes lies a way which recognises the ways in which anorexia
nervosa may be culturally determined but also the possibility that the symptoms associated with
anorexia nervosa may arise in other eras and contexts. I acknowledge that particular cultural
influences may create conditions for anorexia nervosa to flourish, and in some circumstances the
cultural pressure promotes disordered eating. This may account for the apparent increase of people
suffering from anorexia nervosa in twenty-first century societies exposed to particular ideals and
images of beauty. This is tempered by the understanding that there may be a more universal
element to anorexia nervosa. Consideration given to the behaviours of some women, including the
one examined by Richard Morton, suggests that food restriction may become a response to a given
situation in any era, regardless of cultural pressure to be slim.

The next phase in the historical literature from a psychological perspective is a medical reading of
the cases of famous fasting women from the sixteenth to nineteenth centuries. 40 W. L. Parry-Jones
identified that in these accounts a typical anorexic picture is revealed in only a small number 41
which is consistent with the interpretation of Joan Jacobs Brumberg who charts this period as the
transition from sainthood to patienthood.42 Once again the question is raised about the historicity

40

W. Ll. Parry-Jones, Archival exploration of Anorexia Nervosa, Journal of Psychiatric Research, 19

(1985), 95.
41
Parry-Jones, Archival exploration of Anorexia Nervosa, 95.
42
Brumberg, Fasting Girls, 43.

35

of a culture-bound syndrome, when the era of eating disorders began and whether interpretation of
particular cultural phenomena has a bearing on diagnosis or emergence of a disorder.

2.1.3.2 Modern medical origin

Regardless of the debate about Morton and the intervening period of nearly two hundred years, the
majority view is that the first significant scientific research on anorexia nervosa was the concurrent
but separate investigations of William Gull and Charles Lasgue. Lasgue was the first to publish
his findings in 187343 though Gull had given a lecture on his cases in the same year and previously
referred to the condition in 1868 as hysteric apepsia. It was Gulls report in 1874 which
originated the term anorexia nervosa and his attributing of lack of appetite to a morbid mental
state led him to conclude:

I believe, therefore, that its origin is central and not peripheral. That mental states may destroy
appetite is notorious, and it will be admitted that young women at the ages named [sic. adolescence]
are specially obnoxious to mental perversity.44

In contrast Lasgue was more inclined to see the lack of appetite as peripheral.45 Despite differing
on what they emphasised, Gull and Lasgue believed that they were describing the same illness
which affected adolescent girls whose symptoms were loss of appetite, amenorrhea, excessive
exercise, slow pulse, emaciation, constipation and an absence of physiological cause. Their work,
identifying anorexia nervosa as having a core syndrome that distinguished it from other illnesses 46
triggered much medical debate which resulted in consigning anorexia nervosa firmly to the realms
of psychological rather than physiological enquiry. 47 Dwelling upon the historical origins of the
psychological and medical literature when there is so much current material may not appear

43

C. H. Lasgue, On Hysterical Anorexia, Medical Times and Gazette 2 (1873), 265- 6.

W. Gull in Hilde Bruch, Eating Disorders, 214.
45
Lasgue, On Hysterical Anorexia.
46
Parry-Jones, Archival Exploration of Anorexia Nervosa, 96
47
Ibid.
44

36

relevant, yet I argue that many of the debates around the key questions of diagnosis and aetiology
which are still happening to day have their roots in these early discussions.

Locating the origins of anorexia nervosa in the area of nervous disorders, many of which were
termed hysteria and attributed to women, caused the medical profession to look to psychological
causes and treatments for a nervous lack of appetite. Later research would determine that
anorexia nervosa involved a suppression of appetite rather than a loss of it; hence the majority of
the literature on anorexia nervosa acknowledges the misnomer of the diagnosis.

This discussion of the early exploration of anorexia nervosa has already identified the complex
interrelationships between the psychological symptoms, the physical symptoms and the wider
debate surrounding the influence of society or culture. My assertion that anorexia nervosa can
properly be described as a biopsychosocial phenomenon of multifactorial origins traces this
interconnectedness of body, mind and society back to the foundations of the medical investigation
of anorexia nervosa. The research which built upon the work of Gull and Lasgue wrestled with the
same issues, attempting to discover which could be described as the causal factor for the patients
refusal to eat physiology, psychology, or cultural influence.

2.1.3.3 Psychology versus Physiology

The argument that disordered eating is a biopsychosocial phenomenon does not presuppose either
that the biological factors cause the psychological reaction or the reverse. This has not always been
the case as the quest for the cause of anorexia nervosa gained momentum.

The emphasis on psychological diagnosis and treatment changed in 1914 when M. Simmonds
published an autopsy report suggesting anorexia nervosa was caused by hypopituitarism,48 based on
his treatment of a woman whose pituitary gland had been destroyed. For a time anorexia nervosa
48

Hypopituitarism is a condition where the pituitary gland fails to supply sufficient hormones to the rest of
the body, resulting in many similar presenting symptoms to anorexia nervosa (such as fatigue, weight loss,
dizziness, and physical weakness).

37

passed from the realms of psychology to a more simple physiological explanation. It appeared that
there was a physiological origin to anorexia nervosa which then presented as a psychological
disease. In some quarters the quest for a physiological cause for anorexia nervosa has continued to
the present day, scrutinising every possible causal factor from head injury to hormonal imbalance.
In fact, what has continually challenged medical classification of anorexia nervosa has been the
complex interweaving of psychological and physiological dynamics resulting in an inability to
comprehensively ascertain the extent to which physiological changes are the cause or effect of
mental processes.

The physiological origin view began to wane during the 1930s when a growth in cases of anorexia
nervosa was reported and attributed to the spreading of the slimming fashion and the more
emotional lives of the younger generation since the War by psychiatrist John A. Ryle. 49 In 1949,
Simmonds theory was superseded by the research of H. L. Sheehan and V. K. Summers which
concluded that anorexia nervosa could not be attributed to pituitary deficiency. 50 What followed
was a rejection of the purely physiological definition and a return to the psychological explanation.

Also focussing on the return to psychology were the psychoanalytic studies reviewed by Bruch
which were heavily influenced by Freudian thought and attributed disturbed eating manifested in
anorexia nervosa to a fear of oral impregnation. 51 These studies were prevalent from the 1930s and
developed into the psychoanalytic thinking of the 1960s which located as its focus the relationship
between parent and child, and most usually between mother and child.

The alternative psychological approach to the symptom of non-eating, which existed at a similar
period to the psychoanalytic method, was to focus on the lifestyle of the patient, including the total
personality. This involved considering the patients relationship with food being connected to their
49

John A. Ryle, Discussion of Anorexia Nervosa Proceedings of the Royal Society of Medicine 32 (1939),
735-737.
50
R. E. Kendell and A. K. Zeally (eds.), Companion to Psychiatric Studies (London: Churchill Livingston,
3rd ed. 1983), 538.
51
Bruch, Eating Disorders, 216.

38

feelings of ineffectiveness and lacking identity, rather than the psychoanalytical view of non-eating
as a struggle against parent or sexuality. Whilst different psychological approaches were used in
attempting to understand anorexia nervosa, the fact that there was a psychological dimension to the
disease became firmly established.

The majority conclusion reached by twentieth-century medicine was that anorexia nervosa must be
an illness of the mind, for it was not rational to refuse food to the extreme of emaciation for fear of
becoming fat.

Since its modern medical classification by Gull and Lasgue, anorexia nervosa has never been far
from psychological investigation. From its origins the key questions which have consistently
emerged in the discipline of psychology are: What constitutes anorexia nervosa? How is it defined?
What causes it? Is it physiological or psychological in origin? Are some groups of people more
prone to develop it than others? How should treatment be administered? These questions have been
refined and revisited in nearly every decade since the 1880s, yet the questions addressed in
contemporary literature are surprisingly similar.

2.1.3.4 Significant psychological developments the work of Hilde Bruch

Possibly the most influential book about eating disorders written in the discipline of psychology
has been Eating Disorders by the psychiatrist Hilde Bruch, published in 1973. Also the author of
The Golden Cage and Conversations with Anorexics, she based her work on her experience of
working with patients with anorexia nervosa over a period of nearly 40 years.

Interestingly, she devotes half the book Eating Disorders to obesity and half to anorexia nervosa,
seeing them as two extremes of a scale of disordered eating, as maladaptive responses to hunger.
Her approach differs from much of the current literature which prefers to treat anorexia nervosa
and obesity as separate discrete entities, defined exclusively by diagnostic criteria. One reason
evinced by Christopher Fairburn and Paul Harrison for not classifying binge eating disorder, a

39

contributory factor to obesity, as an eating disorder is because it affects a different group of people
in terms of age profile and psychological profile from those who are prone to anorexia nervosa or
bulimia nervosa.52 Yet a simplification of Bruchs response to this is the suggestion that disordered
eating can be a coping strategy for many different people and that may hinge around treating food
as a friend or foe, one leading to anorexia nervosa, the other to binge eating and obesity.

Much of Bruchs work has influenced the literature which followed it and so it is necessary to
spend some time on setting out her key ideas.

From the very beginning Bruch is explicit in recognising the complex and different meanings of
food.53 The scene is set for discussing behaviour which relates to a subject matter food, whose
significance or meaning cannot simply be assumed. Also within the contextualisation of the
discussion is Bruchs identification of thinness as a cultural ideal:

Though anorexia nervosa deserves to be defined as a special clinical syndrome, one may also
conceive of it as a counterpart to obesity. In a way, it represents a caricature of what will happen
when the common recommendation that reducing will make you slim, beautiful, and happy is taken
too literally and carried out to the extreme. 54

In an attempt to help readers understand some of the dynamics at work within the anorectic or
obese person, there is a description of the course of starvation as having two phases, beginning with
intense preoccupation about the absence of food and moving to an apathy and withdrawal from
life.55 This mirrors some of the reactions from anorectics whose starvation is self-imposed,
beginning with an almost obsessional desire for the one thing they will not allow themselves to
have and then later, when the body has entered the second phase, a seemingly genuine lack of

52

Christopher G. Fairburn and Paul J. Harrison, Eating Disorders, 411.

Bruch, Eating Disorders, 3.
54
Bruch, Eating Disorders, 4.
55
Bruch, Eating Disorders,10.
53

40

hunger. The two stage theory proposed by Bruch is developed much later by Brumberg who charts
the progression of anorexia nervosa from recruitment phase to career phase. 56

Despite laying foundations for later work, there are elements within Eating Disorders which
identify it as a book of its time. Bruch had no reported accounts of anorexia nervosa in Negroes or
members of other underprivileged groups 57 living in the USA, nor did she know of cases of
anorexia nervosa in the non-industrialised countries of the world, a picture which has now
changed.58

Research today is currently looking at the existence of anorexia nervosa in families and attempting
to determine the extent to which family risk is concerned with possible genetic predisposition,
family dynamics or other factors. Bruch examines the nature/nurture debate but only in relation to
obesity, not in regard to anorexia nervosa. Her discussion of the biological basis for eating
disorders is shaped by the emerging influence of the systems theory of the body. The basis of this is
that the body is comprised of a number of internal systems which operate on a cause and effect
basis in generating physiological processes. The body is also influenced by external environmental
factors which impact the body in particular ways and may affect the internal systems. It is a move
to consider the body as an integrated whole and provides the possibility of examining eating
disorders as a complex interaction between external influences and psychological mechanisms
causing bodily responses which then cause different psychological reactions.

Body image has become a well-worn phrase in discussions about eating disorders. It has generated
psychological research into how visual perception links to self understanding and has led to a
popular understanding that the anorexic who looks in the mirror has such a distortion of body
image that they see the reflection of a fat person. The popular identification of the concept of body
56

Brumberg, Fasting Girls, 39.

Bruch, Eating Disorders, 13.
58
For the impact of eating disorders upon black students see K. K. Abrams, L. Allen, and J. J. Gray,
Disordered Eating Attitudes and Behaviors, Psychological Adjustment, and Ethnic Identity: A Comparison
of Black and White Female College Students, International Journal of Eating Disorders 14 (1993), 55.
57

41

image and eating disorders comes from Bruch. In drawing on the work of Paul Schilder she
explains her view of what body image is:

He spoke of body image as the picture of our own body which we form in our mind, that is to say
the way in which the body appears to ourselves. This is a plastic concept which is built from all
sensory and psychic experiences and it is constantly integrated into the central nervous system.
Underlying it is the concept of Gestalt, which sees life and personality as a whole.

59

The significance of body image to the ongoing debate is its role in addressing the patients
understanding of themself and also its role in treatment. Bruch was convinced that A realistic
body-image concept is a precondition for recovery in anorexia nervosa.60 Weight gain is not
enough in itself for full recovery as it does not appear to address the underlying problem, namely
how the anorectic perceives herself.

In her discussion of the developing concept of anorexia nervosa, Bruch notes that the more
observations are made, the fuzzier the concept becomes. This acknowledgement of the elusive
nature of a definitive diagnosis for anorexia nervosa is one of the key themes of literature on the
subject. In an attempt to clarify the phenomenon to which she was referring Bruch sub-typed
anorexia nervosa into primary and atypical cases. She distinguishes atypical anorexia nervosa as
having a different motivational and dynamic focus from that of primary anorexia nervosa.61

Her definition of primary anorexia nervosa indicated what she saw as its key elements; the main
issue is a struggle for control, for a sense of identity, competence and effectiveness. 62 In contrast to
the many and varied symptoms suggested as criteria for anorexia nervosa Bruch notes a strong
uniformity in the core psychopathology of primary anorexia nervosa comprising three areas of

59

Bruch, Eating Disorders, 87.

Bruch, Eating Disorders, 90.
61
Bruch, Eating Disorders, 228.
62
Bruch, Eating Disorders, 251.
60

42

disordered psychological functions. Firstly she perceives a disturbance of delusional proportions in

the body image and body concept,63 secondly, a disturbance in the accuracy of the perception or
cognitive interpretation of stimuli arising in the body, with a failure to recognize signs of
nutritional need as the most pronounced deficiency. 64 and thirdly, A paralysing sense of
ineffectiveness, which pervades all thinking and activities of anorexic patients. 65

Despite making reference to the role of dieting and cultural preoccupation with thinness, Bruch
does not diagnose all eating disturbance as anorexia nervosa, preferring to keep that definition
closely defined and subdivided. In this way Bruch focuses on a tight definition where primary
anorexia nervosa is caused when the mother fails to accept the childs independent needs resulting
in the misinterpretation of hunger cues and other experiences. Treatment involves therapists
correcting the patients misconceptions of her experience and seeking to enable her to discover a
genuine self. I will seek to build on this concept of being formed and rediscovering identity in
Chapter 4, arguing that the most genuine self is discovered through participation in the Body of
Christ.

Whilst the research of Hilde Bruch is becoming dated as far as it relates to changes in culture which
have been effected by globalization, her views on the core nature of disordered eating are arguably
as insightful as ever. Though more structured means of diagnosing and categorising eating
disorders have arisen since Bruch, I proceed on the basis that her assessment of the origins and key
features of anorexia nervosa remain invaluable in seeking to understand the nature of the disorder.
Her identification of one of the significant symptoms of anorexia nervosa being delusions in the
sufferers perception of body image or body concept give us the enduring image of the emaciated
young woman staring into a mirror and seeing the reflection of an overweight young woman.
Bruchs understanding that at the heart of anorexia nervosa lay a quest for control, identity,
competence and effectiveness, advanced the discussion about anorexia nervosa. Focus moved from
63

Bruch, Eating Disorders, 251.

Bruch, Eating Disorders, 252.
65
Bruch, Eating Disorders, 254.
64

43

broad psychological enquiries concerning lifestyle, childhood or sexuality to addressing specific

issues surrounding control, identity, competence and effectiveness.

Bruchs view that the more observations are made about anorexia nervosa, the more slippery the
concept becomes, is certainly an enduring feature of the history of the disease. Any attempt at
forming criteria by which one may make a diagnosis must decide which symptoms to include and
which to exclude. The balance must be struck between a broad categorisation which includes all
possible symptoms and therefore, many people, and a narrow categorisation which may create
arbitrary distinctions and exclude those who should be included. It is to that complex matter of
diagnostic criteria that we now turn.

2.1.3.5 Emerging diagnostic criteria

Physiological and psychological diagnostic criteria emerged as anorexia nervosa became medically
recognised as a disease in its own right rather than as a form of other mental illnesses. The section
which follows charts the development of criteria used to medically diagnose anorexia nervosa and
argues that although they have been helpful in identifying symptoms, the classification system is
not without its difficulties.

2.1.3.5.1 Diagnostic criteria defining symptoms or constructing a disease?

J. P. Feighner published criteria in 1972 based on empirical observation and statistical frequency of
symptoms. The six criteria specified for diagnosing anorexia nervosa were:

1.

Onset prior to age twenty-five

2.

Lack of appetite accompanied by loss of at least 25 percent of original bodyweight.

3.

A distorted, implacable attitude toward eating, food, or weight that overrides hunger,
admonitions, reassurance, and threats; for example, (a) denial of illness with a failure to
recognize nutritional needs, (b) apparent enjoyment of losing weight with overt
manifestation that refusing food is a pleasurable indulgence, (c) a desired body image of

44

extreme thinness with overt evidence that it is rewarding to the patient to achieve and
maintain this state, and (d) unusual handling or hoarding of food.
4.

No known medical illness that could account for the anorexia and weight loss.

5.

No known other psychiatric disorder, particularly primary affective disorders, schizophrenia,

obsessive-compulsive disorder, and phobic neurosis. (The assumption is made that even though
it may appear phobic or obsessional, food refusal alone is not sufficient to qualify for obsessivecompulsive or phobic disease.)

6.

At least two of the following manifestations: (a) amenorrhea, (b) lanugo (soft, fine hair), (c)
bradycardia (persistent resting pulse of 60 or less), (d) periods of overactivity, (e) episodes of
bulimia (binge eating), and (f) vomiting (may be self-induced). 66

Bell criticises these criteria for their subjectivity and lack of causal mechanism and the attempt to
define anorexia nervosa by means of excluding what it is not in criteria four and five. 67 In fact the
criteria are quite objective and Bells dissatisfaction is illustrative of the difficulties in definition
which pervade discussions on anorexia nervosa. The use of criteria to define conditions, diseases or
syndromes is a necessary way of forming a consistent diagnosis, but as knowledge advances and
criteria change it can be argued that this in fact changes the condition itself. Where criteria change,
some who were previously diagnosed may be excluded from the new definition or others who were
previously excluded may be included.

Hepworths categorisation of anorexia nervosa as a social construction is persuasive when

consideration is given to the various diagnostic criteria reflecting trends and theories of particular
eras.68 The argument that disease only exists because we define it as such was advanced by Szasz69
and it is in relation to concepts such as anorexia nervosa that this theory appears to bear weight. It
would explain the contrast between attitudes of reverence toward saints who abstained from food
for long periods of time and the contemporary desire to medically treat as diseased those who
66

John P. Feighner et. al., Diagnostic Criteria for use in Psychiatric Research, Archives of General
Psychiatry 26 (1972), 57 63, quoted in Bell. Holy Anorexia, 2-3.
67
Rudolph Bell, Holy Anorexia (London: University of Chicago Press, 1985), 5.
68
Hepworth, The Social Construction of Anorexia Nervosa.
69
T. S. Szasz, The Myth of Mental Illness, American Psychologist 15, 113-115.

45

exhibit similar behaviour. If, however, anorexia nervosa is only a social construction then questions
remain about our reaction to the physiological consequence of anorexia nervosa. Attitudes of
revulsion toward skeletal anorectic bodies appear to reflect a connection with illness and death
which cause us to believe that this is fundamentally a dis-ease, in the sense of a departure from
what is normal. It could be argued that the definition of anorexia nervosa is so difficult to
ascertain because there is in fact no such thing as anorexia nervosa, yet just because something is
difficult to define, it does not mean that it does not exist. In rejection of Szaszs extreme position I
acknowledge that there is something about the nature of disease that though it may be mediated
through and influenced by cultural expressions and understandings, makes it nonetheless real.
Anorexia nervosa is most properly referred to as a disorder rather than a disease and the
appropriate means of classifying it as such must now be established.

2.1.3.5.2 From symptoms to stance

One of the key authorities on eating disorders in the field of psychology, A. H. Crisp sought to
clarify the confusion surrounding the diagnosing of anorexia nervosa thus:

In psychiatry we are very much at the stage of recognising disease entities in terms of clinical
phenomena symptoms and signs. Some would argue that with psychiatric disorders it is not
possible to impose this medical model of disease. Others would claim that such disorders do have
some common biological and behavioural qualities which distinguish them from each other. It is
upon this matrix of syndromes within psychiatry, with emphasis upon underlying neuropathology,
that attempts have been made to superimpose the state of anorexia nervosaI believe this to have
been a misdirected endeavour.

70

Instead of calling anorexia nervosa a disease, Crisp acknowledges that biological factors come into
play: I see anorexia nervosa more as a psychologically adaptive stance operating within biological

70

A. H. Crisp, Anorexia Nervosa: Let Me Be (London: Academic Press, 1980), 4.

46

mechanisms.71 In referring to it as an adaptive stance Crisp hints at what he sees at the

underlying psychopathology, namely an inability to negotiate adolescence and adapt to adult life.
The fear of maturing into an adult body with adult weight and the perceived psychological
challenges of adult life are what causes the anorexic to stop eating in an attempt to remain prepubertal.

What appears to have happened with anorexia nervosa through history, is that an underlying core of
symptoms have remained at the heart of anorexia nervosa but they have been added to, modified
and attributed different meanings and causes. Crisps position acknowledges the difficulty of trying
to diagnose anorexia nervosa using the clinical-descriptive model of disease. In regard to what he
considers a flawed approach of clustering together signs and symptoms to form diagnostic criteria,
the practical difficulty remains that the first contact with those suffering from anorexia nervosa is
usually a local physician, rather than a psychologist or psychiatrist. I therefore argue that some
form of clinical diagnostic criteria are required in order for anorexia nervosa to be identified by the
medical profession and appropriate help offered to the sufferer. For this reason, I proceed on the
understanding that anorexia nervosa is a disorder taking the form of a psychologically adaptive
stance operating within biological mechanisms.72 I do however accept the need for clinicaldescriptive criteria, despite the flaws inherent in this approach, on the grounds that it is the current
understanding upon which the medical profession operates when addressing the question what is
anorexia nervosa?.

The most current diagnostic criteria in the psychological field are the DSM IV73 and IDC1074,
although both are undergoing revision pending new editions.75 DSM IV requires the following
conditions to be satisfied for a diagnosis of anorexia nervosa:

71

Crisp, Anorexia Nervosa: Let Me Be, 5.

Ibid.
73
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders IV Revised
(DSM R) (Washington DC: American Psychiatric Association , 4 th ed. 1994).
74
World Health Organisation, The IDC 10 Classification of Mental and Behavioural Disorders: Clinical
Descriptions and Diagnostic Guidelines (Geneva: World Health Organisation, 1992).
72

47

A. Refusal to maintain body weight at or above a minimally normal weight for age and
height (e.g., weight loss leading to maintenance of body weight less than 85% of that
expected, or failure to make expected weight gain during period of growth, leading to body
weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which ones body weight or shape is experienced, undue
influence of body weight or shape on self-evaluation, or denial of the seriousness of the
current low body weight.
D. In postmenarchal females, amenorrhea, i.e., the absence of at least three consecutive
menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only
following hormone, e.g., estrogen, administration).
Specify type:
Restricting Type: during the current episode of Anorexia Nervosa, the person has not
regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or the
misuse of laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person
has regularly engaged in binge-eating or purging behavior (i.e. self-induced vomiting or the
76
misuse of laxatives, diuretics, or enemas).

The criteria for a diagnosis according to ICD 10 are:

(a) Body weight is maintained at least 15% below that expected (either lost or never achieved), or
Quetelet's body-mass index is 17.5 or less. Prepubertal patients may show failure to make the
expected weight gain during the period of growth.
(b) The weight loss is self-induced by avoidance of "fattening foods". One or more of the following
may also be present: self-induced vomiting; self-induced purging; excessive exercise; use of
appetite suppressants and/or diuretics.
(c) There is body-image distortion in the form of a specific psychopathology whereby a dread of
(c) fatness persists as an intrusive, overvalued idea and the patient imposes a low weight threshold
on himself or herself.
(d) A widespread endocrine disorder involving the hypothalamic - pituitary-gonadal axis is
manifest in women as amenorrhoea and in men as a loss of sexual interest and potency. (An
apparent exception is the persistence of vaginal bleeds in anorexic women who are receiving
replacement hormonal therapy, most commonly taken as a contraceptive pill.) There may also
be elevated levels of growth hormone, raised levels of cortisol, changes in the peripheral
metabolism of the thyroid hormone, and abnormalities of insulin secretion.
(e) If onset is prepubertal, the sequence of pubertal events is delayed or even arrested (growth
ceases; in girls the breasts do not develop and there is a primary amenorrhoea; in boys the
genitals remain juvenile). With recovery, puberty is often completed normally, but the
menarche is late.
Differential diagnosis. There may be associated depressive or obsessional symptoms, as well as
features of a personality disorder, which may make differentiation difficult and/or require the use of
more than one diagnostic code. Somatic causes of weight loss in young patients that must be
distinguished include chronic debilitating diseases, brain tumors, and intestinal disorders such as
Crohn's disease or a malabsorption syndrome.
Excludes: loss of appetite (R63.0) psychogenic loss of appetite (F50.8)
F50.1 Atypical anorexia nervosa
This term should be used for those individuals in whom one or more of the key features of anorexia
nervosa (F50.0), such as amenorrhoea or significant weight loss, is absent, but who otherwise
present a fairly typical clinical picture. Such people are usually encountered in psychiatric liaison
75

Likely developments proposed in relation to eating disorders include a change to the frequency with which
a person purges themselves of food in a diagnosis of bulimia nervosa, see section 2.2.2.
76
American Psychiatric Association, DSM IV, 544-545.

48

services in general hospitals or in primary care. Patients who have all the key symptoms but to only
a mild degree may also be best described by this term. This term should not be used for eating
disorders that resemble anorexia nervosa but that are due to known physical illness. 77

These have become the standard medical definitions of anorexia nervosa, a codification of the core
symptoms. Having accepted anorexia nervosa as a clinically defined disorder rather than as social
construction the medical profession is faced with the question What type of disorder? Is this a
primarily psychological disturbance which manifests itself in physical ways, or for those who enter
anorexia nervosa through dieting, is there a physiological reaction caused by abstinence from food
which generates the psychological features, such as body weight disturbance and intense fear of
weight gain? This involves questions of aetiology which there is insufficient space to address here,
so I will proceed on the basis that anorexia nervosa is a disease involving both psychological and
physiological symptoms related in a way not yet fully understood.

This in fact reflects the position of the most recent clinical textbooks on the diagnosis and treatment
of eating disorders which indicate that as more is being discovered about eating disorders and
research continues, assumptions that were once seen as central do not necessarily hold any longer. 78
The culture has changed, the world has changed and within this context there is a suggestion that
anorexia nervosa and the other eating disorders are not static concepts either.79 Perhaps the ongoing
discussions about the basis of diagnostic criteria would benefit from acknowledging that not only
does anorexia nervosa progress through different stages in the life of the patient, but it may itself be
a changing entity.

In this section I have considered the criteria which have emerged in an attempt to diagnose
anorexia nervosa as a disorder, noting the difficulties inherent in applying the disease concept to
conditions which have a psychological element. I have dismissed the contention that anorexia
77

World Health Organisation, The IDC 10 Classification of Mental and Behavioural Disorders: Clinical
Descriptions and Diagnostic Guidelines (Geneva: World Health Organisation, 1992), 138-9.
78
For example Bruchs view that only middle or upper class white people were likely to suffer from
anorexia.
79
G. F. M. Russell, The Changing Nature of Anorexia Nervosa: An Introduction to the Conference, Journal
of Psychiatric Research 19 (1985), 101-109.

49

nervosa is most appropriately referred to as a disease, preferring to accept the term disorder in
line with its usage in current medical practice, whilst acknowledging the socio-cultural context has
a bearing upon the perception of anorectic behaviour. Using the insights of Crisp and the diagnostic
criteria of both the World Health Organisation and the American Psychiatric Association I have
demonstrated that anorexia nervosa is firmly established within medical and psychological
investigation as a disorder.

Having established that anorexia nervosa can properly be referred to as a disorder, the discussion
moves on to consider some of the interpretations of anorexia nervosa which are located either on
the boundary of medical diagnosis or beyond. The argument of the following sections takes the
traditionally held understandings of the disorder - that anorexia nervosa is a medical condition
affecting adolescent, middle-class, white women in patriarchal Western societies - and challenges
the extent to which they remain true in light of the findings of current medical and sociological
research.

2.1.4 Is anorexia nervosa a disorder which only affects women?

Reference has been made previously to the historical context of diagnosing anorexia nervosa in
connection with female hysteria. The notion of anorexia nervosa as a gendered disorder remains
strong despite the incidences of male anorexia nervosa and the suggestion that males may be more
likely to develop bulimia nervosa than anorexia nervosa. The ratio of males to females being
diagnosed with anorexia nervosa has remained constant at 1:9. Some dispute this figure as an
accurate reflection of reality on the basis that men may be less likely to seek medical assistance and
doctors may not diagnose men as anorexic due to a perception that it is a female disease.
Nevertheless, research indicates women are more concerned about their body image and weight
than men, more likely to be restricting calorie intake on a diet than men and greater numbers are
diagnosed with anorexia nervosa than men.80

80

Hesse-Biber, Am I Thin Enough Yet?

50

As noted above, amenorrhea is one of the diagnostic criteria for women. This is where one of the
medical boundaries of definition lies is this a disorder which genuinely affects more women than
men or are the diagnostic criteria established in such a way that more women are diagnosed than
men? The situation of anorexia nervosa is unlike a disease such as ovarian cancer which,
physiologically, is restricted only to women and yet it is unlike diseases which affect men and
women equally and where there is no biological difference in diagnostic criteria. The association of
anorexia nervosa with women has a number of effects. Hepworth 81 suggests that such identification
becomes self-perpetuating with doctors failing to diagnose male anorectics.

The nature of the discourse of anorexia nervosa as gendered has been identified as being based on
particular assumptions about women.82 These include the notion that women are prone to irrational
hysteria, stemming from the context of Gull and Lasgues original diagnoses, the view that
women are manipulative and deceitful (behaviour typified by the anorectics relationship with
food), and that women are always oppressed in society and will use their bodies or food as a means
of addressing that oppression. The aetiological theory which believes anorexia nervosa to be
triggered by the onset of puberty and fear of becoming a woman also reinforces the notion of
anorexia nervosa as a phenomenon particular to women.

Despite the discussion about real incidence as opposed to diagnosed incidence, this does not
account for the strikingly high proportion of females with anorexia nervosa compared with
anorectic males. Suggestions about biological predisposition have been made, 83 ranging from the
physiological difference between male and female fat reserves, the complexity of female pubertal
hormonal development and a view that females may be more prone to endogenous depression,
which in turn is linked to the development of bulimia nervosa. This is merely a consideration of the
biological material. What is perceived by others to be more significant is the cultural pressure on

81

Hepworth, The Social Construction of Anorexia Nervosa, 72.

Hepworth, The Social Construction of Anorexia Nervosa.
83
Richard A. Gordon, Anorexia and Bulimia Anatomy of a Social Epidemic (Oxford: Basil Blackwell Ltd,
1990), 50-51.
82

51

women to conform to a body image which for many is unobtainable. 84 To develop this further it is
necessary to consider anorexia nervosa not only as a medical condition, or as a medical condition
affecting predominantly more women than men, but to consider the wider cultural context which
appears to have a bearing on the existence of anorexia nervosa.

2.1.5 Is anorexia nervosa a disorder affecting women in developed societies which emphasise
thinness as an ideal of female beauty?
One of the sociological insights into anorexia nervosa is its occurrence in societies where there is
ample food and typically its absence in developing non-western countries.

Significance has been attributed to the fact that the desired body of a woman in the post-industrial
age has been one of slimness. The idealisation of women as dainty and decorative was prominent at
the time of the first modern diagnoses of anorexia nervosa and the current image of slenderness as
beauty prevails in Western society. Hesse-Biber links this in the USA to the Puritan heritage which
makes body shape a moral issue. Thinness is associated with self-control and goodness, whereas
fatness is seen as laziness, lack of control and greed. This can be contrasted with cultures where
food is sparser and a rounded body is esteemed as indicative of wealth and prized as having the
ability to survive through times of famine. Traditionally, cases of anorexia nervosa have been rare
in Hispanic and Black communities in the USA, though the rise in incidences of anorexia nervosa
in the current generation of young women suggests that cultural assimilation includes adopting the
prevailing views of desirable body image and with them, anorexia nervosa.85

Not only is anorexia nervosa bursting its traditional ethnic boundaries in situations where ethnic
minorities live in a culture where the prevailing culture recognises eating disorders, but
globalisation is transmitting anorexia nervosa further afield.

84

Hesse-Biber, Am I Thin Enough Yet?

K. K. Abrams, L. R. Allen, and J. J. Gray, Disordered Eating Attitudes and Behaviors, Psychological
Adjustment, and Ethnic Identity: A Comparison of Black and White Female College Students, International
Journal of Eating Disorders 14 (1993), 55.
85

52

Capitalism is helping to spread (white) Western values across racial, class and ethnic
linesDeveloping societies import Western norms of beauty through the purchase and consumption
of Western media, clothing styles, and beauty products. Increasingly, non-western societies will be
86

presented with an ideal of feminine beauty that takes on Anglo-Saxon traits.

Hesse-Biber concludes that with that ideal comes the pressure for women to be thin and with that
pressure comes anorexia nervosa. Rather than basing the definition of those at risk from or affected
by anorexia nervosa on geographical boundaries, this chapter proceeds with the premise that the
significant cultural risk factor is exposure to consumerist Western cultural ideals and aspirations.

2.1.6 Is anorexia nervosa a disorder affecting adolescent middle class females in developed
societies which emphasise thinness as an ideal of female beauty?
Related to the previously stated cultural understandings in which anorexia nervosa has emerged the
specific classes of people affected had been narrowly defined as middle class adolescent girls.

2.1.6.1 Socio-economic status

The class dynamic can be explained in similar terms to the reasons for the existence of anorexia
nervosa in developed industrialised countries. To be middle class at the time of Gull and Lasgues
diagnosis was to be aspiring to Victorian ideals of morality and social advancement. In her analysis
of the early cases of anorexia nervosa in the late nineteenth century, Brumberg identifies the social
status of anorectics as drawn from families across the middle classes from the lowest end,
where social respectability was new or precarious, to more established families, with some
modicum of financial security and an established social identity. 87 In some senses this mirrors the
wider picture of the international scene that self-starvation exists not where there is a lack of food
but where there is ample. It has been suggested that food takes on greater symbolism and

86
87

Hesse-Biber, Am I Thin Enough Yet?, 111-112.

Brumberg, Fasting Girls, 111-112.

53

significance than merely that which keeps us alive 88 and interpretation of food use in anorexia
nervosa, particularly in relation to middle class families and anorectic daughters has been a case in
point.

Whilst this may have been a typical picture through the early to mid-twentieth century, recent
research which reviewed articles written between the early 1970s and early 1990s has challenged
the view that anorexia nervosa is primarily a disorder affecting the aspiring middle class, or higher
socioeconomic group.89 The examination of the influence of clinical impression, methodological
problems in existing research, bias in referral procedures and a failure to separate anorexia nervosa
from bulimia nervosa90 concludes that the link between high socio-economic status and anorexia
nervosa is one of the stereotypes which has developed around the disorder but which lacks
evidential basis.

2.1.6.2 Adolescence
Locating the cause of anorexia nervosa in the mother-daughter relationship and defining it as an
attempt on the part of the adolescent daughter to establish an adult identity separate from the
mother has been a popular theme in the discussion of anorexia nervosa. In reference to the early
cases at the turn of the century, it was noted that food preparation was the responsibility of the
mother for most middle class families. This provided a focus for the adolescent daughters
behaviour, as rejecting food was a rejection of the mother.

88

Caroline Walker Bynum, Holy Feast and Holy Fast (Berkeley, CA: University of California Press, 1987).
Maisie C. E. Gard and Chris P. Freeman, The Dismantling of a Myth: A Review of Eating Disorders and
Socioeconomic Status, International Journal of Eating Disorders 20 no.1, 1996, 112.
90
The article suggests that bulimia nervosa may be more closely linked to those of low socio-economic
status.
89

54

With reference to the anorectic as adolescent, the majority of cases of anorexia nervosa are
diagnosed in people under the age of twenty. 91 Psychological literature such as A. H. Crisps
significant work Let Me Be had defined anorexia nervosa as

a distorted biological solution to an existential problem for an adolescentExperienced as adaptive

in the face of an otherwise imminent crisis, it results, through its massive and abortive effect on
physical, psychological and social development, in increasingly destructive isolation for the
individual as the years go by.

92

His focus on anorexia nervosa as a predominantly teenage failure to cope with the onset of
adulthood still holds sway but has been challenged by research indicating onset as early as eight or
ten years old and the occurrence of late onset anorexia nervosa. Despite these anomalies the
prevailing trend is for anorexia nervosa to develop in teenage years with some anorectics making
full recovery but some retaining problems with food for the rest of their lives.

This section has addressed some of the features of anorexia nervosa which have become connected
with medical diagnosis but which actually provide norms or types of those predisposed to anorexia
nervosa, some of which are being eroded as culture changes. It has argued for treating anorexia
nervosa as a disorder with core features but acknowledges that there are increasingly exceptions to
the pre-existing categories. The following section raises some of the alternative responses to the
question what is anorexia nervosa? which do not necessarily define it as a medical disorder. The
sociological and feminist responses articulated below argue the case that the medical definition
alone is insufficient to fully understand disordered eating. Their assertion that the cultural context
of anorexia nervosa explains why it occurs and what it is supports the contention of this thesis that
disordered eating is more than an individual disorder and reflects a deep dis-ease within particular
societies about the relationship between food, control, consumption and identity.
91

Hans W. Hoek, Incidence, Prevalence and Mortality of Anorexia Nervosa and other Eating Disorders,
Current Opinions in Psychiatry19 no.4, 2006, 389-94.
92
A. H. Crisp, Let Me Be, v.

55

2.1.7 Is anorexia nervosa a modern female response to patriarchy?

Despite the prevailing medicalised definition of anorexia nervosa, the decade of the 1970s appeared
to lay foundations for other contributions to the aetiology debate. As the feminist movement grew,
questions were asked about the nature of anorexia nervosa as a womens problem and the
societal understanding of and influence upon the bodies of women. Hesse-Biber identifies the late
1960s as having combined an ultra slender body ideal, personified in the model Twiggy, the
feminist movement, changes in womens roles, the increasing power of the media and rampant
consumerism, a combination which she believes set the scene for an explosion in the number of
cases of anorexia nervosa.93 This becomes important when discussing the causes of anorexia
nervosa, and feminist analyses have provided valuable insights into womens relationship with
food in contemporary society and also historically. 94

Within this discourse there is dispute regarding whether the anorectic is making a statement against
patriarchal oppression or being conformed to it. Is this an assertion of power, taking control over
perhaps the one thing the anorectic can control? Parallels in this view are drawn with hungerstrikers whose defiance is to shame the system and effect change through self starvation.
Alternatively, the view that the anorectic is a victim of patriarchal oppression can be drawn from
the same set of actions. In this case the pressure of a culture which only values women who
conform to a male ideal of unattainable thinness drives young women to diet to such an extent that
they undergo physiological and psychological change, their body image becomes distorted and they
starve to death. The latter rather than the former dominates popular literature on anorexia nervosa
which seeks to highlight the forces driving the commercialisation of body image and diet culture. 95
As well as socio-feminist approaches there have been feminist critiques of the dominant
psychological understandings of anorexia nervosa.

93

Hesse-Biber, Am I Thin Enough Yet?, 28.

For historical analysis see Bynum, Holy Feast and Holy Fast.
95
A good example of this is Elizabeth Filleul, Consuming Passion (London: Triangle, 1996).
94

56

One key feminist text on anorexia nervosa, published in the 1980s, focused on the mother-daughter
relationship and the quest for identity. 96 Susie Orbachs insight in Hunger Strike was significant as
it introduced a way of understanding anorexia nervosa into popular discourse which had previously
been overlooked. Despite this, the terms used to discuss anorexia nervosa remained those of
medical discourse, hence taking on the assumptions of this behaviour as disorder/illness. This
raises the question as to whether it is possible to discuss anorexia nervosa in terms that are nonmedical and which do not carry the implications of medical terminology with them. This becomes
relevant when considering historical phenomena predating the modern medical definition of
anorexia nervosa.

Whilst the insights provided by such thinkers broaden the horizons of the debate about anorexia
nervosa, framing as they do the experience of disordered eating as something other than an illness
about food, to remove all reference to anorexia nervosa as a medical disorder is, in the view of this
thesis, unhelpful. It is essential to acknowledge the wider framework of relationships and
community bound up with and affected by the individual anorectic, and the later chapters of this
thesis proceed on the basis that such relationships are significant. This does not, however, require a
rejection of the claims of medicine to provide a framework of understanding the psychological and
physiological processes involved in anorexia nervosa. It is on this both/and basis of attending to the
insights of medical and non-medical disciplines that this chapter proceeds.

The focus on the effect of patriarchy and culture influenced not only debates surrounding twentieth
century anorexia nervosa but caused some to reconsider historical cases of non-eating. This raised
the question of the effect of cultural context upon the diagnosis of anorexia nervosa.

2.1.8 Is anorexia nervosa a non-modern response to patriarchy?

Rudolph Bells assertion in Holy Anorexia is that essentially the fasting of particular saints in the
Middle Ages was synonymous with what is now known as anorexia nervosa. He seeks to persuade
96

Susie Orbach, Hunger Strike (London: Faber, 1986).

57

students of medieval history that a historically significant group of women exhibited an anorexic
behavior pattern in response to the patriarchal social structures in which they were trapped. Bells
second stated aim is to suggest to psychologists and physicians that the historical reality of holy
anorexia may indicate a need to reevaluate certain modern approaches to the disease and in
particular to be no less concerned with etiology than with therapy.97 His definitions of holy
anorexia and anorexia nervosa are identical in terms of behaviour patterns and attitudes. The
difference is the cultural context:

The modifier is the key; whether anorexia is holy or nervous depends on the culture in which a
young woman strives to gain control of her life. In both instances anorexia begins as the girl fastens
on to a highly valued societal goal (bodily health, thinness, self-control in the twentieth century/
spiritual health, fasting and self-denial in medieval Christendom) Anorexia becomes her identity,
and ultimately the self-starvation pattern continues beyond her self control.

98

To accept this definition would require altering the understanding of anorexia nervosa as a modern
day phenomenon particular to the post-Enlightenment world. The issue at hand is whether the
phenomenon currently termed anorexia nervosa has existed for centuries but was not previously
treated as an illness. Is this a comparison between two identical forms of behaviour, one defined in
religious terms (anorexia mirabilis), the other in medical/psychological terms (anorexia nervosa),
or are the variable factors of culture and motivation sufficiently different to make these two
different phenomena altogether? Brumberg, author of the highly acclaimed history of anorexia
nervosa, evades addressing this question on the basis that the evidence is lacking for all the relevant
criteria of diagnosis once one goes further back in history than the documented cases of the late
1800s.99

97

Bell, Holy Anorexia, xxi.

Bell, Holy Anorexia, 20.
99
Brumberg, Fasting Girls, 44.
98

58

Despite disagreeing with Bells analysis of medieval women saints as suffering from anorexia
nervosa, Brumberg does acknowledge the historical dimension to the use of food by women as
significant, It becomes evident that certain social and cultural systems, at different points in time,
encourage or promote control of appetite in women, but for different reasons and purposes. 100 As a
historian, Brumberg refuses to be drawn on the question of whether anorexia nervosa predates the
industrial age but I find her view convincing that particular cultural ideals shape the behaviour of
those within the culture. Just as small feet were esteemed as desirable in women in China, leading
to the practice of foot binding, we can imagine cultures existing in non-western, cultures which
idolise thin women and result in appetite restriction. Brumberg goes on to identify two such
cultures and points in time. The earlier of these is thirteenth to sixteenth century Catholicism, and
the later is the post-industrial age, to which I now turn.

2.1.9 Is anorexia nervosa an emerging epidemic?

The difficulties surrounding understanding eating and food practices in history depend on
reliability and interpretation of evidence, a feature which is no less problematic in contemporary
society. The impression created by print media, glossy magazines and a particular type of television
documentary is one of rampant disordered eating, featuring those who are too thin or too fat. I
propose in this section that clinically diagnosed eating disorders have increased in incidence over
the last forty years, due to a combination of greater awareness among doctors who are more likely
to diagnose a condition as anorexia nervosa, but also because of an increase in disordered eating
within the population.

Even as recently as the 1970s reported cases of anorexia nervosa were comparatively few, though it
is difficult to say whether this is due to there being genuinely fewer cases than today or whether
doctors were less likely to diagnose the relatively obscure disorder anorexia nervosa. In the early
1970s anorectic patients were seen as something of a novel rarity by the psychiatrists entrusted

100

Brumberg, Fasting Girls,48.

59

with their treatment, 101 though it was at this time that anorexia nervosa and eating disorders began
to impinge on public consciousness.

Hoek notes that

an upward trend has been observed in the incidence of anorexia nervosa in the past century till the
1970s. The most substantial increase was among females aged 15-24 years, for whom a significant
increase was observed from 1935 to 1999.102

The difficulty in making such claims is the extent to which it corresponds to actual prevalence
within the population (and how this is determined) or whether it refers to an increased incidence of
diagnosed cases. The emergence of the diagnostic criteria explored previously has increased
awareness of eating disorders among doctors, thus increasing the likelihood of a rise in diagnoses.

In attempting to address whether any rise in reported incidence of eating disorders is exclusively
attributable to the willingness of doctors to diagnose the condition, it is useful to consider research
conducted by Y. May Chao and colleagues. 103 Their study of high school students in the USA used
the Youth Risk Behavior Surveillance System to examine trends in weight control practices from
1995 to 2005. Looking at five marker behaviours104 across nationally representative samples of
students, the prevalence of dieting and diet product use increased among females over a ten year
period and all five weight control behaviours increased among males during the decade. Whilst this
is not firm evidence of an increase in diagnosed eating disorders within a population, it indicates a
trend of behaviours which have a connection with eating disorders and are becoming more
prevalent.

101

Gordon, Anorexia and Bulimia Anatomy of a Social Epidemic, ix.

Hans W. Hoek, Incidence, Prevalence and Mortality of Anorexia Nervosa and other Eating Disorders,
Current Opinion in Psychiatry 19 no.4, 2006, 389.
103
Y. M. Chao, E. M. Pisetsky, L. C. Dierker, F. A. Dohm, F. Rosselli, A. M. May, R. H. Streigel-Moore,
Ethnic Differences in Weight Control Practices among U.S. Adolescents from 1995 to 2005 International
Journal of Eating Disorders 41 (2008), 124 133.
104
The behaviours assessed were, dieting, using diet products, purging, exercising and vigorously exercising.
102

60

Richard A. Gordon notes that there was a sharp increase in the prevalence of anorexia nervosa and
bulimia nervosa during the 1970s.105 It was in this decade that the first Eating Disorders support
group was established in the USA and the high-profile death of Karen Carpenter in 1983 served to
increase awareness of eating disorders in general but also their potentially fatal outcome.

The growth in diagnosed cases of anorexia nervosa in the 1980s caused some to believe that this
was a fad or passing social trend, where the ever-popular dieting was just being taken to extremes.
Talk of an epidemic was rife and greater resources were put into researching eating disorders which
were making their way into popular consciousness at a rapid rate.

Since the 1990s awareness of anorexia nervosa among the population has increased and
particularly among teenage girls, the most prolifically affected group. In the UK more treatment
facilities exist than ever before and yet waiting lists to access treatment are oversubscribed. This,
combined with the sub-clinical picture of the number of people in the UK who claim to be dieting
to lose weight but who medically do not need to, suggests that even if anorexia nervosa has not hit
epidemic proportions, disordered eating has taken root within the populace. The high profile given
to the news that Diana, Princess of Wales had suffered from bulimia nervosa had a similar effect to
the news of the death of Karen Carpenter from anorexia nervosa in generating interest in the
phenomenon, and it is to the definition of bulimia nervosa that we now turn.

2.2 Defining Bulimia Nervosa

The purpose of defining the core components for the different eating disorders at this stage of the
thesis is primarily to acknowledge the existence of their difference. The specific criteria used to
distinguish one from the other are not particularly pertinent to the development of the thesis since
the family concept, 106 incorporating all forms of disordered eating, will be the usual means of
reference. Whilst the section which follows will argue that anorexia and bulimia nervosa are
105
106

Gordon, Anorexia and Bulimia Anatomy of a Social Epidemic, ix.

See section 2.1.2.

61

different disorders, the core similarities they share regarding the sufferers relationship with food,
and their attitude toward weight, body and self are the common features which unite them within
the category of eating disorders. These shared features are what enables them to be addressed
together in later chapters.

2.2.1 Introduction
For two hundred years the evolution of anorexia nervosa was charted and debated by those working
in the field of psychology and psychiatry. The DSM III 107 included in its definition of anorexia
nervosa restrictive and purging types in order to account for the emerging difference in behaviours
of patients with the disorder.

It was as recently as 1979 that G. F. M. Russells article Bulimia Nervosa: An Ominous Variant of
Anorexia Nervosa opened the way for a reclassification of eating disorders within the discipline of
psychology.108 Russells premise was that the binging and purging of bulimia nervosa was not the
same as the behaviour of anorexia nervosa patients who lapse from restricting and occasionally
binge.

2.2.2 A separate disorder

In a later contribution Russell states his case for bulimia nervosa being a recent development which
appeared on the scene without previous history. 109 He builds on the theory of Regina C. Casper110
that bulimia nervosa has increased concurrently with a greater frequency of body shape awareness
from 1940s onward, and that bulimia nervosa recruits a different psychological type of woman
from anorexia nervosa, to conclude, My own view is that bulimia nervosa is indeed a new illness,
107

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, (Washington
DC: American Psychiatric Association, 3rd ed. 1980).
108
G. F. M. Russell, Bulimia Nervosa: An Ominous Variant of Anorexia Nervosa, Psychological Medicine
9 (1979) 429-448.
109
G. F. M. Russell The History of Bulimia Nervosa, in David M. Garner and Paul. E. Garfinkel,
Handbook of Treatment for Eating Disorders (London: Guilford Press, 2nd ed. 1997), 21.
110
Regina C. Casper, Elke D. Eckert, Katherine A. Halmi, Solomon C. Goldberg, John M. Davis, Bulimia:
Its Incidence and Clinical Importance in Patients with Anorexia Nervosa, Archives of General Psychiatry 37
(1980), 1030-1035.

62

notwithstanding its emergence from anorexia nervosa, and the very occasional description of
similar patients in the pre- 1979 literature.111

Over twenty years later, bulimia nervosa has become accepted as an eating disorder in its own right
rather than as a subtype of anorexia nervosa. It has its own diagnostic criteria within DSM IV and
ICD10:
DSM-IV
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the
following:
(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is
definitely larger than most people would eat during a similar period of time and under similar
circumstances
(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop
eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as selfinduced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive
exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice
a week for 3 months. 112
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Specify type:
Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in
self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other
inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly
engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas 113
ICD-10
(a) There is a persistent preoccupation with eating, and an irresistible craving for food; the patient
succumbs to episodes of overeating in which large amounts of food are consumed in short periods of
time.
(b) The patient attempts to counteract the "fattening" effects of food by one or more of the
following: self-induced vomiting; purgative abuse, alternating periods of starvation; use of drugs
such as appetite suppressants, thyroid preparations or diuretics. When bulimia occurs in diabetic
patients they may choose to neglect their insulin treatment.

111

Russell, The History of Bulimia Nervosa, 22.

The proposed revision for DSMV changes the average occurrence of binge eating and inappropriate
compensatory behaviours from twice a week to once per week.
113
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Washington
DC: American Psychiatric Association, 4th ed. 1994).
112

63

(c) The psychopathology consists of a morbid dread of fatness and the patient sets herself or himself
a sharply defined weight threshold, well below the premorbid weight that constitutes the optimum or
healthy weight in the opinion of the physician. There is often, but not always, a history of an earlier
episode of anorexia nervosa, the interval between the two disorders ranging from a few months to
several years. This earlier episode may have been fully expressed, or may have assumed a minor
cryptic form with a moderate loss of weight and/or a transient phase of amenorrhoea. 114

Whilst there may be similarities between anorexia nervosa and bulimia nervosa and some sufferers
may move from one to the other, distinct differences have emerged with regard to the types and
circumstances of people who develop anorexia nervosa and those who develop bulimia nervosa,
though such distinctions are still a cause for debate among those working in the field. Writing in
2003, Bob Palmer states the current situation regarding the classification of bulimia nervosa in
relation to anorexia nervosa as follows:

The canon contains only two major categories anorexia nervosa (AN) and bulimia nervosa (BN).
Anorexia nervosa has low weight as an essential criterion. Bulimia nervosa has binge eating as a
necessary criterion. The two disorders share the criterion of what in broad terms might be described
as an over-concern about body weight and size although some would see a major difference in
degree or emphasis in the typical ideas held by sufferers from AN and BN. 115

There are as many articles in the current literature about bulimia nervosa as anorexia nervosa
though the relationship between them continues to be a source of confusion. Palmer concludes,
AN and BN are far from being entirely discrete disorders and can be made to seem so only by a
dint of a certain sophistry, 116 thus recognising that there are differences between the disorders but
that their complex interrelation defies simple classification boundaries.

114

World Health Organisation, The ICD-10 Classification of Mental and Behavioural Disorders (Geneva:
WHO, 1993),140.
115
Bob Palmer, Concepts of Eating Disorders, in J. Treasure, U. Schmidt and E. van Furth (eds.) Handbook
of Eating Disorders (Chichester: John Wiley, 2003), 2.
116
Bob Palmer, Concepts of Eating Disorders, 2.

64

2.3 Defining Atypical Eating Disorders

2.3.1 Introduction
A category of eating disorders has emerged which recognises both the wide scope of disordered
eating in some populations and also the restrictiveness of clinical diagnostic criteria for anorexia
nervosa and bulimia nervosa. Christopher Fairburn and Paul Harrison identify the close
resemblance between atypical eating disorders and both anorexia nervosa and bulimia nervosa. In
addition, they note the fact that atypical disorders may also be long lasting and serious. 117 Their
analysis of atypical eating disorders is that they comprise many of the behaviours and symptoms of
anorexia nervosa or bulimia nervosa but do not meet their precise diagnostic criteria. 118 This may
be because the patient weighs fractionally more than the definition of anorexia nervosa allows, or
due to the absence of amenorrhea in post-menarchal females, though this has been queried as a
diagnostic criterion, 119 or some other reason.

2.3.2 Binge Eating Disorder

Fairburn and Harrison are eager to mark a boundary between binge eating disorder and the three
previously discussed categories of anorexia nervosa, bulimia nervosa and atypical eating
disorders.120 Their rationale for this is the profile of those who suffer from binge eating disorder.
Age, gender, remission rate and lifestyle context (i.e. a natural tendency to overeat) are seen as
factors which distinguish those with binge eating disorder from the other eating disorders. Despite
this, Fairburn and Harrison acknowledge that at the present time little is known about binge eating
disorder.121

117

Fairburn and Harrison, Eating Disorders, 408.

Ibid.
119
P. E. Garfinkel, E. Lin, P. Goering, Should Amenorrhoea Be Necessary for the Diagnosis of Anorexia
Nervosa? Evidence from a Canadian Community Sample, British Journal of Psychiatry 168 (1996), 500 506.
120
Fairburn and Harrison, Eating Disorders, 411.
121
Fairburn and Harrison, Eating Disorders, 411.
118

65

2.3.3 Eating Disorder Not Otherwise Specified (EDNOS)

Fairburn and Harrison identify the problem of atypical eating disorders becoming a catch-all
category. The diagnosis may be perceived as a safe option for doctors who do not have to justify
the tighter criteria of either anorexia nervosa or bulimia nervosa and this leads to uncertainty about
treatment which does not help the patient. Others have voiced dissatisfaction with the current state
of classification and its effect on the area of eating disorders as a whole. Arnold Andersen, Wayne
Bowers and Tureka Watson122 found that the category of Eating Disorder Not Otherwise
Specified (EDNOS)123 was too broadly defined and they conducted a study which led them to
conclude that a minor change in diagnostic criteria could mean many current cases of EDNOS
being subsumed into diagnoses of either anorexia nervosa or bulimia nervosa. They critique the
basis of the current categorisation of anorexia nervosa and bulimia nervosa as being too researchderived 124 and instead suggest looking at anorexia nervosa and bulimia nervosa as syndromes. In
their revised criteria a diagnosis of anorexia nervosa would no longer require weight to be less than
a designated threshold and amenorrhea would cease to be a core criterion for diagnosis. Their
extensive proposed criteria include most of the features currently used but they propose excluding
numerical values from the criteria in favour of using terms such as decreased and substantial
weight loss to determine the boundaries.

125

If implemented, this may have the effect of moving

patients from one category to another, 126 and perhaps giving credence to the variegated nature of
disordered eating, but it also serves to confuse an already unclear situation. Alternatively, Fairburn
and Harrisons view that part of the cause of confusion is the fact that current rigid classification
has arisen from historical anomaly and does not reflect clinical reality 127 may support a change in
the direction suggested by Andersen, Bowers and Watson.

122

Arnold E. Andersen, Wayne A. Bowers and Tureka Watson, A Slimming Program for Eating Disorders
Not Otherwise Specified: Reconceptualizing a Confusing, Residual Diagnostic Category, The Psychiatric
Clinics of North America 24 (June 2001), 271.
123
The US term for Atypical Eating Disorders.
124
They argue that the criteria are too rigid and driven by the outcomes of research into weight and body
mass, rather than reflecting clinical experience which observes the existence of eating disorders even if
benchmark criteria are not precisely met.
125
Andersen, Bowers and Watson, A Slimming Program, 278.
126
Andersen, Bowers and Watson highlight this as important as health insurance in the USA covers anorexia
nervosa and bulimia nervosa but not EDNOS.
127
Fairburn and Harrison, Eating Disorders, 414.

66

2.4 Current Opinion

Having reviewed the historical development of eating disorders and the changes in medical and
sociological views about the causes, nature and impact of the disorders, this section draws together
these threads in stating the current consensus within mainstream medical and psychological
research and clinical practice.

In their editorial in the British Journal of Psychiatry, Collier and Treasure chart the issues involved
in forming an aetiology of eating disorders and conclude;
Increasingly the consensus is that eating disorders are complex disorders consisting of both genetic
and social factors, with a developmental component strongly linked to adult illness. This means that
integrated research into their aetiology, which includes genetic, biological, developmental and social
perspectives, is now realistic.128

Collier and Treasure propose a model they call the Empirical Structure of Eating Disorder and
explain the relationship between the various factors, thus;
Cultural factors include pervasive factors such as diet and cultural attitudes to weight and shape.
Cognitive style and personality are influenced by both genes and environment. Correlations exist
between biological factors (serotonin function), environment (adverse childhood experiences),
personality (e.g. impulsivity) and affect. All of these factors are influenced and mediated by
genes.129

The model gives credence to the multi-layered nature of the causes of eating disorders and though
they cannot specify exactly how each of the factors relates to other factors, the authors recognise
the interplay and influence of each of the features identified. The role of genes and serotonin levels
acknowledge the biological aspect, the place of cognition and personality refer to the psychological
element and the cultural factors (which include the influence of family and social expectations)
note the social dimension which make eating disorders a biopsychosocial phenomenon of multi
factorial origins.

128

D.A. Collier and J. L. Treasure, The Aetiology of Eating Disorders, The British Journal of Psychiatry
185 (2004), 365.
129
Ibid.

67

I proceed on the basis that the external environment130 is encountered by the agent who, responds to
it in a way shaped by their genetic, physiological, biological and psychological disposition. Factors
within each of these categories can either predispose or protect the person from responding to their
environment by developing an eating disorder, so the greater the areas of predisposition, the higher
the risk. Despite the positive advance of constructing a model of how it is understood eating
disorders arise and develop, Collier and Treasure identify a number of questions which continue to
be at the forefront of clinical research and debate;
Can a set of valid diagnoses reflecting underlying aetiology be constructed? Why are those affected
predominantly women? How can the dual influence of genes and societal pressures be successfully
reconciled? What is the exact nature of the developmental component?131

As the journey to answer these questions progresses, those researching eating disorders and those
working in clinical practice proceed on the most complete information available in addressing these
complex disorders.

2.5 Conclusion
2.5.1 Eating disorders as biopsychosocial phenomena of multifactorial origins
In attempting to answer the question what are eating disorders?, I argue that anorexia nervosa,
bulimia nervosa and atypical eating disorders are neither purely an individual psychological
disorder nor merely a socially constructed problem. I accept the DSM IV criteria as a definition
boundary because of the biological and psychological factors which constitute eating disorders. I
would however, want to place eating disorders in the context of a historical use of food as
something more symbolic than mere physical nourishment. To do so gives recognition to the point
raised in section 2.1.8 that food has meaning within societies beyond its physical properties and can
become a means of expressing particular things about identity and values.

130
131

Which includes societal, ethnic and family cultural ideals, norms and practices.
Collier and Treasure, The Aetiology of Eating Disorders, 365.

68

The presence of biological changes132 and their psychological correlates133 which occur within
those suffering from eating disorders is sufficient to establish these disorders as biopsychological. I argue that the influence of society, with regard to the symbolic meaning of food,
and the social conventions of what is normal and desirable, is also a key factor in understanding
eating disorders. Anthropological studies, such as that conducted by Anne Becker in Fiji, 134 make it
difficult to deny the prominence of culture as a critical variable regarding the presence of eating
disorders within a population. There has been a rise in diagnosed cases of eating disorders in
women over four decades, 135 during which time the projected media images of ideal female beauty
have become progressively thinner. It is extremely difficult to scientifically prove any causal link
between the two, but the pressure, particularly on young women, can be observed in studies which
consider food behaviours and preoccupation with body image. 136 Such indications justify the
consideration of culture as an essential feature of eating disorders, hence the appropriate nature of
the term biopsychosocial. My approach is broadly consistent with those researching eating
disorders in the field of psychiatry137 but gives greater credence to the wider social context and the
impact of cultural pressure.

With regard to the multifactorial origins of eating disorders, I would also want to use the DSM IV
criteria in the wider framework of considering family dynamics.138 This takes into account the

132

Such as reduced body weight and amenorrhea in anorexia.

For both anorexia and bulimia nervosa, these would include fear of weight gain and self-evaluation being
overly dependent on body shape and weight.
134
A.E. Becker, R.A. Burwell, S.E. Gilman, D.B. Herzog, P.Hamburg, Eating Behaviours and Attitudes
Following Prolonged Television Exposure Among Ethnic Fijian Adolescent Girls The British Journal of
Psychiatry 180 (2002), 509-14.
135
Academy for Eating Disorders. http://www.aedweb.org/Prevalence_of_ED.htm (2nd March 2011).
136
Chao, Pisetsky, Dierker, Dohm, Rosselli, May, Streigel-Moore, Ethnic Differences in Weight Control
Practices among U.S. Adolescents from 1995 to 2005 International Journal of Eating Disorders 41 (2008),
124 133.
137
Leaders in the field in the UK would include Christopher G. Fairburn and Janet Treasure.
138
This refers not only to the immediate or nuclear family but to a wider understanding of family which may
include extended family or those not related by blood but who have a significant influence within the daily
life of the anorectic. Family dynamics are important in possible emotional turmoil linked with the onset of
anorexia, but family also has an influence in terms of shaping attitudes to food, eating and control. Ongoing
research into genetic factors related to anorexia may also identify another reason for considering anorexia
within the context of the family rather than as an individual disease.
133

69

family not necessarily as a causal factor in developing the disorder,139 but as the context of
immediate community where the shaping and forming of identity and self-perception occurs. This
allows for the possibility that one of the many factors allowing eating disorders to develop in some
individuals is their immediate family context, influenced by the prevailing cultural norms and
preoccupations.

Attempts to define anorexia nervosa and other eating disorders have often focused on internal
psychological states or external physical symptoms. As can be seen above, it has been almost
impossible to separate the question what are eating disorders? from the question what causes
eating disorders?. Though I believe the causes of eating disorders are many, varied and not
uniform for every sufferer, a significant omission is made when the external pressure of
materialistic consumer society is removed from the equation. Disordered eating may be more subtle
and more personal than a widespread response to consumer culture but the pervasive nature of
dieting, understandings of thinness as beauty, and the impact of advertising images create a context
for eating disorders to flourish, even to the extent of being seen as normal 140 (or at the very least as
a natural consequence of the way things are). 141 Adopting the view of Charles E. Rosenberg that
A disease is no absolute physical entity but a complex intellectual construction, an amalgam of
biological state and social definition,142 I proceed on the basis that anorexia nervosa, bulimia
nervosa and atypical eating disorders are such disorders and that within social definition there is
scope for a theological engagement with disordered eating which contributes a different
perspective. In relation to what constitutes social definition, I concur with Brumberg that Culture
is the critical variable that explains why and how anorexia nervosa became the characteristic
psychopathology of the female adolescent in the late twentieth century. 143 Any attempt to engage
theologically with disordered eating must therefore proceed on the basis that the influences of the

139

Unlike the approach which locates the origins of anorexia within the mother-child relationship.
Hesse-Biber, Am I Thin Enough Yet?.
141
Ibid.
142
Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago:
University of Chicago Press, 1962).
143
Brumberg, Fasting Girls, 10.
140

70

prevailing culture upon those within that culture have the potential to profoundly affect how
particular individuals respond to their bodies, food and eating.

71

Chapter 3
Towards a Theological Response to Eating
Disorders
3.0 Introduction
3.0.1 Towards a methodology
The first chapter raised the questions posed to the church by the existence of eating disorders and
the previous chapter defined the nature and character of disordered eating in its various forms. The
purpose of this chapter is to give a critical and in depth account of the methodology I employ in
moving toward a theological response. It is my contention that any methodology seeking to address
disordered eating needs to take into account both the individual and the broader social factors at
work within the disorder and to do so theologically and practically. Within this chapter I argue that
current responses to eating disorders advocated by the Church do not adequately address the
problem. It is my intention to show in what aspects current approaches are deficient and argue that
my own model of using practices of the church creates a more fruitful response. I will consider
three commonly advocated approaches; the provision of pastoral support, the use of Cognitive
Behavioural Therapy and self-help strategies, and the practical theology methodologies offered as
an alternative to my approach, arguing that each in its own way is inadequate to the task of
providing a robust theological response to eating disorders.

Addressing the issue of disordered eating through the methodology of practices will be explored
through this chapter before it is worked out with reference to particular practices in the subsequent
four chapters.

72

3.0.2 Chapter Overview From critiques to constructive methodology

In reviewing the variety of approaches available to address the issue of disordered eating I propose
indicating the broad modes of engagement, noting their strengths and weaknesses and defending
my choice of methodology in the light of those choices. As the Church seeks to address an issue
which is faced by society at large, the critique of approaches deals with different strategies
employed in three fields of knowledge. This can be understood as the tendency of contemporary
mainline churches to look to pastoral care and counselling, the tendency of modern Western
cultures1 to look to the medical discipline of psychiatry, and the tendency of academic theology to
look to practical theology with its emphasis on interdisciplinary dialogue. 2

3.0.2.1 Pastoral support

The first approach is a methodology which sees eating disorders as a pastoral problem and looks to
address them from an individual perspective, beginning with the interior faith life as a starting
point. The approach of pastoral support by the church, often exercised through the ordained clergy
or a youth leader, can be beneficial to those who seek help from the church as it at least
acknowledges the spiritual dimension of a person and the interrelation between body, mind and
spirit. Section 3.1 below considers the advantages but also the limitations of pastoral support
offered by the church and argues that on its own it is an insufficient approach to addressing
disordered eating.

3.0.2.2 Clinical and self-help approaches and theology

The second methodological approach considered is perhaps the dominant unspoken methodology
employed by many in the Church when considering eating disorders. It is an approach which
begins with the insights of psychiatry as the primary discipline concerned with disordered eating
and seeks to build a theological position based on that psychological foundation. What is embarked

Including a significant number of people who would consider themselves to be Christians.

Another way to consider this would be to see the critique of approaches in relation to the three publics
identified by David Tracy; Society, the Church, and the Academy. David Tracy, The Analogical Imagination
(London: SCM, 1981).
2

73

upon is an attempt to correlate truths emerging from the psychological investigation with
theological concepts.3 The underlying position that is taken is one of accepting psychology as part
of Gods gift for bringing healing, wholeness and human flourishing and seeking to affirm all truth
as Gods truth whether it is found in cognitive behavioural therapy or theology.

Whilst not expressly articulating this theological position much of the popular Christian literature
on eating disorders employs a similar methodology, particularly in use of terminology. Gregory L.
Jantz refers to the inherently psychological concept of the self in his section entitled losing the
sense of self4 and also works with denial and addiction as chapter titles, drawing on terms
from popular psychology in a book intended to integrate a Christian theological approach with a
pressing societal issue. Section 3.2 below will consider the ways in which psychological
approaches such as CBT and self-help programmes can be a useful but incomplete contribution to
the Churchs response to disordered eating.

3.0.2.3 Other Practical Theology approaches

Section 3.3 acknowledges that there are a variety of theological approaches which may be used
when addressing a topic of this nature, most of which would be classed as practical theology. The
focus of this critique is the pastoral cycle, chosen because it has been as the dominant theological
method in pastoral theology in recent years. The argument made is that as a method it has
deficiencies as a means for addressing the issues of disordered eating which make it a less suitable
method than the approach I take.

3.0.2.4 Practices
Having considered the key approaches by which the Church seeks to address disordered eating, I
propose a method based upon practices of the church as an approach which is both theologically
3

Such an approach owes much to the understanding of critical correlation advanced by Paul Tillich and has
been pursued by many seeking to relate psychology and theology. This approach is recognised and
challenged in the work of Deborah Van Deusen Hunsinger, Theology and Pastoral Counselling (Grand
Rapids, Mi.: Eerdmans, 1995), x.
4
Gregory L. Jantz, Hope and Help for Eating Disorders (Colorado Springs: Shaw Books, 2002), 27.

74

and practically convincing. Sections 3.4 and 3.5 which develop this method articulate my
understanding of what is meant by practices, which practices will be considered and how the
practices I refer to were chosen. A subsequent section 5 will establish how the practices discussed in
this thesis relate to one another, particularly with reference to an understanding of Baptism and
Eucharist as overarching sacramental practices with the other practices considered in the light of
this.

3.1 Inadequacy of Pastoral Support

3.1.1 Inadequacy of Pastoral Support
In the introduction it was noted that one of the most common points of contact between the church
and the world of eating disorders is where a youth leader or member of the clergy is approached by
someone with an eating disorder seeking pastoral care. There are interesting questions requiring
further empirical research about what manner of care is being sought in these circumstances. 6 At
the point at which someone either acknowledges they have a problem and need help, or where they
have been diagnosed with an eating disorder and are reacting to that diagnosis, approaching a
church leader raises particular issues. The care and support sought is likely to be different than
what is expected from a counsellor or therapist or medical practitioner, and this suggests that there
is a role for church pastoral support to play.

3.1.2 What is the understanding of pastoral care I will be working with in this section?
Whilst an extensive exploration of the expectations of pastoral care given by church leaders is not
possible here, due to the limitations of space and focus, there are particular common themes which
may aid understanding of what is intended to be offered. Anorexiabulimiacare, the leading

Section 3.6.
Goodliff notes the changing relationship between psychology, pastoral counselling and pastoral care within
the church in Goodliff, Care in a Confused Climate (London: Darton, Longman and Todd, 1998), 16-20; and
Kate Litchfield identifies some of the consequences of this, However, confusion can arise because, with an
ever-increasing demand for personal counselling and the lack of affordable counselling services, people may
turn to their ordained minister for a form of help which may go well beyond the normal expectations of
pastoral care( K. Litchfield, Tend my Flock (Norwich: Canterbury Press, 2006), 16).
6

75

Christian Eating Disorder charity in the UK, acknowledges the value of church leaders, youth
leaders and pastoral carers in helping those who suffer from eating disorders. 7 ABC include within
the elements of pastoral care which might be offered: (i) a better understanding of eating disorders
and what the key issues are; (ii) changes to church events or preaching which may make church a
less difficult place for sufferers to attend; and (iii) the care given to families and close friends of
those with an eating disorder, acknowledging that this is something which has consequences for a
wider range of people than just the person with the eating disorder.

Key texts on pastoral care pick up the imagery of the shepherd and flock. 8 As the shepherd leads
and tends the flock, the tasks of feeding, nurturing and binding up the wounded sheep are balanced
with directing and steering the sheep away from danger. The inference is that pastoral care within
the Church involves more than being friendly or compassionate and will involve speaking the truth
in love and addressing challenging issues.

The emphasis upon the individual and their needs is an appropriate place to start addressing the
eating disorder as a presenting issue. This is similar to the approach taken in psychological and
medical fields where, even if wider issues such as family dynamics or relationships with others are
brought in at a later point, the method of addressing the eating disorder is to begin with the
individual as they present themselves seeking help.

The merits of the Church providing pastoral care to those with eating disorders are significant.
Pastoral care provided by the Church can enable the eating disorder sufferer to acknowledge the
spiritual dimension of who they are and the impact of the eating disorder upon that. For those
seeking pastoral support because they are already part of the church, there is the benefit of
receiving unconditional love and support even if they are unable to see themselves as worthy of
such care.
7

www.anorexiabulimiacare.org.uk/churchleaders (Last accessed 12/03/12)

K. Litchfield, Tend my Flock (Norwich: Canterbury Press, 2006), 16; John Patton, Pastoral Care An
Essential Guide (Nashville: Abingdon Press, 2005), 77.
8

76

Pastoral Support given by the church can also encompass the family members affected by the
eating disorder if they are also part of or open to the church. This addresses the broader context of
eating disorders and the difficulties many families face in supporting a family member with an
eating disorder.9

3.1.3 Clergy response

In the introduction it was noted that often the initial contact between the church and disorders was
often the pastoral encounter between congregant and clergy. At this point it is significant to note
the training clergy receive in pastoral care. Across training institutions and programmes, the
curriculum for training in pastoral care varies, but common to all is an acknowledgement that
clergy will encounter individuals whose problems exceed the skills and competences of the local
church minister. Emphasis in pastoral training of clergy is placed on the care of souls and being
able to discern at what point to refer a person to a specialist in a particular field when the expertise
of the ordained has reached its limit. 10 When faced with a person with an eating disorder, many
clergy and youth workers may feel 'out of their depth' and refer the person to their GP in order to
access services through the NHS or to seek counselling through formally accredited professionals.
This, in turn, places the person suffering from the eating disorder in the situation discussed below
in section 3.2. Whilst CBT may be helpful or a self-help route may provide a way through
disordered eating, it is argued below that as a Church response it is insufficient in theological
terms.

3.1.4 Helpful but insufficient

Despite the importance of fulfilling this need for pastoral care, a church response to eating
disorders which goes no further than offering pastoral support is inadequate.

Grainne Smith, Anorexia and Bulimia in the Family (Chichester: Wiley, 2004).
John Patton uses the example of alcohol addiction as a situation where the pastor can assist in some aspects
but needs to know when to refer a person to an addiction specialist. John Patton, Pastoral Care An
Essential Guide (Nashville: Abingdon Press, 2005), 77.
10

77

I argue that pastoral care of the individual sufferer does not go far enough in terms of theologically
responding to the cultural environment in which disordered eating occurs. It is to focus in upon the
individual without addressing the broader context which contains features which if unquestioningly
accepted, promote and sustain eating disorders.

Pastoral support concerns itself with dealing with the symptoms of disordered eating, caring for
those who have found themselves caught up in the world of eating disorders and trying to stand
alongside them as they navigate the path to recovery. It is an important response by the Church as it
models weeping with those who weep, showing compassion to those who suffer and speaking the
truth in love. Pastoral support and care is a necessary part of the way the Church engages with
disordered eating but without also addressing the issues which allow disordered eating to develop
the Church will only ever respond to the problem rather than seek to model an alternative way of
being which seeks to propose a solution.

Pastoral support alone as a response to disordered eating is of limited psychiatric effectiveness. The
reason many clergy are encouraged to refer parishioners on to professional psychiatric help is the
recognition that psychiatric help may be more helpful in addressing the eating disorder than
pastoral care. The following section will discuss in what sense this is and is not an adequate Church
response to disordered eating.

3.2 The Inadequacy of CBT and other clinical and self- help
approaches as a sufficient Church response
3.2.1 What is Cognitive Behavioural Therapy?
The dominant professional discipline encountered in relation to disordered eating is that of
psychiatry, based on the construction of disordered eating as a mental disorder. The development of

78

a variety of approaches within the field of psychological investigation has been referred to
previously,11 but the increasing use of Cognitive Behavioural Therapy warrants particular attention.

It is becoming widely recognised that cognitive behavioural therapy 12 is the clinical approach
having the greatest success rate in treating eating disorders. 13 Experimentation with specially
adapted forms of CBT have yielded encouraging results and generated hope that what is
acknowledged to be an extremely difficult disorder to treat can be successfully addressed.
Enhanced forms of CBT for treating eating disorders are identified as CBT-E,14 with the specific
form of CBT for bulimia identified as CBT-BN.15

In a departure from traditional psychoanalysis, CBT is based on the principles of identifying

maladaptive responses to situations or stimuli and seeking to change how these events are
perceived, thus altering the emotional response and the behaviour which flows from it. In his
appraisal of CBT, Hofmann articulates the key foundations thus:

The central notion of CBT is simple. It is the idea that our behavioral and emotional responses are
strongly influenced by our cognitions (i.e., thoughts), which determine how we perceive things. That
is, we are only anxious, angry or sad if we think that we have reason to be anxious, angry or sad. In
other words, it is not the situation per se, but rather our perceptions, expectations, and interpretations
(i.e., the cognitive appraisal) of events that are responsible for our emotions. 16

11

Chapter 2.
Hereafter referred to as CBT.
13
Carol B. Peterson and James E. Mitchell, Cognitive-Behavioural Therapy for Eating Disorders in The
Outpatient Treatment of Eating Disorders, ed. James E. Mitchell ( Minneapolis: University of Minnesota
Press, 2001).
14
Michael W. Otto and Stefan G. Hofman (eds), Avoiding Treatment Failures in the Anxiety Disorders
(NewYork: Springer, 2010).
15
C.G. Fairburn, M.D. Marcus, and G.T. Wilson, Cognitive-behavioural therapy for binge eating and
bulimia nervosa: A comprehensive treatment manual in C.G. Fairburn and G.T. Wilson (eds), Binge Eating:
Nature, assessment and treatment. (New York: Guildford Press, 1995), 361-404.
16
Stefan G. Hofmann, An Introduction to Modern CBT (Chichester: Wiley-Blackwell, 2011).
12

79

In terms of what this looks like in practice for those with disordered eating, the best summary of
the approach in non-specialist language is contained within the advice given to clinicians on how to
tell patients what is involved:

the treatment is a one-to-one talking type of treatment that primarily focuses on what is keeping the
eating problem going. It is therefore mainly concerned with the present and the future. It addresses
the origins of the problem as needed.
The treatment is tailored to your specific eating problem and your needs. You and your therapist
will need to become experts on your eating problem and what is keeping it going.
[For patients with a body mass index over 17.5] Treatment will involve 20 sessions over 20 weeks
plus one initial assessment session, the first eight sessions being twice a week, the next 10 being
weekly, and the last three being at 2-week intervals.
[For patients with a body mass index between 15.0 and 17.5] Treatment will involve about 40
sessions over approximately 40 weeks, the first 20 or so sessions being twice a week. Thereafter
they will spread out.
You and your therapist will agree upon specific tasks (or next steps) for you to undertake between
each session. These tasks are very important and will need to be given priority. It is what you do
between sessions that will govern, to a large extent, how much you benefit from treatment.17

Following an initial assessment which aims to identify the perceptions of the eating disorder
sufferer about food, eating and body image, the next stage is to reconceptualise how these are
thought about and thus address the emotions and behaviour which flow from those perceptions.
Exercises will be set to acquire new skills which help reinforce this new way of thinking 18 and
further work to consolidate those skills will follow. Later stages look to how this new pattern of
thinking, feeling and acting can become the general way of functioning and be maintained over the
long term. At the conclusion of treatment will be an assessment of whether it has been successful
and how the patient should be followed up.

If CBT is so successful in treating disordered eating it could be argued that all the Church needs to
do to help those with eating disorders is to help them through the process of CBT as outlined above
and that will constitute an adequate response. Whilst it is good to acknowledge the benefits and
methods of healing discovered through the discipline of psychology, I argue that this alone is an
insufficient response for the church to make, for the following reasons:
17

Christopher G. Fairburn, Cognitive Behavior Therapy and Eating Disorders (New York: Guildford Press,
2008).
18
A. H. Crisp, N. Joughin, C. Halek, C. Bowyer, The Wish to Change (Hove: Psychology Press, 2nd ed.
1996), 39.

80

Firstly, CBT addresses the individual, their symptoms and the underlying thoughts and mechanisms
which sustain the behaviour which manifests itself in those symptoms. It does not explicitly deal
with the wider context of the community in which the individual lives and the views, practices and
understandings of that immediate context. This deficiency applies to both the local and broader
societal context, as both these environments have an influence over the individual with disordered
eating. Whilst advocates of CBT would argue that the strength of CBT is that it enables the
individual to navigate their way through these challenging societal environments without resorting
to disordered eating as an adaptive strategy, there is nothing within CBT to address the concerns
noted in Chapter 2 that part of the context of eating disorders is a culture which promotes
unattainable ideals of thinness as perfection. It can be argued that this is not the role or place of
CBT. It has no intention of affecting social change on a grand scale or challenging cultural
pressures. It is a means of helping individuals work through their disorder. This wider perspective
about challenging those things which diminish humanity created in the image of God are things
which the Church is called to address and therefore, merely adopting CBT as the Churchs sole
response to disordered eating is insufficient.

Secondly, CBT makes no claims which could be termed 'theological' and has no place for prayer.
In order to give credence to its understanding of the place and story of God, the Church response
may want to frame its language and articulate a worldview which looks different to that within
which CBT operates. The centrality of prayer to the Churchs life and a particular understanding of
prayer as significant in healing and wholeness19 suggests that CBT alone does not fully reflect the
kind of response the Church would want to make to the sphere of disordered eating.

The third way in which CBT alone constitutes an inadequate church response to disordered eating
is to do with the fact that only addresses the treatment of a disorder once it has taken hold. My view

19

John Swinton and Richard Payne (eds.), Living Well and Dying Faithfully (Grand Rapids, Mi:Eerdmans,
2009), xxi.

81

is that a church response in its fullest sense needs to look at what can be done about factors which
potentially contribute to disordered eating and act prophetically. The previous chapter established
that though much of disordered eating is not about food or thinness, the cultural pressure to achieve
a particular weight, size or body shape is a contributing factor in the development of disordered
eating. Whilst CBT may help the individual sufferer to identify why this may be an issue for them
personally, it does not have the capacity to shape corporate attitudes to what is desirable weight or
body size or even the wider question of what the purpose of the body or the person is.

3.2.2 Church based self-help approaches: towards an empirical study?

Some churches have sought to supplement the approach of CBT used by a psychologist and eating
disorder sufferer by offering a support or accountability group, to help and encourage the patient to
keep going to appointments and working through the programme. Other models of small group
self-help programmes have formed in particular church contexts. An original intention of this thesis
was to conduct empirical research into the role and effectiveness of such groups as they operate
within the Church. As there were few groups established or operating in UK churches at the time,
the aim was to conduct observational ethnographical research with an established eating disorder
self-help group which was part of a wide-ranging Twelve Step Ministry programme in a large
Church in the USA. The questions to be explored included what made it a Christian or Church
response to disordered eating, why people went to it, whether this was a group of people who were
already part of the Church or whether this was a ministry the Church offered to those outside itself.
The intention was to assess to what extent it was helpful in people overcoming their struggle with
disordered eating and whether any of the proposed benefits of the approach I pursue in this thesis
were experienced in practice. Due to circumstances beyond my control, the effectiveness of the
proposed ethnographic research was severely limited by problems within the group with which I
had planned to work. It is in this context that the theological reflection on my time spent with the
group occurs in Chapter 5. Despite its limitations in terms of the low numbers of those attending
the group and the short amount of time I was able to spend with them, the material is included as an
illustration of a church response to eating disorders which draws upon the ideas of self-help

82

through confessing and being accountable. It indicates that the work of self-help groups hosted by
or connected to the Church may be a fruitful area for future research into how effective they are
and in what sense they consider themselves to be part of the Churchs response to disordered
eating.

Despite many positive features of both CBT and self-help programmes based on psychological
methodologies I contend that, as a Church response, an unquestioning acceptance of CBT as the
last word or the only approach to eating disorders is inadequate. CBT was developed as a
psychological treatment and therefore obviously falls short of being a theological response, as it
was never intended to be one. Work undertaken to explore the relationship between Christian faith,
spirituality and CBT 20 suggests a helpful way forward in thinking theologically about CBT and its
use within the Church and further interdisciplinary engagement of this kind is to be welcomed. This
however does not resolve the difficulty that an adequate theological response to disordered eating
needs to be one which is capable of addressing not only the individual and their behaviour and
attitudes but the culture within which their worldview is formed. The suggestion may therefore be
made that what is required is an approach which integrates both theology and psychology and so
the claims of practical theology as a methodology will now be considered.

3.3 Inadequacy of other practical theology approaches

This thesis addresses the contemporary issue of disordered eating, and as such may be categorised
by some as an exercise in 'practical theology'. The debates surrounding the existence of practical
theology as a discipline and its boundaries and relationship with other strands of theology are too
numerous to recount here.21 It is necessary from a methodological perspective to establish why my
approach to the issues of disordered eating, namely the use of practices of the church based on a

20

S. Plum and P. Hebblethwaite, The Third Wave of Cognitive Behavioural Therapy (CBT) Can it be
Integrated into a Christian Context? Accord Autumn 2010, 24-29.
21
See J. Woodward and S. Pattison, The Blackwell Reader in Pastoral and Practical Theology (Oxford:
Blackwell, 2000), 59-72; and Ballard and Pritchard, Practical Theology in Action, 9-26.

83

canonical narrative reading of scripture, has been chosen over other approaches favoured by
practical theology.

Space does not allow an extensive exploration and critique of the full range of methodologies and
approaches which could have been pursued in this thesis. 22 Instead I intend to demonstrate why the
most obvious methodological tool, the pastoral cycle, has not been used and why.

3.3.1. The Pastoral Cycle

The most commonly encountered method of theological practical reflection is the pastoral cycle. 23
In its various forms it has been chosen as a methodology for addressing contemporary issues in a
variety of contexts, leading Ballard and Pritchard to assert, Such widespread acceptance clearly
suggests that the pastoral cycle should be at the heart of any contemporary perspective on practical
theology.24 Whilst the overarching process of insertion/analysis/theological reflection/practical
outcome can be detected as the overarching structure for this thesis, as a methodology for
addressing disordered eating in detail or depth, it proves insufficient. Despite its careful attention to
multi-disciplinary analysis and theological reflection the pastoral cycle is not without difficulties.
Ward notes how the process of the pastoral cycle can result in the reverse of the outcome it was
intended to create:

The pastoral cycle tends to reinforce the dislocation between reflection and the everyday... The
problem is that it separates both the analysis of a pastoral situation and the theological reflection as
particular stages in the method. Thus experience is effectively distanced or distilled through
analytical moves. 25

22

For an account of alternative practical theology methods, see Graham, Walton and Ward, Theological
Reflection: Methods.
23
Ballard and Pritchard, Practical Theology, see also Emmanuel Lartey Practical Theology as a Theological
Form, in David Willows and John Swinton, Spiritual Dimensions of Pastoral Care: Practical Theology in a
Multidisciplinary Context (London: Jessica Kingsley, 2000), 72.
24
Ballard and Pritchard, Practical Theology, 74.
25
Pete Ward, Participation and Mediation (London: SCM, 2008), 35.

84

To use the Pastoral Cycle would be one way to look to how the Church responds to disordered
eating. It would, however, require the theological reflection to follow an analysis of eating
disorders as understood by other disciplines. Walton notes the difficulty of determining which
discipline is given primacy. 26 In the case of disordered eating, as has already been noted, competing
claims from sociology, psychology and feminist approaches make a consensus about eating
disorders difficult to reach. To then lay a layer of theological reflection upon them creates a
number of difficulties including which analysis to theologically reflect upon and if more than one
theological reflection emerges, how to reconcile or relate differing responses.

Perhaps the greatest deficiency in using the pastoral cycle is that it allows the disciplines used in
analysis to frame the issue, rather than taking the view exemplified in Barth that the centre of all
things is the revelation of God in Christ. Taking an approach in which the Church sets the agenda,
based on its understanding of the revelation of God about the purpose of humanity, the body, food,
and eating constitutes a more faithful response by the Church than letting others determine the
grounds and terms within which the Church should respond.

Taking an approach which works out of the tradition of the Church enables a Church response
which avoids the danger of simply baptising the latest secular thought and calling it the Christian
response. The emphasis of Barth continually causes us to ask how new knowledge and insights
relate to the tradition of the Church and Gods revelation in Christ as the Church has received it.
This is not to say that the church has nothing to learn from other disciplines but ensures that such
learning is considered in the context of the Churchs own understanding, tradition and practice.

3.3.2 Summary of Approaches

Having considered three key ways in which the Church has attempted to engage with disordered
eating it has been established that though each approach has its benefits, none of those considered

26

Roger L. Walton, The Teaching and Learning of Theological Reflection: Case Studies of Practice(Ed.D
Thesis, Durham University, 2002), 34.

85

above is adequate in itself. The critiques note that any method used needs to be theologically
robust, yet engage with the issues central to disordered eating and combine helping the individual
sufferer and their immediate support network, whilst asserting at a societal level that particular
cultural pressures create an environment which predisposes some people to eating disorders.

3.4 Practices of the Church

The criticism of methodologies which require us to separate out theological reflection from
problems as they are encountered in daily life is similar to the criticism of approaches which
advocate looking at one area of life in isolation from another, or only looking at theological
engagement as a process of stages to be worked through. All of these fail to integrate theology and
practice in a seamless whole existing within the same person or within the whole Church. Ward
looks to a relationship between theology and practice which sees them held together so faith is an
embodied practice:

In the practice of faith, doctrine is performed as it is prayed, sung, preached and enacted in mission.
To be a person of faith means that the theological is embodied as lifestyle, belonging and identity. 27

This idea of practices being the embodied witness of the people of God is taken from the individual
level expressed by Ward, to a corporate level in the writings of John Howard Yoder. 28 The Church
therefore engages with the issues it encounters through the practices it enacts. The questions then
raised are about where its practices are drawn from and who discerns which practices address
which issues.

3.4.1 Canonical Narrative

Those who advocate the approach of practices as the means by which the Church lives and
witnesses to Christ base those practices upon the narrative of the canon of Scripture and
27
28

Ward, Participation and Mediation, 35.

Yoder, Body Politics.

86

particularly the story of Jesus as read in the gospels. Graham identifies this as a form of
theological reflection that is based upon the story of Jesus as recounted in Scripture. 29 In engaging
with the biblical narrative, the Church hears Gods story told and is challenged to understand its
own experience within the light of the ongoing story of God and his people. Graham notes:

The aim of theological reflection in this perspective is not to discover some new truth appropriate to
our own age and context but rather to enable believers to locate their diverse and particular stories
within the framework of the story God told through Christ. Having made this act of committed
identification they should then discover how their own lives become transformed into a dramatic representation of the gospel in the contemporary situation.

So Yoder uses the example of Jesus instructing his followers on the practice of binding and
loosing to shape how the Church understands forgiveness and what that may mean for Christians
today.30

In the chapters which follow, the questions raised by the existence of disordered eating will be
addressed by recourse to a canonical narrative approach to Scripture, looking at the biblical
narrative to examine what shapes the Christian churchs view of food and eating, body image and
body purpose, identity, and perfection which are all key elements of disordered eating identified in
Chapter 2.

The methodology will draw on perspectives of Karl Barth, Stanley Hauerwas and Gerard Loughlin,
taking the biblical narrative as the story within which the Church lives. In a thesis focussing upon
distinctive practices of the Church, the canonical narrative approach to Scripture enables an
identification to be made of practices in the story of the life of Jesus and the early church. Taking
the accounts of the practice of Baptism and Eucharist, of Jesus feasting with his disciples, of the
early church confessing sin and confessing Christ, it is possible to follow those practices, which
29
30

E.L. Graham, H. Walton and F. Ward, Theological Reflection: Sources (London:SCM,2007), 151.
Yoder, Body Politics,1.

87

may seem alien to todays culture, but which somehow speak of God. I argue in this thesis that the
Church needs to be different from the culture which allows or promotes disordered eating. The
telling of Gods story and seeking to live in conformity to it is one way I suggest as an appropriate
means by which the Church may be distinctive.

Each of the chapters considering practices of the Church begins with how the practice is patterned
in Scripture and only later discusses how it is interpreted in the historically unfolding story of the
Church. Only then is the relationship to disordered eating examined. This follows Loughlins view,
building on the work of Karl Barth and Hans Frei, concerning the revelation of God to be the place
to begin:
Unlike most modern theology, narrative theology does not look to the world and its possibilities, but
to the actuality of Gods story as it is told in the Churchs Scripture. It does not seek to show the
possibility of revelation, but its actuality; not that God can and may speak, but that God has
spoken.31

Loughlin notes:
The Eucharist enfolds all the themes of narrativist theology. It is itself a narrative that enfolds the
participants within the biblical story, not simply in each performance but in the cycle of
performances throughout the Churchs liturgical year. 32

Mindful of this, the central chapter of the thesis (Chapter 4) considers what the story of Baptism
and Eucharist mean as the Church inhabits and participates in Gods ongoing story. It is argued
from the consideration of the biblical narrative that living as the baptised who regularly share in the
Eucharist shapes the identity of those who are the Church. The shaping and forming of the Church
through participation in the Eucharist a telling of the story of Christ and consuming of bread and
wine - can be likened to Loughlins view of the Church shaped by consuming the narrative of
Christ:
31
32

Gerard Loughlin, Telling Gods Story (Cambridge: Cambridge University Press, 1996), 35.
Loughlin, Telling Gods Story, 223.

88

The Church is a Christ-shaped people; its shaping a matter of virtuous discipline, a pedagogy of the
body. It is a community in which people learn how to embody the story of Jesus Christ. The Church
can only tell the story of Christ if it has first read Christs story, consumed it in such a way that it
nourishes and shapes the consumer, reader and teller of the story. 33

The means by which the telling and retelling of the story is undertaken is examined in Chapter 5 as
the place, purpose and power of confessing is explored.

Having identified the place and significance of food, body and eating within the biblical narrative,
the thesis addresses the subject of disordered eating through key practices in the life and history of
the Church which flow from response to Scripture and may speak into addressing disordered eating
in a contemporary context.

3.4.2 Practices
Aligned with seeking to discern what a canonical narrative approach to Scripture leads the Church
to understand about its place in Gods story, the core chapters (4, 5, and 6) will draw on the
insights of J. H. Yoder, particularly the methodology of Body Politics 34and the significance of the
rediscovery of Christian practices. Based on Yoders proposition that [t]he people of God is called
to be today what the world is called to be ultimately 35 the thesis looks to how the people of God
may live in such a way that their relationship to food is appropriately orientated to God.

What emerges is that by rediscovering Christian practices which have been neglected in some parts
of the Church, there is the potential for the Church to engage with disordered eating on a number of
levels.

33

Loughlin, Telling Gods Story, 86.

John Howard Yoder, Body Politics (Nashville: Discipleship Resources, 1992).
35
Yoder, Body Politics ix.
34

89

Firstly, through living in a way which is countercultural there is the possibility of prophetic action.
Through its practice the Church articulates to the watching world a different understanding of life.
Hauerwass observation that Sin consists in our allowing our characters to be formed by the story
that we must do everything (pride) or nothing (sloth) 36 has particular resonance in the area of
disordered eating. The cultural narrative which demands that perfecting the body be pursued
through hard work in the gym and minimal consumption of calories (doing everything) is
contrasted with the competing cultural narrative which proclaims why work at it when you can
take a diet pill/ have cosmetic surgery? In refusing to live within the story of the individual body
as an all-consuming project, the Church entertains the hope that there is something different that
bodies were created for.

Secondly, through the communal creating of meaning which differs from the prevailing culture
there can be a preventative effect regarding disordered eating for those in the Church. Through the
practices of the Church there is the potential for people to be formed into those who can discern
that, for example, constant dieting to look a certain way is not what humanity was created for.
Susie Orbach indicates that what is needed is an expanded understanding of our bodies, to bolster
our resilience in the face of unprecedented attack and to bring sustainability to our bodies so that
we can live with and from them more peaceably. 37 This thesis will argue that through its practices
the Church is exactly a place where such an expanded understanding of bodies, food, eating and
identity may be formed and nurtured.

Thirdly, through being Church there is the possibility of healing for those already suffering from
disordered eating. The practices shaping and forming the Church have the potential to shape and
form those within the life of the Church who suffer from disordered eating. Within this new way of
living there is the potential of transformation based on redemption through grace.

36
37

Stanley Hauerwas, The Peaceable Kingdom: A Primer in Christian Ethics (London: SCM Press, 1984), 48.
Susie Orbach, Bodies, 17.

90

Despite the strengths of a Church response to disordered eating beginning with the revelation of
God in Scripture and flowing into practices which form the Church and witness to a watching
world there are criticisms which can be levelled at such an approach. Many have criticised this
approach when used by Hauerwas as being sectarian, 38 arguing that it dwells on the Church as not
only separate from the world but separated and retreating to a place from which it cannot contribute
to society by engaging in what has been traditionally called public theology. The key argument
against taking the approach I follow in regard to disordered eating is primarily to do with the
difficulties of engaging those outside the church. The criticism levelled is that it does not engage on
the same terms, use the same language or work on the same basis as the medical professionals
seeking to help those with eating disorders and therefore will not be recognised by psychologists as
having anything to contribute to the field. It is suggested that as an approach it does not make sense
to those outside the Church, particularly those with eating disorders, because it is so
ecclesiocentric.

However, in a world in which the tenets of Enlightenment rationalism are frequently disputed, the
argument advanced by Hauerwas for the Church to seek ways of faithful discipleship which are not
dependent upon the upholding of liberal politics is convincing. Any Church response to issues
within society must primarily be faithful to Christ rather than the demands of contemporary culture.
In this, the Church demonstrates that witness to the kingdom of God is part of faithful discipleship
and at times may involve a clash of views with those of Enlightenment rationalism.

The argument can be made that to be credible to psychology the Church cannot work with a
methodology which begins with revelation through Scripture and is made manifest through
practices. In response to this I demonstrate in the chapters which examine practices in detail how
the practices of the Church may be understood and responded to by those outside the Church. 39 The
argument that a methodology based on church practices is less capable of engaging with those who
38

Most notably James Gustafson, The Sectarian Temptation: Reflections on Theology, the Church and the
University, Proceedings of the Catholic Theological Society 40 (1985), 83-94.
39
See, for example, confessing and accountability as practiced in various forms in chapter 5.

91

understand disordered eating from a psychological background than any other practical theology
approach underestimates the challenges faced by any attempt to bring the two disciplines into
dialogue.

When theology has sought to engage with psychology the different perspectives of each discipline
have sometimes created problems. Mark Sutherland acknowledges the difficulties experienced
when psychiatry and theology have attempted to dialogue. 40 He argues that in its quest to be taken
seriously by the medical establishment as a scientific discipline, psychology has increasingly
focussed on research which produces measurable results in regard to symptoms and treatments.
The result of this is, he argues, The human person ceases to exist, becoming simply a collection of
symptoms and behaviours which have to be modified or brought under control. 41 This, he contrasts
with theological approaches which endeavour to hold to a more integrated anthropology of
humanity rather than a series of issues which can be clinically categorised. Despite this, positive
signs are emerging in the relationship between theology, spirituality, religion and psychiatry,
suggesting that what was once an area overlooked by both theologians and psychiatrists is now
being given serious attention.42

Having considered ways in which a more productive relationship between theology and psychology
may emerge, Sutherland concludes, Perhaps the real task of practical theology is to recall the
wider religious tradition to the central task of facilitating human co-operation with a God who
maintains an intention and purpose for the whole of the creation. 43 My contention is that the
approach I take enables such a human co-operation with God to occur as the Church lives out its
ethic, making manifest Gods purposes for creation.

40

M. Sutherland, Towards Dialogue: an Exploration of the Relations between Psychiatry and Religion in
Contemporary Mental Health, in James Woodward and Stephen Pattison (eds), The Blackwell Reader in
Pastoral and Practical Theology (Oxford: Blackwell, 2000), 272.
41
Sutherland, Towards Dialogue, 277.
42
Chris Cook, Andrew Powell and Andrew Sims, Spirituality and Psychiatry (London: RCPsych
Publications, 2009).
43
Sutherland, Towards Dialogue, 281.

92

The thesis concludes by suggesting that a rediscovery of these practices of the Church offer an
alternative pattern for life, counteracting much of what generates and sustains disordered eating and
offers healing and hope to those who suffer from eating disorders.

3.5 How are the practices within this thesis selected?

3.5.1 Being the Church and Relating to Bruch
In the previous section I sought to establish why I believe a methodological approach based on
practices of the Church to be the most fruitful means of addressing the problem of eating disorders
from a Church perspective. My contention is that this method holds together a theology grounded
in biblical and historical tradition with a practical outworking (in fact it is no theology at all until it
is enacted in practice), and also holds in tension the corporate and the individual. It is clear that in
the course of its life and witness, the Church has many practices and so the next question raised is
how one selects which practices are relevant to the topic in hand and defends such choices.

There are many practices of the Christian Church, 44 not all of which are relevant to disordered
eating. The previous section noted that one of the perceived weaknesses of this approach is
knowing which practices are appropriate to be considered in relation to particular issues. The lack
of systematic process in selecting practices to be considered in this thesis is accepted as a valid
criticism of this approach within the understanding that, whilst this aims to be a theologically and
practically robust engagement with disordered eating, it does not claim to be exhaustive. Future
research may explore how other Christian practices relate to different aspects of disordered eating,
such as the practice of hospitality as it relates to making welcome those who struggle with eating.

The process by which it seemed best to select practices to be considered in the thesis was to
consider the central sacramental practices of baptism and Eucharist, then look to ecclesial practices

44

Stanley Hauerwas and Samuel Wells (eds.), The Blackwell Companion to Christian Ethics (Oxford:
Blackwell, 2004).

93

relating to eating, identity and food,45 and conclude by considering the practices related to secular
responses to eating disorders. 46 It became apparent that the work of Hilde Bruch which was
identified in the previous chapter as key in defining disordered eating, had significant implications
for the selection of practices.

Bruchs identification of the core issues at the heart of what she termed primary anorexia nervosa
was expressed as, the main issue is a struggle for control, for a sense of identity, competence
and effectiveness. Many of these youngsters had struggled for years to make themselves over, and
to be perfect in the eyes of others. 47

This involves considering ecclesial practices which relate to identity, 48 control, competence and
effectiveness,49 and perfection. 50 In this way Bruchs insights form a pivotal link between the
defining of eating disorders as a bio-psychosocial phenomenon of multifactorial origins and the
practices of the Church which articulate good news about identity, control, competence,
effectiveness and perfection. This is not to say that what Bruch means by identity or control is
identical to what is meant by the same terms when used by the Church. 51 The significance lies that
in identifying these core issues Bruch opens the door for an approach based on ecclesial practices
to consider how the story of the Church may be lived faithfully in the midst of such issues.

45

Including the central practice of eucharist, along with baptism,.

The practices of confessing and accountability considered in relation to talking therapies, CBT and selfhelp groups.
47
Hilde Bruch, Eating Disorders: Obesity, Anorexia Nervosa and the Person Within, (London: Routledge &
Kegan Paul, 1974), 251.
48
Hence Baptism as the initiation rite of the Church into a new identity and Eucharist as the regular reenactment of being united with Christ and his Church.
49
The desire to increase competence and effectiveness is worked out in the practice of confessing ones
incompetence and ineffectiveness and being accountable to others to become more competent and affective.
50
Though perfection is not a single practice, the element of perfectionism appeared to run through the other
elements and practices and raises interesting questions about the doctrine of Christian perfection.
51
See Deborah Van Duesen Hunsinger, Theology and Pastoral Counselling (Grand Rapids, Mi: Eerdmans,
1995),xi-xii.
46

94

3.5.2 Which practices will be considered?

Having identified the means by which practices were selected this section builds on the previous
one and identifies the practices which will be considered in later chapters of the thesis.

The central practices considered in this thesis are the two sacramental practices of baptism and
Eucharist. Their significance and function within the thesis will be addressed in greater depth in the
next section, but in a thesis concerning itself with food eating and questions of identity, the central
place of Eucharist as a consuming of bread and wine as a regular confirmation of baptismal identity
cannot be underestimated. The issue of seeking a sense of identity brings into focus the means by
which Christian practices form and shape identity 52 and identify baptism as the practice in which
Christian identity is marked, and Eucharist as the practice in which identity in Christ is re-enacted.
The selection of baptism and Eucharist as practices of the church with relevance to disordered
eating in many ways reflects the relevance of baptism and Eucharist to every aspect of the life of
the church. The other practices chosen as part of this thesis are considered as subsequent to baptism
and Eucharist.

The struggle for competence and effectiveness looks to those methods by which people seek to
increase their competence and effectiveness. This could manifest itself in the practices of study or
meditation on scripture but the practices which resonated most strongly were confessing and
accountability. The Churchs practice of confessing (in the sense of speaking out, as well as
admitting sin) has been significant in bringing healing as has the support of being accountable to
others for ones actions. The inclusion of confessing and accountability also connects with Bruchs
approach of talking therapy bringing positive change, as well as her identification of a quest for
competence and effectiveness as core syndromal values of disordered eating.

The quest for perfection identified by Bruch as a feature of many anorectics she had worked with is
considered in the chapter looking at the practice of Christian perfection and how it relates to
52

Swinton and Payne, Living Well, xxii.

95

perfectionism. Whilst it is acknowledged that Christian Perfection is not a single practice in the
sense that the other practices are, 53 it is an element which binds them all together and if omitted
would be a serious deficiency in a thesis on Christianity and disordered eating.

Bruchs identification of the underlying issues beneath anorexia nervosa 54 therefore provide a
framework for considering which practices of the Church are most appropriate to consider in
relation to eating disorders. Having identified the practices to be considered, further exploration of
the core practices is required.

3.6 Baptism & Eucharist

The previous sections have identified the practices to be considered and the reasons and methods
for their choice. A particular mention needs to be made about the practices of Baptism and
Eucharist in regard to the way in which they will be approached.

3.6.1. Baptism and Eucharist A theological or psychological understanding?

The previous chapter acknowledged the significance of psychology in defining and seeking to treat
disordered eating insofar as it falls within the definition of a clinically recognised mental disorder.
The relationship between psychology and religion was noted earlier in this chapter as having been
at times awkward and at other points, fruitful. This interplay of disciplines raises the question of
how the practices of baptism and Eucharist will be understood in the remainder of the thesis.

In Totem and Taboo, Freud draws upon Robertson Smiths analysis of sacrifice and famously
combines it with the notion of totemism and the Oedipus complex to assert that:

53

Christian perfection or perfect love will involve a variety of practices from prayer and worship to acts
of mercy such as almsgiving.
54
Bruch, Eating Disorders, 270.

96

the old totem feast is revived again in the form of communion in which the band of brothers now
eats the flesh and blood of the son and no longer that of the father, the sons thereby identifying
themselves with him and becoming holy themselvesAt bottom, however, the Christian
communion is a new setting aside of the father, a repetition of the crime that must be expiated.55

Whilst the acceptance of totemism as a universal phenomenon common to all religions and groups
is now widely discredited 56 Freud is not alone in seeking to understand the Eucharist in
psychological terms. Gordon E. Jackson considers the connections between the Eucharist and
primitive oral experiences, dating from the first year of a persons life 57 tying in remembering
within the context of Eucharist with remembering early childhood experiences of feeding and
nurture. He seeks to avoid the blunt methodology of explaining religious experience in simple
terms of childhood experience but draws upon Freudian primary process thinking as the means by
which early experiences shape later adult responses. In the quest for greater understanding of how
the mind works, psychology will seek to understand the practices of baptism and Eucharist within
the framework of psychological concepts, whether that be totemism or memory, sacrifice or
transformation through self-immolation.58

Interesting though these approaches are, this thesis proceeds on the basis that the Eucharist is
addressed from a primarily theological point of view. In this I concur with Jackson that,

Its content is theological, the act of God by which he continues to give himself to his church. Its
power is theological for it is a grace-gift. But its power is also that it meets the primitivism of the
unconscious and sublimates this into the profound eucharistic feast.59

55

S. Freud, Totem and Taboo, trans A.A. Brill, (New York: Moffat, Yard & Co. 1919), 254-5.
M. Weber, The Sociology of Religion, trans. E. Fischoff, Beacon: Boston, 1963, 40.
57
Gordon E. Jackson, Eucharist: Feeding and Faith in Theology Today 31, no.1 (1974), 19.
58
G.S. Spinks, Psychology and Religion (London: Methuen, 1963), 146-150.
59
Jackson, Eucharist, 23.
56

97

Baptism and Eucharist are considered as practices which speak of God and in that sense are
theological. Those who practice them may be transformed in ways which may be considered
psychological but the emphasis of this thesis is on practices of the Church understood
theologically. Partaking in eucharistic bread and wine may cause a psychological transformation in
the recipient, linking to positive memories of receiving a gift but the theological emphasis of the
practice would include recognition of God as the source of self-giving love. Having established that
I will be understanding the practices of baptism and Eucharist in a theological sense, a further
clarification is required regarding how they will be understood in relation to healing.

3.6.2 Eucharist specific significance to eating disorders or general significance to healing?

The Church of England House of Bishops Report, A Time to Heal, asserted The Eucharist is
essentially a service of healing even though many lay people do not appreciate it as such. 60 This
affirms an understanding of healing in a wide sense, acknowledging that as the Church partakes of
this sacrament, the grace and power of God is present imparting life and hope. This thesis proceeds
on the basis that the Eucharist is significant in a generic role as a sacrament of healing.

However, the inescapable fact at the heart of the Eucharist is that it involves eating and drinking
and thus also has particular relevance to disordered eating. Within the aforementioned general
understanding of the Eucharist as the principal healing sacrament of the Church 61 there is the
possibility that the Eucharist may be a point at which specific healing in relation to disordered
eating takes place. In her exploration of the history of healing within the life of the Church,
Amanda Porterfield recognises that an understanding of the Eucharist as a context for healing in a
general sacramental sense was also consistent with more specific instances of physical healing;

60

The Church of England House of Bishops, A Time to Heal - A Contribution towards the Ministry of
Healing, (London: Church House Publishing, 2000), 37.
61
Martin Israel, Healing as Sacrament (Cambridge: Cowley Publications, 1984), Chapter 7.

98

Healing was part of the Eucharist from the beginning. Early Christians anticipated bodily
resurrection through participation in fellowship with Christ during the Eucharistic meal and physical
healings in the course of the meal were not unusual.

62

The methodological use of baptism and Eucharist on which I proceed is that they have a generic
role sacramentally and may therefore be the point at which people experience a sense of Gods
love, grace and healing. Additionally, baptism and Eucharist are also of specific relevance to eating
disorders due to their impact upon identity and also the nature of Eucharist as involving eating and
drinking. In such a situation, the actual receiving of bread and wine may be a point whereby they
are enabled to eat and drink without fear. Having examined the sense in which these sacraments are
understood in relation to psychology and healing, the final consideration to be addressed is the way
in which the practices explored in this thesis relate to one another.

3.6.3 The relationship of Baptism and Eucharist to other practices within the thesis
As the core sacramental practices of the Church, baptism and Eucharist stand as primary and
overarching practices through which the life of the church is formed and expressed. The chapter
which immediately follows this considers the importance of baptism and Eucharist as practices of
the Church which speak of identity and what it means to be the Body of Christ. This chapter is
foundational to those which follow as it lays the groundwork for what it means to be the Church
which seeks to respond to disordered eating.

The later chapters on confessing and accountability and perfection and perfectionism are
considered as sub-practices within the overarching framework of baptism and eucharist. This does
not mean that the later practices are less significant as regards disordered eating, only that these
practices flow from the prior practices of baptism and eucharist.

62

Amanda Porterfield, Healing in the History of Christianity (New York: Oxford University Press, 2005),
87.

99

3.7 Summary
In seeking to establish a methodological approach I have noted the established ways that disordered
eating has been addressed by those within and outside the Church. The commonly advocated
methods which constitute a helpful contribution to supporting those suffering from disordered
eating have been shown to be inadequate in various ways as a Church response.
The method of inhabiting practices drawn from a canonical narrative approach to Scripture has
been proposed as a unique and superior methodology which will be worked out in subsequent
chapters. The reasons for selecting particular practices have been stated as considering those
practices core to the life of the Church and then looking to those connected with food, eating and
identity. The work of Hilde Bruch has been identified as the connecting link between the church
practices and the understanding of eating disorders as bio-psychosocial phenomena of
multifactorial origin. Having clarified the ways in which baptism and Eucharist will be understood
theologically, rather than psychologically, and having regard to both the general and specific
healing possibilities of the Eucharist, it is to those practices I now turn.

100

Chapter 4
Baptism & Eucharist
Christians, of all people, should know that food shapes belief because their religion is
defined by a dinner. 1

4.0 Introduction
In a thesis considering the response of the Christian church to disordered eating, the inclusion of
the practices of baptism and eucharist is fundamental to the assertion that the Church has
something to offer those affected by disordered eating. In the light of this, it is therefore appropriate
to consider the impact of baptism and eucharist in forming the Church and its understanding of
what food and bodies were created for.

In many ways the practices of baptism and eucharist demonstrate what lies at the heart of the
church and what it means to be Christian, and a fuller examination of these themes will be
conducted below. Lest this focus be considered exclusive, looking only to the meaning of baptism
and eucharist for those within the Church, the assertion of this chapter is that the Churchs practice
of baptism and eucharist witness to the watching world something of Gods goodness and grace. In
baptism and eucharist it is argued that fragments of hope are offered to all who suffer from
disordered eating as the practices of baptism and eucharist connect profoundly with the issues
associated with disordered eating.

The importance of looking at the practice of baptism lies in its role as the initiation rite of the
church. Whilst it is acknowledged that different ways of understanding and means of administering
the sacrament of baptism exist in the breadth of the church catholic, there is little to be gained in

Stephen H. Webb, Good Eating (Grand Rapids, MI: Brazos Press, 2001), 141.

101

this context from becoming embroiled in the debate about infant or believers baptism. The focus is
not so much about the one being baptised but what the practice of baptism into the church signifies.
The variety of ways that baptism is practiced in different expressions of the church does not
diminish the common understanding underpinning baptism, that it is a ritual of initiation into the
life of the church. 2

One of the recurring themes among those suffering with disordered eating is that of identity. In
fact, in her seminal work Eating Disorders, psychologist Hilde Bruch identified identity (along
with autonomy and perfection3), as one of the key issues in disordered eating. 4 She discovered that
for many of her anorectic patients, their distorted body image and refusal to eat were outward
symptoms of an inward lack of a sense of identity. Bruch notes, [My] view of anorexia nervosa as
a desperate struggle for a self-respecting identity developed gradually from contact with many
patients.5 One of her insights was that her patients exhibited a sense of not being in control of their
sensations, not being able to know how they felt and therefore found it difficult to establish an
identity, in some cases, particularly an identity independent of the patients parents.

This being the case, it is imperative that the Church addresses the issue of identity. Building on
Bruchs foundational belief that identity is a core issue for those suffering from anorexia nervosa,
this chapter explores one key way in which the Church addresses identity - through its sacramental
practices of baptism and eucharist. As well as taking a wide focus in addressing the significance of
baptism and eucharist in shaping the identity of the Church, this chapter maintains links with
Bruchs work at the points where the focus is narrowed to include specific examples where

The commentary on the text of the World Council of Churches document, Baptism Eucharist and Ministry
acknowledges that the inability of the churches mutually to recognize their various practices of baptism as
sharing in the one baptism, and their actual dividedness in spite of mutual baptismal recognition, have given
dramatic visibility to the broken witness of the Church (World Council of Churches Baptism, Eucharist and
Ministry Faith and Order Paper No. 111 (Geneva: World Council of Churches 1982), 3). Yet even those
who do not recognise baptism conducted within another denomination and only consider legitimate the
baptism within their own denomination nevertheless maintain that baptism is a once only event. The previous
baptism is not considered as baptism.
3
Further discussed in Perfection and Perfectionism, Chapter 6.
4
Hilde Bruch, Eating Disorders.
5
Hilde Bruch, Eating Disorders, 250.

102

participation in these practices enables those suffering from eating disorders to connect with their
feelings and recover a sense of identity.6 In this way Bruchs insights provide a standpoint from
which to step into theological consideration of ecclesial practices, but also function as a recurring
thread running through the chapter whereby the impact of church practices upon identity may be
connected with psychological approaches.

To consider Christian baptism is to explore how the church views identity. The biblical references
to those baptised into Christ7 speak of those who have been initiated into a new identity, no
longer the old self but a new creation. 8 Exploring the themes of dying to the old self, new life in
Christ, participation in the new community which is the Body of Christ are all ways of
understanding Christian identity and ways in which the practice of baptism speaks of a way
forward for those enslaved by disordered eating who struggle with their own identity and the
possibility that they may be able to be different to their current state. Baptism into Christ is an
action defying the natural human inclination to define identity through biological kinship, gender,
race, sexuality, economic status, nationality or consumer preference. In baptism it is identification
with Christ which becomes the primary lens through which identity is understood. It is proposed
that this is the practice which addresses the distortion of body image associated particularly with
anorexia nervosa. The possibility of dying to false images and regaining true perspective is the
theological response to this aspect, whilst the practical means of confessing and being accountable 9
may provide the framework for acknowledging the problem and working through it.

If baptism is considered as a once only transition from one identity to another, eucharist is
discussed in the light of it being a regularly performed practice which not only relates to identity
but also involves eating and drinking. The combination of identity and eating and drinking is a
potent mix when viewed in the context of disordered eating. The significance of looking at the

See the account of Margaret Bullit-Jonas at section 4.3.3.6.

Rom. 6:3, Gal. 3:27.
8
2 Cor. 5:17.
9
See chapter 5.
7

103

practice of eucharist in the context of this thesis revolves around how the central act of the
Churchs worship not only shapes the identity of the Church but potentially either defines the
disordered eater as other, excluded from participation, or offers a means of healing and
transformation at the Lords Supper.

The question of whether there is power in the practices of baptism and eucharist in and of
themselves will be discussed or whether there is something else happening in the life of the Church
and the world to whom the Church witnesses as these practices are undertaken.

To discuss disordered eating and the response the Church can offer without reference to the
practices of baptism and eucharist would be to miss what is essential to the life of the Church in its
identity and purpose and to omit one of the unique contributions the Church can make to the lives
of those affected by disordered eating. Examining the practices of baptism and eucharist will
demonstrate how the Church can share the fullness of the hope it has in Christ, albeit offered in the
fragmentary way it lives.

4.1 Methodology
In order to discuss the practices it is necessary to have some established understanding of their
meaning and purpose. Some prefer to talk about practices in an idealised framework of how it
would be if the Church understood and lived them as the author understands them. This thesis
acknowledges that though the church is not perfect and has fragmented and at times misused those
means of grace ordained by its Lord to unite itself to him, serious attempts have been made to
rediscover common ground in theology and practice. The methodology of this chapter is to ground
the understanding of baptism and eucharist firmly within the reality of the ecumenical consensus of
the discussions of the World Council of Churches, as articulated in the document Baptism,
Eucharist and Ministry. 10

10

WCC, Baptism, Eucharist and Ministry.

104

The reason for choosing this as a framework for theological reflection is in part due to the breadth
of ecumenical consensus it represents. The report was carefully put together after considerable
ecumenical dialogue and though responses from individual denominations commenting on the
original document run to four volumes, the positive welcome given to the document makes it a
good starting point when considering the practices of the church. Moreover, the headings generated
by the WCC are comprehensive enough to encapsulate the different dimensions of the practices of
baptism and eucharist and provide some helpful theological avenues to explore in relation to
disordered eating, and particularly the themes drawn from previous chapters. 11 To work with
Baptism, Eucharist and Ministry as a conversation partner in exploring the theology and practice of
baptism and eucharist is to engage with both the reality and the aspirations of the Church. As a
document Baptism, Eucharist and Ministry represents a unity of approach despite the diversity of
traditions who contributed to it.

The chapter which follows will bring into dialogue the conclusions of the WCC document, the
practices of the Church and the world of disordered eating. In doing so the implications of the
practices of baptism and eucharist will be seen from the theological standpoint from those
representing what it means to be church, but these understandings will be interpreted in the light of
the lived practice of the Church and applied in relation to those struggling with disordered eating.
As well as taking this ecumenical, practical approach, the chapter which follows seeks to be
aspirational in the sense of looking to how the practices of baptism and eucharist may offer
something positive to those whose eating is disordered.

11

Such as identity, autonomy, perfection, community, food, and control.

105

4.2 Baptism
Baptism introduces or initiates persons into a new people. The distinguishing mark of this people is
that all prior given or chosen identity definitions are transcended. 12

This section of the chapter considers baptism as a practice performed once only as a rite of
initiation into the Church which holds out the possibility of life not as biologically, psychologically
or culturally determined, but capable of transformation.

Baptism, Eucharist and Ministry introduces the section on baptism thus:

Christian baptism is rooted in the ministry of Jesus of Nazareth, in his death and in his resurrection.
It is incorporation into Christ, who is the crucified and risen Lord; it is entry into the New Covenant
between God and Gods people. Baptism is a gift of God, and is administered in the name of the
Father, the Son, and the Holy Spirit. 13

The following discussion of the meanings of baptism, whilst acknowledging the significance and
equal validity of the all the headings stated in Baptism, Eucharist and Ministry, dwells particularly
on the fourth and fifth emphases regarding how incorporation into the body of Christ has the
potential to shape how embodied living is practiced.

4.2.1 Baptism: How does participation in Christs death and resurrection, conversion,
pardoning and cleansing and gift of the spirit relate to disordered eating?

Christian baptism in the name of the Father and of the Son and of the Holy Spirit has several facets
but the argument of this section is that the change in identity wrought by baptism is the defining
mark. The first section considers what the practice means in terms of participating in Christs death
and resurrection and suggests that for those suffering with eating disorders, the practice of baptism

12
13

Yoder, Body Politics, 28.

WCC, Baptism, Eucharist and Ministry. 2.

106

speaks of solidarity in suffering, identification with Christ and hope of a life resurrected without the
presence of disordered eating. The section on conversion, pardoning and cleansing discusses the
importance of new beginnings and the possibility of leaving the past behind. Baptism as a gift of
the spirit and the identity confronted by grace is the focus of the third section, exploring how the
gift of new identity in Christ challenges the notion of creating ones identity through bodily
perfection.

The fourth section suggests how this new identity, received as a gift in baptism into Christ, finds its
practical outworking in the way in which embodied existence is re-envisioned in light of
participation in Christ. The prevailing worldview of the individual autonomous body shaped by
cultural pressures to look in a particular way and thus give meaning to ones identity is challenged
by the practice of baptism. The implications of defining the embodied existence of the baptised in
relation to participation in the body of Christ will be discussed and lead to an exploration of ways
in which that new identity in Christ works out in practice as a sign of the Kingdom of God.

4.2.2 Dying to Self, Risen with Christ, Dying to Disorder, Rising with Hope
A. Participation in Christs Death and Resurrection
Baptism means participating in the life, death and resurrection of Jesus Christ. Jesus went down into
the river Jordan and was baptized in solidarity with sinners in order to fulfil all righteousness (Matt.
3:15). This baptism led Jesus along the way of the Suffering Servant, made manifest in his
sufferings, death and resurrection (Mark 10:38-40, 45).14

The identification with humanity made manifest in Christs baptism offers hope to all who struggle
with the idea that God does not and cannot understand them. That Jesus was baptised in solidarity
with all who have failed in their attempts to live life with God at the centre gives hope. That Jesus,
who was perfect, was willing to identify in baptism with all who fall so far short of perfect serves
as a reminder that it is by grace and not by works that salvation comes to us.
14

Baptism, Eucharist and Ministry, 2.

107

That this document on baptism, on Christian identity, makes reference explicitly to suffering is
noteworthy. The understanding that baptism involves baptism into Christs sufferings has been
interpreted various ways. Jesus knew what it was to suffer and whilst not wishing to conflate the
sufferings of Christ with the suffering of those in the grip of disordered eating, the notion of
solidarity in suffering offers a dimension of hope.

By baptism, Christians are immersed in the liberating death of Christ where their sins are buried,
where the old Adam is crucified with Christ, and where the power of sin is broken. Thus those
baptized are no longer slaves to sin, but free. Fully identified with the death of Christ, they are
buried with him and are raised here and now to a new life in the power of the resurrection of Jesus
Christ, confident that they will also ultimately be one with him in a resurrection like his (Rom. 6:311; Col.2:13, 3:1; Eph. 2:5-6).15

In the practice of baptism, to say that it is possible to change ones identity by dying to self
literally putting off who one once was, is a powerful sign of the hope of the gospel. And yet, for
those whose lived experience is more closely articulated by Pauls lament that I do not understand
my own actions. For I do not do what I want, but I do the very thing I hate 16 rather than being no
longer slaves to sin, but free, 17 the question of changed identity in baptism raises further questions.
If one is enslaved to disordered eating, is that the same as being enslaved to sin, and if so, what of
the practice of baptism?

More positively, the eschatological hope expressed in the sentence they will also ultimately be one
with him in a resurrection like his18 may well be the theme which needs emphasising in the context
of disordered eating, that though every day the triumph of new life in the power of the resurrection
is not felt, just because it is not experienced, does not mean it is not true. On a level beyond
15

Ibid.
Rom. 7:15.
17
Rom. 7:17-18.
18
Baptism, Eucharist and Ministry, 2.
16

108

individual experience it can be said that a transition in identity has been made and it is in this
transition marked by baptism that identity is different and the door to a future hope is opened. This
is not to say that because nothing physical or experiential has happened that therefore something
spiritual must have,19 rather that there is an aspect of the practice of baptism which witnesses to a
deeper reality of the way the world is and the categories by which it is defined.

Participation in Christs death and resurrection witnesses to our need to die to those parts of
ourselves and the world we are part of which do not reflect the ways of the kingdom of God.
Language about dying to self is particularly emotive in the case of disordered eating where from a
psychological point of view it may be suggested that the lack of self or conflict about ones
identity lies at the heart of the problem. Understanding baptism in terms of dying to the disorder
may frame baptism in a more specific way, particularly for those who have come to define their
identity in terms of being anorectic or bulimic. For some whose experience is that an eating
disorder has become a dominating force within their life, dying to the disorder has been likened to
ending an abusive relationship.20 Whilst understanding the potentially helpful consequences of
likening participation in Christs death with dying to the eating disorder, caveats need to be raised
about the danger of completely equating the sickness of the disorder with sin. On the one hand,
having acknowledged that clinically defined eating disorders are classified as a mental illness, the
pastoral consequences of increasing the guilt of the sufferer by terming their illness sin are
potentially damaging. On the other hand, totally equating dying to sin with dying to the eating
disorder narrows the definition of sin much too far and excludes other forms of sin which have
nothing to do with the eating disorder.

Perhaps the greatest significance of the element of participation in the death and
resurrection of Christ, as practiced in baptism, is the focus on Christ as the one in

19

Lysaught identifies this process occurring in relation to sacraments and healing within a healthcare setting.
M. Therese Lysaught, Suffering in Communion with Christ, in John Swinton and Richard Payne (eds.),
Living Well and Dying Faithfully (Grand Rapids, MI: Eerdmans, 2009), 66.
20
Jenni Schaefer with Thom Rutledge, Life without Ed (New York: McGraw-Hill, 2004).

109

whom identity is shaped. His pattern of laying down one form of existence to be
raised to another testifies to a means of transformation which entails sacrifice and
suffering in stark contrast to easy promises of self-actualisation.

4.2.3 Conversion, Pardoning and Cleansing

The baptism which makes Christians partakers of the mystery of Christs death and resurrection
implies confession of sin and conversion of heart. The baptism administered by John was itself a
baptism of repentance for the forgiveness of sins. 21

Whenever someone is baptised the act of either pouring water over them or immersing them in the
waters of baptism testifies to the cleansing power of God. The emphasis on forgiveness in much
popular literature on disordered eating bears witness to the guilt experienced by many sufferers. 22
Whether guilt is the lived experience or not, the symbolism surrounding baptism as an act washing
away the past and initiating a new person is powerful. IfChristian baptism proclaims that change
in identity, understanding, and behavior (what the apostles call repentance) is possible for all,
then whether people feel guilt or not may not be so important. 23

4.2.4 Incorporation into the body of Christ and a Sign of the Kingdom
Through baptism, Christians are brought into union with Christ, with each other and with the
Church of every time and place. Our common baptism, which unites us to Christ in faith, is thus a
basic bond of unity When baptismal unity is realized in one, holy, catholic, apostolic Church a
genuine Christian witness can be made to the healing and reconciling love of GodBaptism
initiates the reality of the new life given in the midst of the present worldIt is a sign of the
Kingdom of God and of the life of the world to come. 24

21

Mark 1:4.
Gregory L. Jantz, Hope & Help for Eating Disorders (Colorado: Shaw Books, 1995) contains chapters
entitled Finding the way to Forgiveness and The Dance of Fear, Guilt and Shame.
23
Yoder, Body Politics, 42.
24
WCC, Baptism, Eucharist and Ministry. 3.
22

110

The practice of baptism is a physical act involving embodied human beings. The sprinkling of or
immersing of the candidates body in water is a physical sign of a new identity in Christ and as part
of his Church.

The following section will explore what it means to be incorporated into the body of Christ. This
will involve a consideration of embodied identity and the change that is brought about by baptism
into Christ. The focus on this element of understanding identity in relation to union with Christ and
participation in the church which is the body of Christ is key to developing the application of this
practice so far as it relates to disordered eating.

The understanding that every human experiences life as an embodied person seems almost too
simple a statement to make, but its importance lies in the bearing that it has on our understanding
of the place and significance of the body. Having a body is a shared feature of human existence,
though the subjective experience of being embodied is unique to every person. Since the
Enlightenment, the societal conception of the body in the Western world has been founded on the
understanding of the whole person as autonomous.

Much ethical debate has sought to engage with this view of the body on its own terms. Particular
strands of theology have been at the forefront of such debate. Evangelical theologies have worked
on the understanding that in response to the gospel Christians pursue a life of active discipleship
and that the sanctification of the believer relates to the whole of life. This includes ones
relationship with and use of ones body. Many pronouncements by the church about what should
and should not be done with our bodies come from an individualist post-enlightenment treatment of
scripture as universal principles to be applied to all, regardless of their relationship or nonrelationship with Christ. As such, the view of what bodies are for and what behaviour is appropriate
or permissible has been reduced to a series of maxims. Taken out of the context of the community
of faith who witness to the centrality of the risen Christ, these pronouncements may at times appear

111

unconnected, arbitrary rulings for those within the church; and irrelevant, unintelligible dictates to
those outside the church. 25

This section contends that the emphases on individual piety and rationality in a context of
modernity leads to an impoverished account of how Christians live embodied lives and that the
practice of baptism is disruptive to this way of perceiving embodied existence. The links between
Protestant theology which had a formative influence on the cultures of the USA and the UK and its
possible outworking as one of the socio-cultural features which forms a breeding ground for
disordered eating will be discussed below.

Theology at its worst has prized cognitive understanding of doctrine over the exercise of Christian
practices, individual privatised commitment over corporate participation, and an emphasis on
redemption at the expense of incarnation. As a consequence some sections of the church have
concentrated theological interest heavily on what may be done or not done with ones body in
relation to certain areas26 but virtually ignored other aspects of embodied existence. 27 Indeed,
emphases which have stressed the salvation of souls rather than the salvation and redemption of the
whole person have generated two opposing extremes. The first is a Gnostic leaning towards
viewing the matter of the body as corrupt and corrupting. This results in a retreat from, and
suspicion of the body and a renewed pursuit of the safer ground of the intellectual quest for
doctrinal purity. In contrast to this negative view of the body, the second response is that identified
by R. Marie Griffiths.28 The individual body is seen as the canvas on which the state of the soul is
displayed and therefore to be cultivated to an ideal of perfection. This idolisation of the body of

25

An example of this would be the way in which the media approaches the Churchs response to issues
concerning beginning and end of life, and specifically the womans body when discussing the issue of
abortion.
26
Bodies which are male or female are gendered and sexual, and in some circles ones stance on sexual ethics
is counted as a defining mark of whether one is orthodox or not.
27
Note for example the limited number of publications during the twentieth century which considered the
discipline of fasting or the appropriate response of the Christian toward food.
28
R. Marie Griffith, Born Again Bodies (London: University of California Press, 2004).

112

the individual is as much a distortion of the tradition as the neo-Gnosticism and it is toward a third
way which avoids both these extremes that in the course of this section is directed.

In his articulation of the sanctified body, Stanley Hauerwas argues that individual bodies should
be interpreted in the light of participation in the body of Christ, precisely that which is initiated in
baptism. 29 In engaging with this work, whilst not fully endorsing its conclusions, I seek to
formulate how these insights might provide a way of perceiving embodied identity in a way which
may liberate those bound by disordered eating. A further development of this possibility looks at
how participation in the body of Christ might form disciples who take as their example the
incarnate Jesus revealed in scripture and how the embodied existence of humanity may be shaped
by his.

Any discussion of the relationship between the individual body and the body of Christ into which
the Christian is baptised necessarily acknowledges the complexity of meanings generated by the
subject. The variety of interpretations of the individual body and embodied existence which
influence any theological treatment of the body need to be named 30 before embarking upon any
discussion. As someone culturally located in the UK I am aware that in this society the individual
experiences life in a context where the body is more than a functional physicality; it is a signifier of
identity, protected by law and laden with meaning. The first part of this section argues that the
philosophical foundations stemming from the Enlightenment create a societal understanding of the
body as the autonomous property of the individual, defined in the various languages of professional
disciplines and separated into spheres of interest. The body and the influences upon it as defined in
psychology may differ considerably from what is described in sociology. 31 The consequences of

29

Stanley Hauerwas, Sanctify them in the Truth, (Nashville: Abingdon Press, 1998).
These would include a dualistic view of mind and body, pursued by those who view the body as simply a
vessel to house the important essence of the person which resides in the mind. In contrast, an approach
influenced by phrenology would see the importance of the body as a canvas upon which the inner life and
character of the person was displayed through their physical features. Feminist analyses of the body note the
significance of gender in the way the body is perceived and experienced. These and many other ways of
referring to the body and embodiment all have a bearing on how theology relating to the body is understood.
31
See Chapter 2.
30

113

this for how people relate to their own bodies and the bodies of others will be explored and
especially the fact that much modern theology has often accepted the claims of Enlightenment
thought in its own interpretation of the body and embodiment.

My contention is that in discussions surrounding the relationship between body and identity many
have failed to appreciate that the body is not neutral. By neutral I do not refer to the theological
sinfulness or redeemed nature of the body, whether Christians perceive their bodies as good or
bad,32 but that aware of it or not, many seeking to discuss the relationship of the individual body
to the body of Christ carry with them unspoken assumptions about the notion of body which they
have adopted from the culture around them. Most typically this will be adopting the prevailing
view of the liberal political society that the body of the individual is autonomous and sacrosanct.
That the body is the autonomous domain of the individual is likely to be unquestioningly accepted
and this position has been defended by the majority of theologians until relatively recent times. 33
Without this principle the political and legal constructs of society are threatened and the close
allegiance of particularly evangelical Christians to politics of the liberal state makes it difficult for
some to conceive of any other way of understanding the body. That the body as understood by the
State and the body as lived in the Church and defined by its relationship to Christ are not the same
may cause discomfort among some, but it is on this basis that this argument proceeds.

The naming and defining of the body in terms which are inconsistent with the revelation of God
constitute powers which exert influence over the body. The starting point for any opening up of
theology concerned with body, identity and disordered eating must be to recognise the existence of
these underlying assumptions or powers and hold them to the scrutiny of Gods revelation in
Christ.

32

Though these binary distinctions do little to help our understanding of our bodies as being part of the
ongoing process of sanctification.
33
For perspectives which do not argue for the absolute autonomy of the individual body, see Stanley
Hauerwas, Sanctify them in the Truth, (Nashville: Abingdon Press, 1998); Dale B. Martin, The Corinthian
Body (New Haven: Yale University Press, 1995); Robert Song, Genetic Manipulation and the Body of
Christ Studies in Christian Ethics 20 (3), 399-420.

114

The extent to which the body is referred to in the language of modern medicine or concepts of
sociology, psychology, anthropology or feminist thought frames the values and understandings
attributed to it. Modern medicine has as its aim the relief of suffering and as such struggles to
conceive of a situation where bodily suffering may serve a purpose or where the death of a patient
can be anything other than failure.34 The viewpoint which almost deifies the medical profession and
consequently believes that medicalisation of a problem and hospitalisation of the patient is always
for the best, is not necessarily supported by evidence. Current research into the treatment of
eating disorders in the home of the sufferer demonstrates an awareness within the medical
establishment that a purely clinical approach of hospitalisation and medical intervention may not be
the best solution for all disordered eaters. 35

Feminism has highlighted the diversity of embodied experience, particularly making the case for
the female experience of patriarchal oppression being borne out in relation to the female body.36
The influence of feminist thought upon society includes raising questions about how the fact that
people are embodied in actual, physical bodies shapes their perception, experience and
understanding of the world. The nature of identity as gendered and the relevance of that to
disordered eating has been explored previously, but the discussion below brings into dialogue the
primacy of identity as being determined by gender with the words of St Paul in Galatians 3, that
within the Church there is now neither male nor female, all are one in Christ.

Psychologys description of the relationship of the body and mind or the constitution of the self
has become a dominant narrative in some quarters, defining how the world is for those who
describe themselves by its language. The complex relationship between the body and the mind is
34

See Gerald P. McKenny, To Relieve the Human Condition (New York: State University of New York,
1997) 180-1, for what McKenny describes as a geography of suffering. He identifies five kinds of suffering,
some which have a purpose and others which do not and argues that the Baconian project tends to conflate all
five into suffering which must be eradicated.
35
See research in progress conducted by J. F. Morgan reported in The Northern Centre for Eating Disorders
Annual Report 2009(Leeds: Leeds Partnerships NHS Foundation Trust, 2009).
36
See discussion in Chapter 2.

115

not a new issue, but within popular culture there exists a willingness to accept the professional
opinion of the psychologist in defining the relationship of mind and body. The insights of
psychology are not to be dismissed, particularly when referring to a disorder previously defined as
biopsychosocial. There is an acknowledgement that the body of Christ includes the body, mind
and spirit of those incorporated into it.

All these disciplines make claims about what embodied identity is and to some extent express value
judgements about it. The challenge for Christians in the midst of these competing truth claims is to
decide which to accept and which to reject. It matters a great deal whether when speaking of the
body we are thinking of merely flesh and bones or a living, breathing canvas of meaning which
encapsulates the very essence of a person. Whether we speak of having a body rather than being
embodied reveals our relationship to the body. In the first case, having a body takes a possessive
stance. It locates the nature of the real us as having a totality of existence which is greater than the
body. When we talk of having a body, it recognises that our physical body is but one aspect of our
person, related to the other parts which make us us. The second expression which speaks of being
embodied suggests a more closely integrated personhood combining body, mind and spirit.

As human experience cannot be separated from being embodied beings, this will naturally raise
questions about the nature, theology and purpose of the body. It is therefore imperative that any
discussion of the body is clear about the power language has in defining and controlling debate,
and that it is important that Christians do not unquestioningly legitimate the prevailing cultural
definitions.

My assertion is that the body in western liberal society bears a plethora of meanings and is subject
to influences which Christians are often unable to name because of our complicity in the system
which determines how the body is understood. In identifying ourselves so closely with the liberal
state which has prized bodily autonomy and privatised belief we struggle to articulate a Christian
response to views of embodied identity and practices of the body with which we disagree because

116

we are so firmly wed to the notion of ones body as ones own inviolable kingdom. This may be
one of the reasons the Church has struggled to address disordered eating. Where an individual
chooses to starve their body or fill it with food, only to then purge it of that food, the resources of a
theology based on the autonomous individual body are stretched. Whilst there is a recognition that
something is wrong, the best that can be argued is and appeal to natural law that this is against
nature.

4.2.4.1 Incorporating different bodies into the body of Christ from the body as given to fluidity
and modification
As someone located in the UK I am aware that I live in a culture whose attitude toward the body
borders on the obsessional. Alongside the challenges identified above in actually conceptualising
embodied identity, there is the challenge that the issues surrounding bodies and embodiment are
not static. Advances in medical research challenge the very notion of the body as it has historically
been understood, as bodies are increasingly described in and controlled by medical terminology.
The ethical debates about the beginning and ending of life are often framed in terms of personhood,
seeking to delineate when a person and a body are no longer congruent. 37

Aesthetic developments in body modification also bring into question the fundamental nature of the
purpose and givenness of the human body. Cosmetic surgery for aesthetic reasons is on the
increase38 and the flexibility and fluidity of the bodily form is greater than ever before. Media
speculation about an obesity crisis in the general population, 39 a rise in eating disorders among
adolescents and focus on the weight and body shape of celebrities has heightened societal
awareness of the body and placed its size and practices firmly on the political agenda.

37

This section does not engage in specific discussion of personhood nor of the anthropological relationship
between body and soul. Instead the focus is on the body as the physical manifestation of embodied existence.
38
The British Association of Aesthetic Plastic Surgeons reported a 6.2% rise in the number of breast
augmentation operations performed by their members between 2010 and 2011, taking the total for 2011 to
10,003. (The Guardian, 30th January 2012).
39
For example The Guardian Online reporting on government measures to tackle obesity in the population
http://www.guardian.co.uk/uk/2006/jun/16/health.foodanddrink (30th September 2008).

117

These are but a few of the challenges flowing from secular culture which seek to shape and define
twenty-first century bodies. To lay all blame at the door of secularisation would, however, be a
failure to accept the part that Christianity has played in generating a distorted view of the body. In
an attempt to separate from the world and pursue individual piety within the confines of American
evangelicalism, a disturbing picture has emerged of the ideal of bodily perfection becoming an all
encompassing pursuit. Rather than separating themselves from the culture, as is often the
evangelical position, 40 American evangelicals have influenced societal aspirations and practices. 41
Over time, however, the failure to ground such practices in the life of the worshipping community
in relationship with Christ has caused the evangelical pursuit of a sanctified body to collapse into
an individual body project undertaken without reference to God.

4.2.4.2. Bodies in Crisis

Writing from a North American context R. Marie Griffiths contends that analysis of the culture in
which she finds herself reveals that individual bodies are in crisis. 42 The drive to cultivate the
perfect body has, she believes, become a consuming project within mainstream America. The
combining of spiritual, moral, political and health beliefs has generated a culture where born-again
bodies as she terms them are the form to which many aspire as the outward manifestation of an
inward spiritual state of holiness. In a thorough and nuanced appraisal of factors influencing this
situation she concludes that this is not simply forces of secularisation at work but that the Protestant
heritage of the United States has been a significant factor in generating attitudes to the body:
Rather than a logical outgrowth of religions supposed dislodgment, American fitness culture is an
end that Protestantisms specific American forms boldly pursued: a devotional project aimed at
bodily perfectability.43 Popular literature aimed at the evangelical market, such as Deborah
Newmans Loving your Body make explicit the link between individual piety and the body: Youll

40

This may be expressed in terms of being in the world but not of the world.
Such as encouraging dietary restraint as an outworking of the moral virtue of self-control and advocating
exercise as a means of increasing the effectiveness of the body in service of God.
42
Griffith, Born Again Bodies.
43
Griffith, Born Again Bodies, 13.
41

118

realise that growing close to the Lord naturally creates a desire to care more for the body He gave
you.44

It is not only within the confines of the church that such material flourishes. Griffith identifies the
three elements which originated as Protestant practices for individual spiritual growth which have
come to exert considerable influence upon the populace in general. Food abstinence, sexual
restraint and phrenology (the idea that the visible exterior of the body or face reflects the spiritual
reality within) are having an ongoing influence over the bodies of Americans, and Griffith
identifies the resulting outcome as a culture which is obsessed with a quest for a perfect body.

It can be seen that the pietistic strand within Christianity, both in evangelicalism in the US and in
Griffiths examples from early Methodism in the UK 45 provide fertile ground for focus on the
individual body as the locus of holiness. Initially, the purpose of fasting and sexual restraint was
framed clearly in terms of the individual believers sanctification and the use of the body to glorify
God. What developed over time, however, was a combining of a quest for individual piety with the
privatising of religious faith. What emerged was a situation where the traditional evangelical
emphasis placed on personal commitment and personal growth became susceptible to an
individualistic quest for holiness separated from other believers.

If the outworking of salvation is framed in terms of developing a born-again body, in the sense
that the toned, disciplined body reflects the disciplined self, then the potential for two serious
distortions exists. Firstly there is the possibility of censure of those within the church who do not
conform to the healthy bodily ideal. When the aesthetic value or fitness of bodies become the
means by which a Christians life is judged, even based on the justification that what is seen
externally reflects the inner life, then the good news that salvation is a gift of Gods grace has been
lost. The second consequence of equating born-again bodies with growth in holiness is a tendency
44

Deborah Newman, Loving Your Body (Wheaton, Illinois: Tyndale House, 2002), back cover.
Griffith quotes John Wesleys advice to the early Methodists to fast weekly, as was the stated practice of
the Anglican Church. Griffith, Born Again Bodies, 13.
45

119

to generate self-righteousness among those who achieve it. This also is a perversion of growth in
holiness as it ignores the grace by which salvation comes. Overtones of both these mindsets can be
seen in disordered eating. In the anorectic who feels the only thing she can control is her food
intake we see the visible representation of her spiritual/mental quest portrayed on her emaciated
body.

The evangelical emphasis on personal conversion and individual commitment has often reduced
questions about the body to a quest to get right what I do with my body. The jump from biblical
texts to application is made without seeking to understand the context and concepts unstated in the
text but which form the scaffolding around which they are built.

There are many similarities in attitudes toward the body between those in the UK and the US but
significant cultural differences can be detected. These include historical, social and religious
differences which have shaped cultural understandings. Although these differences ensure that the
situation in the US will not be identically replicated in the UK, sufficient points of congruence exist
to hold up a mirror to the UK context that some of the dangers within it might be recognised.

Locatedness in a particular time and context cannot be denied nor escaped from but undoubtedly
shapes identity and how the body is perceived. Views about what is beautiful or natural or normal
will to some extent have been influenced by the culture inhabited. How Christians read the Bible
and seek to discern the purpose and right use of their bodies in such a situation can be problematic.
How then might the Church extricate itself from the situation Griffiths describes where the quest
for bodily perfection has become an all-consuming feature of individual holiness? Is it possible to
prevent incorporation into the body of Christ through baptism collapsing into obsession about ones
individual body, sustained through disordered eating?

120

4.2.4.3 Recovering fragments letting go of my body as my autonomous inviolable kingdom

The movement toward what is being termed postmodernity presents both challenges and
opportunities in forming a Christian understanding of the body of the individual which is faithful to
scripture. As raised above, the increased interest in the body and pressures upon concepts of the
body to respond to a changing and diverse context challenge Christians to live a story of
embodiment consistent with the claims of faithful Christian discipleship.

Stanley Hauerwas understands postmodernism to offer fertile ground for a re-imagining of

holiness, including holiness related to embodied existence, because of the change in the way people
understand the world to be.

The loss of the self and the appreciation of the significance of the body, and in particular the bodys
permeability, can help us rediscover holiness not as an individual achievement but as the work of the
Holy Spirit building up the body of Christ. 46

The assertion is that postmodernity entails a loss of the self. As people are confronted by a diversity
of complex situations, they adapt to respond to the context in which they find themselves. Their
identity in any given situation differs to the point of their existing in a number of different
identities, thus breaking down an integrated, stable identity or self. Without the constraints of
tradition or inherited social convention to dictate behaviour there is a fluidity of identity unknown
by previous generations. This in part accounts for the focus on the body as a canvas of identity,
since in an environment where others form their impressions only from what they see in the body
before them,47 the image projected by that body becomes increasingly important.

Rather than agreeing with Hauerwas that what exists in contemporary western society is a loss of
the self, I find more convincing the analysis of Anthony Giddens: [t]he reflexive project of the
46

Hauerwas, Sanctify them in the Truth, 78.

Rather than by relationship to kin or social class or occupation as would have been the case in previous
generations.
47

121

self, which consists in the sustaining of coherent, yet continuously revised, biographical narratives,
takes place in the context of multiple choice as filtered through abstract systems. 48 The self is not
lost, merely continually redefined in the reflexive project of self-identity. The body is necessarily
drawn into this project in the way it is fed, nurtured, styled, dressed, used, sculpted, adorned,
articulated and perceived.

Where the body was once an inviolable autonomous unit there is now an openness to otherness,
and instead of rigidity there is flexibility. In seeking to form theology at the juncture between
modernity and postmodernity the body becomes an example of many of the features of the
paradigm shift proposed. What was once controlled, boundaried, and individual is now more fluid,
permeable and receptive to participation with the other.

The opportunity this presents is for a relinquishing of understanding the body as the locus of
individual piety, which has, as Griffith demonstrates, the potential to lure humanity away from
dependence on the grace of God. Instead, while not denying the need for conversion in response to
the love of God which reaches out to human beings personally, it is fitting that our understanding
of the body moves beyond an individual response to participation with the other.

4.2.4.4 Bodies and the Body of Christ

What the influence of postmodernity and the questioning of the traditional understanding of the
body may be leading to is this: the embodied self is most truly who it is in relationship with God
through Christ and in the community that is the Body of Christ.

When Paul writes to the Church at Corinth he writes to people concerned with how their allegiance
to Christ determines their embodied relationship to food, sex and each other. It appears that they

48

Anthony Giddens, Modernity and Self-Identity: Self and Society in the Late Modern Age (Stanford, CA:
Stanford University Press, 1991), 5.

122

too were prone to understanding their individual identity and needs as their primary focus, 49 and it
is in this context that Pauls use of the image of the Body of Christ expresses something profound
about the call to Christian living. In stating the proper end of bodies as glorifying God, 50 Paul
challenges them Do you not know that your bodies are members of Christ? 51 and to provide
further emphasis, Or do you not know that your body is a temple of the Holy Spirit within you,
which you have from God, and that you are not your own? 52

It has been symptomatic of the individualism which has been embraced that the individual body as
the temple of the Holy Spirit has been the dominant image when discussing the body in some
Christian circles. Too often the failure to heed the second part of that verse, that we are not our
own, has led to a failure to recognise that relating to individual bodies as members of Christ
requires living in such a way as to reclaim embodied existence as fully participating with others in
Christ. Consequently thoughts, words and actions are to be shaped, not by the theological
justification of the prevailing culture (which may have been influenced by a distortion of Protestant
theology in the first place), but by faithfulness to Christ who became incarnate and who by his
Spirit now lives in his people.

The purpose of embodied identity should not be an autonomous project of self actualisation. The
radical disruption to the prevailing worldview, occasioned by attending to Scripture, calls
Christians to understand their individual bodies as primarily part of the body of Christ. In sharp
contrast to the secular culture which enshrines the autonomous individual body and sections of the
church who have appropriated that same concept, the challenge to view individual bodies through
the lens of participation in the body of Christ subverts what many have been led to believe the body
is for.

49

See Pauls condemnation of the Corinthians for their selfishness at communion in 1 Cor. 11:21-22.
1 Cor. 6:20.
51
1 Cor. 6:15.
52
1 Cor. 6:19.
50

123

As Paul develops the reference to bodies and the body of Christ, 53 Hays notes the fact that, instead
of equating the one body with many members and the church, Paul equates them with Christ.
Instead by identifying the many members of the church directly with Christ, Paul seems to press
beyond mere analogy to make an ontological equation of the Church with Christ. 54 Whereas we
are tempted to reduce this to a metaphor, to understand that the embodied people who follow Christ
are in some way Christs body has implications for the interpretation of individual bodies.55

Most radically to the ears of contemporary Christians, our bodies are not our own, in the sense that
we may do with them exactly as we please. The significance of conversion is not merely a
conversion of the mind, an assent to a proposition that Jesus Christ is Lord. It is more than that a
submission of the whole person, body, mind and spirit to the Lordship of Christ and a becoming
part of the body of Christ. That surrender to Christ involves a surrender of all that we are means
that, in contradiction to the voice of the secular culture, I no longer own my body. If bodies no
longer belong to the individual but are first and foremost members of the body of Christ, the
perception of those members and what may be done with them must be shaped by that
understanding. Learning to interpret bodies in the light of this gives understanding of why
condemnation of particular practices in scripture matter. In the Christians attempts to glorify God
in your body the question changes from is this the right thing to do with my body? to how does
my behaviour affect the life of the body of Christ? To eat at communion whilst other bodies are
undernourished demeans the body of Christ. 56 To unite Christs body with a prostitute is
unthinkable.57 In relation to eating disorders, this challenges the Church to offer care to emaciated
bodies and address the embodied person with love and grace. For those suffering from disordered
eating, the challenge is to see their body as part of a greater enterprise than their own battle with the
disorder.

53

1 Cor. 12:12.
Richard B. Hays, First Corinthians, (Louisville, Kentucky: John Knox Press, 1997), 213.
55
It is not clear how Paul would have understood the relationship between the individual bodies and the body
of Christ. For further discussion, see Hays, First Corinthians.
56
1 Cor. 11.
57
1 Cor. 6:15.
54

124

The worth of the body which was previously expressed in its usefulness, health or beauty is now
found in its participation in Christ. Experiencing embodied existence as part of the body of Christ
releases those in the Church from the quest for individual bodily perfection in the present age (as
defined and sought by particular sections of society). Participation in the body of Christ transforms
the understanding of what bodies are and what they are for. Bodies speak of identity, not as
canvases exalting individual personal moral choices, but participating in the body of Christ they are
bodies shaped by worship of God and service of the other. In moving from interpreting bodies as
individual projects of piety to emphasising the relational nature of embodied discipleship within the
body of Christ our focus changes. It is less about whether or not it is permissible to have a WWJD
tattoo on ones body and more about doing what Jesus does.

The body of Christ speaks prophetically of what true embodiment might be, for there is room
within the body of Christ for all types of body. In contrast to the secular culture or even the
individual pietistic ideal, there is no pressure for bodies to look a particular way. The diversity of
gifts within the body of Christ indicates that a diversity of bodies in terms of colour, ethnicity,
disability and size is to be celebrated not ignored. Being embodied has a particularity to it which
makes us gendered, sexual, racial beings. The human tendency to create binary categories of
black/white, male/female, left-handed/ right-handed, deaf/ hearing, none of which fully explains
the complexities of our human experience, does have the potential to generate barriers and false
assumptions. When I perceive myself first and foremost as a member of the body of Christ, bodily
particularity is no longer the primary marker of identity. It is not the particularity which defines me
over and against other Christians but common identity as members of the body of Christ.

The radical disruption of scripture to ethics and the body is seen truly when the body of Christ, the
church, is the means by which the individual body is understood. The sharp contrast can be seen
with the view undergirded by western liberal capitalist ideals which seek to establish bodily
autonomy over and against the bodies of others. In the body of Christ, the mutual submission of

125

members reveals the interdependence of the strong and the weak. If one suffers, all suffer and so
the mutuality and care for the needs of others stems from fact that they are also part of the body of
Christ. The attentiveness to the weak, the poor and the suffering which this view of body enables
reflects the incarnate Christs refusal to shun those whose bodies did not meet the standards of
health and purity demanded by their society.

Together, the body of Christ seeks to discern the revelation of God in Christ and what that might
mean for a Christian response to the many issues facing the body. In worship, this is not merely a
collection of individuals, but primarily the body of Christ, each member aware of and attentive to
the others. In worship, in praying for the sick, all suffer with them, for when one part of the body
suffers, all suffer. In hearing and responding to Scripture those who are the Church seek not what
this might mean firstly for each individual body, but what this means corporately for the body of
Christ. In confession there is an opening up, speaking truthfully of who we are, so that in receiving
the forgiveness of others in the Body we experience the forgiveness of God.

If this emphasis on the body of Christ as a community of Christians sounds more Catholic than
Methodist, it should be noted that Christian heritage contains various examples of when we have
sought genuinely to live our embodied existence not as a private individual quest but open to
others. This requires a depth of commitment to being the body of Christ found in some of the
assemblies of the early evangelicals. Their commitment to being the body of Christ entailed
openness and vulnerability, acknowledgement of sin, serving the poor, proclaiming the good news
and living as the body of Christ. Through participation in the body of Christ discipleship was a
communal activity and the shaping and actions of individual bodies formed a natural part of such
participation.

126

I mentioned earlier that Griffith uses John Wesleys instructions to Methodists about fasting as a
negative example of the pursuit of individual piety.58 It is my assertion that early Methodist class
meetings and band meetings are examples of being the body of Christ and pursuing embodied
holiness which do not collapse into an individual quest or salvation by works. 59 Wesleys
consideration of the practicalities of discipleship reveal a concern for the pursuit of holiness which
is grounded in the realities of eating, drinking and clothing the body. Rather than becoming a
prescriptive moral code, however, these issues were considered in the context of a disciplined
community of believers. The band and class meetings constituted an outworking of being the body
of Christ as the bodies of early Methodists ordered themselves to receive the grace of God, to be
accountable to one another and together, to pursue holiness.60 Hauerwas alludes positively to the
value of Wesleys understanding that the church should be a disciplined community, 61 a recovery
of which would mark a welcome return to both a neglected heritage and to a place where
understanding the body in the light of participation in the body of Christ could be a reality.

For Christians, participation in the body of Christ is the antidote to the quest for bodily
perfection62 as promoted in western industrialised nations. The radical nature of scripture subverts
such ideals and instead the body of Christ is a place where bodily perfection is neither a quest for
eternal youth in an attempt to deny the onset of age (and with it death), nor a purely spiritual
endeavour, denying the reality of embodied living. Instead participation in the body of Christ
allows for embodied Christians of all shapes and sizes to encounter Christ in community and as
they meet, to be transformed by his grace.

58

Griffith, Born Again Bodies, 13.

For a fuller discussion of early Methodist class and band meetings, see Chapter 5.
60
For further discussion, see Barrie Tabraham, The Making of Methodism, (Peterborough: Epworth, 1995),
46.
61
Hauerwas, Sanctify them in the Truth, 80.
62
Namely having a body which is slim, toned, unblemished and conforming to a particular ideal of beauty.
59

127

4.2.4.5 The Body of Christ and the Incarnate Christ

If it is through participation in the body of Christ that we understand the purpose and appropriate
uses of our bodies, how then do we seek to reconcile this with our understanding of the place of
scripture? I will suggest that central to understanding our participation in the body of Christ is our
attentiveness to the incarnate Christ revealed in scripture and the risen Christ present in his church
by the Holy Spirit.

Being people who are shaped by living in relationship with the risen Christ and participating in the
community which is his body re-orientates our bodies. Being shaped and formed in discipleship
means being faithful in worship and service, and as we encounter the incarnate Christ in the
gospels we become more aware of the Christ present by his Spirit in his body, the church. It would
be possible to identify many passages in scripture where the body of the incarnate Christ witnesses
to how the church as the body of Christ should be. The following example addresses just one aspect
of how those who understand their own bodies as members of the body of Christ may engage with
the incarnate Christ. In the gospels we see Jesus unashamed of his body as a woman pours perfume
over his feet and wipes them with her hair. As the body of Christ we learn that being embodied is
good and that to experience physical devotion or affection need not be primarily sexual. 63 In our
practice of discipleship we then become those who welcome the lonely and unloved and witness to
the love embodied in Christ which affirms the gift of physicality.

If it is possible to relinquish the overemphasis on piety focussed on the individual body and allow
scripture to radically disrupt our self understanding that we are autonomous individuals who gather
to be a collective of individuals called church, then we may be able to encounter a richer
understanding of embodied existence which flows from the experience of being participants in the
body of Christ. In looking to the incarnate Christ, we see embodied existence where physicality is

63

In John 12:3, Marys action in anointing Jesus feet and wiping them with her hair is a highly sensual act
which goes beyond what would be expected social interaction between a man and a woman. Jesus reaction
to this expression of bodies which are sexual is not condemnation but an implicit affirmation that to be a
sexual being is part of being an embodied being.

128

enjoyed and it is pure,64 where the physical limitations of the body provide opportunities for
encountering Gods grace, 65 and where Jesus use of touch demonstrates an affirmation of bodies
deemed outcast by society.

Understanding our own bodies through their participation in the body of Christ enables us to draw
some conclusions which are counter-cultural. They are not counter-cultural in the sense of what
they stand against, which has been a feature of some church pronouncements about the body.
Instead they re-orientate our way of thinking about the body, what it signifies and what end it might
pursue.

The result therefore is that the Christians body derives its value from the fact that it is part of the
body of Christ, a fact to which other members of the body bear witness. Consequently, the
relationship of that member with other members of the body of Christ means they seek only to do
those things with their body which encourage and build up other members to maturity, rather than
seeking personal fulfilment. This is to suggest that in approaching our bodies this way, Christians
might become embodied people on the way to being more fully the bodies they were created to be.
That is to understand the body not as something to be escaped from, nor something to idolize, but
as integral to a disciplined life lived fully to the glory of God in participation with the community
which is the articulation of his body on earth.

4.2.5 Baptism - Conclusion

Having established that baptism into the body of Christ has a direct bearing on how Christians
understand and use their bodies, the conclusion reached is that this witnesses to a new way of
being. In baptism, the powerful imagery of death and resurrection serves as a reminder that powers
which hold the old self captive can be vanquished and instead, the new self is raised to life. The
possibility of dying to the eating disorder and living life in all its fullness is a possibility attested to

64
65

See the anointing of Jesus feet in John 12.

See Jesus asking for a drink as he meets the woman of Samaria in John 4.

129

in the practice of baptism. The hope is held out to those within the church and witnessed by those
outside the church that identity change is possible. To those defined by the label of anorexia
nervosa or bulimia nervosa, baptism, and the community of the baptised, offers hope of a
different way of definition which has at its heart being loved, cleansed, pardoned and transformed
by the Christ into whom one is baptised. The growing into this identity in the sense of becoming
what you already are is practiced in the eucharist:

Baptism needs to be constantly affirmed. The most obvious form of such reaffirmation is the
celebration of the eucharist.66

It is to that practice that we now turn.

4.3 Eucharist
4.3.1 Introduction
At the heart of this thesis lies one of the fundamental questions which instigated it: what does it
mean for a faith whose central act is eating and drinking to engage with disordered eating? Or to
look at it from another perspective, what does a Christianity with eucharist as its defining practice
mean for those who suffer from disordered eating?

If baptism into the Church marks being part of a new way of life, a new community, a new identity,
and eucharist is a sign and means of affirming that identity, the position of those who suffer from
disordered eating presents a challenge to the church. Is it possible for those who suffer from
disordered eating to participate in the eucharist, and what does it mean both for those whose eating
is disordered and for those whose eating is not?

66

WCC, Baptism, Eucharist and Ministry, 5.

130

4.3.2 What sort of meal is the eucharist and does it matter?

When speaking of eucharist as one of the practices of the church it is necessary to clarify what is
being spoken of. Whilst it is necessary to enter into some discussion about what is being referred
to, it is equally important not to be diverted by the controversies which have arisen through the
centuries considering this central Christian practice. 67 Some reference will be made to the debates
surrounding the origin and development of the eucharist 68 regarding the transition between
common meal, token feast and ritualised act, as this has particular significance when relating the
practice of eucharist to disordered eating. The question of whether the practice of sharing a token
feast in a ritualised setting is more or less inclusive than a full shared meal including breaking of
bread and sharing wine will be explored.

Rather than tracing the historical development of the eucharist, key expressions of eucharist as
practiced in the life of the Church will be discussed insofar as they offer ways of exploring the
relevance of the practice of eucharist in relation to disordered eating. The main focus of this
chapter is less about what sort of meal is shared and more about what the practice itself
demonstrates in the life of the church and beyond.

Aside from the debate about whether the Last Supper was indeed a Passover meal, 69 various
scholars locate the origins of the eucharist in the Jewish practice of the prayers of blessing at
mealtimes.70 From this, Raymond Moloney notes the link between our dependence on food
reminding us of our dependence upon God. He views the Jewish prayer over the food, blessing God
for his provision, as denoting all meals as religious meals. The form of prayer before the meal and
prayer after the meal combined with the action of eating the meal form a ritual of worship:

67

For a background to some of these issues, see Thomas J. Fisch (ed.), Primary Readings on the Eucharist
(Collegeville, M.N.: Order of Saint Benedict, 2004).
68
Dennis E. Smith, From Symposium to Eucharist (Minneapolis: Fortress Press, 2003).
69
B. M. Bokser, Was the Last Supper a Passover Seder? Bible Review 3 (1987) 24-33.
70
Raymond Moloney, The Eucharist (London: Geoffrey Chapman, 1995); R. H. Gundry, The Use of the Old
Testament in St. Matthews Gospel with Special Reference to the Messianic Hope (Leiden: Brill, 1975); L.
Johnson, The Date of the Last Supper Scripture 9 (1957), 108-115; Craig E. Evans Mark 8:27- 16:20,
Word Biblical Commentary vol. 34b (Nashville, T.N.:Thomas Nelson, 2001), 389.

131

A basic thesis of this book is that, in instituting an act of worship for his community, Our Lord did
not begin from nothing. For the external form of his worship he turned to the familiar rituals of
grace before and after meals. These he celebrated in a new way relating them to himself and his
death.71

The insights of Moloney are pertinent at this point as the locating of eucharist within the context of
giving thanks or pronouncing blessing over the food bears witness to the fact that the Last Supper
was not the only occasion where Jesus blessed and broke bread. In the feeding of the five thousand
we see a foreshadowing of eucharist as Jesus acts as host at a meal of blessed bread shared,
communion experienced and the kingdom of God witnessed in the feeding of the hungry crowd. To
hold the eucharist within the framework of Jesus ministry, including times of table fellowship, and
also the still wider framework of Jewish mealtime practice is to see it in context. The eucharist as
seen in the institution narrative, 72 has particular, defining characteristics not found in other
occasions when Jesus broke bread with his disciples;73 but to separate it from the rest of Jesus
ministry is to lose the importance of meals as a time where Jesus welcomed the unwelcome, fed the
hungry and taught about the Kingdom.

In considering the wider context of the eucharist scholarly opinion has debated whether the Last
Supper was a Passover meal or not. 74 The significance of this lies in the understanding of what
Jesus was doing in the meal. The parallels drawn between the Passover lamb sacrificed and the
sacrifice of Jesus are woven into the Eucharistic liturgy. 75 The language of covenant is explicit in
the institution narrative and so the references to God fulfilling his covenant to Israelites in leading

71

Moloney, The Eucharist, 10.

Matthew 26: 26-29, Mark 14: 22-25, Luke 22:14-20, and 1 Corinthians 11: 23-26.
73
Namely the command Do this in remembrance of me.
74
The synoptic gospels representing the occasion of the Last Supper as a Passover whereas John portrays
Jesus as the Paschal Lamb but not the meal as Passover. See also Bokser, Was the Last Supper a Passover
Seder?.
75
Christ our Passover Lamb is sacrificed for us, therefore, let us keep the feast, Holy Communion Ordinary
Seasons, Order 3 in The Methodist Church, Methodist Worship Book (Peterborough: Methodist Publishing
House, 1999).
72

132

them out of Egypt and new covenant in Jesus blood leading humanity out of sin are significant
points of reference within the eucharist.

This eucharist as instituted by Jesus is more than a token ritual meal. The inclusion of the sharing
of bread and wine in the context of a more substantial meal is discussed by Dennis Smith. In From
Symposium to Eucharist Smith suggests that the banquet was the foundation of social interaction in
the ancient world and though there were various forms practiced by various groups, the Christian
eucharist finds its place in this social context. 76 It is therefore no surprise that the early Christian
community had as one of its foundational practices breaking bread.77 Quite what is meant by
breaking bread has been open to interpretation. Historians have proposed a variety of suggestions,
based on the dining culture of the time and the various ritual meals taking place in that era. Smith
asserts that his study of the meals celebrated in the culture surrounding the early church leads him
to believe that the [e]arly Christians celebrated a meal based on the banquet model found
commonly in their world.78

For the early Church, eucharist was not a token meal but a full meal at which Christ was
remembered when they broke bread together. The deeply significant feature in Pauls writings
concerning the eucharist is the eating together of Jews and Gentiles. The disagreement between
Peter and Paul in Galatians 2 about Jew and Gentile eating together goes to the heart of the identity
of the baptised. Breaking bread is a visible demonstration of unity in Christ, a primary marker of
identity of those baptised into Christ and therefore eating with those who are also in Christ is now
permissible. Paul is similarly incensed when the eucharist becomes the focus of division between
rich and poor. Identity in Christ makes food laws and preservation of Jewish purity secondary as
much as it requires the wealthy to share with and attend to the poor.

76

Smith, From Symposium to Eucharist.

Acts 2:42.
78
Smith, From Symposium to Eucharist, 279.
77

133

By the third century it appears that the common meal or agape feast became separated from the
more formal liturgy for celebrating the eucharist 79 partly due to the changes in meeting venue from
the homes of the believers to gathering in larger assemblies; The community that began its
existence in private homes around a banquet table evolved into a church that met in a meeting hall
before an altar.80

The essence of the Eucharist as token feast has remained consistent despite changes in wording,
language and interpretation of what is taking place within the liturgy. Whilst valuing the eucharist
in its form as token feast, various attempts have been made to recapture the early church model of a
more substantial meal at which Christ is remembered. From my own tradition, John Wesleys
appropriation of the Moravian Love Feast or agape meal was one such attempt to provide some of
the benefits of communion when it was not possible due to the constraints of church order to
celebrate the eucharist.81

Having acknowledged the transition from table fellowship and shared meal to token ritualised feast
the question remains: What defines eucharist? In response to this, Baptism, Eucharist and Ministry
offers the following guidance:

The Eucharistic liturgy is essentially a single whole, consisting historically of the following elements in
varying sequence and of diverse importance:
-

hymns of praise;

act of repentance;

declaration of pardon;

proclamation of the Word of God, in various forms;

confession of faith (creed);

79

Smith, From Symposium to Eucharist, 286.

Smith, From Symposium to Eucharist, 285.
81
As an ordained Anglican priest John Wesley urged members of the Methodist Societies to receive
communion at their parish church. As the numbers of Methodists increased Wesley celebrated communion
with the members of the Methodist societies. Where there were insufficient ordained clergy to preside at
communion, Methodists celebrated the Love Feast, sharing cake, drink, prayer and testimony.
80

134

intercession for the whole Church and for the world;

preparation of the bread and wine;

thanksgiving to the Father for the marvels of creation, redemption and sanctification (deriving from
the Jewish tradition of the berakah);

the words of Christs institution of the sacrament according to New Testament tradition;

the anamnesis or memorial of the great acts of redemption, passion, death, resurrection, ascension
and Pentecost, which brought the Church into being;

the invocation of the Holy Spirit (epiclesis) on the community, and the elements of bread and wine
(either before the words of institution or after the memorial, or both; or some other reference to the
Holy Spirit which adequately expresses the epikletic character of the eucharist);

consecration of the faithful to God;

reference to the communion of saints;

prayer for the return of the Lord and the definitive manifestation of his Kingdom;

the Amen of the whole community;

the Lords prayer;

sign of reconciliation and peace;

the breaking of the bread;

eating and drinking in communion with Christ and with each member of the Church;

final act of praise;

blessing and sending.82

This combining of many elements into a single entity in the Eucharistic liturgy is an attempt to
differentiate celebrating the eucharist from any number of other events in the life of the church at
which some of those elements are present. Where the five facets of eucharist mentioned in
Baptism, Eucharist and Ministry83 are present, that is what distinguishes it from other occasions.
The thesis I propose is that the practice of eucharist within the life of the Church is an act which
transforms those who participate and initiates ways of living which witness to God in Christ.

82

WCC, Baptism, Eucharist & Ministry, 16.

These being ;Thanksgiving to the Father, Anamnesis/ Memorial of Christ, Invocation of the Spirit,
Communion of the Faithful and A Meal of the Kingdom. WCC, Baptism, Eucharist & Ministry.
83

135

4.3.3 Eucharistic meanings and attendant practices

The section above discussed the various forms in which Eucharistic practice has developed and
which features are considered essential. The purpose of this discussion is to explore whether
eucharist is synonymous with one or more practices.

John Howard Yoder looks beyond the controversies of the church from the Middle Ages and
Reformation and discusses eucharist in the early church as simply the practice of breaking bread.
This he develops into considering the common table at which Jesus is remembered as a model for
economic equality. Yoder puts forth the argument that the act of breaking bread is the practice of
eucharist, sharing material sustenance in a context where all are of equal status. 84 This is a
reinforcing of the new identity and new community initiated through baptism.

Whilst the understanding of eucharist as a single practice of breaking bread may form an
overarching narrative about how the church is called to live, I seek here to develop the argument
about practices by considering how the various elements identified in the WCC document as
meanings of the eucharist can be found in scripture as practices or virtues of the Christian
community which shape the way Christians live in the world. Specific attention will be given to the
ways these practices witness to the world in which disordered eating manifests itself.

4.3.3.1 Thanksgiving and giving thanks

That the word eucharist has as its linguistic origin thanks or blessing should convey something
about the practice of the Christian church.

The WCC document in discussing the meaning of the eucharist, identifies thanksgiving to the
Father as one of the five headings under which Eucharist is discussed:

84

Yoder, Body Politics, 20-22.

136

The eucharist, which always includes both word and sacrament, is a proclamation of the work of
God. It is the great thanksgiving to the Father for everything accomplished in creation, redemption
and sanctification, for everything accomplished by God now in the church and the world in spite of
the sins of human beings, for everything that God will accomplish in bringing the Kingdom to
fulfilment. Thus the eucharist is the benediction (berakah) by which the Church expresses its
thankfulness for all Gods benefits.85

This section will argue that thanksgiving is more than a liturgical framework. It proposes that
thanksgiving to give thanks is an action which flows from the communion table out into the
world and as such is a practice the church must attend to. The implications for this in relation to
disordered eating will also be discussed.

Thanksgiving to God the Father in the Lords Supper echoes the prayer of thanksgiving prayed by
Jesus at the beginning of his final meal on earth with his disciples.86 As has been previously
indicated,87 this was not uncommon: in fact the prayer of blessing before meals was a feature of
Jewish table practice and served as a reminder to be thankful to God for daily food. 88 Within the
Eucharistic liturgy, the great prayer of thanksgiving includes giving thanks to the Father for
creation and for the new creation in Christ. No distinction is made between the physical and the
spiritual; thanks is offered for both. Likewise, thanks is given for the bread and wine, material,
physical substances used to convey divine love.

The thanksgiving which forms part of the practice of eucharist is formative in shaping Christians
into a people who are thankful and joyful in the face of the seemingly thankless and joyless
challenges of the world. In his chapter on the word eucharist, Smith draws together the nature of

85

WCC, Baptism, Eucharist and Ministry, 10.

Matthew 26: 26-29, Mark 14: 22-25, Luke 22:14-20, and 1 Corinthians 11: 23-26.
87
See section 4.3.2.
88
Moloney, The Eucharist, 10.
86

137

thanksgiving and joy. That the early church broke bread and ate their food with glad and sincere
hearts89 marks one of the facets of Eucharistic practice as joyful celebration.

To give thanks is to express gratitude. To be grateful is to acknowledge indebtedness to the

goodness of another and to acknowledge indebtedness generates the realisation that one is not selfsufficient. In the Eucharist, the Church is reminded of its need to depend upon God, for the simple,
physical bread which sustains life, but also for the unsurpassable gift of salvation and everything in
between. Developing a culture of gratitude flows from the communion table and shapes the lives of
those who partake.

Such thankfulness stands in sharp contrast to western consumerist cultural pressures to be

constantly dissatisfied with life. This discontentment is deemed necessary in order to suggest the
solution might be found in acquiring particular possessions or consuming particular products or
having particular experiences to assuage the discontentment. Psychologist Susie Orbach identifies
cultural forces which suggest people should be anxious about their bodies rather than thankful for
them when she observes, there is a subtle tracery of outside urgings which works on us, creating
a new and often dissatisfied relationship with our bodies.90 Exhibiting thankfulness in the face of
discontentment and dissatisfaction is a counter-cultural witness, grounded in the goodness and
grace of God.

The capacity to be a thankful people is challenged but not overcome when faced with the harsh
realities of disordered eating. My contention is that those who have been shaped through the
eucharist to practice thankfulness to God for the small and seemingly insignificant things of life as
well as the spectacular and obvious, are people well placed to stand alongside those struggling with
disordered eating. To be able to see each moment as a fragile step toward recovery and be thankful
for progress made is as important as being able to thankfully depend on Gods grace when setbacks

89
90

Acts 2:46
Susie Orbach, Bodies (New York: Picador, 2009), 2.

138

occur. The practice of thanksgiving, learned and enacted in the eucharist, equips the Church to live
in such a way as to support those who feel they have nothing to be thankful for.

4.3.3.2 Anamnesis and Remembering

Do this in Remembrance of me
The eucharist is explicitly instituted as an occasion of remembering. Wider questions exist about
who is doing the remembering and what is to be remembered.91

As the Church remembers Christs death and resurrection there is the challenge not to forget what
the Church exists to be and do. In faithfully remembering Christ there is more to it than an
intellectual process. To merely remember as a thought process is a shadow of what Eucharistic
remembrance is about in the life of the Church:

For most twentieth century Christians, remembering is a solitary experience involving mental recall.
But for ancient Jews and early Christians (the first of whom were all Jews), remembrance was a
corporate act in which the event remembered was experienced anew through ritual repetition. To
remember was to do something, not to think something. 92

This is why the practice of remembering as an action involving the physical participation in
breaking bread and drinking wine is so central to the life of the Church. The physical nature of
eating bread and drinking wine calls into play the element of embodied memory, where
participation involves an ontological connection with sharing in the body and blood of Christ. This
remembrance of Christ is more than a memory, and participation in the practice of remembering
reflects something of the uniqueness of eucharist.

91

Andrea Bieler and Luise Schottroff, The Eucharist, Bodies, Bread and Resurrection (Minneapolis: Fortress
Press, 2007). Brevard S. Childs, Israels Theology of Memory in Thomas J. Fisch (ed.), Primary Readings
on the Eucharist (Collegeville, MN: Order of Saint Benedict, 2004), 1-14.
92
Laurence Hull Stookey, Eucharist: Christs Feast with the Church (Nashville, TN: Abingdon Press, 1993),
28.

139

To remember Christ in eucharist is to remember not only Christs life, ministry, death and
resurrection but also to remember that all those who gather round his table are members of the
Body of Christ. In this sense what is also regularly remembered is that the life of the baptised is not
a solitary pursuit. Those incorporated into the body of Christ through baptism are called together to
live in response to his death and resurrection in practical ways.

In sharing in the Eucharist each is reminded of the body of Christ broken and his blood outpoured.
In a culture which seeks to avoid suffering and brokenness the Christian cannot escape the
realisation that it is Christs body broken on the cross which is the focus of salvation and hope. In
the mystery of the Eucharist the words this is my body, broken for you remind the Church that
participation in the body of Christ is at his invitation, through his grace and by his broken body.
Such remembrance reveals the futility of the secular quest for the perfect individual body and
declares that the way of salvation is not in some construct of bodily perfection or purity, but in
Christ whose broken body hung on a cross. In breaking bread and sharing wine the Church
participates in the mystery which sustains the body of Christ by remembering that it is Christ who
saves and transforms embodied selves. It is Christ, who in becoming incarnate revealed that
holiness is not an escape from the body but a purpose of the body, practised in the mess and
complexity of life.

In celebrating the resurrected Christ through sharing in the Eucharist we give thanks that though
our earthly bodies will die, in Christ there is the promise of the resurrected body. Though we do not
know what form or substance the resurrected body will take, we trust the witness of the risen Christ
and live our embodied existence in faith that death is not the end. Bodies which do not fear aging or
dying stand in sharp contrast to the myth of eternal youth portrayed in contemporary popular
culture. The idolising of youthful bodies and the careful sidelining of aged bodies in film,
television, fashion and business speak of a society which sees aging as a path to death and thus
attempts to deny its existence. Within the body of Christ the presence and acceptance of bodies

140

which age serves as a witness to the world that to the Christian, aging is not the worst thing that can
happen to ones body and death is not to be feared.

With regard to embodied living and eating, the practice of remembering stands as an antidote to the
frenetic busyness of elements of twentieth century living and the constant levels of background
noise, visuals and distractions existing to entertain and amuse but prevent serious reflection. As the
Church shares in eucharist, it becomes possible to collectively remember that the body of Christ
exists to eat well in the midst of a culture where disordered eating exists.

To eat well in eucharist is to eat simply, thankfully, discerningly and hopefully. Simply, because
in this sharing of bread and wine there is acknowledgement that nourishment, spiritual and physical
need not be elaborate or complex. Remembering to eat thankfully resonates with the Jewish
practice of meals as sacred events, living in a way which acknowledges the presence of God in the
practical details of life. Eating discerningly requires that in remembering Christ in the breaking of
bread, the body of Christ also remembers one another. Discerning the body of Christ in the midst of
disordered eating is difficult. Does it require that out of love for the weaker brothers and sisters 93
whose eating disorder causes them deep anguish when facing food, the rest of the body of Christ
refrains from celebrating the eucharist when those with eating disorders are present? Or does
discerning the body of Christ instead mean approaching breaking bread with due care and
sensitivity as a visible sign, remembering Gods faithfulness that all things can be overcome in
Christ?

In a culture where taking time to allow remembering to lead to a deep attentiveness to the present
moment is often perceived as wasting time, for the Church to practice remembrance enables it to
live from eucharist to eucharist reminded of what it means to look to Christ and live in the light of
his death and resurrection.

93

Rom. 14.

141

4.3.3.3 Invoking and depending

The Spirit makes the crucified and risen Christ really present to us in the Eucharistic meal, fulfilling
the promise contained in the words of institution The whole action of the eucharist has an
epikletic character because it depends upon the work of the Holy Spirit.94

In the eucharistic liturgy the Holy Spirit as the third person of the Trinity is invoked to make the
presence of the risen Christ a reality to those who participate. To invoke is the practice of asking
for help, to acknowledge dependence.

In invoking the Spirit the body of Christ acknowledges that it is dependent upon the grace of God
alone for everything. This liberates the Church from the understanding that it must work harder or
try harder. Practicing dependence upon the Spirit flows out into the life of the church as members
learn to live in interdependence upon one another as they are enabled by the Spirit. In this way the
regular practice of eucharist inculcates within the Church a means of sustaining that new identity in
Christ initiated in baptism. In mutual interdependence, looking to attend to one another, the reality
of living as the body of Christ is made manifest.

In relation to those with disordered eating the Churchs practice of invoking, of depending upon
God and one another, speaks in several ways. To those within the body of Christ whose eating is
disordered, the practice of asking for help involves depending upon grace rather than earned
achievement. Within the body of Christ, those who know what it is to depend upon God and who
practice mutual interdependence within the Body make themselves available to those with
disordered eating to offer help and support through recovery. One of the marks of life within the
Church as it depends upon the work of the Spirit is an openness to mutual support within the body
of Christ as in humility each part depends upon another. In addition, the practice of invoking and
depending may operate within the felt experience of the person suffering from disordered eating.

94

WCC, Baptism, Eucharist & Ministry.

142

Knowing oneself to be dependent upon grace may provide release from the relentless pursuit of
perfection.95

4.3.3.4. Communion and belonging

In Baptism, Eucharist and Ministry, the recognition that eucharist is communion of the faithful
occurs as the fourth meaning of this sacramental meal. In the two and a half decades since this
report was published, the understanding of eucharist as a practice of the Christian community has
been increasingly emphasised. The horizontal aspect of the bread and wine shared, its ability to
unite and speak of the bonds of the community which is the church has been articulated with some
vigour. This may be a counter-cultural corrective to the church in the face of an increasingly
fragmented and individualistic post-modern culture, particularly in the church in North America
and Europe. It is however striking in a context where eucharist as a practice is seen primarily as a
shared meal with its significance located in the relationships between those who partake, that in the
WCC document the reminder is present that in Eucharist, Thanksgiving to the Father,
Anamnesis/Memorial of Christ and the Invocation of the Spirit all precede the horizontal
dimension of Eucharistic practice.96

That is not to diminish the valuable insights of what it means to share in the Eucharist with fellow
believers and the significance of the church as a community sharing in bread and wine. The point
here is that any theology which seeks to establish eucharist as a sign of community as prior to the
three elements mentioned above misses the point. Participation in the eucharist is primarily about
participating in Christs death and resurrection until he comes again. We therefore have the re-

95

For a fuller discussion of the relationship between the drive for perfection in eating disorders and the
operation of grace, see chapter 6.
96
I do however acknowledge that the element of participation on the part of the Church in Anamnesis/
Memorial of Christ makes too clear a distinction between the vertically oriented and horizontally directed
aspects of eucharist unsustainable.

143

enacting of what happens in baptism being drawn into Christ, in whom sins are forgiven and we
are made new creations, and a participation in the eschatological hope of resurrection.97

With regard to eschatological imagination, we understand the holy meal practices of the followers of
Jesus and of the early churches as celebrations in which experiences of resurrection were shared as a
foretaste while social conflicts related to poverty, slavery, and privilege experiences of the powers
of death were not suppressed. Those who took part in the meal were infused into the body of
Christ with their actual bodies. Those meal practices express faith as a relational act of trusting in
Gods future with Gods people. Those who followed Jesus participated in resurrection in a
fragmentary way.
Also today, eschatological imagination is about the real stuff of life in all its pleasure, pain and
alienation. Bodies in pain are and will be transformed into resurrected bodies at the table bodies
that are indeed the temple of the Holy Spirit (1Cor. 3:16) abundantly filled with divine life.

To make the Body of Christ the primary reference in the meaning of the practice of eucharist is to
overlook what it means to be baptised into the body of Christ. To remember in communion that we
have been crucified with the Christ we gather to remember shapes the way we celebrate eucharist.
To remember Christ first and our new identity in Christ subsequently, maintains the link with
baptism but is a firmer foundation on which to celebrate eucharist as a meal shared by the faithful.
To hold together at table that each person comes with their own story of brokenness, failure, and
potential, but also stands there as one of those who has received grace, love and mercy purely
because of the resurrection of Jesus is part of the mystery of eucharist.

In the practice of eucharist, through the hearing of scripture, the liturgy and song, the sharing of
peace, the eating and drinking and prayer, in Christ the faithful are mystically incorporated and
bound together as the Body of Christ. In making reference back to the meaning of baptism for

97

Andrea Bieler & Luise Schottroff, The Eucharist, Bodies, Bread & Resurrection (Minneapolis: Fortress
Press, 2007), 6.

144

ones identity, eucharist becomes a practice reinforcing another way of understanding identity. All
that was expressed about seeing identity firstly through belonging to the Body of Christ rather than
primarily as an individual is mirrored as those who break bread together put the needs of others
before themselves. In heeding Pauls admonition of the Corinthians, the community who share
Eucharist by ensuring others needs are met before ones own exhibit the new identity and new
creation birthed at baptism.

In sharing in the eucharist the community of the faithful identify themselves with Christ rather than
whatever threatens to overwhelm them. In some contexts this may be eucharist shared in the face of
political oppression, violence or persecution. In other cases it may be that for the anorectic the act
of receiving communion, of eating the bread and drinking the wine and what is more, doing so in
the presence of others, constitutes an act of defiance against the disorder which threatens to control,
diminish and consume the sufferer.

To receive Christ in bread and wine is an act of confirming identity in Christ rather than being
defined by the label of anorectic, bulimic or binge eater. It is an act which affirms Christ as
healer, the one who can enable such an act involving food to take place. It is an action which
contains in its practice a fragment of hope that what takes place in eucharist may become one day a
life free of disordered eating.

4.3.3.5. Meal of the Kingdom and Hoping

The eucharist opens up the vision of the divine rule which has been promised as the final renewal of
creation, and is a foretaste of it. Signs of this renewal are present in the world wherever the grace of
God is manifest and human beings work for justice, love and peace. The eucharist is the feast at
which the Church gives thanks to God for these signs and joyfully celebrates and anticipates the
coming of the Kingdom in Christ (I Cor. 11:26; Matt. 26:29)98

98

WCC, Baptism, Eucharist & Ministry, 14.

145

The eschatological hope expressed in the eucharist holds out a vision of reality not yet here. What
then does it mean for the Church to practice hope? How is the kind of hope envisioned in the
eucharist made tangible in the practical life of the Church?

The members of the body of Christ who gather to celebrate eucharist in a Methodist Church in
Texas became aware of those in their Church and community who suffered from a variety of
addictions. From a conviction that celebrating eucharist involved acknowledging Christs victory
over sin and death and all that holds people captive, in hope, the church began a 12 Step Ministry. 99
To practice hope involved small groups of people struggling with addictions, meeting together
weekly to share experience, be accountable to one another and live with hope that they can live a
life free of addiction.

The hope for those whose eating disorder disables them from consuming the eucharistic elements
lies in the fact that as the body of Christ continues this practice, the knowledge that the kingdom of
God has been inaugurated but not yet made manifest means that one day, those with disordered
eating may be able to partake.

4.3.3.6 One Practice or Many?

Having de-lineated the eucharist into five discrete yet interrelated practices it is the contention of
this section that to view such practices independently from one another would be a mistake. The
following section seeks to discuss these practices as held together in the breaking of bread, that in
fact eucharist is one practice with many moments.

Sharing bread and wine in the Eucharist may in itself may be a point of transformation but it is also
a practice which may prove the greatest stumbling block to the participation within the church of
those with disordered eating.

99

For a detailed discussion of this church and its 12 Step Ministry, see Chapter 5.

146

When considering the central act of the practice of eucharist, sharing bread and wine, it might be
assumed that in relation to disordered eating this is the most difficult and exclusionary practice thus
far explored. The section which follows (4.5.4) suggests that despite the link between eucharist and
consuming which may prove a stumbling block for those in the church suffering from disordered
eating, there are both theological and practical indicators which run counter to this view.

Whilst it is commonly assumed that disordered eating is a problem with food, as Chapter 2
established the disordered relationship with food and eating can be observed as the symptom of
other complex issues in the life of the sufferer. To make a simple correlation between eating and
eucharist and deduce that this will result in the exclusion of those with eating disorders from
participation in the central act of Christian worship is to engage in a reductionism which fails to
acknowledge the complexity of disordered eating.

In describing her experience of receiving communion, bulimia nervosa sufferer Margaret BullittJonas articulates how, far from excluding her, eating the bread and drinking the wine become a step
on the road to her recovery:

When I stepped forward and stretched out my hands to receive Holy Communion, for the first time I
noticed the sheer physicality of the sacramental bread and wine. You literally taste, you swallow,
you take in God. I was amazed and moved to tears. It was as if Christ was willing to address me in
the only language that I could presently understand, the language of food. Here was the bread that
might give sustenance to the starving little horse trapped in the blizzard. Here was the bread that
might lead me home.100

Whilst Bullitt-Jonas experience cannot be taken as usual, it does at least suggest that the eucharist
may not be always a point of exclusion for eating disorder sufferers, and may for some, be a place
of healing.

100

Margaret Bullitt-Jonas, Holy Hunger (Oxford: Lion, 1998), 120.

147

Whether the bread and wine in contemporary Eucharistic practice may be perceived as food or as
something different is an interesting issue. As can be seen in the accounts of medieval fasting saints
there are occasions were the elements of communion are considered in an entirely different
category to the food which is being refused. To explore how individuals perceive the bread and
wine is highly subjective and cannot be adequately researched here, but the fact that in the context
of eucharist, bread and wine may be considered in the mind of the recipient as different from other
things they may ingest is of significance.

The practice of breaking bread for those whose eating is disordered may, as with Bullitt-Jonas, be
the occasion where deep healing takes place. For those members of the body of Christ who do not
suffer disordered eating, the practice of remembering the broken body of Christ and his power to
save, transform and nourish should heighten their awareness of the needs of those for whom even
partaking of a simple token meal is a major difficulty.

This understanding of Eucharist as a place of transformation or conversion through which those

who partake are formed and equipped to live differently in the world will be explored below in
dialogue with the Wesleyan view of Eucharist as a means of grace and converting ordinance.

4.3.4 What contemporary significance can be attached to Wesleys view of the Lords Supper
as a means of grace and a converting ordinance?
John Wesley classed the Lords Supper as one of the means of grace. In defining his usage of this
term he stated:
By means of grace, I understand outward signs, words, or actions, ordained of God, and appointed
for this end, to be the ordinary channels whereby He might convey to men, preventing, justifying, or
sanctifying grace.101

101

John Wesley, The Means of Grace in Forty-Four Sermons (London: Epworth, 1944), 136.

148

For Wesley, the eucharist or Lords Supper as he usually referred to it had no power in and of
itself. He was at great pains to ensure his hearers did not believe that the practice of celebrating the
eucharist nor the elements themselves were an end in themselves, but that they were a means which
God had ordained to convey to the human heart something of his grace. Wesley also took to task
those who advocated dispensing with the Eucharist lest it become an outward sign upon which
people relied at the expense of what he referred to as inward religion.

Treading the line between those who rejected the need to participate in the Eucharist and those who
sought to rely on it, Wesley endeavoured to defend the ways in which the practice of sharing the
Lords Supper may be a conduit of experiencing a transforming encounter with Christ. Taken
together with the other means of grace, prayer and searching the scriptures, Wesley conceives of
an instance where the earnest seeker partakes of the means of grace and it is only after
encountering God through the bread and wine that the seeker is assured of his salvation. In this
sense, eucharist, which in the majority of denominational traditions is reserved for the committed
only, is opened up to those who have examined their conscience but are not at that point able to
testify to an experience of conversion.

The implications of this theology when considered in relation to disordered eating are significant.
If, as Wesley suggests, the participation in eating bread, drinking wine and remembering Christ,
can be the point at which God speaks to the individual with an assurance of forgiveness, salvation
and promise of peace, then the possibilities for those who suffer from disordered eating are
profound.

Compared with the non-disordered eater it appears the effect of grace is heightened. The mystery of
God communicating with his children through the remembrance of Christs death and resurrection
and the eating of bread and drinking of wine appears compounded by the fact that something which
is so elementary to most people (and in many ways the profound nature of God communicating

149

with us in the simple and ordinary) is actually the breaking through of chains which bind those with
eating disorders, so that participating in eucharist is extra-ordinary.

Where Wesleys example in the sermon The Means of Grace saw eucharist as the culmination of
a series of steps on the sinners journey to conversion, the potential exists for the receiving of bread
and wine to be the moment where an individual is converted from being an eating disorder
sufferer to someone not defined by that label, or someone resolved to seek recovery. This is not the
same as equating Eucharist as a catalyst for instant healing, 102 but more about either a fraction of a
second in time where in eucharist all things are different, or a sense of this is a small step on a new
journey.

That the eucharist has the potential to be a converting ordinance is not the same thing as saying
every time a person participates in the Lords Supper they are, in either some tangible or intangible
way, transformed. For that to be the case, there would be some guaranteed link between the
practice of eucharist and its effect in a mechanistic sense. Nor does it follow that if a moment of
conversion or transformation in the life of the communicant does not take place resulting in a
physical healing or change, then something spiritual must have taken place. 103

For the community of faith, the practice of the eucharist with the understanding that what is being
performed may be a place of conversion from one way of being, or one framing of identity to
another is a way of demonstrating the possibility of transformation. Meeting around the Lords
table as a community of broken individuals and sharing in the narrative of Christs life, death and
resurrection speaks powerfully of the hope of transformation in the present and an eschatological
perspective that things will not always be as they are now.

102

Which, whilst possible, is not the most common experience.

See Lysaught on Instrumental Sacramentality and the tendency to assert that if a sacrament does not
work in bringing physical healing, it therefore must have had some effect in spiritual healing. Therese M.
Lysaught, Suffering in Communion with Christ, in John Swinton and Richard Payne (eds.) Living Well and
Dying Faithfully (Grand Rapids, MI: Eerdmans, 2009), 63.
103

150

Flowing from the act of breaking bread together the practices of a community united to Christ and
one another are shaped. Within the context of a culture where disordered eating is prevalent and
bodies are valued according to culturally moderated ideas of size and shape, the fact that those
baptised into the body of Christ have shared in an act which is social as well as economic has a
bearing on the conduct of life as the community disperses.

4.4. Conclusion
Those who have remembered Christs body broken and consumed bread as a physical attestation to
that remembering should go into the world ready to act compassionately toward those whose
bodies are broken by disordered eating. For some this will mean setting up a support network or
befriending scheme for those with eating disorders, 104 for others it may mean choosing not to
subscribe to magazines which promote airbrushed images of bodies which are part of the cultural
breeding ground for disordered eating. The breaking of bread, sharing the eucharist, also provides a
means of communal eating where relationships are fostered which may not be formed in another
way. Breaking bread in awareness of those for whom consuming bread is a struggle changes the
way food is handled in the family or community. It changes how men and women view and value
one another, not as objectified bodies but as fellow forgiven sinners who have met around the
Lords table in a state of grace. To break bread as those united to Christ is to proclaim his victory
over that which binds and oppresses and to commit to working to see that victory take hold in
individual lives until the kingdom comes and the heavenly banquet is enjoyed.

104

See Sarahs story in Appendix.

151

Chapter 5
Confessing and Accountability
Therefore confess your sins to one another, and pray for one another, so that you may be
healed.1

We admitted to God, to ourselves and to another human being the exact nature of our
wrongs.2

5.0 Introduction
Previous chapters have addressed the nature of food and identity, concluding that the Church has a
contribution to make to disordered eating by rediscovering some of its historical practices. Chapter
4 identified the significance of the Church as the body of Christ, a Eucharistic community
exploring together what becoming a new creation in Christ means. One element of this includes
Church becoming a place where life can be shared in all its depth and complexity. This chapter has
as its focus the practice of confessing and being accountable, which at its foundations requires
speaking forth and taking responsibility for what is expressed.

Hilde Bruch discovered that helping her patients speak about their eating disorder and be
accountable for their actions enabled them to move forward in treatment. She identified a core
feature of anorexia nervosa as lacking competence and effectiveness and confessing and
accountability is a practice which seeks to enable growth in those areas. Bruch details how she
adapted her approach and therapeutic method when treating patients with anorexia nervosa, If
there are things to be uncovered and interpreted, it is important that the patient makes the discovery
1
2

James 5:8.
Step 5 of the Twelve Step Recovery Programme

152

on his own and has a chance to say it first.3 Moving away from a psychiatric approach of listening
to the patient then immediately explaining and labelling 4 their experience, Bruch discovered the
value of allowing the anorectic patient to speak out (or confess) their feelings and concerns. This
enabled her patients to discover things about themselves, rather than be told them by the therapist
and with this increased confidence in their ability to think, judge and feel, the patients grew to
overcome the sense that they were incompetent and ineffective. This discovery of the power of
confessing has been developed subsequently through the advances made in CBT and particularly
its adaptation for treating eating disorders.

Bruchs important work in the field of developing a model of confessing and accountability
among those with anorexia nervosa introduces the issue of whether this is the same as the Churchs
ancient practice of confessing and being accountable for ones actions. Through identifying and
leaving behind past failures and aiming for goals with the support and encouragement of others it is
a practice which has been adopted by those outside the Church in their work with those with eating
disorders. Bruchs work is significant in identifying the usefulness of confessing and being
accountable from the perspective of psychotherapeutic treatment. This is further explored in the
sections of the chapter which look at models of secular confession, self-help groups and talking
therapies.5 As with the previous chapter, Bruchs identification of a core feature of anorexia
nervosa opens up possibilities for a much fuller theological exploration of the practice, in the case
of this chapter, confessing and being accountable.

In some sections the discussion will deal with confession to and accountability before God, as
practiced in the life of the Church, but it also takes into account the practice of confession and
accountability to other people as practised inside and outside the Church. The nature of corporate
confession by the Church and individual confession within the context of being part of the Church
will also be considered.
3

Bruch, Eating Disorders, 338.

Ibid.
5
See section 5.2.
4

153

To confess, in the sense of speaking out, as well as in the sense of admitting sin, has been a practice
of the Church through the ages. The fact that it has been an integral part of the life of the Church
throughout history is one of the factors which make it a significant choice for analysis in this thesis.
The core of the practice has always been there, through creedal confession and confession of sin,
though the way in which it has been undertaken has changed in different eras. The choice to
consider these particular practices of confessing and being accountable in this thesis is primarily
generated by two influences which are separate from one another in origin but which form an
interesting framework for discussing disordered eating in relation to the Church.

One factor in considering the power of confessing and accountability is the methodology of this
practice as exercised in secular weight loss and weight management programmes. There are
striking similarities in behaviour between what occurs in some Christian accountability or
discipleship groups and what happens in Weight Watchers or Slimming World sessions. In a diet
culture which speaks of confessing diet sins, a group support mechanism for individuals to help
order their eating has developed whereby mutual confession and accountability is employed to
reach a desired goal. Likewise in some programmes designed to support those with clinically
defined eating disorders, the practice of confessing in the sense of speaking out and being
accountable to another for ones thoughts and actions is increasingly seen as a means of bringing
behavioural change and combating disordered eating. 6

It can be argued that groups such as Weight Watchers have identified features which have been
inherent in the life of the Church since New Testament times. At a time when many in the church
in the West have neglected the regular practice of confessing to one another and being mutually

See recent research on cognitive behavioural therapy in, C. G. Fairburn, Z. Cooper, H. A. Doll, M. E.
OConnor, K. Bohn, D. M. Hawker, J. A. Wales, R. L. Palmer, Transdiagnostic Cognitive-Behavioral
Therapy for Patients with Eating Disorders: A Two-site Trial with 60-Week Follow-up, American Journal of
Psychiatry 166 (2009), 31119.

154

accountable, those outside the church have seen their value and harnessed their power to meet their
particular aims.

If one of the reasons for considering the practice of confessing and accountability in relation to
disordered eating is drawn from the secular popularity of this practice, the other reason for
including it in this research is an emphasis which is deeply felt within this authors Methodist
heritage.

Ecclesiological questions raised by the growth of Cell church toward the end of the twentieth and
beginning of the twenty-first centuries have caused renewed interest in the small group as a
particular understanding of church.7 The distinction is made between ecclesia and ecclesiola,
between a church with small groups (which for example meet for Bible study or fellowship or
particular ministries) and small groups which themselves constitute church. This becomes
profoundly significant when considering the context of confessing sins to one another in a church
context. Accountability within the small group which is church is different to the larger gathering
where a small group may be viewed as an added extra for those who are especially committed or
have particular needs. The possibilities for the church rediscovering the practice of confessing
together and being accountable may be greater as the understanding of the purpose and nature of
church is subjected to scrutiny and as models and structures of church change.

The interest in small groups has caused a number within Methodism to return to the roots of
Methodist practice and revisit the Class meeting or Band meeting as a means of engendering
faithful discipleship.8 The historical practice of the Methodist Band meeting will be discussed in
the section considering the nature and purpose of confessing as it illuminates the power and
potential of confessing faith in the form of testimony and confessing sin before God and to others.

7
8

See, for example, Phil Potter, The Challenge of Cell Church (Abingdon: BRF/CPAS, 2001).
David Lowes Watson, Covenant Discipleship (Nashville: Discipleship Resources, 1991).

155

A later section in this chapter will consider the practice of accountability within the Covenant
Discipleship group which is a reworking of the Methodist Class meeting.

It would appear that both groups associated with eating behaviours and those seeking to faithfully
be the church have common ground in focussing on confessing and accountability. This raises
questions about whether the same thing is happening in both and what processes are at work in
each. Is the Weight Watchers group merely a particular form of confessing sins (in the form of
failure to keep to an agreed diet) and being accountable to the others in the group (that one will try
harder next week or have to endure another week of failure), or is there something fundamentally
distinctive about the nature of the accountability group where Christians confess to one another in
the sight of God and are accountable for their discipleship which marks it out as different? Drawing
on the insights of Walter Wink in his work on the powers, it is the assertion of this chapter that
although it may appear that the content of both groups may be similar, the nature of those groups is
essentially different.

In order to make a case for this difference but also to acknowledge points of congruence this
chapter will articulate an understanding of confessing and accountability as practiced by the church
and discuss how it relates to disordered eating. The theology of the practice of confessing and
being accountable will be explored, suggesting that there is something distinctive in the way this is
practiced in Christian community which shapes how the church is enabled to speak into society
regarding those elements which provide fertile soil for disordered eating to flourish. It is argued
that this goes significantly deeper than the church merely establishing support groups for those with
eating disorders (though this is one outcome) but also that the practice of confessing and being
accountable may speak into how the church acts as prophet as well as drawing those who are part
of it into more wholesome lives of holiness. The final section acknowledges the basis of the secular
model as having insight into a richer reality which may be offered by a church which rediscovers
the power of confessing and accountability.

156

5.1 What has been the Churchs historical understanding and

practice of confessing and being accountable?

5.1.1 Introduction
The introduction to this chapter suggested a twofold rationale for discussing the practice of
confessing in relation to disordered eating and the Church. The section which follows considers the
notion of confessing in the wider sense of speaking out, and what it means for the Church to
confess its faith. It is argued that to confess faith goes to the heart of the identity of the Church and
it is from that position that it is able to contribute to the field of disordered eating.

5.1.2. Confessing Faith

Confession is the act of astonished, fearful, and grateful acknowledgement that the gospel is the
one word by which to live and die; in making its confession, the church lifts up its voice to do what
it must do speak with amazement of the goodness and truth of the gospel and the gospels God. 9

Within this section I will consider the particular body of work which has emerged in discussing the
theology of confessing faith in the words of the creeds, and of those forms of confessing Christ
which are found in Scripture as the forerunners to the creeds as recited today. Particular attention
will be drawn to what confessing faith is and means in such terms. The non-creedal confession of
faith discussed later shares the same attributes as creedal confession as defined by Webster,
speaking with amazement of the goodness and truth of the gospel and the gospels God and yet
differs in that it does not share some of the same functions in the life of the church as creedal
confession.10

John Webster, Confession and Confessions, in Christopher R. Seitz (ed.), Nicene Christianity (Carlisle:
Paternoster, 2001), 119.
10
Such as being a corporate act.

157

5.1.2.1 Confessing as creed

One distinguishable type of confessing found in the New Testament is the use of homologia to
denote a type of faith confession which appears to take a particular form. In his analysis of the use
of the Greek word homologia Vernon H. Neufeld explores the various meanings of confessing in
the early church.

In early Christian literature, as one might have expected, the influence of the Septuagint is apparent
in the use of exomologein exomologesis to express praise and thanks and, increasingly, the
confession of sin. A few other classical uses are evident, such as the meanings to promise, admit or
agree, and declare or acknowledge openly. But most importantly, and in most instances, the word
group is utilized specifically to introduce or express a conviction, i.e. the objective confession which
especially has reference to confessing Christ or the teaching of his church..11

Neufeld, among other commentators, asserts that the origins of Christian creedal confession are
located in the Jewish Shema. The male Jewish converts to Christianity would have been familiar
with reciting the Shema on a daily basis and this is as close to a confession of faith as is practiced
within Judaism.11 The declaration of Hear O Israel, the LORD our God is One was a constant
reminder of several key factors. Firstly, in pronouncing the LORD our God it identified Israels
commitment as communal as well as individual. Secondly, in affirming that God is one, the Jewish
people set themselves apart from their pagan neighbours as they committed themselves to a
monotheism which refused to accept the claims of others as equal to or superior to God. Into this
situation the early Christians of Jewish heritage required a way of confessing their faith in the risen
Jesus Christ and His relationship to them.

11

Neufeld, The Earliest Christian Confessions, 35.

158

From his study of the Pauline corpus, Neufeld identifies the confession of the early church in the
writings of Paul to be Jesus is Lord.12 In his letter to the Romans Paul states that if you confess
with your lips that Jesus is Lord and believe in your heart that God raised him from the dead, you
will be saved.13 An almost identical form every tongue confess that Jesus Christ is Lord14
appears in Philippians suggesting that the earliest distinctive confession of faith for the Christian
Church was Jesus is Lord. Neufeld explores the significance and meaning of this confession in
terms of its shaping of the early church suggesting that such confession had a twofold effect.
Confessing Jesus is Lord identifies:

(I) it is Jesus, the person who lived and died at a specific time in history, who (2) is the Lord of the
Christian and of the church by virtue of his resurrection from the dead. 15

In the gospel and letters of John, Neufeld identifies the basic confession of faith as Jesus is the
Christ16 but also the additional Jesus is the Son of God,17 and on two occasions the combination
of both terms in Jesus Christ, the Son of God.18 The purpose of these forms of confession is
noted is being somewhat more developed than the Pauline confession of Jesus is Lord. The
homologia in John functions as the test of true inspiration and belief (1 Jn.4.1-3)19 operating as a
primitive creedal confession, a test of personal belief and conviction, 20 and as a statement of
orthodoxy21 to rebut heretical belief, particularly those who denied the Incarnation.

The confession of Jesus is the Christ is also prevalent in the synoptic gospels and Acts. The
circumstances in which these forms of confession of faith arose and were used are varied. They

12

Neufeld, The Earliest Christian Confessions, 43. This is echoed by J. D. G. Dunn in The Theology of the
Apostle Paul (Grand Rapids, MI: Eerdmans, 2006), 175.
13
Rom. 10:19.
14
Phil. 2:11.
15
Neufeld, The Earliest Christian Confessions, 67.
16
Jn. 1:20, 7:26, 7:41; 9:22; 1 Jn. 2:22, 5:1.
17
Jn. 1:34, 49; 10:36; 1 Jn. 4:15; 5:5
18
Jn. 11:27; 20:31.
19
Neufeld, The Earliest Christian Confessions, 106.
20
Neufeld, The Earliest Christian Confessions, 107.
21
Neufeld, The Earliest Christian Confessions, 107.

159

include preparation for baptism, in the practice of exorcism, in times of persecution, as polemic
against Jewish opponents, as a defence of the Christian faith against its critics, and as a test of
orthodoxy. In these statements, the embryonic form of the creeds can be seen and it is in creedal
confession that confessing faith in Christ takes on a different purpose and function within the life of
the Church than merely expressing personal belief.

The development of the creeds in response to doctrinal questions and the challenges of heresy is
widely documented but the purpose of this chapter however is not to chart the historical emergence
of the Church confessing faith in the creed but to explore its theological significance.

It is the assertion of this chapter that the nature and purpose of the Churchs practice of confessing
faith both creedally and in testimony lies in the dual aims of speaking truthfully and of
transformation. The following section explores what it means for confessing the faith in the words
of the creed to direct the church in speaking truthfully and the impact that confessing the creed has
upon the transformation of the Church and the world.

5.1.2.1.1 Confessing Faith and Speaking Truthfully

Discussing the creed in terms of speaking truthfully may suggest to some that this is about using
the creed as some basis for stating propositional truth based on the clauses of the creed. The
argument made here however is that confessing the creed is more about shaping the speech of the
Church and setting a framework for thinking and speaking than it is about proclaiming a completed
doctrinal formulae.

The complexity of many of the issues faced by those living in the twenty first century means that
simple answers are rarely satisfactory. The challenge to the Church is not to provide simplistic
answers but to speak truthfully in its witness to God revealed in Christ. It is in this context that
confessing the faith of the Church in the words of the creed serves to enable truthful speech, for

160

[S]peaking the truth means acknowledging that, although God is unknowable, God shows himself
to us.22

It is from this starting point that the Church begins its speaking from a different perspective to
others working in the field of disordered eating. Instead of beginning with a presenting case of an
individual problem or looking at a societal trend or pathological behaviour it begins with a
God who reveals himself to humanity and shows the nature and purpose for humanity.
Theologically, confessing the creed shapes the speech of the Church in how it speaks of God, itself
and others. Adams recognises the content and function of the Creed as follows:

First, the Creed is a summary. It is a summary of Scripture, more particularly of the Gospels. It
summarizes who God is, what the Church is, and what the Church hopes for Secondly, the Creed
contains criteria by which certain Christian communities measure their reasoning. The Creed sets
limits on how members of such communities think and speak about God, humanity and the future. 23

To confess such a creed is to speak of the primacy of God in the life of the Church and the believer.
Just as the earliest Christian confessions declared the lordship of Christ and thus left no room for
the lordship of Caesar nor any other ruler or power, so those who confess the creed today name the
priorities of God and his reign over all other competing gods. Yet in speaking this truth, as the
Church confesses faith in the creed, the proclamation of those words stand in judgement upon a
Church which has failed to live by what it confesses. The complicity of the Church in systems
which fail to acknowledge the supremacy of God and fail to assume their true place, in surrender,
worship and service before Him is brought before the Church as the creed is confessed. Whilst the
creed is a confession of faith it can lead the Church into seeing itself with greater clarity and
causing it to confess not only Christ as Lord but also confess its shortcomings in living as the Bride
of Christ. This turning of speech from truthfully confessing the rightful place of God to truthfully

22

Nicholas Adams, Confessing the Faith, in Stanley Hauerwas and Samuel Wells (eds.), The Blackwell
Companion to Christian Ethics (Oxford: Blackwell, 2004), 213.
23
Adams, Confessing the Faith, 215.

161

confessing the failings of the Church theologically and prayerfully holds together these two aspects
of confessing and echoes Adamss view that, The Creed is a prayer that ends with Amen. This is
good news because it frees Christians from the prison of thinking it a mere bold declaration.24

If to confess is to declare the goodness of God and to declare oneself as part of the Church, caught
up in the purposes of God, the corporate nature of that confession defies the individualism which
has become ingrained in the western industrialised societies, shaped by the Enlightenment, which
has become fertile ground for the development of disordered eating. The truth spoken in corporate
creedal confession is indicated in the words We believe. The fact that it is as a community that
the creed is confessed opens the way to exploring the understanding that humanity was created for
relationship in authentic community with God and with other people. This stands in contrast to a
society which sets individuals as competing against one another in the area of body image and
proposes that only those whose bodies fit the cultural ideal will find fulfilling relationships.
Corporate creedal confession signifies a counter-cultural message and introduces a different agenda
for community. This is not a comprehensive outworking of what that community might look like
but as Webster notes, Creeds serve the confessing community, but cannot of themselves make up
the totality of what it means to be such a community.25

Not only does the practice of confessing the Creed corporately speak of community within the
Body of Christ, the content of the creedal confession acts as a reminder of the relational nature of
the triune God.

The Creed does not operate primarily by silencing certain types of speech but, because it is
Trinitarian, by discouraging certain types of silence: the neat, the closed, the finished. 26

24

Adams, Confessing the Faith, 220.

Webster, Confession and Confessions, in Christopher R. Seitz (ed.), Nicene Christianity, 120.
26
Adams, Confessing the Faith, 216.
25

162

Building on Nicholas Lashs view of the Trinity as the foundation for discourse, Adams sees the
creed not as a set of rules creating intellectual harmony but as a way of legitimately speaking of the
one God. Within the one God, the three persons of the trinity also demonstrate that trinitarian
confession is grounded deeply in relationship. There is a sense in which creedal confession holds
before the Church a reminder of what it is to be in relationship, that the Father, Son and Holy Spirit
form the perfect model of community. The perichoresis or theology reflecting on the dance of the
Trinity captures something of the movement of God present within the Trinitarian relationship and
in confessing the creed the Church resists carefully defining God. Within this absence of neat,
closed and finished silence is the life-giving possibility that the mystery of relationship within
the Trinity and the workings of God can be mirrored in the life of the Church. The possibilities for
community where relationships are deep through confessing honestly who one truly is and the
practice of holding one another to account in Christian love mitigates against the shallow
individualism offered by society.

What is enabled by this confession is an articulation of how community should be, founded not on
collusion with an ideal body shape, size or appearance, but welcoming and loving because of an
understanding of humanity made in the image of God. The pressure to achieve or fit in, to make
the grade or be perfect enough experienced by many suffering from disordered eating should be
replaced by a welcoming community which seeks deep relationship as it reflects the triune God it
confesses.

Confessing faith in the words of the creed is not an attempt to encapsulate the totality of Christian
doctrine or experience. Where the purpose of creedal confession has been misunderstood or the
theological challenges of recent years 27 have caused some to abandon creedal confession on the
grounds that not all within the church can confess it, calls have been made for doctrinal confession

27

For example the debate about the Virgin Birth.

163

reasserting the place of the historic creeds to be undertaken. 28 Instead, creedal confession speaks
truthfully of the God to whom the Christian church bears witness and does so in a practical
demonstration of a community corporately confessing something greater than the sum of their
individual parts.

5.1.2.1.2 Confessing faith and transformation

Confession, we might say by way of definition, is that event in which the speech of the church is
arrested, grasped, and transfigured by the self-giving presence of God.29

There can be a temptation to assess creedal confession using the interpretive tools of sociology,
group dynamics or linguistics. Considering the function of language and the power of words,
particularly the use of words repeated in a liturgical manner, it is possible to see creedal confession
as significant in its power to shape the individual identity of the one who recites those words. 30

When the dimension of collective recitation of the creed is added to this perspective of language as
formative, there is a temptation to see the significance of confessing faith as linguistic mutual
reinforcing of individual and group identity. Analysed from this perspective the content of the
confession becomes almost immaterial, it is the act of confessing and the context of confession
which matters. To assert ones belief by the act of confession psychologically reinforces those
things which are confessed and contributes to the individual or groups sense of identity by laying
down boundaries between those who confess and those who do not. They remind those who
confess of their core belief or purpose and rekindle their vision to continue practicing or working
toward those ideals or principles they confess. In these terms the confessing of faith in creedal
confession is no different to Brownies reciting the Brownie promise or Americans swearing
allegiance to the flag. Such confessions can all be seen in such terms as having the same purpose

28

See William J. Abraham, Doctrinal Confession and the Renewal of the Christian Church: Confessing the
Faith: A View from US Methodism (Calver: Cliff College Publishing, 1995).
29
Webster, Confession and Confessions, in Christopher R. Seitz (ed.), Nicene Christianity, 121.
30
See discussion on consuming belief in Chapter 4, Baptism & Eucharist.

164

and outcome: affirming identity, forming purpose, instilling virtue and differentiating insiders from
outsiders.

Within the world of disordered eating, creedal confession has been appropriated in an assertion that
anorexia nervosa shapes the life practices of the anorectic as a religion shapes the views and
behaviour of its adherents. The Ana 31 Creed is clearly based on the liturgical format of the Nicene
Creed and the content focussed on self-loathing and being trapped contrasts sharply with all that
has been stated above about the transformative nature of speaking truthfully the Christian hope.

The Ana Creed has appeared, without attributed authorship, on pro-Ana websites as part of a genre
known as thin inspiration or thinspo. The impact and significance of such sites has been a cause
for concern and is currently the source of research to determine if their effect is as harmful as has
been alleged.32 The intention behind material such as the Ana Creed is to inspire those with eating
disorders to continue restricting calorie intake or to purge food they have eaten.

Ana Creed
I believe in Control, the only force mighty enough
to bring order to the chaos that is my world.
I believe that I am the most vile, worthless and useless person ever to have existed on this
planet, and that I am totally unworthy of anyones time and attention.
I believe that other people who tell me differently must be idiots.
If they could see how I really am,
then they would hate me almost as much as I do.
I believe in oughts, musts and shoulds as unbreakable laws to determine my daily behavior.
I believe in perfection and strive to attain it.
I believe in salvation through trying just a bit harder than I did yesterday.
31

Ana is often used as an abbreviation for anorexia nervosa on websites, some of which are designated
Pro-ana websites as they offer suggestions encouraging anorectics in their quest to not eat.
32
A.M. Bardone-Cone, K.M. Cass, What does viewing a pro-anorexia website do? An experimental
examination of website exposure and moderating effects. International Journal of Eating Disorders 40
(2007), 53748.

165

I believe in calorie counters as the inspired word of god, and memorize them accordingly.
I believe in bathroom scales as an indicator of my daily successes and failures
I believe in hell, because I sometimes think that I'm living in it.
I believe in a wholly black and white world, the losing of weight, recrimination for sins, the
abnegation of the body and a life ever fasting. 33

It is notable that this is a creed which begins I believe rather than we believe, highlighting the
isolation of those with anorexia nervosa and serves as a personal reflection on being captive to the
disorder, rather than a corporate statement of faith.

Whilst these insights may be interesting in the exploration of how practices of the Christian church
have been adopted by other groups for the effect those practices have on their participants, if the
confession of faith is reduced to analysis in these terms the theological significance of confessing
the faith is missed. Websters criticism of those who focussed purely on the way the creeds came
into existence is combined with criticism of those who fail to acknowledge the spiritual
significance of confessing the faith in the creeds:

More recent attempts to depict the creeds as instruments of community-description, identity-avowal,

social differentiation, or formation and virtue, while they are more alert to the religious functions of
the creeds, still run the risk of immanence.

34

The approaches Webster mentions do not do justice to what those who confess the creed are
actually saying as these approaches operate a form of sociological reductionism eradicating the
transcendent nature of the creed. It is my assertion that the reciting of the creed is transformative
because of the transcendent power of the Holy Spirit operative in those who confess the creed. The
presence of God is the factor omitted in analyses of creedal confession which understand it as
merely a formative tool or exercise in group identity re-enforcement. To equate the orientation to
33
34

http://www.pro-thinspo.com/proanareligion.html (28th August 2010)

Webster, Confession and Confessions, in Christopher R. Seitz (ed.), Nicene Christianity, 120.

166

God with the orientation to the community fails to understand the nature of the creed and action of
those who confess it.

As the creed is confessed, the Spirit is at work in breathing life into what is spoken and transforms
the language and speakers so that they find themselves drawn into the presence and work of God.
In drawing the Christian community back to the heart of what it proclaims, the confessing of the
creed is transformative in releasing the Church from merely speaking, - instead it reminds those
who confess of their place within Gods eternal purposes. To make baptismal vows is to announce
oneself ready for labour. To say the Creed is for a community to proclaim itself engaged in it. And,
because it is uttered publicly, it is to invite the rest of the world to hold us to that promise, and join
us in our work.35

As the church recites the creed it becomes accountable before God and before the watching world
for the confession it makes and is challenged to live by what it professes faithfulness to the
Trinitarian God.

The formational nature of confessing includes articulating what was previously internalised, that
thought or belief becomes real and takes on a power in a way it could not whilst it remained in the
mind of the speaker. This is both a theological and a general truth. Theologically it finds expression
in such accounts as the creation narrative, 36 where the universe becomes real once it is spoken
into being. In a general sense, the power of speaking thoughts into existence is recognised by those
who advocate talking things through, and the popularity of talking therapies as a means of
expressing, naming and addressing problems also recognises the formational power of confessing.

This relates to the nature of speaking truthfully, as discussed above, and the theological
significance of the Church speaking truth in its confession of Christ and its articulation of the way

35
36

Adams, Confessing the Faith, 215.

Genesis 1.

167

the world is. Facilitating truthful speech is part of the Churchs task in confessing Jesus Christ as
Lord and being accountable to that confession requires the re-ordering of life under the lordship of
Christ. As the Church confesses faith so it is reminded of its need of transformation, of the power
of God who transforms and of the churchs calling to exhibit Gods transforming work before a
watching world. In confessing sin the church recognises both its imperfection, the reality of where
it falls short of its calling, but in confessing sin in penitence and faith it finds the joy and hope of
forgiveness, a gift of Gods grace. It is from this understanding of confessing and accountability
that the church proceeds in its engagement with disordered eating; that it is neither arrogant,
holding all the answers, but trusting in the one whom it confesses as Lord, Saviour, healer and
restorer.

To confess the faith in the words of the creed is to state the position from which the Church
engages with the world. This is done not in rigid or doctrinally closed categories, but prayerfully
and partially as the church is open to the transformative power of God renewing and guiding it as
its life and speech are transformed more fully into the truth of its Lord.

5.1.2.2 Confessing as testimony

Not all confessions of faith recorded in the New Testament have discernable creedal forms. There
is a confessing of faith which takes a more general tone of confessing in the sense of speaking out.
To confess in this sense is to declare allegiance to Christ, to testify or bear witness, but the precise
form of words is unspecified. Within this category of confessing would be the exhortation to
always be ready to make your defence to anyone who demands from you an accounting for the
hope that is in you,37 or do not worry about how you are to speak or what you are to say. 38 It is to
declare utterly faith in Jesus Christ where confessing is to bear witness.

37

1 Pet. 3:15. In his commentary on this passage, Edmund P. Clowney takes this line, whereby confessing
equates to speaking out in testifying or bearing witness. Edmund P. Clowney The Message of 1 Peter
(Leicester: IVP, 1988), 151.
38
Matt. 10:19. Hagner notes that in the situation Matthew is referring to, the confession will come through
the Spirit of your Father, who will speak through the disciples enabling them to defend the faith. Donald A.
Hagner, Matthew 1-13 Word Biblical Commentary vol. 33a (Nashville, TN:Thomas Nelson, 1993), 277.

168

This confessing of Christ in a way which is not articulated in the New Testament by one of the
formulaic descriptions as explored in the section above is congruent with the emergence of several
forms of speech: apologia, proclamation/preaching, and marturia/witnessing.

Examples of this kind of confessing can be found in the words of the Samaritan woman in John 4
who confesses Jesus before her friends and neighbours; He told me everything I have ever done,39
and the blind man healed by Jesus who confesses, One thing I do know, that though I was blind,
now I see.40

Throughout church history confessing faith through the means of individual testimony as opposed
to corporate creedal confession of faith has experienced times of prominence and times of neglect.
The features of such confessing which distinguish it from the creedal confession considered above
are that it is individual rather than corporate; it has a subjectivity which differentiates it from
creedal confession; and it tends to be narrative in form rather than doctrinal.

Confessing as testimony is partially bound up with creedal confession, for any extemporary
confession which is not based on speaking of Jesus as Lord and of the goodness of God in his selfrevelation and salvation is not within the bounds of confessing Christian faith. Yet there is a place
for testimony within the life of the Church which is grounded in the Christians experience of God
revealed in Scripture, attested in the creeds and witnesses to through personal faith in the
Trinitarian God.

To confess faith in Christ which is personal and expressed in a form which is extemporary is one of
the dimensions of the practice of the Church. Within some denominations of the Church where

39

John 4:39. Indeed, with regard to her testimony, George R. Beasley-Murray notes that, [s]he joined with
John the Baptist as a witness before the disciples bore any testimony to her people. George R. BeasleyMurray, John Word Biblical Commentary vol. 36 (Nashville, TN: Thomas Nelson, 2 nd ed. 1999), 64.
40
John 9:25.

169

believers are brought for baptism it is a requirement that candidates confess their faith in Christ
through testifying to his work in their life. It is only after this confession of faith that the candidate
may proceed to baptism.

Other circumstances within the public acts of worship of the Church are also appropriate settings
for confession of faith through testimony sometimes during regular services, in house groups, and
in evangelistic meetings or ordinary conversation. In confession which takes the form of testimony
the key element of telling ones story of witnessing to encounter with God - is what distinguishes
it from creedal confession.

Confessing faith through the medium of testimony becomes particularly interesting when
considering the Churchs response to disordered eating. If confessing faith in testimony is
essentially reduced to telling ones story as it relates to experience of God, the points of contact
with particular therapies used with those suffering with disordered eating become apparent. As will
be seen later the place of personal testimony in groups such as the Twelve Step programmes and
the use of personal testimony relating to disordered eating by churches reveal the impact of
confessing in the sense of speaking out personally about ones experience.

5.1.2.3 Confessing as speaking out

Confessing the creed enables the Church to speak out from its position of attentiveness to God,
speaking prophetically into the world. Grounded in the creed, in its experience of the self-giving
revelation of God, the Church is enabled to see something of Gods purpose for humanity and to
speak that truth into the world. It is through both speaking the words of the creed and personally
confessing experience of God through the medium of testimony that the Church declares that
disordered eating is not what humanity was created for.

It is through testimony that some are able to speak of a God who transforms those enslaved by
powers which entrapped them. It is by confessing the creed that the Church names Christ as Lord

170

and no other authority. In this way the Church is enabled to name the powers which hold captive
those who fear to eat and those who are gripped by self loathing because they are unable to control
when they stop eating.

5.1.3 Confessing sins

5.1.3.1 Introduction
If the general sense of to confess is to speak out, a more focussed and widely acknowledged
understanding of confessing is specifically related to confessing wrongdoing. This section will
explore the biblical foundations of confession of sin and also various stages of the Churchs
practice of confessing sin to God and to other people.

5.1.3.2 Biblical
The exhortation within scripture to confess your sins appears in both the Old and New
Testaments, anchoring the practice in the context of a humanity which is fallen and prone to sin
which needs confessing. Throughout the Old Testament confession occurs both individually 41 and
corporately,42 and the consequences of sin and its confession are evident. The Psalmist records:

Blessed are those whose transgressions are forgiven,

whose sins are covered.
Blessed are those whose sin the Lord does not count against them
and in whose spirit is no deceit.
When I kept silent my bones wasted away
through all my groaning all day long.
For day and night your hand was heavy on me;
41

Josh. 7:19, Ps. 38:18. There is debate surrounding the extent to which Psalm 38 is an individual prayer or a
psalm of corporate confession. James L. Mays suggests that Psalm 38 was being used corporately in
Lamentations 3:1-15, due to the similarity of motifs employed. He also makes the case for corporate use of
Psalm 38 in the early synagogues. James L. Mays, Psalms Interpretation: A Bible Commentary fro Teaching
and Preaching, (Louisville: John Knox Press, 1994), 163. This contrasts with Peter C. Cragie who states, It
is thus safest to conclude that the psalm had initially no formal associations with cultic or liturgical practice.
Peter C. Cragie, Psalms Word Biblical Commentary vol. 19 (Nashville, TN: Thomas Nelson, 2001), 302-3.
42
Lev. 26:40, Ne. 9:2-3.

171

my strength was sapped as in the heat of summer.

Then I acknowledged my sin to you
and did not cover up my iniquity.
I said I will confess my transgressions to the Lord.
And you forgave the guilt of my sin. 43

For the Psalmist, the failure to confess sin results in consequences which are physically
experienced. Confessing that sin is the means by which guilt is removed and life is restored. Whilst
the Psalm begins with a general pronouncement about those whose transgressions are forgiven,
the recounting of confession of sin is a personal, individual instance. The confession appears to be
made before God alone, rather than to another person, and the aim of confessing is to uncover
transgressions that they may be forgiven.

Interpreting passages which refer to individual confession of sin in the context of a society which
both exalts the place and autonomy of the individual, whilst also engaging in a blame culture which
seeks to identify the faults of others as a means of absolving self of responsibility, has a potential
danger. To dwell exclusively on the individual confession potentially individualises sin,
disregarding the location of the individual within a world which is fallen and corrupted by sin. The
complexity of what sin is to be confessed by an individual lies with identifying not only what
transgression can rightly be attributed to that individual (thus raising questions of free will and the
individuals capacity to think or act independently of the structures in which they find themselves)
but also complicity in systems which themselves perpetuate sin.

The call to the people of Israel to repent and confess sin in preparation for the Messiah is found
later in Scripture. John the Baptists ministry is a call to repentance, characterised by the people
confessing their sins and being baptised in the Jordan. 44 Confessing sin is integral to baptism,
hence Johns initial refusal to baptise Jesus who was without sin. The purpose of confession in this
43
44

Psalm 32: 1-5 (NIV).

Matt. 3:6, Mk. 1:5.

172

context was to respond to the message preached by John that repentance was the way to prepare for
the coming Messiah. Johns baptism was a seal on the repentance confessed. Whether the
confession was made to John alone in the waters of the Jordan prior to baptism or whether the
confession was made publicly before all who had gathered to hear John and observe the baptisms is
unclear. What can be discerned is that confessing sins was practiced in New Testament times and
was seen as the appropriate way of preparing to receive Jesus. Despite the prominence of
forgiveness in the gospels, there is very little emphasis on confessing sin within the accounts of
Jesus ministry.

The two instances of the word confess used of confessing sins in the New Testament Epistles
appear in James and 1 John. The first instance in James 5:16 is where disciples are encouraged to
confess your sins to one another, and pray for one another, so that you may be healed. The second
speaks of the forgiveness which accompanies confession, If we confess our sins, he who is faithful
and just will forgive us our sins and cleanse us from all unrighteousness. 45

The emphasis on confessing sin as a means of restoration in relationship with God, freedom from
guilt and wholeness in body and mind runs like a thread through the biblical passages dealing
explicitly with this form of confession. The early church continued to practice confessing sins and
being accountable to one another and it is to the development of these practices that we now turn.

5.1.3.3 Church Practice through History

Within the Early Church particular forms of sin soon became identified as particularly serious;
these required separation from the Church until penance was completed. 46 For lesser sins private
prayers of confession before God would suffice. The practice of appointing presbyters to hear
confessions and suggest appropriate forms of penance did emerge during the Patristic era, although
it was not until the Early Middle Ages under the influence of monasticism that the practice of
45

1 John 1:9.
J. Halliburton, A Godly Discipline, in M. Dudley and G. Rowell (eds.), Confession and Absolution
(London: SPCK, 1990), 42.
46

173

individual confession before a priest became prevalent. 47 Rather than an overview of the historical
development of the practice of confessing sin in the Church, the section which follows focuses on
practices of confession which may resonate with what is emerging from the field of disordered
eating.

5.1.3.3.1 Wesleyan practice Band meetings

Whilst the practice of auricular confession before a priest continued within Roman Catholicism, in
the midst of the eighteenth century revival a different form of confessing came into being. As
Methodism gained converts, inspired by the preaching of the early Methodist preachers, and
members were exhorted to pursue lives of holiness, a need arose for avenues to pursue such
discipleship. At this point the influence on Wesley of the pietism practiced by the Moravians came
to the fore. In his organising zeal, John Wesley gathered together small groups of dedicated
Christians who were intent on leading holy lives and who endeavoured to lay aside every weight
and the sin that clings so closely andrun with perseverance the race that is set before. 48 These
gatherings became the Methodist band societies, the aim of which was stated as The design of our
meeting is, to obey that command of God, Confess your faults to one another, and pray for one
another, that ye may be healed. 49

These weekly meetings began with singing or prayer and the members would then proceed to speak
freely and plainly, the true state of our souls, with the faults we have committed in thought word
or deed, and the temptations we have felt, since our last meeting. 50

47

M. Dudley and G. Rowell (eds.), Confession and Absolution (London: SPCK, 1990), 56.
Heb. 12:1.
49
The Rules of the Band Societies drawn up December 25, 1738 in The Works of John Wesley, 14 vols.
(London: Wesleyan Conference Office, 1872); (reprinted, Grand Rapids, Michigan: Baker Book House,
1979), 272.
50
Wesley, The Rules of the Band Societies.
48

174

According to the rules drawn up in 1738 there were eleven questions which may be asked of any
member of the group as often as appropriate 51 but there were another four (initially five)52 which
were to be asked at every meeting. These were:

1.

What known sins have you committed since our last meeting?

2.

What temptations have you met with?

3.

How were you delivered?

4.

What have you thought, said, or done, of which you doubt whether it be sin or not?53

Not only was this a place for confessing sins but also for confessing temptation toward sin and
even those things of which the group member was uncertain whether they were sins or not. This
was a comprehensive examination of the conscience and included taking seriously Jesus words
that even sin committed in ones heart but not translated into action was nevertheless sin. Yet this
detailed and disciplined confessing and accountability bore fruit in the lives of those who were part
of such groups. John Wesley attests the effectiveness and the value of these meetings thus;

Many were delivered from the temptations out of which, til then, they found no way to escape. They
were built up in our most holy faith. They rejoiced in the Lord more abundantly. They were
strengthened in love, and more effectually provoked to abound in every good work. 54

Rather than an unhealthy obsession with dwelling on ones sins and reluctantly confessing them to
another, this practice successfully balanced the seriousness of sin and its consequences with an
assurance of Gods forgiveness of the penitent and the exciting possibilities of life ahead when
freed from guilt and resisting sin.
51

Including, Have you the forgiveness of your sins? and Have you peace with God, through our Lord Jesus
Christ?.
52
Later reduced to four in editions after 1779-80 Frank Baker, A Union Catalogue of the Publications of
John and Charles Wesley (Stone Mountain, Georgia: George Zimmermann, 2nd ed. 1991), 55- 57.
53
Wesley, The Works of John Wesley, 272-3.
54
John Wesley, A Plain Account of the People Called Methodists in The Works of John Wesley, vol. 8
(London: Wesleyan Conference Office, 1872; reprinted, Grand Rapids, Michigan: Baker Book House, 1979),
259.

175

5.1.3.4. Contemporary thinking

Since the early days of Methodism, confessing and being accountable has waned in popularity and
many within the Church today would be uncomfortable with the encouragement to confess their
faults plainly to one another. Confession today is more likely to be practiced directly to a priest
within the Roman Catholic or Anglo-Catholic traditions of the Church. In his consideration of the
practice of confession today, Butler focuses on the experiences of priests and laity within the
Anglo-Catholic tradition of the Church of England.55 Their responses to confession as auricular and
sacramental reveal something of contemporary experience.

Features noted by respondents included; a decline in penitents over the last 50 years, 56 confession
being made in response to feeling something particular to confess (rather than observed as a regular
practice), an uncertainty about what to confess (possibly attributable to the breakdown in moral
consensus and lack of clarity about what constitutes sin) and a blurring between the boundaries of
confession and counselling.

The picture of confession practiced in contemporary Anglo-Catholicism which emerges from

Butlers research is one of confusion. He summarises his findings as follows;

The Anglican clergy questioned seemed, overall, to lack a clearly articulated theological rationale
for sacramental confession in todays Church while being able to talk quite interestingly and
intelligently from their own experience. 57

John Stott states the Protestant evangelical position with reference to both biblical interpretation
and the 1662 Book of Common Prayer. Stott recognises three types of confession: confession

55

Perry Butler, Introduction: Confession Today, in M. Dudley and G. Rowell (eds.), Confession and
Absolution (London: SPCK, 1990).
56
A variety of reasons were offered for why this may be the case.
57
Butler, Introduction: Confession Today, 11.

176

before God in secret when the sin committed has been against God alone, private confession where
the sin committed is not only an offence against God but also against another person, and public
confession where the sin is committed against God and a group of other people, namely the
congregation. He concedes that auricular confession to a priest may in rare cases be permissible to
assist penitents who otherwise are unable to feel forgiven, though Stott still considers this an
inferior option to encountering forgiveness in Christ through the promises of Scripture.

If sin has been committed against God, it should be confessed to God secretly; if it has been
committed against the church it should be confessed to the church publicly. Confessing such sins to
a priest is not right, since it makes secret confession not secret through including another person and
public confession not public through excluding the church.

In an age where those in the church have on the whole become subtly influenced by a secular
agenda, and Christians in the West have grown up in an era of consumer choice in matters of faith
as well as culture, the idea of confessing sins or being accountable to one another is often seen as
the preserve of the very holy or the very committed. The vulnerability entailed in the sort of
openness and self-disclosure seen in the band meetings of early Methodism is rarely embraced by
members of the average church. Yet the insights of confessing sins to others and watching over one
another in love have been appropriated by programmes which seek to help people facing particular
temptations and problems. Some of the best known self-help programmes devised to help
sufferers of particular addictions or disorders have their roots in the confessing and accountability
tradition of the Christian church. There is an irony in the fact that whilst many in the church shy
away from the intimacy and accountability of the small group where truth is spoken, sins are
confessed and each member is accountable to the others in their thought life and behaviour, some
outside the church are embracing the model of small group confession and accountability.

177

5.1.3.5 From confessing sin to accountable discipleship

The outcome of confessing sin before another is an accountability for ones actions. To confess
past wrongdoing and take responsibility for it in the presence of another accepts that one is
accountable for ones actions. There is also another sense in which confession produces
accountability where what is confessed is a temptation to take a particular course of action. To
confess that a particular thing is a weakness or temptation and to know that one will have to give
account for this area of life before another person is an accountability which has the potential to
shape behaviour.

5.1.3.6 The link between confessing and accountability

What appears to emerge from a variety of contexts is that what begins as a defined confessing of
sins appears to naturally evolve into a broader interest in being accountable for the whole of life.

Though the Band meeting worked for those who were maturing in faith and were serious about
discipleship, Wesley soon found that the demands were too great for those who were recently
converted. The majority of people responding to the gospel preached by the early Methodists were
uneducated and had neither the vocabulary nor the grounding in Christian understanding to be able
to articulate what their sins and temptations were or how their discipleship was progressing. In
response to this, whilst the Band meeting continued for the spiritual elite, the Class meeting
emerged as a place for being accountable in discipleship.

Here there was less focus on confession of sin but a wider accountability for discipleship exercised
in the whole of ones life. The Class meeting enabled members to confess (in the sense of speak
out) their experience of following Christ in the week since the group had last met. The aim of the
Class Meeting was to watch over one another in love, entailing an accountability broader than
confessing sins to one another. In this less intimidating form all early Methodists were incorporated
into a structure which enabled them to confess the state of their discipleship and hold one another
to account in a spirit of Christian love.

178

Likewise, the priests surveyed by Butler found that whereas confessions earlier in their ministry
had been focussed and quite clear about the sin confessed, from the priests point of view,
confessions today are often longer and looser than in the past and sometimes more akin to the
pastoral interview. 58

What emerges in each case appears to be a movement from confessing specific sins to a wider
consideration of life and faith in general and a desire to confess, in the sense of speak out about,
how the sin confessed relates to the rest of life.

The following section will consider ways in which the church is taking seriously the practice of
being accountable before God and to others. I propose that only when the elements of confessing
and being accountable are brought together that the potential of this practice is realised. Within this
framework of confessing and being accountable I argue that the vulnerability and acceptance
shared within groups which confess to each other and hold one another accountable makes for a
depth of community which enables human flourishing.

5.1.3.7 Covenant Discipleship as a model of confessing and accountability

Covenant discipleship originated within the United Methodist Church in North America. The first
group was formed in 1975, endeavouring to provide a means to pursue accountable discipleship
akin to the early Methodist Class meeting, but contextualised for the contemporary cultural
situation.

Groups are comprised of between two and seven members, and are usually mixed in gender,
though for particular reasons some single gender groups have been formed. The aim is to pursue
committed discipleship in response to Gods grace, whilst remaining within a broad and inclusive
church. Each group draws up a covenant to which they agree and hold one another accountable.
58

Butler in M. Dudley and G. Rowell (eds.), Confession and Absolution, 3.

179

The details of each covenant are unique to that group, though all will cover the areas of acts of
compassion, acts of justice, acts of worship, and acts of devotion. Groups meet every week
for one hour and the primary factor determining membership of a group is availability to meet at
the appointed time.

Meetings begin with prayer followed by a reading of the covenant. The leader of the group reads
each clause of the covenant in turn and [b]egining with herself or himself, the leader asks each
member whether the intent expressed in the clause has been fulfilled during the last week. 59 The
question and answer format enables each member to both confess the ways in which they have
failed but also to confess the grace and goodness of God in his dealings with them during the past
week. What is produced by this confessing and accountability is disciples growing in grace and
holiness, making a difference in the world. All covenants contain clauses about practical means of
showing compassion, mercy and kindness and in this sense the small group becomes as much about
confessing faith in words and actions as it is about confessing sin.

5.1.4 On the link between confessing faith and confessing sin

Though confession of faith and confession of sin have been explored separately because of the
different ways in which they shape the life of the Church and the different insights which can be
gained from each in the way the Church engages with disordered eating, these two forms of
confessing are fundamentally connected.

Webster argues that the sin we confess is the sin of refusing to confess God as Lord of all:

Sin is, in part, the refusal to confess the sullen and hard-hearted refusal to acknowledge Gods
self-gift, failure to respond to Gods lavishness by voicing Gods praise. Confession refuses these

59

Lowes-Watson, Covenant Discipleship, 147.

180

refusals. It is a repentant act, a turning, and therefore a decisive no to silence about God or to that
murmuring against God that is the response of the wicked to Gods generosity. 60

One way of locating the relationship between confessing faith and confessing sin is in the response
to the powers. Wink states, What we are arguing is that the Powers are simultaneously the outer
and inner aspects of one and the same indivisible concretion of power.61 In confessing faith in
Jesus Christ as Lord, Christians place themselves in a position to be able to discern the nature of
the powers and confess their own complicity within the Powers which Wink asserts are good, fallen
and will be redeemed. 62

Winks approach is not the only model for understanding the relationship between confessing sin
and confessing faith but it is has particular virtues to commend it. In contrast to the model which
views sin and faith, or good and evil as a dualistic battle played out solely within the individual,
Winks understanding of the Powers recognises a wider context and the possibility of being caught
up in systems (economic, political or social) which are themselves fallen. This provides an antidote
to a purely individualistic view of powers and demons which assumes the world is neutral and the
struggle between right and wrong is dependent entirely on the free choice of the individual. The
disadvantage of this is that it could be implied that there is no personal responsibility or individual
psychological element when it comes to confessing sin or faith, which is not an interpretation of
Wink which I would accept, but which others may propose.

The impact of the Powers upon disordered eating lie in the fact that food, which we believe to be
created by God and therefore good can be used in a way to dominate, oppress and enslave human
beings. In her account of living with her anorectic daughter, Grainne Smith makes a deliberate
choice in the language she uses, speaking of when anorexia comes to stay and referring to her

60

Webster, Confession and Confessions, in Christopher R. Seitz (ed.), Nicene Christianity, 122.
Walter Wink, Naming the Powers: The Language of Power in the New Testament (Philadelphia: Fortress
Press, 1984), 107. Italics original.
62
Walter Wink, Engaging the Powers (Minneapolis, MN: Augsburg Fortress, 1992), 65-86.
61

181

daughters actions as things anorexia does. This could be interpreted as understanding anorexia
nervosa as some form of illness or demon possessing Smiths daughter and causing her to pursue
behaviours against her will. A different, and in my view, better reading reflects Winks
interpretation of the Powers. The anorectics distorted relationship with food, image and identity is
a manifestation of the falleness of the Powers. Smith observes the external aspect in her daughters
refusal to eat and her emaciated body and the internally oppressive force controlling and destroying
her life. 63

It might be assumed that the Church which confesses Christ as Lord and is aware of the Powers
would be a place where the Domination System has no hold over the relationship with food and
eating, but this is not the case. The Church in the West, particularly in the US, has been squeezed
into the mould of the society around. In the name of hospitality food is often manipulated in such a
way that the excess consumerism of the world is mirrored in the Church where every event must be
amply supplied with food for constant consumption.

For those already enslaved by the operation of the Powers in the workings of media ideals of
slimness and constant pressure to diet or be thin, the Church provides no alternative and it can be
difficult to observe any redemption of the Powers under the reign of God. It is in this context that
the Church confessing faith in Christ needs to confess its involvement in structural sin in order to
be redeemed to model a different way of being. Such confession is necessary and important but not
the complete solution. Wink notes, There are no prepackaged answers that tell us how Christians
should engage the powers. 64 This suggests that in confessing faith and confessing sin, engaging the
Powers may require some within the Church to take particular forms of action. For some, this may
be to take a stand campaigning against the oppressive projection of ideals of overly-thin beauty in
advertising, teenage magazines and other media. Others may form groups to enable people to talk
about their issues with food and eating in a confidential and supportive setting. What is apparent is

63
64

Grainne Smith, Anorexia and Bulimia in the Family (Chichester: Wiley, 2004).
Wink, Engaging the Powers, 84.

182

that confessing faith and confessing sin are intrinsically linked and are a powerful practice in
discerning and resisting the system which seeks to dominate.

5.2 What is the role and significance of Confessing and

Accountability in relation to disordered eating?
Having discussed the way in which the practice of confessing and being accountable shapes the
church, this section looks at the differences between secular models of confessing and
accountability in relation to disordered eating, and considers one churchs response to try and
provide ministry in this area.

5.2.1 The emergence of secular confession small groups, self help and talking therapies
5.2.1.1 Weight Watchers
One of the reasons for exploring the theological significance of the practice of confessing and
accountability within the life of the Church was that it appeared that it was those outside the church
who had adopted similar practices and applied them to the area of disordered eating. Within an
organization which claims no spiritual authority, members of Weight Watchers meet regularly and
confess to one another their experience of trying to lose weight and adhere to their agreed diet. The
nature of the group is to act as encouragement to keep to the confessed path of action and their
presence is and incentive to avoid the sin of deviating from ones diet. The notion of sin and
confession is subtly but pervasively part of the dieting and weight loss industry, with Slimming
World dividing foods into free foods which there are no restrictions on consuming and syns
which are permitted foods but less healthy.

Content analysis
The previous sections have identified key features of the Churchs practice of confessing and
accountability. Within the small group there was a clear understanding of the purpose of the group

183

 the aim being to encourage members in faithful discipleship to Christ. The methods employed in
pursuit of this aim involved; open and honest confession about the state of ones soul, reflection on
behaviour over the previous week (or since the group last met), encouragement from other
members of the group to continue in ones aims, possibly exhortation or advice from a more
experienced member (class group or band group leader, but not in a covenant discipleship group).

The analysis below takes the stated aims and practice from the organisation Weight Watchers and
discusses the similarities and difference in structure and aims between it and the Christian
accountability groups in the previous section.

Community
Weight Watchers as an organisation has great appeal to those who have tried on their own to lose
weight but have been unsuccessful. A significant part of that appeal is the community created by a
group of people working toward the same goal and supporting one another as they do so. The
emphasis on support and community features strongly in Weight Watchers publicity:

Support can be an important part of your weight loss success. In fact, in a study of women trying to
lose weight, getting support accompanied an improvement in the participants ability to control their
eating and choose lower-calorie foods.1

Along with a weekly discussion topic and guidance from the Leader, youll also hear about the
struggles and successes of these fellow members. You dont have to participate in the discussion if
you don't want to, but youre bound to hear helpful tips and motivating advice that helps you
through the week. 65

The assertion of the earlier part of this chapter was that the creed confessed corporately speaks
truthfully of the nature of Christian community and forms the parameters and character of that

65

Website of Weight Watchers, www.weightwatchers.co.uk/plan/mtg/index.aspx (20th October 2010).

184

community. The practice of the early Methodists for meeting together to confess and be
accountable for their discipleship was based on Wesleys understanding that Christian discipleship
could not be adequately pursued alone. The value of community in Weight Watchers is identified
as a key feature of helping participants meet their goals, and for some the friendships made and
non-judgmental attitudes of others in a similar situation is what attracts them to Weight Watchers.

The key feature of community within the Weight Watchers is being supportive. Members meet
because they have the purpose of losing weight and it is taken for granted that this unity of purpose
will engender support for others pursuing the same goal. Whilst this may be assumed, a more
deliberate feature of engendering support within Weight Watchers is the development of a positive
ethos based on unconditional positive regard. There is an acknowledgement that many who
struggle with food and eating have a complex relationship with their own emotions and eating, and
the focusing of the community around positive affirmation of each other, even in the face of failure
to achieve goals is seen as key to long term progress.

Whilst the experience of many who have been part of Christian accountability or Covenant
Discipleship groups would be that they are supportive, this is not their primary aim. In relation to
Covenant Discipleship groups, Lowes-Watson expresses it thus:

They are not encounter groupsthey are not spiritual formation groups and they are not care and
share groups. All of these aspects of Christian discipleship and community will feature in covenant
discipleship groups, over and over again; but none of them is the purpose of the weekly meetings.
Covenant discipleship groups are nothing more than a weekly checkpoint of accountability, and
nothing less. 66

66

Lowes-Watson, Covenant Discipleship, 100-101.

185

The distinction here is that within the Christian accountability group the result of confessing is not
to be positively affirmed and encouraged to try harder next week but rather to acknowledge failure
and be directed to the all sufficient grace of God.

Format and Structure

Just as the Methodist Band meetings followed the structure of singing hymns, praying then
working through their questions, the covenant discipleship group works through the clauses of the
covenant, the penitent and priest follow the liturgical format of confession and absolution, so
Weight Watchers structure their meetings to ensure confessing and accountability can take place.
Before the meeting begins the weigh-in takes place, then there is opportunity for members of the
group to speak of their experiences relating to food and diet during the week. There is input from
the Leader and discussion.67

Accountability
Within their explanation of what happens in a meeting, Weight watchers actually use the word
accountable in relation to the weigh-in. It is argued below that the accountability occurring within
Weight Watchers is different in kind to that within the Christian accountability group but that it
nevertheless has value and purpose.

Once youve decided to lose weight, holding yourself accountable is essential to achieving success.
Thats the purpose of the meetings private weigh-in. Our members find that meetings and private
weigh-ins help them keep their resolve and motivation.

67

What happens at a meeting?

Each meeting is a discussion guided by your Leader, with a new topic every time. One week, the topic might
be strategies for curbing stress eating, and the next week might centre on favourite foods and recipes. Youll
pick up great tips from the group and contribute your ownor just listen. This combined with the insights of
the Leader and the individuals within the group make each meeting unique.
After your first meeting, youll stay for a brief getting started session. The Leader explains what to expect
and how to follow the food plans, and will give you a chance to ask additional questions. Website of
Weight Watchers, www.weightwatchers.co.uk/plan/mtg/index.aspx (20th October 2010).

186

Right before the meeting, youll be weighed privately and confidentially by the meetings Leader or
helper. The weigh-in is a way to help you track your progress and stay accountable to yourself.

The stated aim of the weigh-in is to enable accountability to self and the reason it happens in
private is to avoid disclosure to the other members of the group. This speaks clearly of the
understanding of accountability operating within Weight Watchers it is both individual and
partial.

The nature of Weight Watchers being a group which is essentially a gathering of individuals
seeking to be accountable to themselves whilst being supported by other individuals pursuing the
same goal may appear similar to Church accountability groups. The argument though is that they
are by nature different due to the understanding of what it means for the Christian to be part of the
Church, the Body of Christ. In accountability groups within the Church accountability is to God
and to one another, acknowledging that the Christian belongs not to themselves but to Christ and as
brothers and sisters in Christ, the actions of each member of Christs body have an impact on every
other member. This differs substantially from being a collection of individuals whose interests
coincide in a particular sphere of life but no deeper relationship exists.

Whilst the Weight Watchers weigh-in happens in private, it does provide a concrete moment of
reckoning which cannot fabricated as there is an objectivity which reveals the truth of the situation.
This can be compared with the more complex situation in the Christian accountability group where
the desire to cover faults and failings or confess only a partial account of ones discipleship
wrestles with the promise to speak truthfully. The nature of the type of accountability practiced is
brought out by this contrast between individual and corporate and objective and subjective.

Comparisons and contrasts

Whilst the elements of the groups above have striking similarities with the Christian discipleship
and accountability groups mentioned previously, the foundation of organizations such as Weight

187

Watchers and Slimming World does not acknowledge any spiritual dimension to the programme.
As previously indicated the psychology behind the speaking out in the group and returning to the
group week by week to be accountable for ones eating habits owes much to Carl Rogers theories
of person-centred therapy, where the group constitutes an environment for individuals to work out
their issues with food and weight.68 The emphasis on unconditional positive regard for members of
the group, offering affirmation whether or not it has been a successful weight loss week or not
further confirms the differences between the confess, repent, be accountable model practiced
within the Church and the secular basis of groups such as Weight Watchers. The contrast with the
discipleship and accountability group is not only seen in the failure to recognize a spiritual
dimension to the individual, or their struggle to achieve their stated aims, but more than that the
discipleship or accountability group anticipates appealing to God to help in the process.

Another contrast is that between individual and corporate focus. In Weight Watchers, despite
seeking to encourage others within the group, the aim is to enable the individual to achieve their
stated weigh-loss goals. The group is comprised of individuals joined by a common interest in
achieving their individual aims. This can be contrasted with the discipleship or accountability
group, which whilst it seeks to encourage spiritual growth in each member, exists primarily for the
corporate building up of the body of Christ.

5.2.1.2 Cognitive Behavioural Therapy and Talking Therapies

Confessing in the sense of speaking out is fundamental to Cognitive Behavioural Therapy where
a client speaks of their thoughts, emotions and resulting behaviour in a particular situation. To be
able to articulate and confess to another person (the counsellor or therapist) is the beginning of the
process of behavioural change. In this way confessing can be seen as that which marks the move
toward wholeness and restoration in a way parallel to that described by the Psalmist. 69

68

Carl Rogers, Client-Centred Therapy: Its Current Practice, Implications and Theory (London: Constable &
Robinson, 2003).
69
See 6.1.3.1. above.

188

The first purpose behind considering CBT in particular as a form of secular confession in this
section relates to the fact that its aim is facilitating behavioural change. Rather than simply being a
mechanism for individuals to talk about issues and see this unburdening as the desired outcome, the
hope is that CBT will achieve an externally observable difference in the way an individual acts. In
this respect it mirrors the practice of confessing and accountability in that the intended aim of
confessing is to speak out and be held accountable for what is spoken, and where the confession is
a confession of sin, be accountable for altering ones behaviour as a result.

The second reason for discussing CBT in this section is the effectiveness particular forms of CBT
appear to be having regarding those suffering from disordered eating. 70 Research continues into
why a particular form of CBT is succeeding in helping those suffering from bulimia nervosa to
make significant recovery when so many other treatments have failed. The tentative suggestion
made at this point is that the practice of confessing and being accountable has a power and value
that was recognized by the early Church and is now being discovered in twenty-first century
science. Whilst it is an over simplification to equate CBT too closely with the practice of
confession and accountability seen in the Church, it is a possibility that fragments of truth are being
glimpsed in this area.

5.2.2 The secularized/ spiritual or spiritualised/secular model of confessing: Twelve Step

Between the poles of secular confession and Christian confession lies an interesting third way
which emerged from beginnings grounded in faith but which has sought to broaden its appeal by
acknowledging spirituality but being quite ambiguous about the nature of that spirituality.

70

C. G. Fairburn, Z. Cooper, H. A. Doll, M. E. OConnor, K. Bohn, D. M. Hawker, J. A. Wales, R. L.

Palmer, Transdiagnostic Cognitive-Behavioral Therapy for Patients with Eating Disorders: A Two-site Trial
with 60-Week Follow-up, American Journal of Psychiatry 166 (2009), 311319.

189

The Twelve Step movement has its origins in the founding of Alcoholics Anonymous in the mid
1930s, and traces its heritage back to the Oxford Group,71 an evangelistic revival organisation
active in the first few decades of the twentieth century.72 It is within AA that the Twelve Steps were
developed and their spiritual roots are sunk so deeply into the Twelve Steps that, though there is
great latitude in how individuals conceive their Higher Power it remains difficult to see how one
could follow the programme from an entirely rationalist stance, denying any spiritual force
operative in the world.

1.

We admitted we were powerless over alcohol - that our lives had become unmanageable.

2.

Came to believe that a Power greater than ourselves could restore us to sanity.

3.

Made a decision to turn our will and our lives over to the care of God as we understood
Him.

4.

Made a searching and fearless moral inventory of ourselves.

5.

Admitted to God, to ourselves and to another human being the exact nature of our wrongs.

6.

Were entirely ready to have God remove all these defects of character.

7.

Humbly asked Him to remove our shortcomings.

8.

Made a list of all persons we had harmed, and became willing to make amends to them all.

9.

Made direct amends to such people wherever possible, except when to do so would injure
them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we
understood Him, praying only for knowledge of His will for us and the power to carry that
out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message
to alcoholics and to practice these principles in all our affairs.

71

The Oxford Group was originally known as A First Century Christian Fellowship.
Robert Hemfelt and Richard Fowler, Serenity: A Companion for Twelve Step Recovery (Nashville: Thomas
Nelson Inc., 1990), 16.
72

190

The principles behind Alcoholics Anonymous,73 have been transferred to other forms of
dependency and so there are now Twelve Step groups such as Narcotics Anonymous, Gamblers
Anonymous and particularly relevant in this context, Overeaters Anonymous and Anorexics and
Bulimics Anonymous. Whereas Alcoholics Anonymous works on the basis of complete abstinence
from alcohol, the difficulty with disordered eating is that having declared a powerlessness over
food, abstaining from food is not an option. In order to address this Overeaters Anonymous defines
abstinence as abstaining from eating compulsively 74 which provides a workable model though is
clearly vaguer than its AA counterpart.

The Twelve Step movement has its origins in the USA and it is noted that within that culture there
appears to be a greater prevalence of dependency problems than elsewhere in the world but this
may be due also to the wider medical acceptance of dependency, treating it as an illness rather than
a character defect. In this way, confessing, in the sense of speaking out ones story in a Twelve
Step meeting is culturally normative, as is confessing failure to abstain as sin in a culture deeply
influenced by Christianity. Culturally, the spiritual element of the Twelve Step Programme fits
more closely with the North American context though the groups and programmes are found all
over the world.75

The nature of confession within the Twelve Steps is interesting as the steps themselves are almost
creedal in asserting the beliefs of the founders about what is the core of recovery. Step Two even
expresses itself in terms of believe, though the phrase came to believe owes much to the
philosophy behind AA that recovery is an ongoing journey and so language of process rather than
dogmatic statement reflect more faithfully the character of the organization.

73

Namely that there is anonymity in the meeting, that no member represents the group as a whole, that there
is opportunity within the meeting for members to tell their stories and that the Twelve Steps form the basis
for recovery.
74
Shulamith Lala Ashenberg Straussner and Stephanie Brown, The Handbook of Addiction Treatment for
Women (San Fransisco,CA:Jossey-Bass, 2002), 133.
75
Worldwide 12 Step, www.12stepgroups.com/about (16th October 2010).

191

In the area of confessing sin, it is explicitly stated in Step Five that confession of wrongdoing is a
threefold confession to God, self and another. The model found in the Twelve Step approach
combines the practice of confessing to others within the framework of an individualized
spirituality. Whilst the support found within the group forms a context of community, as with
Weight Watchers this is a group of individuals looking to pursue individual goals. The benefits of
the Twelve Step programme should not be overlooked in their capacity to support and enable
ongoing recovery from disordered eating. Its testimony to the power of confessing, both in the
sense of speaking out and confessing failure stands as a reminder to the Church of a practical
discipline to rediscover. Whilst it is argued that the operation of the nature of the confessing within
the Church and in a Twelve Step group is different, the existence of Twelve Step programmes point
the Church toward a means of engaging with the specific challenges of disordered eating. The way
in which this has been attempted in the life of one congregation will now be explored.

5.2.3 Church Appropriation of Confession & accountability group

Local Church Engagement in Eating Disorder Recovery A Case Study and Reflections

One way of aiming to address the gap between secular psychology and weight management groups
and spiritual guidance has been a church based programme in Dallas, Texas, which aims to follow
the Twelve Step approach, pioneered in Alcoholics Anonymous. The methodology of the research
was to observe a session of the Twelve Step Eating Disorders Group with their permission. At a
different time structured face to face recorded interviews were conducted with the Director of the
Twelve Step Ministry and the Senior Pastor of the Church. Telephone interviews were conducted
with one of the founding members of the group, and with a local Psychiatrist who specialises in
Eating Disorders and works in an advisory capacity with the church programme.

The section which follows aims to describe the programme, its context and content, its relationship
to the church and the experiences of participants. Some reflections and evaluation based on an

192

ethnographic approach to studying the programme will be offered, as will observations on how
cultural factors may affect the transferability of such an enterprise to other situations.

5.2.3.1 Context
The programme was part of the outreach ministry of a United Methodist Church in Dallas. The
church has approximately 5000 members and its 40 paid staff are based on the church campus,
comprising a 1000 seater Sanctuary, a smaller side chapel, a large multipurpose hall and a suite of
offices. Directly across a major highway from the campus is the Center for Spiritual Development
which was once a private house but now hosts the Twelve Step ministry of the church. The CSD is
set in tranquil gardens and is discreetly hidden from the public and the church campus by trees.
There are a number of meeting rooms including a large lounge downstairs and several bedrooms
converted into smaller meeting rooms upstairs. In the small hallway is a notice board detailing the
venue and time of groups meeting in the CSD. The atmosphere is very much one of if not secrecy,
anonymity. There is no welcome desk and if there is not a meeting due to start or finish there is noone in the building. This is a marked contrast with the church campus across the road where there
are always people and highly visible activity. The mission statement of the Twelve Step ministry
operating in the CSD is:

The Twelve Step Ministry of X United Methodist Church is a fellowship of individuals who
through shared experiences and mutual support are seeking spiritual growth in Christian faith. By
using both the scriptures and the Twelve Steps, participants are able to further their own recovery
and faith journey. The Twelve Step Ministry programs are not limited to those persons in
recovery. A wide variety of educational, spiritual and support groups are offered, as well as other
activities. The best mission statement for this ministry is: Christian faith, like life itself, is a
journey and the Twelve Steps are the road map.

At the time of visiting the Senior Pastor of the church was expressing a desire to see the Twelve
Step ministry brought more closely together with the other ministry of the church as a whole. This

193

was being resisted by the leader of the Twelve Step ministry who felt the anonymity which he
believed was crucial to the success of the programme would be compromised if there were greater
interaction between the church and those attending Twelve Step programmes (some of whom were
church members). The relationship between the church and the CSD was interesting to observe.
The wider church seemed supportive and proud of having an outreach programme which, as was
discovered in interviews with other local agencies dealing with addictions recovery, was well
respected outside the church as well as by it. Much of the credibility for the programmes rested on
the Director of the CSD who was on the staff of the church and was well known in the small and
fairly closed world of addictions programmes in Texas.

The geographical siting of the church and CSD seemed to metaphorically express the relationship
between the two: visible to one another and linked by personnel, inhabiting quite different worlds
but still needing one another.

5.2.3.2 The Eating Disorders Group

The Eating Disorders group began in February 2004 and was co-founded by a young woman whose
testimony has been shared on the churchs website and is included in this thesis as appendix A, and
by the woman who was the facilitator at the time the ethnographic research took place.

In the time it had been in existence the groups format and membership had altered so that at the
time of research there were only two regular members (one of the co-founders having moved away
and others having come and gone). The facilitator had also moved the focus away from the
Twelve Steps and described the group in terms of being a support group stating her reason for the
change that the Twelve Steps did not transfer very well from AA because of the difficulties about
defining abstinence.

The usual format of the group was to each person to talk in turn about how they had found the
previous week in relation to their relationship with food and eating, identifying what had been

194

major challenges to avoiding compulsive eating and recalling trigger events. Looking to the week
ahead, strategies for avoiding compulsive eating and finding checks and balances were discussed.
This was the context for confessing and accountability and though in a group of two there was
adequate opportunity for confessing in both senses of speaking out and more specifically,
confessing wrong behaviour, the absence of structure led to a very wide ranging sharing of
thoughts, feelings and actions in which confessions of specific sins could evade accountability
through being swamped with further sharing.

Both members of the group have been to individual psychological therapy and both also attend
other support groups. It is the stated aim of the Director of the Twelve Step ministry that the Eating
Disorders Group is an added support provided by the church for those with disordered eating,
rather than a substitute for individual therapy. He saw the purpose of the Eating Disorders group in
terms of accountability and helping members of the group continue in their resolve to seek
recovery by attending sessions with their therapist. His view on this is supported by a local
psychologist specializing in the field of eating disorders who was interviewed as part of this
research. She forms part of the wider team of professionals with specific training in areas which
link to the different areas covered by the Twelve Step ministries via the Director.

In a programme run on behalf of the church and operating under the umbrella of the Twelve Step
ministry the lack of spiritual content or reference observed within the eating disorders group
session was surprising. Other than one participant referring to her Higher Power on one occasion
there was no other mention made of the spiritual. Although the group purported to be a support
group, suggesting a mutuality and equality between members, the facilitator appeared to want to fill
the role of counsellor and the other member of the group accepted and in many ways encouraged
this.

The Director initially seemed unaware that this was how the group was operating because he does
not attend groups unless problems are brought to his attention, as he feels his presence would

195

inhibit the freedom of the group to function. On further conversation it emerged that he was aware
that the Eating Disorders group was not working as well as it might and that comments had been
made to him by others who had left that group and moved on to other groups. As the Director only
meets with the facilitator of the Twelve Step groups twice a year there is a lack of accountability in
the running of the groups. When things are not functioning well within a group such as the Eating
Disorders Group this threatens to damage the reputation of not only the group or the Twelve Step
Ministry but potentially the church as a whole. There was an element of irony in the existence of a
group set up for individuals to be accountable to one another which lacked accountability to the
wider Twelve Step ministry and the church.

5.2.4 A Response to Confessing and Accountability pursued in the context of Disordered

Eating

The willingness of the church in the case study to seek to offer help to those with
disordered eating is to be commended and the original attempted use of the Twelve Step
process of confessing and accountability points toward a deeper reality of the power of
God to bring liberation and healing through such a practice. It does however run the risk of
blurring the distinction between the Churchs historic practice of confessing and
accountability, and confessing to a subjective religious Higher Power, created in the image
of the participant in the Twelve Step programme. Where the purpose of confessing and
accountability in the Church is to witness to the truth and transforming power of God, the
more limited aims of confessing and accountability within the Twelve Step programme and
also within Weight Watchers are the personal development of the individual. The benefits
found in both these programmes are not to be dismissed and though they may differ in kind
from what is practiced in the life of the Church the good that is done through them reveals
a reflection of what could be.

196

Looking to what could be runs the risk of creating an idealised programme which glosses over the
complexities of dealing with real people in the midst of difficult issues. Nevertheless, the argument
of this chapter has been that the practice of confessing and accountability, as practiced by the
Church, may have potential in releasing those trapped within disordered eating. 76

5.3 Conclusion
What can be seen from the preceding sections is that there are significant themes which are both
part of the practice of the Church but which have also been appropriated by those outside the
Church in a quest for human flourishing. It is the assertion of this chapter that those outside the
church have grasped something of the power and potential of confession and accountability. Whilst
this may involve a greater depth of honesty and relationship than exists in some church groups, it is
still a pale reflection of what could be achieved by rediscovering the practice in the life of the
Church as it engages with a God who aids humanity in their longing for wholeness.

The examples explored above demonstrate that there are various ways of working out the practice
of confessing and being accountable as far as they relate to the Church and disordered eating. It is
vital that the Church rediscovers this practice if it is to connect with those seeking to speak
truthfully of how they are and be transformed.

76

It is proposed that a programme adopting these insights may run in a similar way to that pioneered by
Mercy Ministries. The Mercy Ministries programme in the UK is an explicitly Christian residential
programme for women between the ages of 18 and 28. The programme involves a daily structured routine
from Mondays to Thursdays, involving worship, bible study and discussion, recreation, one-to-one meetings
with a facilitator, appointments with doctors, and classes addressing behavioural, emotional and spiritual
aspects of life. Fridays and Saturdays are more relaxed with greater free time and Sunday is spent at the
church with which the programme participant is linked.
The residential nature of the programme and the expertise involved in Mercy Ministries make it beyond
replication in many places, though the elements of worship, learning, sharing, discussing, confessing and
being accountable could all be practiced within the life of a Church community and/or small group.

197

Chapter 6
Perfection and Perfectionism

Be perfect, therefore, as your heavenly Father is perfect1

6.0 Introduction
The first task of this chapter, as with previous chapters is to explain and justify its inclusion within
the wider work of the thesis. This being established it will proceed to argue that whilst in a
theological sense sanctification or the pursuit of perfect love 2 is not a practice in the same way that
the three preceding chapters focus on practices, it is a thread interwoven through them. The
theology of perfection, as articulated by various theologians during the Ante-Nicene period, then
by Augustine and later by Thomas Aquinas, will be explored. Particular attention will be given to
the extent the theological understanding of perfection is shaped by the prevailing philosophical
worldview and also the impact of language in determining and shaping the concept of perfection.

A later section of the chapter examines how the doctrine of perfection is reframed in different
historical periods. In the immediate aftermath of the Reformation, few Protestant theologians were
willing to press the pursuit of perfection for fear of confusing the primary message of salvation by
grace through faith alone. 3 The chapter will discuss the nuances of the understandings of
perfection in order to establish whether there is a common thread in theological understanding, or
whether the word perfection and particularly the term Christian Perfection are discussing
different things by the same name.
1

Matthew 5:48
As John Wesley referred to it. See Wesley, A Plain Account of Christian Perfection (London: Epworth
Press, 1952).
3
Robert Friesen, Christian Perfection, Direction 13, no.3 (1984), 25-32.
2

198

The discussion of theology in the first part of the chapter is significant in interpreting the recourse
to dialogue with psychology in the second part of the chapter. In addition to the theological
importance of Christian Perfection within Methodism, the key reason for discussing perfection
within this thesis is the identification of perfection or perfectionism as a personality trait within
those suffering from disordered eating, particularly within anorexia nervosa.

The work of Hilde Bruch focussed mainly upon anorexia nervosa and what she sees as its opposite
extreme, obesity. 4 She identifies perfection along with identity and autonomy as the key
psychological issue driving anorexia nervosa.5 Bruch writes about one of her patients,

She described in many details the agony of living a life of perfection, never being able to do what
she wanted to do or felt like doing, always under the compulsion to do what was expected of her. 6

The identification of perfectionism as a trait within anorexia nervosa requires attention, both from
the perspective of contemporary psychology, and in relation to the theological concept of Christian
Perfection as understood by the Church. If Bruch is correct in suggesting that perfectionism is
profoundly bound up with eating disorders then the Church, in seeking to respond compassionately
and constructively to those with eating disorders, needs to give serious consideration to the content
and communication of the doctrine of Christian Perfection.

It is with this in mind that this chapter takes Bruchs insights and seeks to explore them further in
the light of current psychological research on perfectionism. The sections on the psychology of
perfectionism discuss some of the latest psychological research which defines perfectionism from
the perspective of psychology and identifies its impact upon the emergence, development and
maintenance of anorexia nervosa. Again, discussion will draw out whether the concept of
4

Hilde Bruch, Eating Disorders.

Ibid.
6
Hilde Bruch, Eating Disorders, 264.
5

199

perfection or perfectionism as understood in psychology is congruent with that discussed in

theology.

The final section of this chapter seeks to rediscover what a doctrine of Christian Perfection may
look like in an emerging contemporary cultural context. Parallels are drawn with, and lessons
learned from the rediscovery of Christian Perfection in early Methodism. The re-emergence of
Christian Perfection in the early Methodist movement came as such a revelation to many within
the church that some called it Mr Wesleys doctrine, asserting that this was some new theology
rather than a recovery of something with a significant historical pedigree. 7 The focus on this
Methodist understanding seeks to tie in with other features of Methodism emphasised in previous
chapters, establishing that a rediscovery of some of the practices of Christian discipleship which
have been key in Methodism have potential to offer something positive in addressing the issues of
disordered eating.

In looking to what Christian perfection may mean for the Church today, consideration will be given
to whether or not this is a helpful contrast to the model of perfection pursued by those with
disordered eating. The question is raised as to whether, in even articulating a theology of Christian
Perfection, the Church is putting a stumbling block before those whose disordered eating is in part
generated or sustained by an unhealthy pursuit of perfection in creating an environment which
encourages a potentially harmful set of thought patterns and behaviours.

6.1 Perfection Theological and Philosophical Foundations

6.1.1 The Early Church
The early church, comprised as it was of those from Jewish and Gentile backgrounds, inherited two
philosophical traditions of perfection. The Hebrew Scriptures spoke of a perfect God 8 whose law

7
8

Wesley, A Plain Account, 25.

Ps. 18:30.

200

was perfect9 and who desired the undivided devotion of his people. 10 Alongside this relational
concept of perfection stood the influence of the Academy where those schooled in Greek
philosophy would be aware of the definition of perfection articulated by Aristotle. What follows is
a brief engagement with both those traditions in order to establish their content and significance in
order that the way later theologians understood perfection might be traced back to their
foundations.

6.1.1.1 Hebrew Perfection Perfection in Relationship

The Hebrew words shalem, tamim, tam and kalil are all translated into English as perfect. Shalem
pertains almost exclusively to people11 and carries the sense of whole or complete 12 or
finished. There is a sense of entirety about it as the person who is totally committed, fully
focussed upon God finds in him their completion. This understanding of perfect which is set in
the context of the Genesis account of humanity being created in relationship with the Creator God
sees completeness and wholeness in how one relates to God. A perfect heart 13 is deemed perfect
in as far as it finds its end and focus in God; as Donovan notes, The good man will long for the
labh shalem, perfect heart, or complete devotion which a few are said to have attained. 14

The word tamim is also translated perfect and is used of people, God, Gods way, and Gods
law.15 The meaning, like shalem, encapsulates complete but also sound or unblemished.
Whereas it could be said that the definition synonymous with complete indicates there is no more
that could be added to the person or thing, the idea of it being unblemished indicates the absence
of anything which could detract from or mar it. The use of tamim in relation to abstract notions

Ps. 19:7.
See the command to have no other gods before me in Deut. 5:7 and the response of the people articulated
in the Shema, Love the Lord your God with all your heart and with all your soul and with all your strength
in Deut. 6:5.
11
With the exception of Deuteronomy 25:15 which refers to perfect weight.
12
As in wholly or completely devoted to YHWH (1 Kings 8:61).
13
1 Kings 8:61.
14
W. N. Donovan, The Homiletical Worth of the Study of Hebrew, The Biblical World 32, no. 1 (1908),
54.
15
See Gen. 6:9, Ps. 18:30 and Ps. 19:7.
10

201

such as the way of the Lord16 still retain the relational element in that it is because the law is the
law of YHWH and because it is Gods way that they are perfect, just as the person wholly or
completely devoted to God is perfect, due to that relational aspect of perfection. Donovan identifies
it thus:

Another phase of goodness is exhibited by the hasidh, the pious, godly, man, whose tender heart and
loving acts witness his acquaintance with the God who is adored for his hasidh, tender mercy or
loving kindness. The man of balance and poise who unites these good qualities is well described as
tam or tamim, complete. This "perfect man" of our texts is no theoretical perfectionist who may for a
variety of reasons be a marked man, but an all-around, symmetrical man.17

Further examples of this understanding of perfection are embodied in the stories of the heroes of
the Jewish people. Noah is one of whom the word tamim is used which in some translations
appears as blameless but the King James Version translates as perfect. The use of tam to
describe Job as blameless can also be translated perfect. Those who fear the Lord, walk in his
ways, and avoid evil are those deemed blameless or, in some sense, perfect.

In a worldview centred around a God who is perfect in wisdom, providence, and faithfulness to his
people, the perfect servant of God is one who seeks and obeys his wisdom, is wholeheartedly (thus
perfectly) faithful to Gods commands and finds their completeness in him. All this is learned and
bound up within the sacred stories of the Jewish people, passed from one generation to another
through the community of faith. This concept of perfection as understood as wholehearted devotion
to God and living out his ways would have been the context into which Matthew wrote Be perfect,
therefore, as your heavenly Father is perfect. 18 It is not so much a call to perfection in terms of
primarily obeying precepts and keeping laws, for they are simply the means by which commitment
to God is expressed. This is a call to wholehearted devotion in loving God which pours out into

16

Ps 18:30.
Donovan, The Homiletical Worth, 54-55.
18
Matt. 5:48.
17

202

love of neighbour and, in the particular context of the passage in Matthew, enemies. 19 The
centrality of relationship with God in the Jewish understanding of perfection contrasts sharply with
the abstract philosophy of the Greek Academy which was the context of many of the converts to
Christianity who responded to Pauls preaching. It is into this different worldview that we now
enter in order to note the similarities and contrasts within the concept of perfection.

6.1.1.2 Greek Perfection From Relationship to Abstraction

The earliest philosophically articulated definition of what is perfect is traced back to Aristotle,
who gives the concept its philosophical foundations. In his Metaphysics, he defines four senses in
which something may be perfect, though it is arguable that these may easily be collapsed into three
strands of thinking.20
The first heading refers to That outside which it is impossible to find even a single one of its
parts.21 This draws heavily on the meaning of perfection being completeness. The example given
by Aristotle relates to time but can equally be applied to substance, namely that to be complete or
perfect it must be impossible to find additional matter belonging to a thing outside of it.

The second instance of perfection stated by Aristotle concerns itself more closely with the notion of
excellence, defining as perfect That which in respect of goodness or excellence, cannot be
surpassed in its kind. 22 Here we are presented with perfect used as a superlative adjective,
illustrated by Aristotle in reference to the perfect doctor or the perfect musician as one of
unsurpassable skill. He acknowledges that in this usage perfect may also be used to describe the
most negative of characteristics, as in the perfect thief.

19

Wink, Engaging the Powers, 267-271.

Aristotle, Metaphysics V. X, 1012b -1002a, in The Complete Works of Aristotle, vol. 2, ed. Jonathan
Barnes (Princeton: Princeton University Press, 1998).
21
Aristotle, Metaphysics V. X, 1012b.
22
Ibid.
20

203

The third suggestion that goodness is a kind of perfection 23 goes on to combine the first two
headings with a suggestion of both being excellent and also lacking nothing.

The final strand of Aristotles definition brings into focus the understanding of teleos most
commonly used in theology, that pertaining to the end of things: Things which have attained their
end, if their end is good, are called perfect. 24 Despite the nuances within his definition, the
enduring senses of what it means to be perfect relate to being complete, being unsurpassed and
achieving the end for which something exists.

The discussion of perfection in the abstract raises questions about the subjectivity of its application.
It may be relatively simple to suggest that a perfect spoon is one which attains its end of enabling
the eating of food in a satisfactory manner, being neither too large nor too small to fit in the mouth
and capable of containing an amount of food fitting to the user. More complex is defining the
perfect person, for this requires agreement on the end or purpose of humanity. Aristotle and his
contemporaries esteemed knowledge and the faculty of reason and therefore framed the notion of
the perfect man in terms of intellect and wisdom and the way in which such qualities combined
with others to produce perfection. Throughout history the concept of perfection articulated by
Aristotle has been used as the basis of what it means to be perfect in terms of morality, 25 skill,26 and
beauty.27

6.1.1.3 Latin Translation From movement to static

A further shift in the meaning of perfection came with the adoption into English of the word
perfect from the Latin perficio. The Latin notion of things which are perfectus is static, whereas
the Greek teleiots has nuances which allow for a sense of movement. Teleiots and its cognates

23

Ibid.
Ibid.
25
See Thomas Aquinas in later section.
26
For example Renaissance Man as the image of perfection as one who excelled in many disciplines.
27
See material on aesthetics, and contemporary discussions on body image in Chapter 2.
24

204

are used fifty-three times in the Greek New Testament and is variously translated as make
perfect,28 fulfill,29 mature/ full grown, 30 and perfect31. As Oden notes,

The Greek teleiots (Col. 3:14; Heb. 6:1) has been commonly translated as perfection, but also
under metaphors of maturation and completeness. The Christian life is not a static perfectus in the
sense of no possible improvement, but a dynamic teleiots in the sense of the most excellent
conceivable contextual functioning of the developing person. 32

This linguistic difference and its impact on the framing and understanding of the concept of
perfection may be the reason why Christians have differed in whether they believe Christian
perfection is possible and if so, in what sense.

The construction of meaning through language is a more complex subject than there is scope for
discussing in this context and yet the potential implications of recapturing the essence of the Greek
over the Latin are significant. The developing conversation within the emerging church 33 about
what it means to inhabit and understand the contemporary cultural context has exposed the cultural
accommodation of modern thought in Christian theology.34 The neat categorisation and
systematisation of theology is being questioned by those taking a narrative approach in line with
one of the prevailing themes of contemporary thought. Those within the emerging church
conversation are looking to describe being a Christian in terms of being a journey, indicating

28

Hebrews 11:40.
James 2:8.
30
1 Corinthians 2:6.
31
Matthew 5:48.
32
Thomas C. Oden, John Wesleys Scriptural Christianity (Grand Rapids, Michigan: Zondervan. 1994), 320.
33
The Emerging Church movement is a late twentieth/ early twenty-first century movement seeking to be
and do church within postmodern culture. As a movement it is varied and resists simple definition. One of
the most useful descriptions is given by Eddie Gibbs and Ryan Bolger, two men considered to be as
conversant as one can be with the emerging church scene. Emerging churches are communities that practice
the way of Jesus within postmodern cultures. This definition encompasses nine practices. Emerging churches
(1) identify with the life of Jesus, (2) transform the secular realm, and (3) live highly communal lives.
Because of these three activities, they (4) welcome the stranger, (5) serve with generosity, (6) participate as
producers, (7) create as created beings, (8) lead as a body, and (9) take part in spiritual activities. Eddie
Gibbs and Ryan Bolger, Emerging Churches: Creating Christian Community in Postmodern Cultures (Baker
Academic, 2005).
34
Brian McLaren, A New Kind of Christian (San Francisco: Jossey Bass, 2001).
29

205

movement, change and growth, rather than a view of Christianity as believing or doing the right
things until one reaches a point of having arrived.35

In this contemporary conversation, the ability to trace where our notions of perfection have come
from and any sense in which the meaning has become lost in translation is vital. The above
discussion over origins of the concepts of perfection indicate three different approaches, broadly
pertaining to the same key ideas (completeness, wholeness, attaining the end and goodness) but
with some significantly different outcomes. The Hebrew notion of perfection makes no sense
without reference to God who is perfection and determines the content and context of what it
means to be perfect. The Greek understanding has a clarity of definition and differentiation,
allowing for perfection being a state of ongoing existence, for example the perfect pianist being
capable of sustaining that perfection throughout their career. The punctilliar Latin distinction
frames perfection in a static linguistic construction, evoking the sense that until something reaches
its final point there will always be the possibility of it becoming better or more complete, so that it
is only possible to reach perfection at the end of its existence. The following sections trace the
aftermath of the meeting of the Hebrew, Greek and Latin understandings of perfection and how,
theologically, the question of perfection was addressed in the work of particular theologians
throughout the centuries.

6.1.2 The Ante-Nicene Fathers on Perfection

As Christian theology was being formed and the debates included the relationship between secular
philosophy and its relation to the gospel, the early church fathers grappled with the nature of
perfection as it related to humanity.

Irenaeus believed in the possibility of perfection in this life for those who followed Christ and in
their discipleship were conformed to his likeness through the ongoing work of the Spirit:

35

McLaren, A New Kind of Christian.

206

For truly the first thing is to deny ones self and to follow Christ; and those who do this are borne
onward to perfection, having fulfilled all their Teacher's will, becoming sons of God by spiritual
regeneration, and heirs of the kingdom of heaven; those who seek which first shall not be forsaken. 36

His focus is upon discipleship and the sanctification of the believer through the regenerating work
of the Spirit as the disciple seeks to follow Christ. The sense of growing into perfection and being
borne on toward closer conformity to Christ reflects the understanding of sanctification as
occurring as a process following justification rather than something instantaneous. In emphasising
denial of self and following Christ, Irenaeus considers the pursuit of perfection in the light of what
may be termed in contemporary language whole life discipleship rather than in terms of a
particular set of behaviours, rituals or doctrinal understandings.

It was in the second century however, that Clement of Alexandria pursued the relationship between
knowledge and perfection. Clement entitles Chapter Ten of Stromata Steps to Perfection. His
exploration examines the extent to which faith, life and knowledge were capable of perfection,
concluding that Christian perfection was possible in this life:

For knowledge (gnosis), to speak generally, a perfecting of man as man, is consummated by

acquaintance with divine things, in character, life, and word, accordant and conformable to itself and
to the divine Word. For by it faith is perfected, inasmuch as it is solely by it that the believer
becomes perfect. Faith is an internal good, and without searching for God, confesses His existence,
and glorifies Him as existent. Whence by starting from this faith, and being developed by it, through
the grace of God, the knowledge respecting Him is to be acquired as far as possible. 37

Clement viewed faith as a prerequisite for perfection, for by faith all other qualities and attributes
are brought into the transformative orbit of the grace of God. The refining and honing of
knowledge to bring it to perfection is, in Clements view, possible for the one who directs

36
37

Irenaeus, Fragments from the Lost Writings of Irenaeus XXXVI, Ante-Nicene Fathers vol 1.
Clement of Alexandria, Stromata Chapter X.

207

themselves toward God and seeks to be conformed to the likeness of Christ. Later theologians came
to treat Clements views on Christian Perfection as suspicious and too closely allied to the
Gnosticism with which they felt Clement had become tainted. It was seen as much safer to avoid
the question of whether Christian Perfection was attainable in this life rather than become
embroiled in questions of how one may know perfectly and the degree to which this was
attributable to human achievement.

As doctrinal questions developed, the focus turned in Tertullians thinking toward what happens
after death. He concluded that perfection was something which happened after death, reflecting
perhaps the Latin notion of perficio being a static state possible when there is no more earthly
living to do. His view was that the perfection promised in scripture referred to that which occurs
after death, concluding thus:

We therefore maintain that every soul, whatever be its age on quitting the body, remains unchanged
in the same, until the time shall come when the promised perfection shall be realized in a state duly
tempered to the measure of the peerless angels. 38

It is impossible to determine the extent to which the difference in view between whether Christian
Perfection is possible in this life or comes only after death is influenced by the linguistic and
cultural differences between the early church Fathers. What can be noted is that the identification
of Christian perfection with Gnosticism in the writings of Clement and the role of pursuing
perfection in the later Pelagian controversy have generated a suspicion within Christianity
surrounding any doctrine of perfection which considers it anything other that a response to Gods
grace in Christ.39

Perhaps the clearest statement of this position in the Patristic period came through the writings of
Augustine. The key issues in understanding perfection can be viewed through the lenses identified
38
39

Tertullian, An Answer to the Jews Chapter LVI.

See Friesen, Christian Perfection, Direction 13, no. 3 (1984), 25-32.

208

earlier of the positive movement toward completeness in God and the avoidance of the negative in
the avoidance of sin which keeps one from perfection.

6.1.3 Augustine
6.1.3.1 Augustine - Introduction
In A Treatise Concerning Mans Perfection in Righteousness Augustine writes to refute the
teaching attributed to Coelestius that human beings had within their power the capacity to live
without sin.40 Augustine then seeks to interpret the passages of scripture pertaining to perfection in
a way consistent with such a view of the corrupting nature of sin, concluding that it is not possible
to live without sinning and therefore be perfect in this life. The significance of considering
Augustines contribution at this point lies in the similarity of the questions to those addressed by
John Wesley.41 It is important to note the difference between Augustine and Wesley in their
understanding of sin in order to comprehend why they arrived at different conclusions regarding
the practice and possibility of Christian Perfection.

6.1.3.2 Augustine, perfection and the significance of sin

Regarding perfection, Augustine concluded that to sin was to exclude the possibility of perfection.
This is clearly consistent with any of the definitions of perfection developed through the Hebrew,
Greek and Latin-speaking traditions, namely that one cannot attain perfection or be complete if
something is lacking or if something is dividing the heart from full devotion to God or if something
is detracting from the highest moral purity and capacity to love. Augustines first task therefore was
to establish whether it is possible to avoid sin, and if so, how. Our answer to this is, that sin can be
avoided, if our corrupted nature be healed by God's grace, through our Lord Jesus Christ.42 For
Augustine, the power of sin within the corrupt nature of humanity was a force which could only
be overcome by Gods grace operating in the believer through Christ, that sin is not natural; but
40

Augustine, A Treatise Concerning Mans Perfection in Righteousness, in Alexander Roberts, James

Donaldson, Philip Schaff and Henry Wace (eds.), Nicene and Post Nicene Fathers: First Series, 14 Volumes
(Peabody, MA: Hendrickson, 2nd ed. 1994), vol. V.
41
See later section.
42
Augustine, A Treatise Concerning Mans Perfection in Righteousness, II. i.

209

nature (especially in that corrupt state from which we have become by nature children of wrath
Ephesians 2:3) has too little determination of will to avoid sin, unless assisted and healed by God's
grace through Jesus Christ our Lord.43

Augustines conviction of the corrupted soul led him to distinguish the sinful act from the sinful
self. Even when not acting upon sinful desires by turning them into actions, the human is still sinful
because the soul is defective in that it is orientated to evil. The solution to this is the ongoing work
of redemption wrought through Christ, whereby his grace at work in the heart of the Christian heals
the soul of its evil orientation and deficiency day by day. 44

This healing is in conformity with the will of God who desires sinlessness in humanity, If God
wished not that man should be without sin, He would not have sent His Son without sin, to heal
men of their sins.45 Augustine therefore arrives at the conclusion that God desires that we do not sin
and has provided through grace the gift of Christ in whom there is healing from sin, and yet the
capacity for humanity to follow their corrupted earthly nature precluded being free from sin in this
life; It is one thing, therefore, to depart from all sina process which is even now in operation
and another thing to have departed from all sin, which shall happen in the state of future
perfection.46

Augustines understanding of sin and the nature of humanity is expressed in his articulation of the
four stages of humanity. 47 The first state of humanity before the Fall was the state of innocence in
which humanity was able to sin but also able not to sin (posse peccare, posse non peccare). As a

43

Augustine, A Treatise Concerning Mans Perfection in Righteousness, II. iii.

44

See Augustine, A Treatise Concerning Mans Perfection in Righteousness, II. iv, Is sin an act or a
thing?
45

Augustine, A Treatise Concerning Mans Perfection in Righteousness, II. vii.

Augustine, A Treatise Concerning Mans Perfection in Righteousness, XVII.
47
Augustine, Confessions, in Alexander Roberts, James Donaldson, Philip Schaff and Henry Wace (eds.),
Nicene and Post Nicene Fathers: First Series, 14 Volumes (Peabody, MA: Hendrickson, 2nd ed. 1994), vol. I,
X.
46

210

consequence of the Fall, humanity entered the second phase, the natural state in which man was
not able to not sin (non posse non peccare). Following Christs resurrection, those justified by his
death and resurrection entered the state of regeneration where it was possible to not sin (posse non
peccare). The fourth and final stage identified by Augustine was the state of glorification at the end
of time when glorified humanity will no longer be able to sin (non posse peccare). The third stage,
whereby it is technically possible to not sin, even if the reality is more challenging, causes
Augustine to urge the Christian to pursue virtue despite the natural bias toward sin.

6.1.3.3 What then does pursuing righteousness or perfect love entail in Augustines understanding?
Augustine anticipates a time when the Christian is sinless and totally devoted to God but cannot
conceive of it occurring during earthly life:

In that perfect state the just man shall live absolutely without any sin, since there will be in his
members no law warring against the law of his mind, (Romans 7:23) but wholly will he love God,
with all his heart, with all his soul, and with all his mind (Matthew 22:37) which is the first and
chief commandment. For why should not such perfection be enjoined on man, although in this life
nobody may attain to it?48

Even though Augustine maintained that Christian perfection could not be achieved in this life, he
urges the pursuit of perfection within the Church, perceiving discipleship in this life as preparation
for the life hereafter:

In other words, let us, as many as are running perfectly, be thus resolved, that, being not yet
perfected, we pursue our course to perfection along the way by which we have thus far run
perfectly, in order that when that which is perfect has come, then that which is in part may be done
away;49

48
49

Augustine, A Treatise Concerning Mans Perfection in Righteousness, IXX.

Ibid.

211

and

For the way in which we walk, that is, the road by which we reach perfection, is cleansed by clean
prayer. That, however, is a clean prayer in which we say in truth, Forgive us, as we ourselves
forgive. (Matthew 6:12) So that, as there is nothing censured when blame is not imputed, we may
hold on our course to perfection without censure, in a word, blamelessly; and in this perfect state,
when we arrive at it at last, we shall find that there is absolutely nothing which requires cleansing by
forgiveness. 50

For Augustine, the starting point in the quest for perfection was about rejecting the ever present
pull of the power of original sin. Whilst he theoretically acknowledged Gods power to eradicate
sin in the life of the Christian the practical reality was that Augustine could not bring himself to
assert that perfect love of God was possible in this life.

The ways in which Augustine considered perfection might be pursued are stated and supported by
scriptural reference:

Our righteousness in this pilgrimage is this that we press forward to that perfect and full
righteousness in which there shall be perfect and full love in the sight of His glory; and that now we
hold to the rectitude and perfection of our course, by keeping under our body and bringing it into
subjection, (1 Corinthians 9:27) by doing our alms cheerfully and heartily, while bestowing
kindnesses and forgiving the trespasses which have been committed against us, and by continuing
instant in prayer; (Romans 12:12) and doing all this with sound doctrine, whereon are built a
right faith, a firm hope, and a pure charity.51

50
51

Augustine, A Treatise Concerning Mans Perfection in Righteousness, IXX.

Augustine, A Treatise Concerning Mans Perfection in Righteousness, XVIII.

212

The themes of subjection of the body, giving to the poor and pure charity are taken up and
developed in the monastic period by Thomas Aquinas. As the next major theologian in history to
address Christian perfection it is to his thinking that we now turn.

6.1.4 Thomas Aquinas

Thomas Aquinas addressed the doctrine of perfection within Summa Theologiae and also On
Perfection in the Spiritual Life. Of the eight questions pertaining to perfection within Summa
Theologiae, those which are of most import to this discussion are the first four, namely;

(1) Whether perfection bears any relation to charity?

(2) Whether one can be perfect in this life?
(3) Whether the perfection of this life consists chiefly in observing the counsels or the
commandments?
(4) Whether whoever is perfect is in the state of perfection? 52

Taking various biblical texts relating to being perfect or things perfect Aquinas raises objections
to the notion that perfection in the Christian life is predominantly about love, considers the
objections and then responds with his definition of perfection; A thing is said to be perfect in so
far as it attains its proper end, which is the ultimate perfection thereof. 53 As can be seen this relies
heavily on the definition of perfection espoused by Aristotle, looking to the extent someone or
something corresponds with its teleos or ultimate end as the measure of perfection. Aquinas then
articulates that God is the last end of the human mind 54 and therefore concludes that the
perfection of the Christian life consists radically in charity.55

52

Aquinas, Summa Theologiae, trans. Timothy McDermott (Cambridge: Cambridge University Press, 2006)
II. ii. 184.
53
Aquinas, Summa Theologiae II. ii. 184.
54
Ibid.
55
Ibid.

213

In addressing the proposition that perfection consists not only of love (charity) but also of other
virtues, Aquinas sets forth two definitions of perfection:

A man may be said to be perfect in two ways. First, simply: and this perfection regards that which
belongs to a things nature, for instance an animal may be said to be perfect when it lacks nothing in
the disposition of its members and in such things as are necessary for an animals life. Secondly, a
thing is said to be perfect relatively: and this perfection regards something connected with the thing
externally, such as whiteness or blackness or something of the kind. 56

By means of application Aquinas considers perfect love as the paramount defining characteristic of
the nature of the perfect Christian, and other virtues as relative.

Perfection is said to consist in a thing in two ways: in one way, primarily and essentially and in
another, secondarily and accidentally. Primarily and essentially the perfection of the Christian life
consists in charity, principally as the love of God, secondarily as to the love of our neighbour both
of which are the matter of the chief commandments of the Divine law, as stated above. 57

As asserted previously, one of the greatest difficulties in discussing the nature of perfection is the
multiplicity of meanings generated within such a debate. Within his discussion of the state of
perfection in general Aquinas speaks not only of perfection as pertaining to a thing or person but
in answer to questions from four to eight introduces the notion of a state of perfection:one is
said to be in the state of perfection, not through having the act of perfect love, but through binding
himself in perpetuity and with a certain solemnity to those things that pertain to perfection. 58

This leads him to the view that, having made a vow to pursue perfection by attending to such things
as enable one to love perfectly, the religious, priests and bishops are in a state of perfection. He is

56

Ibid.
Aquinas, Summa Theologiae II. ii. 184.
58
Ibid.
57

214

clear to state that this does not mean such people are perfect, nor does it mean that those who have
not pledged themselves in perpetuity to love God and neighbour perfectly cannot be perfect. 59 This
separating out of the discussion into perfection and a state of perfection muddies the waters in
contemporary discourse of what is being set forth. As will be seen later 60 the semiotics of
perfection has been a cause of confusion, not only in understanding concepts but the consequent
implications for theology.

It is also imperative that any discussion of Thomas Aquinas understanding of perfection

acknowledges the world in which he lived and the worldview within which he was operating.
Within the order, structure and hierarchy of the worldview inhabited by Aquinas and his
contemporaries the differences between how a notion of perfection relates differently to bishops,
the religious and others was an obvious distinction to make. The stratification of degrees of
perfection may appear arbitrary and contrived to those reading Thomas work today, but such
structure mirrors the worldview of hierarchy around which it was understood the universe was
created and functioned.

As well as drawing upon Aristotles foundational propositions of perfection, Aquinas references

Augustine, Jerome, Ambrose and Dionysius in his discussions on the nature of perfection and the
interpretation of biblical texts. His reference to the Patristic debates surrounding perfection serve to
illustrate how the doctrine of Christian perfection is one which passes through times of intense
debate and then much longer periods of neglect.

The conclusion reached by Thomas Aquinas is that in order to love God perfectly it is necessary to
renounce all things which may compromise ones capacity to love God wholeheartedly. This
involves renunciation of temporal possessions, fleshly affections and the capacity to choose as one
wills, or more succinctly, poverty, chastity and obedience.

59
60

Ibid.
See Wesleys attempts to define what perfection is and is not.

215

6.1.4.1 Did Thomas Aquinas believe perfection was possible in this life?
Three arguments are put forward in objecting to the possibility of perfection attainable in this life.
Firstly, the eschatological argument from 1 Corinthians 13 that if when perfection comes that
which we see and know in part will be taken away, we therefore exist in a state of incompleteness
and therefore imperfection. Aquinas differentiates the heavenly perfection from what is perfection
attainable in this life on the grounds that it is a different sort of perfection. He takes the view that
essentially heaven and earth are different worlds and that it is impossible to compare like with
unlike.

The second argument explicitly takes the definition of perfection as that which lacks nothing from
Aristotle and states what is known from observation and experience that there is no-one in this life
who lacks nothing.61 Supporting this argument with Scriptural reference from James 3:2 which
acknowledges we all offend it appears that the point is made that none can be perfect in this life.
In reply, however, Aquinas begins those who are perfect in this life attributing the offences
mentioned in James to weaknesses in this life which make them imperfect in comparison to what
they will be in heaven, but in an earthly state of perfection nonetheless.

Thirdly, the argument of impossibility is suggested, that because our love of God will be greater in
heaven and because we cannot know and therefore actually love all our neighbours in this life, we
are in some senses deficient in our capacity to love in a way deemed perfect. Therefore,

Hence we may consider a threefold perfection. One is absolute, and answers to a totality not only on
the part of the lover, but also on the part of the object loved, so that God be loved as much as He is
lovable. Such perfection as this is not possible to any creature, but is competent to God alone, in
Whom good is wholly and essentially.

61

Aquinas, On the State of Perfection in General, II.ii.

216

Another perfection answers to an absolute totality on the part of the lover, so that the affective
faculty always actually tends to God as much as it possibly can; and such perfection as this is not
possible so long as we are on the way, but we shall have it in heaven.

The third perfection answers to a totality neither on the part of the object served, nor on the part of
the lover as regards his always actually tending to God, but on the part of the lover as regards the
removal of obstacles to the movement of love towards God, in which sense Augustine says (QQ.
LXXXIII, qu. 36) that "carnal desire is the bane of charity; to have no carnal desires is the
perfection of charity." Such perfection as this can be had in this life, and in two ways. First, by the
removal from man's affections of all that is contrary to charity, such as mortal sin; and there can be
no charity apart from this perfection, wherefore it is necessary for salvation. Secondly, by the
removal from man's affections not only of whatever is contrary to charity, but also of whatever
hinders the mind's affections from tending wholly to God. Charity is possible apart from this
perfection, for instance in those who are beginners and in those who are proficient.

62

Building on the foundations laid by Augustine, Thomas Aquinas also approaches the pursuit of
perfection in this life from the perspective of prioritizing the removal of obstacles to perfect love.
That Aquinas quotes Augustines denunciation of carnal desire is significant as the theological
theme continues; the route to perfection is to reject the desires of the flesh, to overcome the
impulses of the body and to exercise such control over the mind that it is no longer focused on the
material aspects of the self but directed toward focus on the spiritual. The layers and levels of
perfection articulated by Thomas Aquinas lend themselves to a process of striving to attain the next
step on the ladder, ascending ever higher until full perfection is achieved in heaven. This leaning
toward self-improvement and works of charity undertaking in the pursuit of perfection easily turns
into a grasping at salvation by works.

The teaching of Aquinas on perfection held sway until the upheaval of the Reformation, at which
point the doctrine of Christian perfection became submerged in the wake of the Reformers passion
for salvation by grace through faith. There simply was not room for any doctrine which could start
62

Aquinas, Summa Theologiae II. ii. 184.

217

people back on the road to seeing salvation as in any way related to their own actions. Whilst some
continued to see sanctification in terms of practicing perfect love, 63 it was not one of the dominant
issues of the time. It was not until the mid-eighteenth century that the doctrine of Christian
Perfection resurfaced as a contentious feature of the emerging Methodist movement.

6.1.5 Summary and Conclusion

Throughout the centuries a doctrine known as Christian Perfection has been discussed and its
practice has been attempted and sought after. Having noted some of the key theological thinkers in
this area, what becomes apparent is that in each case there are significantly different approaches.
These differences are shaped by the reason Christian Perfection was being discussed, other
doctrinal issues which were pressing at the time, and how the nature and operation of sin was
understood. Despite the divergent opinions it is possible to see a common thread running through
the material examined which enables us to identify core issues about the doctrine of Christian
Perfection without attempting to synthesise the varying interpretations of what the doctrine entails.

The value of reflecting upon and engaging with the tradition of the Church lies in its ability to offer
understanding regarding human capacity and propensity to sin or wrestle with not sinning. Holding
in tension Augustines insight regarding the influence of sin, ingrained within the fallen nature of
humanity with the inbuilt human longing for the freedom, forgiveness and cleansing understood as
salvation generates the theme explored in the final section of this chapter, namely how can we
become more than we are?.

Before that, the outworking of perfection is examined in the present day quest of striving to be
good enough. In this endeavour many find the shadow side of seeking perfection, borne out in
perfectionism, and it is to that we now turn.

63

See for example the books which greatly influenced John Wesley; Jeremy Taylor Rules and Exercises of
Holy Living and Dying and William Laws Christian Perfection.

218

6.2 What is perfectionism? The Perspective of Psychology

6.2.0 Introduction
The pursuit of perfection is generally upheld as a noble ideal. It inspires the fastest athletes, the
most beautiful art and the greatest music. This striving for perfection in any given field requires
sacrifices and dedication, often to the detriment of other areas of life, but there are those whose
ideal is to be perfect in every area of life becomes a form of oppression. The question emerges,
when does the pursuit of perfection actually become detrimental to human flourishing? The
discipline of psychology concerns itself not with the philosophical or theological definitions of
perfection but with the perceived maladaptive thought processes which manifest themselves in
perfectionism. Within the field of psychology, perfectionism can be clinically assessed 64 though
as Caroline Riley et al. have acknowledged, Despite the clinical problems that can be associated
with perfectionism, there is little agreement as to the nature of the construct. 65

6.2.1 Perfection perverted - Perfectionism

A simple definition of perfectionism was published in the American Journal of Psychology in
1984. It stated perfectionism was the belief that a perfect state exists that one should try to
attain.66 On these grounds every Christian who acknowledged the doctrine of Christian perfection
would be deemed to be suffering from perfectionism. Since that broad definition, attempts to more
clearly categorise types of behaviour have resulted in the definitions of clinical perfectionism and
multidimensional perfectionism.67

64

Using the Clinical Perfectionism Examination or Frosts Multidimentional Perfectionism scale for
example. See R.O. Frost, P. Marten, C. Lahart, R. Rosenblatte, The Dimensions of Perfectionism Cognitive
Therapy and Research 14 (1990), 449-468.
65
Caroline Riley, Michelle Cooper, Zafra Cooper, Christopher G. Fairburn and Roz Shafran, A Randomised
Controlled Trial of Cognitive-Behaviour Therapy for Clinical Perfectionism: A Preliminary Study,
Behaviour Research Therapy 45, (2007), 2221.
66
A. R. Pacht, Reflections on Perfection, American Journal of Psychology 39 (1984), 386-390.
67
Katharine Halmi et al., Perfectionism in Anorexia Nervosa: Variation by Clinical Subtype, Obsessionality,
and Pathological Eating Behavior, American Journal of Psychiatry 157 (2000), 1799-1805.

219

Riley et al. identify a significant difference, distinguishing between the pursuit of perfection which
one may celebrate as producing people of virtue or athletes or musicians of excellence, and the
crushing restriction of human flourishing seen in those who fear making mistakes, thus failing in
their attaining perfection:

A critical component of clinical perfectionism is not simply that the individual strives for high
standards, but rather, the impact of not meeting those standards on self-evaluation self-criticism
substantially accounts for the relation between perfectionism measures and depressive, anxiety and
eating disorder symptoms (p. 80) which is consistent with the view that self-evaluation is at the
68

heart of perfectionism, rather than striving for high standards per se.

This insight has particular relevance in regard to the interaction between the doctrine of Christian
perfection and the world of disordered eating. It allows for a pursuit of holiness which is not
synonymous with a clinically defined mental disorder. The ideal of loving God and neighbour
perfectly can be pursued without an automatic negative impact upon the one seeking this. The
problem according to Riley only occurs when the failure to achieve perfection results in negative
self-evaluation in the form of self-criticism.69

Alongside the classifications of clinical and multidimensional perfectionism stand the terms selforientated perfectionism(SOP) and socially prescribed perfectionism(SPP). Rather than defining
the severity or areas of perfectionistic behaviour, these indicators measure where the individual
perceives the source of the pressure to be perfect. In the former, the perfectionism is located in selfcriticism and self-imposed standards, whereas the latter is about the individuals perception that
others are making demands upon them to achieve perfection. 70 Perfectionism is a recognised

68

Riley et al., A Randomised Controlled Trial of Cognitive-Behaviour Therapy for Clinical Perfectionism:
A Preliminary Study, 2222.
69
Riley et al., A Randomised Controlled Trial of Cognitive-Behaviour Therapy for Clinical Perfectionism:
A Preliminary Study, 2222.
70
G. L. Flett, P. L. Hewitt, Perfectionism in the Self and Social Context: Conceptualization, Assessment
and Association with Psychopathology, Journal of Personal and Social Psychology 60 (1991), 456470.

220

disorder in its own right but is also an aspect of other disorders addressed within the discipline of
psychology. The following section explores the relationship between perfectionism and disordered
eating in its various forms.

6.2.2 Perfectionism and disordered eating

There is a substantial body of research exploring the relationship between perfectionism and
disordered eating. The work of Hilde Bruch, which identified the quest for perfection as one of the
driving forces behind anorexia nervosa, was atypical in the fact that it also addressed obesity (or
compulsive eating as it is more commonly termed today). Both the refusal to eat and the
compulsion to eat were, in her view, bound up with issues of perfection. More recently the
departure from equating anorexia nervosa alone with perfectionism has been made by Christopher
Fairburn, Zafra Cooper and Roz Shafran in their pioneering work identifying the similarities and
differences within the core mechanisms which maintain eating disorders of varying types. 71 The
multifactorial nature of eating disorders means that not all people with eating disorders are
perfectionists,72 though Bastiani claims, it is well accepted that most patients with anorexia
nervosa are perfectionistic.73 Conversely, not all those with perfectionism will manifest it through
their eating behaviour but may exhibit perfectionism in relation to other aspects of life, such as
checking behaviours.74 From this it can be determined that though there is clearly a relationship
between eating disorders and perfectionism, the two are not co-dependant in the sense that some
people with eating disorders do not exhibit perfectionistic traits and not all perfectionists suffer
from disordered eating.

71

Christopher G. Fairburn, Zafra Cooper and Roz Shafran, Cognitive Behaviour Therapy for Eating
Disorders: A Transdiagnostic Theory and Treatment, Behaviour Research and Therapy 41, no. 5 (2003),
509-528.
72
Kelsie Forbush, Todd F. Heatherton, Pamela K. Keel, Relationships Between Perfectionism and Specific
Disordered Eating Behaviors, International Journal of Eating Disorders 40 (2007), 37-41.
73
Andrea M. Bastiani, Radhika Rao, Theodore Weltzin, Walter H. Kaye, Perfectionism in Anorexia
International Journal of Eating Disorders 17 (1995), 147.
74
C. Bouchard, J. Rhaume, R. Ladouceur, Responsibility and Perfectionism in OCD: an Experimental
Study Behaviour Research and Therapy 37 (1999), 239-248.

221

The relationship between perfectionism and disordered eating may initially appear to be an attempt
to attain the perfect body and thus be a response to external cultural pressures. Certainly, within
the sub-clinical world of food restriction and body image, otherwise known as the dieting and
exercise industry, much is made of the link between particular diets and attaining the perfect
body. From here it is only a short step to striving for perfect control over the appetite in order to
achieve a desired physical appearance, in a psychological mechanism which is taken to the extreme
in the anorectic. This simple equation that the perfectionism encountered in disordered eating is
merely a pursuit of the perfect body presented in western media images is championed by some
but tells only part of the story. To suggest that the relationship between disordered eating and
perfectionism is that disordered eaters are perfectionists who are attempting to beat their appetite
into submission in order to attain a slimness which is not possible may be true in some cases but is
too simplistic a conclusion in most.

Perfection within anorexia nervosa is more likely to manifest itself in relation to perfecting control
over oneself, being able to fight the urge to satisfy hunger or to need food at all. In this way there
are obvious parallels with the struggles Augustine identified in relation to sex, control of the urges
to indulge sexual desire and the need for sex at all.

6.2.2.1 Perfection, Desire and Dualism

What Augustine ought to have concluded was that to be fully human was to be present to another in
body, mind and soul. This would view sex as the consummation of that being present. Instead, a
notion of perfection based on rational control was what led Augustine to his negative view of sex.
The animalistic attention and loss of rational control is noted by TeSelle:

Sexual desire was striking to him as that area of human life in which passion farthest outruns the
control of reason, and he could not think this natural to so exalted a creature as man. It is to be
noted, however, that concupiscence, though it consists chiefly of sexual desire, is not that alone for

222

there are many other ways in which the animal aspects of the soul can escape rational control and
tempt man.

75

If the salient point in the pursuit of perfection is about self-control and not departing from rational
control then the links between Augustines theology and the disordered eating of our own times
becomes interesting.

Anorexia nervosa, Bulimia nervosa and Binge Eating Disorder all have a close correlation with
Augustines understanding of sex as far as they relate to desire. The lust for food, in the sense of
succumbing to either the temptation to binge or to purge, appears to be the operating of desire in
the same way Augustine referred to sex. In fact, Augustines words in relation to sexual desire can
be applied to the experience of the anorectic in the area of resisting food or the bulimic or binge
eater in purging revealing powerful similarities, Those hankerings (concupiscentia) that came
from sin are in principle resistible, but in practice no one ever resists them. We suffer addiction
with no known cure.76

The influence of Platonic thought upon Augustine has been noted as significant in Augustines
understanding of sin and the soul.77 Augustines reticence to commit himself to the means by which
he believed original sin to be transmitted left four options open. Within these four options, the
understanding that God created the soul which then became sinful by choosing to be united with
the body is a view laden with body/mind dualism. It is this very dualism of body as the corrupting
enemy of the mind or soul which continues to exist in the world of disordered eating. The anorectic
quest to overcome the desire to eat and to maintain perfect control over the body with its
dangerous and negative flesh is as strong an example of dualistic thinking as the commercial
dieting industry encouraging people of all body sizes to take control of their bodies and appetite
and to overcome cravings for food, setting up an internal battle between mind and body.
75

Eugene TeSelle, Augustine the Theologian (Eugene, OR: Wipf and Stock, 2002), 316-317.
James J. O Donnell, Augustine (New York: Harper Collins, 2005), 301.
77
Ibid.
76

223

Augustines destructive legacy has been the framing of sex and the body as deeply dangerous,
threatening and negative aspects of human existence. This has set the scene for a Christian
viewpoint mired in guilt, almost overwhelmed by the inescapability of failure and sin and in danger
of being unable to address the problem of disordered eating.

The ongoing battle between suppressing desire for food or sex and succumbing to that desire is a
source of deep feelings of guilt. Yet for those who can temporarily attain such control another
danger lies in wait. As was noted in relation to the theology of Augustine and his understanding of
desire, the pursuit of perfect mastery and control over desire was applauded by Augustine but has
the potential to collapse into the very thing he refuted most ardently. The danger of the pursuit of
perfect control over the body and its appetite for food in order to regulate its shape is the potential
for it to become a form of salvation by works.

Once a sufferer has entered the career phase 78 of an eating disorder and the disorder has become
established, traits of perfectionism can be significant in maintaining the disorder and the fear of
failing by departing from the course of disordered eating can have a negative impact on the
effectiveness of treatment. 79 The perfectionism at work within eating disorders has the potential to
distort thinking so that the perfection aimed for is the ability to not eat which becomes the telos of
existence. The altered perception of the body results in a striving for an ideal which cannot be
attained. The goal may appear possible if perfect control can be maintained, but the unreliable
self-perception inherent in clinically diagnosed eating disorders means that the sufferer will move
the goalposts without acknowledging it, resulting in an impossible target.

Throughout this section the close relationship between the psychological understanding of
perfectionism and the theological view of perfection has been demonstrated by references to the
78

See section 2.3.1.4 on recruitment and career phases of eating disorders.

S. J. Blatt, D. M. Quinlan, P.A. Pilkonis, M.T. Shea, Impact of Perfectionism and Need for Approval on
the Brief Treatment for Depression: The National Institute for Mental Health Treatment of Depression
Collaborative Research Programme Revisited, Journal of Consulting and Clinical Psychology 63 (1995),
125-132.
79

224

similarities between Augustines views and those of contemporary disordered eaters. This is not
intended to indicate that these two approaches are identical, rather it is to note the points of
integration and overlap. Perfectionism as a psychological concept is much broader than the quest
for perfect self-control. The theology of perfection, or perfect love, extends far beyond a narrow
focus on resisting forbidden desire. The point of convergence comes at precisely the issues with
which many suffering from disordered eating become preoccupied. The adoption of perfect selfcontrol over appetite and resisting all desire to eat as the goal joins the Augustinian theology of
rational control to the psychological concept of a perfectionism pursuing that ideal.

In seeking salvation through adhering perfectly to particular goals or regimes it becomes

impossible to see what salvation one desires. What it recognised within psychology is the harm
done by perfectionism as it twists the noble desire to attain the best and exchanges it for a slavish
adherence to a set of life-diminishing practices in the mistaken hope that they will attain some form
of salvation.

6.2.3 Physical Perfection and the quest for the perfect body
Whilst it is acknowledged that disordered eating is more likely to centre around perfect control and
conforming to a set of behaviours which, in the mind of the sufferer constitute doing things
perfectly, this is the micro-perspective. This is the conclusion reached by psychologists
encountering disordered eaters of a clinically diagnosed severity on a one-to-one basis.

The assertion of a previous chapter in this thesis was that whilst disordered eating is a recognised
psychological phenomenon, it is also a culturally located, and to some extent societally generated
situation. The wider perspective recognises that in an era where visual media dominate, the ideal of
perfection is expressed not in terms of moral virtue, noble character or even wisdom or intellect but
in physical perfection. The images promoting the perfect body, particularly the female body, are
on billboards, in magazines, on television, the internet and any other available advertising space.

225

6.2.3.1 Who shapes the perfect body?

Ideals of beauty change from decade to decade and from culture to culture 80 but the question rarely
asked is who is promoting or shaping the ideal or perfect body?

One of the most disturbing developments within the digital age has been the use of software to alter
photographed images without the appearance of them being airbrushed. The transition is made
from reality to unreality and the vision of the perfect body becomes a mirage that even the model
herself was unable to attain. In the manipulation of images leg lengths are stretched, curves are
minimised, skin blemishes are erased and differences between the left and right sides of the face
are eradicated in order to maximise the desired effect of symmetry. The result is promoted as the
perfect body to aspire to but the truth is, it is physically unattainable.

This promotion of falsehood sets up women to fail and to be permanently dissatisfied with their
bodies. Just as John Wesley criticised his brother Charles for setting the standard of Christian
Perfection too high, thus setting people too daunting a target to aim for, so the goal of the perfect
body is becoming impossible to achieve. It is not sufficient to state that most women know that the
images they see of other womens bodies are digitally altered. The impact of the image overrides
the cognitive process and so the deceit has a subtle undermining effect on female perception of
what is real.81

How then should the Church respond to this emphasis on the body being the marker of perfection
and also the pressure and deceit in the actual images of perfection promoted?

80

See previous discussion in Chapters 2 and 3.

For empirical research on the effect upon the psyche of being exposed to particular images of the body, see
Anna M. Bardone-Cone and Kamila M. Cass What Does Viewing a Pro-Anorexia Website Do? An
Experimental Examination of Website Exposure and Moderating Effects, International Journal of Eating
Disorders 40 (2007), 537548.
81

226

Taking the Hebrew understanding of perfection as that which is wholly devoted to God in
relationship with him and drawing upon the Aristotelian definition of perfection as achieving its
end, it would appear that the telos of the body is to glorify God. Paul writes to the Corinthians, For
you were bought at a price; therefore glorify God in your body.82 Whilst this may appear merely
an exhortation it does indicate some notable differences between the aesthetic ideal promoted in
society and a biblical view. This means that the perfect body is not simply a visual representation
or a primarily aesthetic ideal, the question to be asked of whether a body is perfect is, is it
glorifying God, i.e. is the embodied person engaged in loving God and neighbour?

This understanding has profound implications for re-envisioning the perfect body. Bodies which
are dismissed in society as imperfect because they are too fat, too thin, disabled, sick or
suffering can be the perfect body if they are the means by which something of God is
encountered. Perfection is no longer about function, achievement or a subjective projection of
beauty, it is about relationship with God. This rediscovery of the purpose of embodiment and
rethinking of what constitutes the perfect body stands in sharp contrast to the airbrushed or
dangerously thin ideal often presented as perfection. In drawing together the insights from
theology and the experiences of psychology the section which follows endeavours to present a
pursuit of perfection which is neither oppressive nor perfectionistic. The desire is to offer hope to
those who have only encountered the pursuit of perfection as a negative experience, suggesting
instead ways of growing into perfect love.

6.3 Rediscovering Christian Perfection for the Present Age

Before offering suggestions for a contemporary discovery of Christian Perfection, it is worthwhile
examining how such a rediscovery was effected by John Wesley in the eighteenth century. He
urged the people called Methodist to pursue Christian Perfection in a culture where many had
never heard of the doctrine. The consequences of the call to perfect love were profound in their

82

1 Cor. 6:20.

227

impact upon the local communities of believers. It is argued that the rediscovery of Christian
Perfection by John Wesley may form a pattern for a contemporary re-engagement with the
doctrine.

6.3.1 Wesleyan rediscovery

The doctrine of Christian Perfection was the source of much controversy when preached and
taught by John Wesley in the early years of Methodism. It was such a bone of contention and open
to such misunderstanding that it was debated and discussed at the conferences held between
Wesley and his ministers and preachers in 1744, 1745, 1747 and 1759.83 Frequently Wesleys
detractors levelled at him the charge of neo-Pelagianism, suggesting that attaining Christian
Perfection was merely another means of declaring salvation by works. 84 Others attacked him on the
grounds that if we can be made perfect in this life there is no need to continue attending to the
ordinances of God or the means of grace, and others still contended, as Augustine had, that
perfection this side of heaven simply was not possible.

There were yet others who referred to Christian perfection as Mr Wesleys doctrine, suggesting
that it was a new theology created by Wesley as one of the idiosyncrasies of the emerging
Methodist movement. This was a charge Wesley vehemently denied and asserted most strongly the
existence of the doctrine within Scripture.85

Over the course of 30 years John Wesley preached the doctrine in several sermons, 86 and
articulated it and defended it at the various Conferences of early Methodists. He published it in
both the preface to the second book of Charles Wesleys hymns and in publications endeavouring
to assist members of the Methodist Societies in their pursuit of holiness. Finally, in 1767 he

83

Wesley, A Plain Account of Christian Perfection.

See Victor Shepherd, Can You Find Anything More Amiable Than This? Anything More Desirable?
Paper given at the Oxford Institute of Methodist Theological Studies, Oxford, 1997.
85
Wesley, A Plain Account of Christian Perfection.
86
Notably Circumcision of the Heart and Christian Perfection in Wesley, Forty-Four Sermons (London:
Epworth, 1944).
84

228

endeavoured to express, in a plain account, his journey to believing this doctrine, what he
understood to be its content and also to defend (with reference to the occasions mentioned above)
that this was no new doctrine but a tenet he had proclaimed for at least 30 years.

The discussion below will set out the doctrine of Christian Perfection as John Wesley understood it
and discuss the implications and challenges for its place in the church today.

6.3.1.1 What did Wesley mean by Christian Perfection?

It is widely acknowledged that John Wesleys primary theological motivation was the pragmatic
drive to teach and equip the new converts. 87 It was theology conducted literally on the hoof rather
than in abstract and therefore in the case of the understanding of Christian Perfection, many
accounts take the form of question and answer in a catechetical style, rather than as propositional
narrative. The exception to this is where Wesley puts forth this doctrine in a sermon. Even in his
sermon Wesley is determined to make it quite clear what he is proposing as the nature of Christian
Perfection and what he is not:

In this I endeavoured to show - (1) In what sense Christians are not, (2) in what sense they are,
perfect.
1. In what sense they are not. They are not perfect in knowledge. They are not free from
ignorance; no, nor from mistake. We are no more to expect any living man to be infallible,
than to be omniscient. They are not free from infirmities, such as weakness or slowness of
understanding, irregular quickness or heaviness of imagination. Such, in another kind, are,
impropriety of language, ungracefulness of pronunciation; to which one might add a
thousand nameless defects either in conversation or behaviour. From such infirmities as
these are none perfectly freed till their spirits return to God. Neither can we expect, till
then, to be wholly freed from temptation: for the servant is not above his Master. But

87

Oden, John Wesleys Scriptural Christianity, 19.

229

neither in this sense is there any absolute perfection on earth. There is no perfection of
degrees; none which does not admit of a continual increase.

88

Wesley is quick to acknowledge that it is possible to be ignorant, mistaken, tempted and physically
or psychologically disadvantaged and yet still attain Christian perfection. This initially appears to
be a list of factors which preclude perfection when conceived as Aristotles definition of complete,
surpassing, lacking nothing and yet there remains the possibility of perfection as achieving ones
end.

The acknowledgement that there is no absolute perfection on earth sounds like an oxymoron, that
if perfection is the end, the complete, the absolute, in what sense is Wesley speaking of
perfection? His assertion that there is no perfection in degrees stands in opposition to Thomas
Aquinas89 who correlated perfection with a state of perfection inhabited by the religious, a state
which may be separated into degrees. Having succinctly introduced the senses in which a Christian
is not perfect Wesley advances to argue that perfection is possible in this life by defining perfection
as perfect love:

Q. What is Christian Perfection?

A. The loving God with all our heart, mind, soul and strength. This implies that no wrong temper,
none contrary to love, remains in the soul; and that all the thoughts, words and actions are governed
by pure love.90

Wesley also responds But whom then do you mean by one that is perfect? We mean one in
whom is the mind which was in Christ, and who so walketh as Christ also walked. 91

88

Wesley, A Plain Account of Christian Perfection, 16.

See above.
90
Wesley, A Plain Account of Christian Perfection, 42.
91
Wesley, A Plain Account of Christian Perfection, 29.
89

230

Part of the difficulty in Wesleys articulation of Christian Perfection was the paradox that stated
plainly, it is simple and easy to understand but elusive to achieve. To love God with the totality of
ones being is not a complex concept, and yet the difficulties and questions arise in the act of doing
so. In order to explain humanitys inability to love perfectly the discussion ultimately turns to the
nature and role of sin. The questions levelled at Wesley were no exception and mirrored many of
the questions posed to Augustine.

6.3.1.2 Wesley and sin

It appears that the very position Augustine opposed, namely that sin could be overcome and
avoided, was raised in similar terms centuries later in the lifetime of John Wesley.

Wesley was challenged by those who quoted Scripture at him in an attempt to prove by his own
reasoning and interpretation that he could be not right. 92 Having countered their challenge to his
satisfaction, Wesley makes this astounding statement, A Christian is so far perfect as not to
commit sin.93

In order to defend such a statement, it is imperative to clarify what is meant by the term sin. In the
light of the historical debate about sin and perfection the notion that the Christian who is perfect
does not commit sin initially appears heretical. Perhaps the reason why the notion of Christian
perfection was so controversial was the recognition within human beings that I do not do what I
want, but I do the very thing I hate. 94 This ingrained sense that in this life we will be ever liable to
battle against sin and not always emerge victorious flies in the face of a doctrine which claims we
may attain a form of perfection in this life. The constant definition and re-iteration of what
Christian Perfection is and is not suggests that part of Wesleys difficulty was in the way he
encountered and challenged the understandings of the idea of sin and its relationship to
perfection.
92

Wesley, A Plain Account of Christian Perfection, 17-19.

Wesley, A Plain Account of Christian Perfection, 19.
94
Rom. 7:15.
93

231

Yet the reason Wesley was able to hold the position he did on perfection was, to a greater extent,
due to the narrowness with which he defined sin. Stating that sin was a transgression of a known
law, Wesley ruled out a number of things which others may regard as sin and therefore a
stumbling block to perfection.

To Wesley there was no such thing as unconscious sin and having already dismissed honest
mistake as to fact as not being sin it becomes clearer why Wesley believed avoiding sin was less
difficult than Augustine had.

John contended with his brother Charles on a number of occasions for setting the standard of
Christian Perfection too high and sought to ensure that none of the other leaders in Methodist
societies did likewise, as John felt that this had the effect of discouraging disciples from pressing
on to perfection.95 He endeavoured not to set the standard higher than that provided in Scripture,
and in contrast to Augustine who prioritised avoiding sin, Wesley stressed the first thing about
perfection was positive: it was loving God with all our heart and serving Him with all our
strength.96

Wesleys understanding of Christian Perfection is so closely bound up with his understanding of

what constitutes sin that any change of heart about the nature of either element had serious
implications for the other. It can be seen that the divergence between Wesley and Augustine is
located primarily in their understanding and definition of sin and its power. Wesley takes sin
seriously but interprets scripture in such a way as to believe that theoretically, sin can be avoided
through the imparting of the Divine gift of perfect love. Despite his experience of life and its
temptations, he is also led to believe that in some cases it is possible to live the Christian life

95
96

W. E. Sangster, The Path to Perfection (London: Hodder & Stoughton, 1943) 79.
Sangster, The Path to Perfection, 79.

232

without sinning. Notably he never claimed this experience directly for himself, but made detailed
accounts of those whom he believed to have attained this goal. 97

6.3.1.3 Wesleys understanding of Christian perfection as a temporary state

Wesleys understanding of the state of Christian Perfection latterly acknowledged that a person
who had attained it may fall from it. His assertion that it was possible to be so utterly filled with the
love of God that ones intentions were pure and devotion unalloyed, but the best way to understand
this state was in a moment-by-moment. Perfection was not a goal which, once reached became a
permanent state, rather an ongoing series of moments in which perfect love was experienced and
practiced. In this way Wesley avoids the situation explained by Aquinas whereby Aquinas could
conceive of those in the state of perfection who were not perfect but those who had not made a vow
and entered a state of perfection who were perfect.

Seeing life as a series of moments in which every moment is an occasion to love perfectly and
grow in love or to turn away from loving, Wesley is able to perceive Christian Perfection as
allowing for continual increase but also a state which is of the moment. Of course, the
cumulative effect of many moments spent loving God with heart, soul, mind and strength was that
for some of the Methodists mentioned by Wesley, Christian perfection was their experience from
the moment they believed they had received it as a gift from God until the moment they died. In
this sense, it was not temporary, but Wesley maintained that Christian perfection was not an
automatically permanent state, which once experienced was irreversible.

At its heart, Christian Perfection is to love God with heart, soul, mind and strength and love ones
neighbour as ones self. This is in response to the grace of God and in no means an attempt to earn
or win favour with God. To love perfectly is to overcome the sin which is at its heart selfish and

97

For a comprehensive account, see Sangster, The Path to Perfection, 124- 130.

233

self-seeking. In trying to describe what Christian Perfection looks like in practice, John Wesley
embarked upon an eloquent description of the perfect Christian as;
[o]ne who loves the Lord his God with all his heart, with all his soul, with all his mind and with
all his strength. God is the joy of his heart, and the desire of his soul, which is continually crying,
Whom have I in heaven but Thee? and there is none upon earth whom I desire besides Thee. My
God and my all! Thou art the strength of my heart and my portion forever. He is therefore happy
on God; yea, always happy; as having in Him a well of water springing up into everlasting life, and
overflowing his soul with peace and joy. Perfect love having cast out fear, he rejoices evermore. 98

In the light of the previous sections of theological and psychological exploration and analysis, this
section seeks to suggest ways in which the Church needs to practice perfection in its current
historical and social context.99

6.3.2. The power of grace

Those throughout history who have misunderstood Christian Perfection have always seen in it the
potential to collapse into Pelegianism. This was the fear of the Reformers, that emphasis on work
out your salvation100 too quickly becomes work at your salvation and the power of the gospel of
grace becomes one more system to work ones way to heaven. Despite Wesleys consistent
preaching of the doctrine of Christian perfection, urging the people called Methodist to love God
and neighbour to the best of their ability, there was no doubt that he believed salvation was by
grace and that it came prior to the pursuit of perfect love.

The most significant offering the Church can make in a world which speaks of tolerance and
acceptance but which leaves many striving to become something in order to be accepted, is to live
in response to Gods grace. The key difference lies between becoming what we are and striving to

98

Wesley, A Plain Account of Christian Perfection, 11.

Specifically, cultural contexts in which disordered eating is found.
100
Phil. 2:12.
99

234

become what we think we should be. For those who have responded to the gospel of grace but have
become caught up in a culture of works within the life of the Church this will require a reorientating of life.

The earlier chapter in this thesis on Baptism and Eucharist holds out the possibility of lives being
re-orientated around the communion table in remembering Christ as risen Lord and in the
remembering of baptismal vows and new identity in Christ. Participation in the practices of
Baptism and Eucharist reminds those who partake of the gift of Gods grace and his power to bring
transformation. It is in this participating, remembering and re-orientating of life and priorities,
rather than in frenetic activity or following rules or programmes that Christian perfection is made
possible.

The security which comes from knowing worth comes from the unmerited favour of God and that
the love of God cannot be earned stands in sharp contrast to the driven-ness and frantic questing of
those seeking to earn approval. A living out of Christian Perfection must be in response to Gods
grace and woven through with the love and grace seen in Jesus Christ. In practice this will mean
welcoming people as Jesus did and not judging them by their clothes, eating habits or body shape.
It may mean creating small groups where people can develop trusting relationships and be real with
one another without fear of rejection. It should mean valuing people whether or not they do
anything in the life of the Church.

This indeed is the great insight of the Reformers whose interpretation of Pauls theology declares
loudly that we are not justified by ourselves, nor our works but by the grace of God in Christ. Such
a response strikes at the heart of perfectionism, becoming a fertile ground in which a response of
perfect love may grow.

235

6.3.3 Community
Rediscovering the doctrine of Christian perfection would be best done in conjunction with the
practices which form the earlier part of this thesis. In a community which confesses to one another
and is regularly and honestly accountable, the excesses of Christian Perfection can be avoided. The
accountability before others mitigates against the pride which results if one is doing well and
provides the encouragement to persevere following failure. Those to whom one is accountable also
stand as a reminder that the pursuit of perfect love is in response to Gods grace, thus preventing
Christian perfection becoming an individualistic endeavour or salvation by works.

Learning in practical ways to love God through loving others is an essential feature of operating as
a community. The practicing of hospitality through offering unconditional love and welcome is a
means by which perfect love, or Christian Perfection, may be realised.

6.3.4 Becoming

The notion of Christian Perfection when understood as a path or a journey allows for what a static
understanding of perfect never could. In responding to Gods saving grace by seeking to love
wholeheartedly there is a recapturing of becoming what you are. There is growth and movement
and the possibility of change in a growing into perfect love. The notion of being transformed by
the power of God who became incarnate in order to draw his creation to himself is expressed by C.
S. Lewis thus:

In the Christian story God descends to reascend. He goes down to come up again and bring the
whole ruined world up with Him. 101

Lewis uses the imagery of a diver plunging into murky waters to rescue a prize found on the sea
bed. The diver plunging from glorious sunlight into murky depths, only to draw the prized object

101

C. S. Lewis, Miracles (San Francisco: Harper Collins, 2001), 179.

236

through the waters to the radiance of the world above the water illustrates the process of the
incarnation and then the sharing in the life of the divine saviour by the object saved.

Through this process of theosis, the salvation found in Christ enables a sharing of the attributes of
the divine, for he who became flesh and was perfect now draws into his dynamic risen life all those
who are in Christ. Instead of the anorectic pursuing an elusive perfection dependent upon her own
self-control, the notion of becoming, to follow Lewis imagery, is like being caught up into a
different world. In this process of becoming what you are the divine love and power are available
to overcome the grip of disordered eating and the desire to pursue perfection through extreme selfcontrol. This understanding of being perfected, based on the saving grace of God allows for a
becoming which is of more profound value and significance than anything which could be
achieved by human effort.

6.4 Conclusion
Initially the question was raised as to whether the Church should even revisit the doctrine of
Christian Perfection for fear of being misunderstood or placing stumbling blocks before those for
whom perfectionism is an appealing but detrimental predisposition. The conclusion of this chapter
is that the rich heritage of Christian Perfection and the exhortation to live lives marked by the depth
of their love, joy, peace and other virtues is too precious a gem to be lost through neglect. What is
required is careful handling of this area in order that the aspect of response to the grace of God is
always understood as the motivation and the desire to imitate Christ in character is the purpose.

Particular elements need to be stressed, particularly in the cultural context which is fertile ground
for disordered eating. The importance of community as a context for becoming what you are
stands in contrast to the competitive desire within some eating disorder sufferers to achieve
secretly and alone. The understanding of sanctification as an ongoing process or the continual
increase of perfect love resonates with the theme of journey, enabling those who have emerged
from disordered eating, or who are currently suffering from eating disorders, to see the potential for

237

moving on from their current state to a better place. This offering of hope is a significant
contribution which can be made by the Church to the world of disordered eating. Such hope stems
from the understanding of the God who offers salvation and transformation and is active in
perfecting his people in love.

238

Chapter 7
Conclusion

Late capitalism has catapulted us out of centuries-old bodily practices, which were centred on
survival, procreation, the provision of shelter and the satisfaction of hunger. Now birthing, illness
and ageing, whilst part of the ordinary cycle of life, are also events that can be interrupted or
altered by personal endeavour in which one harnesses the medical advances and surgical
restructurings on offer. Our body is judged as our individual production.

7.0 Introduction
It has been argued in previous chapters that the Church as the Body of Christ has a distinctive
contribution to make to societies where disordered eating manifests itself in both clinically defined
eating disorders and at a sub-clinical level in non-medical dieting or in persistent overeating. This
is not to undermine the valuable work done by specific Christian organisations whose primary
focus is to support those suffering from, or at risk from developing eating disorders. 2 It is simply to
acknowledge that the Church as a whole has the potential to make a difference by the very nature
of being the Church.

It would be interesting to know, and the content of further study to explore, the ways in which
specific Christian organisations are effective in their ministry to those with disordered eating.
Whilst this thesis is unable to independently verify the efficacy of organisations such as
AnorexiaBulimiaCare, Mercy Ministries or the various independent groups attached to churches in
the UK and USA, I have sought to mention, critique and offer a theology of some of the practice
which takes place within them. This is not based on extensive field research but takes the form of
1
2

Susie Orbach, Bodies (New York: Picador, 2009), 6.

For example ABC and Mercy Ministries.

239

reflection upon telephone and face-to-face conversations, and review of their published literature
and website material. This has informed the theological exploration of what may be helpful
practices for those with disordered eating within the life of the whole church.

7.1 A Context in which to Discern

The first element which is distinctive to the Churchs contribution is the way in which the Church
understands eating disorders. At the outset, the Church has the ability to discern that disordered
eating is a distortion of the intended function of humanity and it also has theological resources to
support that assertion which extends beyond mere biological consequentialism. Whilst the medical
profession may conclude that anorexia nervosa, bulimia nervosa, binge eating disorder and
compulsive eating are disorders because they inhibit physical and mental functioning and if
unchecked, result in premature death, the conclusions of the Church come from a different
perspective.

To be oppressed by a constant focus on food, either overcoming the urge to eat, or persistently
thinking about and following the craving to eat strikes at the disordered way food and the will
relate when in the grip of disordered eating. Interpreted within a biblical frame of reference themes
of idolatry and oppression can be seen operating as food, self-control, or perfect body image
become an all-consuming goal. Idolatry, defined as giving to another the worship due to God, at
first seems a harsh accusation to level at those suffering from disordered eating but it does reflect
the nature of all-encompassing focus which the eating disorder demands as a relentless tyrant
dominating the life of the sufferer. Understanding an eating disorder as a false god which makes
destructive demands upon those who originally turn to it for help, only to oppress and control them,
should not be a means of heaping further guilt upon sufferers but point the way toward possible
healing. It enables the disorder to be named as something separate from the identity of the person

240

with the disorder and from that point, to be addressed as an unwanted part of life. This approach
has been tried in secular psychology and has proved helpful for some people. 3

The Churchs understanding of sin and the fallen nature of the Powers 4 also has a contribution to
make in reference to the nature and purpose of humanity. The capacity of good things, such as
food, beauty and the body, to be distorted, and in this distorted form to hold people captive to
destructive ideals, is an insight neither shared with a view of inevitable human progress nor a
pessimism regarding the futility of life and the impossibility of change. The Christian narrative of
salvation is centred around the crucified and resurrected Christ who fulfils the prophecy to liberate
the oppressed. 5 In holding together the stories of idolatry, enslavement, oppression and liberation,
the Church witnesses to a story in which those suffering from disordered eating are invited to
create themselves in finding a place within this drama an improvisation in the theatre
workshop, but one that purports to be about a comprehensive truth affecting ones identity and
future.6 Shaped by seeking to live in the story of God, with its ultimate revelation in Jesus Christ,
the Church approaches the issue of disordered eating from a profoundly different place to the
society in which it finds itself, a culture which in some ways may generate disordered eating. This
is not to conclude that disordered eating is only a problem for those outside the Church, or that the
Church has not been complicit in generating disordered eating, but to state that when the Church
faithfully attends to living within the story of God there is a unique insight into disordered eating
which may be a means of addressing its destructive consequences.

This insight extends beyond being able to articulate why disordered eating is a problem to naming
the factors at work in the disorder. In contrast to those who wish to define disordered eating as a

Jenni Schaefer with Thom Rutledge, Life without Ed (New York: McGraw-Hill, 2004).
Walter Wink, Naming the Powers: The Language of Power in the New Testament (Philadelphia: Fortress
Press, 1984).
5
Luke 4:18.
6
Rowan D. Williams, Postmodern Theology and the Judgement of the World, in Postmodern Theology:
Christian Faith in a Pluralist World, ed. Frederic B. Burnham (New York: Harper Collins, 1989), 97.
4

241

purely individual problem7 or, at the other extreme, a societal phenomenon impacting every
woman8 the Church has the capacity to see the inter-relation between the individual and the larger
group. The theological understanding of belonging to the Body of Christ shapes how the Church
understands identity, but also the influence of wider society upon the actions of individuals. In
defining disordered eating as a biopsychosocial phenomenon with multifactorial causes I have
sought to balance the individual and societal aspects of disordered eating in a way which reflects
the Churchs understanding of life shaped by the community which it inhabits. Chapter 4 examined
the significance of Baptism and Eucharist in their ability to demonstrate a new framework for
understanding identity, concluding that perceiving the individual body in the light of the corporate
Body of Christ addresses some of the issues generated by disordered eating.

Though many in the field of diagnosing and treating eating disorders have acknowledged a spiritual
dimension to those they seek to help9 this is by no means universally recognised. At a basic level
the Church asserts that humanity is more than mind and body and that therefore when eating
becomes disordered it is not only mind or body which suffers and needs treatment, but that the
whole person is affected. Even those who have sought to understand spiritual issues in the context
of eating disorder sufferers have been required to separate out some notion of spirituality in order
to attempt to scientifically assess its impact within the framework of psychological research. 10 The
conclusion of both Chapter 2 in defining disordered eating and Chapter 4 on identity within the
Body of Christ is to resist the view that spirituality or religious faith is an optional add-on to
personhood. Rather than treating it as a peripheral choice of the sufferer which may impact their
eating disorder, the approach taken in this thesis argues for considering humans as beings with
inherent spiritual capacity, as legitimate as physical or mental capacity, which is core to their
being, whether it is expressed by them or not.

As can be the case in treating individual sufferers without reference to external societal factors.
Which is the conclusion reached by Orbach and Bordo.
9
P.S. Richards, R. K. Hardman, H. A. Frost, M.E. Berrett, J. B. Clark-Sly and D.K. Anderson, Spiritual
Issues and Interventions in the Treatment of Patients with Eating Disorders, Eating Disorders 5 (1997), 261279.
10
Ibid.
8

242

It is in this context that the Churchs response to disordered eating begins by creating a context
within which people can discern glimpses of the nature of humanity, the purpose of embodiment,
the boundaries of appropriate eating and the practices which help and sustain such ongoing
discernment of Gods revelation.

7.2 An Identity to Explore: Counter-Cultural Communities of

Transformation
there is a social practice lived out by the early Christians, under divine mandate, which at the
same time offers a paradigm for the life of the larger society.

11

Not only is the Church a place to begin discerning what eating, identity, perfection and control look
like when orientated toward God, it becomes the place where in practice they are worked out. Even
the simple practice of saying grace before a meal has a number of far reaching consequences. It
reminds the one who prays of the provision of God and the rightness of living every aspect of life
in relation to God. Saying grace inculcates the virtue of a thankful heart, and reminds the one who
prays of their participation in the Body of Christ, including the needs of their brothers and sisters
who go hungry. If such small actions shape the Church in particular ways, the Church as a place to
form disciples of Christ who find their identity in him and order their eating accordingly is a further
contribution that is made in response to disordered eating.

The proposition established in Chapter 4 was that Baptism and Eucharist were practices which
shaped identity and allowed for the possibility of transformation. The practice of baptism forms a
central part in locating identity within the Church and Eucharistic participation is a means of
inhabiting the story of the crucified and risen Christ, consuming that belief in a physical act. The
significance of the formational nature of participation in the Body of Christ is paralleled by
11

Yoder, Body Politics x.

243

research into the influence of established communities in determining appropriate perception of

body image.

The research of Petra Platte, Joan F. Zelten and Albert J. Stunkard investigates the relationship
between cultural sub-context and self perception in their study of body image among the Old Order
Amish.12 In this context religious culture forms the only way of developing self-understanding due
to the closed nature of the Amish community and its separation from Western industrialised
society. Platte, Zelten and Stunkards research is based on the premise that disturbance in the way
body image is perceived is not only experienced by the few extreme cases of clinically diagnosed
eating disorders but is something which affects healthy women of normal weight. 13 To ascertain
whether this disturbance in perception is in any way related to western culture, the choice of Amish
subjects as a research group provided the opportunity to examine those separated from the
dominant influences of media and materialist consumerism.

The limitations recognised within the study included the absence of a group for comparison with
the Amish sample. Platte conceded that the disturbance of body image perception in women in
western industrialised cultures was assumed rather than established via conducting the Figure
Rating Scale test upon a sample. Nevertheless, the findings concerning the lack of body image
disturbance among Amish young people stands in sharp contrast to what is observed in the attitudes
and behaviour of adolescents in western industrialised culture. What can be deduced from these
findings regarding the relationship between religion and eating disorders is less clear. A fair
assumption would be to conclude that the religious community of the Amish served to protect
young people from unrealistic views about the shape their bodies should conform to. There may
also be the dimension noted by Joughin that strong religious or moral frameworks provide

12

Petra Platte, Joan. F Zelten, and Albert. J. Stunkard, Body Image in the Old Order Amish: A People
Separate from The World International Journal of Eating Disorders 28 (2000), 408.
13
Platte, Zelten, and Stunkard, Body Image in the Old Order Amish: A People Separate from The World,
408.

244

protective boundaries in which adolescents may develop, thus negating the need for self-definition
through anorexia nervosa. 14

The absence of the cultural appendages of post-industrial life cannot be adopted by most
mainstream churches, but the concept of counter-cultural communities may be a significant insight.
If body image dissatisfaction is a contributing factor in disordered eating and/or the development of
clinical eating disorders and body image disturbance can be minimised by participation in countercultural communities where values differ from the prevailing materialist beauty myth, then the
practical outworking of finding identity through baptism in the life of the baptised and practiced
through participation in the eucharist takes on great significance.

The witness of baptism and the participation in Eucharist are practices which form those who
partake and those who observe. The outworking of the impact of these practices is aided by
involvement in confessing and being accountable as the Church seeks to live out the consequences
of baptismal identity and Eucharistic participation in the rest of life. The possibility of the Church
being an environment which, by its practices, shapes those within it to develop the kind of
character which can resist some of the influences which may predispose individuals to developing
disordered eating, is a contribution in taking preventive measures. Assessing whether participation
in the life of the Church did indeed have a protective or preventative influence over those at risk of
developing disordered eating may not be as easy to quantify as the study of the Amish, but that is
insufficient reason to attempt it. One of the practical consequences of the Church seeking to be
shaped by the practice of baptism and eucharist has been the work undertaken by some churches
among young women. In various ways, youth workers, church leaders and members of
congregations have developed and delivered material aiming to build self-esteem in teenage girls.
The purpose is to help young women most at risk of being drawn into disordered eating, negative
body image and low self-esteem to find their worth in more than physical appearance, and

14

Neil Joughin, Arthur H. Crisp, Christine Halek, and Heather Humphrey, Religious Belief and Anorexia,
International Journal of Eating Disorders 12 (1992).

245

ultimately in Christ. The impact for some members of the Church of meeting around the Lords
table and being aware of their identity in the Body of Christ has manifested itself in taking action to
share this identity and the release it brings from pressures to view identity through physical beauty,
thinness or achievement, with others.

The conclusion of this final chapter is that, theoretically, a Church rediscovery of the practices
discussed in chapters 4-6 could model to the watching world a way of living which mitigates
against some of the most powerful influences in disordered eating and thus form a preventative
environment from disordered eating becoming established or seen as normative.

7.3 A Community in which to Belong: Counter-Cultural

Communities of Transformation, Part 2
The understanding of identity shaped and formed through baptism and eucharist is that the
corporate nature of the Church as the body of Christ is profoundly significant in how disciples live.
Whilst the section above argued for an understanding of identity and purpose formed through
baptism and eucharist and witnessing to a watching world, this section considers the ways in which
the breadth and depth of community within the Church offers hope in the face of disordered eating.

The significant rediscovery in this area is the place of the Church (particularly in focussed smaller
gatherings) for confessing15 and accountability, through which the Church may be formed as
disciples learning, among other things, appropriate relationship to food and healthy relationships
with one another. Within this context it becomes possible for those struggling with disordered
eating to share their experience with others in a safe and supportive environment, receive prayer
and participate in a community which shares the deep things of life and sees in Christ the hope of
salvation and potential for transformation.

15

In all the senses articulated in Chapter 5.

246

The establishment of support groups for those with eating disorders is a valuable ministry of the
Church as a whole, but not a realistic possibility for every local congregation. Well run and
resourced support groups within the life of the Church find their place in the long tradition of
confessing and being accountable, and also in the ministry of healing. 16 The diversity which exists
within the Church, both in the imagery of the Body of Christ having different parts with different
gifts, graces and functions, and the practical experience of the various people who constitute the
Church, stand as a reminder that there cannot be said to be a normative outworking of the
practices. Some may find Twelve Step programmes work where other forms of confessing and
accountability have failed, others will find a designated support group or an accountability partner
or triplet more helpful. Whilst the similarities with secular weight loss and support group structures
can be found, the chapter arguing for a rediscovery of confessing and accountability within the
Church identified the different nature of what occurs in the practice of the Church. Confessing and
accountability as part of a group which acknowledges the power of God to operate through his
Spirit has a different dynamic to a group established to encourage other individuals in their goals.
The potential for God to reveal truth to and affect transformation of those within the group is more
overt as they open themselves to the challenging, comforting and healing presence of God.

7.4 A Purpose to Re-imagine Life after Perfectionism

The difference between the doctrine of Christian perfection and the perfectionism with which many
eating disorder sufferers struggle gives the Church much to consider, particularly in the way it
communicates in this area. Whereas many outside the Church, and some within it, still believe that
Christianity is about trying as hard as possible to be morally good, the Church is ultimately
dependant upon the grace of God. The re-orientating of perspective to understand life lived in the
context of grace is a powerful challenge to the perfectionistic drive with which many have lived,
and which sustains many forms of disordered eating.
16

See Chapter 5.

247

Working with a model of perfection which, dependent on the grace of God, recognises salvation
has already been attained through Christ, allows for a thankful response to that grace to be made in
growing in grace and holiness into what one already is in Christ. The sense of becoming rather
than striving indicates a fundamental difference between peace which exists because the prize has
already been won and an anxiety that it may never be attained unless one works harder.

In a thesis which may be deemed to take an approach based substantially on virtue ethics and the
developing of Christian practices, the place of grace as a significant foundational contribution to
the debate may be questioned by some. It may be suggested that for the Church to focus on
developing practices of virtuous eating in feasting and fasting and pursuit of holiness through
confessing and being accountable for behaviour, there is much which sounds like seeking salvation
by works. Yet this is fundamentally not the case. Whilst the practices rediscovered are helpful in
the life of the Church particularly in the way it understands and responds to disordered eating, the
fact that much of the discussion of these practices highlights their operation in response to Gods
grace should be sufficient to counter claims of Pelagianism.

The central place of grace within the life of the Church, reflecting the grace of God and permeating
the relationships of those within the Church, means it can be a place of transformation for those
who are locked into a world of perfectionism in disordered eating as they find a different way to
understand their purpose.

In speaking of grace and transformation, it is hoped that the Church is gracious enough to not claim
a monopoly on bringing help and healing to those who suffer from disordered eating. Whilst I
argue for a distinctive contribution being offered by the Church in both theology and practice, it
would be foolish to deny the benefits many disordered eaters have found through medical
intervention and through counselling. The breadth of the impact of the Church proposed in this
thesis is significant. It ranges from seeking to challenge cultural pressures which provide fertile soil

248

for disordered eating to flourish, through communal discovery of good eating practices, to
individual support and accountability. Churches may find themselves running identity and esteembuilding sessions for youth groups as an outworking of understanding baptism as encompassing
identity in Christ and in an attempt to prevent young adults developing eating disorders. Support
groups such as the Twelve Step group in Chapter 5 may be formed across a group of local churches
and operate in addition to individual counselling provided through referral from a GP. A designated
core of people from the Church may provide emotional, physical and prayer support to individuals
and their families where disordered eating has become so severe as to require admission to hospital.
Testimonies to the grace of God, shared in church services may be a means by which some caught
in the grip of perfectionism are enabled to hear the call of God to a new way of life. The
outworking of this may be undertaken through a combination of psychiatric assistance and the
companionship of someone within the Church to whom the sufferer is accountable on their journey
to wholeness.

7.5 Conclusion
The Church does not have all the answers, nor does it claim to be able to solve disordered eating
alone. The argument advanced in this thesis is that there are particular contributions the Church can
make by living in the light of Gods revelation in Christ, demonstrated through a rediscovery of
particular practices. These seek to address the societal context in which disordered eating
flourishes, the underlying issues generating and sustaining disordered eating, and its impact upon
individual and communal life. This thesis has identified and explored practices of the Church
which have a particular bearing upon eating disorders. It has argued that a rediscovery of those
practices will enable the Church to recognise why eating disorders are a problem, shape the identity
of those within the Church in a way which challenges cultural pressures which form the context for
eating disorders; model healthy relationships with food and self- control, create safe spaces for
talking through and recovering from eating disorders, and bring relief from the tyranny of
perfectionism. In re-interpreting ancient practices of the Church it is hoped that the body of Christ

249

in the present age may be equipped to engage with disordered eating and be a conduit of Gods
healing and hope for those who long to know freedom and release.

250

Appendix
Sarahs story
One person who experienced the Twelve Step Eating Disorder Group described in Chapter 5 of this
thesis and went on to find it a way into the church has mixed feelings about the group. On the one
hand, the church to which the Twelve Step programme is attached has been a significant and
helpful feature in her recovery, yet the Twelve Step group itself has not been quite so positive. The
following excerpt from her story is part of her journey, told in her own words:
They say you have to hit bottom before you can recover. I was no exception. For me, bottom was
Easter of 2000 and I was a tender age 21. My holiday was spent in an oversized cloth gown sipping
lukewarm soup in a sterile cafeteria. For the first time I intimately knew loneliness, emptiness, and
helplessness as I envisioned my family gathering around the dining room table in Iowa without me.
I realized this vicious cycle that had consumed my world for seven years would continue to ravage
my body and spirit until I confronted the true issues.
Prior to being admitted for my fourth hospitalization, I hadnt eaten a solid, well-balanced meal in
months. My vital signs were dangerously low and anorexia and bulimia had begun to slowly, yet
violently, eat through my organs. At one point during my illness, the doctors gave me two weeks to
live but I knew that something, somewhere was pushing me onward. I knew that I had a purpose in
life, but I was desperately lacking the sense of direction and stability I needed to understand that
purpose.

When I was released from the security of the hospital and sent back into the big, bad world, I was
aware of the steps I would have to take in order to stay healthy. The one that took precedence was
finding a healthy mental and spiritual outlook. Because I was un-churched, I had no idea if my
personal spiritual beliefs fell in line with any specific denomination. I had regularly driven by a
beautiful, large white church and decided to start there. Truthfully, I was terrified to walk through

251

the doors of X Church. I assumed that I would be judged for my religious ignorance and
condemned for the way I had treated my body.

To my surprise, I was warmly welcomed into the sanctuary on that day and into the membership
two months later. On my second visit, I met a smiling woman named Suzanne who has since
become my Dallas surrogate mother. I confided in her that I had never learned how to pray. She
squeezed my hand and told me to have a conversation with God. To this day I am grateful for that
patience and guidance that X Church continues to show me.

As I became more confident at X Church, I told others about my struggles. They embraced me for
my courage and asked me to share my story with various youth and Sunday School groups. The
church also supports me in my pursuits to implement an eating disorders support group within its
12-Step Ministry program.

Attending X Church has become a gentle, prodding reminder that I was starving for much more
than food. In fact, my church has filled a void in my life with which no other hunger can compete.
This large church family brings meaning and joy to my life. I now have a passion for helping others
as X Church has helped me.1

This account featured on the Testimonies page of the churchs website, though to attribute a reference
would be to compromise the anonymity of the church involved.

252

Bibliography
Abraham, William J., Doctrinal Confession and the Renewal of the Christian Church:
Confessing the Faith: A View from US Methodism (Calver: Cliff College Publishing, 1995)
Abrams, K. K., L. Allen, and J. J. Gray, Disordered Eating Attitudes and Behaviors,
Psychological Adjustment, and Ethnic Identity: A Comparison of Black and White Female
College Students, International Journal of Eating Disorders 14 (1993), 49-57
Adams, Nicholas, Confessing the Faith, in Stanley Hauerwas and Samuel Wells
(eds.), The Blackwell Companion to Christian Ethics (Oxford: Blackwell, 2004), 209-22
Advokat, Claire, and Vesna Kutlesic, Pharmacotherapy of the Eating Disorders: A
Commentary, Neuroscience & Biobehavioral Reviews 19 (1995), 59-66.
Alcorn, Nancy, Beyond Starved (Winepress, 2009)
Alcorn, Nancy, Starved (Winepress, 2007)
All Party Parliamentary Group on Body Image and Central YMCA, Reflections on Body Image
Report, May 2012.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders (Washington DC: American Psychiatric Association, 4th ed. 1994)
American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders IV, Revised, (DSM R) (Washington DC: American Psychiatric Association,
4th ed. 1994)
Andersen, Arnold E., Wayne A. Bowers and Tureka Watson, A Slimming Program
for Eating Disorders Not Otherwise Specified: Reconceptualizing a Confusing, Residual
Diagnostic Category, The Psychiatric Clinics of North America 24 (June 2001), 271-80
Aquinas, Thomas, Summa Theologiae, trans. Timothy McDermott (Cambridge:
Cambridge University Press, 2006) II. ii. 184.
Aquinas, Thomas, On the Perfection of the Spiritual Life, trans. F. J. Procter
(Westminster, ML: The Newman Press, 1950)
Archbishops Council of the Church of England, Promoting Mental health: A Resource for
Spiritual and Pastoral Care (London: Church House, 2005)
Aristotle, Metaphysics V. X, 1012b -1002a, in The Complete Works of Aristotle, vol.
2, ed. Jonathan Barnes (Princeton: Princeton University Press, 1998)
Athanasius, The Life of Antony, in The Life of Antony and The Letter to Marcellus,
trans. Robert C. Gregg, (New Jersey: Paulist Press, 1980)
Augustine, A Treatise Concerning Mans Perfection in Righteousness, in Alexander

253

Roberts, James Donaldson, Philip Schaff and Henry Wace (eds.), Nicene and Post Nicene
Fathers: First Series, 14 Volumes (Peabody, MA: Hendrickson, 2nd ed. 1994), vol. V.
Augustine, Confessions, in Alexander Roberts, James Donaldson, Philip Schaff and
Henry Wace (eds.), Nicene and Post Nicene Fathers: First Series, 14 Volumes (Peabody,
MA: Hendrickson, 2nd ed. 1994), vol. I.
Baker, Frank, A Union Catalogue of the Publications of John and Charles Wesley
(Stone Mountain, Georgia: George Zimmermann, 2 nd ed. 1991)
Ballard, Paul, and John Pritchard, Practical Theology in Action (London: SPCK,
1996)
Baptist Union of Great Britain Safe to Grow (Didcot: Baptist House, 6th ed. 2011)
Bardone-Cone, Anna, M., and Kamila M. Cass What Does Viewing a Pro-Anorexia
Website Do? An Experimental Examination of Website Exposure and Moderating Effects,
International Journal of Eating Disorders 40 (2007), 537548.
Barnes, T. D., Angel of Light or Mystic Initiate? The Problem of the Life of St
Anthony, Journal of Theological Studies 37 (1986), 353-68
Barry, Declan T., Carlos M. Grilo and Robin M. Masheb, Gender Differences in
Patients with Binge Eating Disorder, International Journal of Eating
Disorders 31 (2002), 63-70
Beasley-Murray, George R., John, Word Biblical Commentary vol. 36 (Nashville,
TN: Thomas Nelson, 2nd ed. 1999)
Becker, A.E., R.A. Burwell, S.E. Gilman, D.B. Herzog, P.Hamburg, Eating Behaviours and
Attitudes Following Prolonged Television Exposure Among Ethnic Fijian Adolescent
Girls The British Journal of Psychiatry 180 (2002), 509-14.
Bell, Rudolph, Holy Anorexia (London: University of Chicago Press, 1985)
Berg, Kathleen M., Dermot J. Hurley, James A. McSherry, Nancy E. Strange, Eating
Disorders: A Patient Centred Approach (Oxford: Radcliffe Publishing, 2002)
Berkman, John and Michael Cartwright (eds.), The Hauerwas Reader (Durham N.C: Duke
University Press, 2001)
Bieler, Andrea and Luise Schottroff, The Eucharist, Bodies, Bread and Resurrection
(Minneapolis: Fortress Press, 2007)
Blatt, S. J., D. M. Quinlan, P.A. Pilkonis, M.T. Shea, Impact of Perfectionism and
Need for Approval on the Brief Treatment for Depression: The National
Institute for Mental Health Treatment of Depression Collaborative Research
Programme Revisited, Journal of Consulting and Clinical Psychology 63
(1995), 125-132
Bokser, B. M., Was the Last Supper a Passover Seder? Bible Review 3 (1987) 24-33

254

Bordo, Susan, Unbearable Weight (Los Angeles: University of California Press, 2 nd

ed. 2003)
Bowman, Grace, Vanishing Point, Stella Sunday Telegraph, 19 February 2006,
38- 41
Boyle, Catherine S., Hungry Souls: What the Bible Says about Eating Disorders (New Look Press,
2010)
Bradshaw, Timothy, Judy Jarvis, Michael Jebson and Wendy Ross-Barker , Worth Doing WellGuidance and Good Practice for Churches and Other Organisations (Peterborough: Methodist
Publishing, 2002)
Brown, Peter, The Body and Society (London: Faber & Faber, 1989)
Brownell, Kelly D. and Christopher G. Fairburn (eds.) Eating Disorders and Obesity
289-374
Bruch, Hilde, Eating Disorders: Obesity, Anorexia Nervosa and the Person Within,
(London: Routledge & Kegan Paul, 1973)
Brumberg, Joan Jacobs, Fasting Girls (New York: Vintage Books, 2000)
Bullitt-Jonas, Margaret, Holy Hunger (Oxford: Lion, 1998)
Butler, Perry, Introduction: Confession Today, in M. Dudley and G. Rowell (eds.),
Confession and Absolution (London: SPCK, 1990)
Bynum, Caroline Walker, Holy Feast and Holy Fast (Berkeley, CA: University of
California Press, 1987)
Capua, Raymond of, Life of Catherine of Siena, trans. Conleth Kearns, (Wilmington,
DE: Glazier, 1980)
Casper, Regina C., Elke D. Eckert, Katherine A. Halmi, Solomon C. Goldberg, John
M. Davis, Bulimia: Its Incidence and Clinical Importance in Patients with
Anorexia Nervosa, Archives of General Psychiatry 3R (1980), 1030-1035
Chernin, Kim, The Hungry Self (London: Virago, 1985)

Church of England Board of Social Responsibility, Response to The Draft Mental Health
Bill June 2002 (London: Church House, 2002)
Clare, A. W., The Disease Concept in Psychiatry, in Robin M. Murray, Peter Hill
and Peter McGuffin, The Essentials of Postgraduate Psychiatry, (Cambridge:
Cambridge University Press, 3rd ed. 1997), 41-55
Clement of Alexandria, Stromata in Alexander Roberts, James Donaldson, Philip
Schaff and Henry Wace (eds.), The Ante-Nicene Fathers (Peabody, MA:
Hendrickson, 1994), vol. 2
Collier, D.A., and J.L.Treasure, The Aetiology of Eating Disorders, The British Journal of
Psychiatry 185 (2004), 365

255

Collins Concise Dictionary and Thesaurus (Glasgow: Harper-Collins, 1995)

Cook, Chris, Andrew Powell and Andrew Sims, Spirituality and Psychiatry (London: RCPsych
Publications, 2009)
Cooper, Peter J., Bulimia Nervosa and Binge-Eating: A Self-Help Guide using
Cognitive Behavioural Techniques (London: Robinson, 1995)
Cooper, Peter J., and Christopher G. Fairburn, Confusion over the Core
Psychopathology of Bulimia Nervosa International Journal of Eating
Disorders 13 (1993), 385 -389
Counihan, Carole. M., and Steven. L. Kaplan, Food and Gender: Identity and Power
(Amsterdam: Harwood Academic, 1998)
Counihan, Carole M., The Anthropology of Food and Body (London: Routledge,
1999)
Coveney, John, Food, Morals and Meaning (Abingdon: Routledge, 2nd ed. 2006)
Cragie, Peter C., Psalms Word Biblical Commentary vol. 19 (Nashville, TN: Thomas
Nelson, 2001)
Crisp, A. H., Anorexia Nervosa: Let Me Be (London: Academic Press, 1980)
Crisp, A. H., N. Joughin, C. Halek, C. Bowyer, The Wish to Change (Hove: Psychology Press, 2nd
ed. 1996)
Cross-Government Obesity Unit, Department of Health and Department of Children,
Schools and Families, Healthy Weight, Healthy Lives: A Cross-Government Strategy for
England, (London: Department for Health & Department of Children, Schools and
Families 23rd January 2008)
Cumella, Edward J., Marian C. Eberly and A. David Wall, Eating Disorders- A Handbook of
Christian Treatment (Wickenburg, Az: Remuda Ranch, 2008)
Cutting, Derrick, The Parentalk Guide to Your Child and Food (London: Hodder &
Stoughton, 1991)

Department for Children, Schools and Families, Support for All: The Families and
Relationships Green Paper (London: TSO, 2010
Donovan, W. N., The Homiletical Worth of the Study of Hebrew, The Biblical
World 32, no. 1 (1908), 54
Dudley M., and G. Rowell (eds.), Confession and Absolution (London: SPCK, 1990)
Dunn J. D. G., The Theology of the Apostle Paul (Grand Rapids, MI: Eerdmans,
2006)
Eddy, Kamryn T., David J. Dorer, Debra L. Franko, Kavita Tahilani, Heather Thompson-Brenner,
David B.Herzog, Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa:
Implications for DSM-V, American Journal of Psychiatry 165 no.2 (2008), 245-50.

256

Evans Craig E., Mark 8:27- 16:20, Word Biblical Commentary vol. 34b (Nashville,
TN: Thomas Nelson, 2001)
Fairburn, Christopher G., A cognitive behavioural approach to the treatment of
bulimia, Psychological Medicine 11 (1981), 707-711.
Fairburn, Christopher G., and Sarah J. Beglin, Studies of the Epidemiology of
Bulimia Nervosa, American Journal of Psychiatry 147 (1990), 401-408
Fairburn, Christopher G., and Paul J. Harrison, Eating Disorders, The Lancet 361
(2003), 407-416
Fairburn, Christopher G., Z. Cooper, H. A. Doll, M. E. OConnor, K. Bohn, D. M.
Hawker, J. A. Wales, R. L. Palmer, Transdiagnostic Cognitive-Behavioral Therapy for
Patients with Eating Disorders: A Two-site Trial with 60-Week Follow-up, American
Journal of Psychiatry 166 (2009), 3119.
Fairburn, C.G., M.D. Marcus, and G.T. Wilson, Cognitive-behavioural therapy for binge eating
and bulimia nervosa: A comprehensive treatment manual in C.G. Fairburn and G.T.
Wilson (eds), Binge Eating: Nature, assessment and treatment. (New York: Guildford
Press, 1995), 361-404.
Feighner J. P., Diagnostic Criteria for use in Psychiatric Research, Archives of
General Psychiatry 26 (1972), 5763
Filleul, Elizabeth, Consuming Passion (London: Triangle, 1996)
Fisch Thomas J., (ed.), Primary Readings on the Eucharist (Collegeville, MN: Order
of Saint Benedict, 2004)
Flett, G. L., P. L. Hewitt, Perfectionism in the Self and Social Context:
Conceptualization, Assessment and Association with Psychopathology, Journal of
Personal and Social Psychology 60 (1991), 456470
Forthun, Larry F., Boyd W. Pidock and Judith L. Fischer, Religiousness and
disordered eating: does religiousness modify family risk?, Eating Behaviors 4 (2003), 726
Foster, Kenelm and Mary John Ronayne (eds. and trans.), I, Catherine Selected
Writings of St Catherine of Siena, (London: Collins, 1980)
Foster, Richard, Celebration of Discipline (London: Hodder and Stoughton, 1983)
Foucault, Michel, Discipline and Punish: The Birth of the Prison, trans. Alan
Sheridan, (New York: Vintage Books, 2 nd ed. 1995)
Francis, Leslie J., Pastoral Care Today (Farnham: CWR, 2000)
Freud, S., Totem and Taboo, trans A.A. Brill, (New York: Moffat, Yard & Co. 1919)
Friesen, Robert, Christian Perfection, Direction 13, no.3 (1984), 25-32
Frost, R. O., P. Marten, C. Lahart, R. Rosenblatte, The Dimensions of Perfectionism
Cognitive Therapy and Research 14 (1990), 449-468

257

Gabbacia, Donna R., We Are What We Eat, (London: Harvard University Press, 1998)
Gallie W. B. Essentially Contested Concepts Proceedings of the Aristotelian Society
56 (1956), 167-198
Gard, Maisie C. E., and Chris P. Freeman The Dismantling of a Myth: A Review of
Eating Disorders and Socioeconomic Status, International Journal of Eating Disorders
20, (1996), 1-12
Garfinkel, Paul E., E. Lin, P. Goering, Should Amenorrhoea Be Necessary for the
Diagnosis of Anorexia Nervosa? Evidence from a Canadian Community
Sample, British Journal of Psychiatry 168 (1996), 500 -506
Garfinkel, Paul E., Classification and Diagnosis of Eating Disorders in Kelly D.
Brownell and Christopher G. Fairburn (eds.) Eating Disorders and Obesity
A Comprehensive Handbook (New York: Guilford Press, 1995)
Garner, D. and P. Garfinkel, Handbook of Treatment for Eating Disorders (London:
The Guildford Press, 2nd ed. 1997)
Garner, D., and Paul E. Garfinkel, Socio-Cultural Factors in the Development of
Anorexia Nervosa Psychological Medicine 10 (1980), 647-656
Garner, D., and M. Olmstead, Manual for Eating Disorders Inventory, (Odessa:
Psychological Assessment Resources Inc. 1984)
Germov, John, and Lauren Williams (eds.), A Sociology of Food and Nutrition,
(Oxford: Oxford University Press, 1999)
Gibbs, Eddie, and Ryan Bolger, Emerging Churches: Creating Christian Community
in Postmodern Cultures (Baker Academic, 2005).
Giddens, Anthony, Modernity and Self-Identity: Self and Society in the Late Modern
Age (Stanford, CA: Stanford University Press, 1991)
Goodliff, D., Care in a Confused Climate (London: Darton, Longman and Todd, 1998)
Gooldin, Sigal, Fasting Women, Living Skeletons and Hunger Artists: Spectacles of
Body and Miracles at the Turn of a Century Body and Society 9 (2003), 27-53
Gordon, Richard A., Anorexia and Bulimia Anatomy of a Social Epidemic (Oxford:
Basil Blackwell Ltd, 1990)
Graham, Elaine, Transforming Practice (Eugene, OR: Wipf and Stock Publishers,
2002)
Graham, Elaine, Heather Walton and Frances Ward, Theological Reflection: Methods
(London: SCM Press 2005)
Graham, E.L, H. Walton and F. Ward, Theological Reflection: Sources (London: SCM, 2007)
Graham, M. Anthony, Wendy Spencer, Arnold E. Andersen, Altered Religious

258

Practice in Patients with Eating Disorders International Journal of Eating Disorders 10

(1991), 239-243
Graham, Michelle, Wanting to be Her (Downers Grove, IL: IVP, 2005)
Gray, W. A., Perfection through Fellowship, Expository Times 14 (1902), 30-4
Griffin, J., and E. M. Berry , A Modern Day Holy Anorexia? Religious Language in
Advertising and Anorexia Nervosa in the West European Journal of Clinical Nutrition l57
(2003) 43-51
Griffith, R. Marie, Born Again Bodies (London: University of California Press, 2004)
Grimm, Veronika, From Feasting to Fasting: The Evolution of a Sin (London:
Routledge 1996)
Grossoehme, Daniel H., The Pastoral Care of Children (Birmingham: Haworth Pastoral Press,
1999)
Guinness, Michele, Chosen (Oxford: Monarch, 2008)
Gundry, R. H., The Use of the Old Testament in St. Matthews Gospel with Special
Reference to the Messianic Hope (Leiden: Brill, 1975)
Gustafson, James, The Sectarian Temptation: Reflections on Theology, the Church and the
University, Proceedings of the Catholic Theological Society 40 (1985), 83-94.
Habermas, Tilman, Further Evidence on Early Case Descrpitions of Anorexia
Nervosa and Bulimia Nervosa International Journal of Eating Disorders 11(1992) 351359
Halliburton, J. A Godly Discipline, in M. Dudley and G. Rowell (eds.), Confession
and Absolution (London: SPCK, 1990), 42
Halmi, Katherine, Suzanne R. Sunday, Michael Strober, Alan Kaplan, D. Blake
Woodside, Manfred Fichter, Janet Treasure, Wade Berrettini and Walter H.
Kaye, Perfectionism in Anorexia Nervosa: Variation by Clinical Subtype, Obsessionality,
and Pathological Eating Behavior, American Journal of Psychiatry 157 (2000), 1799-1805
Hauerwas, Stanley, Sanctify them in the Truth, (Nashville: Abingdon Press, 1998)
Hauerwas, Stanley, The Peaceable Kingdom: A Primer in Christian Ethics (London:
SCM Press, 1984)
Hauerwas, Stanley, The Servant Community: Christian Social Ethics, in John
Berkman and Michael Cartwright (eds.), The Hauerwas Reader (Durham N.C:
Duke University Press, 2001)
Hauerwas, Stanley, and Samuel Wells (eds.), The Blackwell Companion to Christian Ethics
(Oxford: Blackwell, 2004)
Hays, Richard B., First Corinthians, (Louisville, Kentucky: John Knox Press, 1997)
Heller, Zoe, My Daughters Dolls have to be Dolls Daily Telegraph May 1st 2004

259

Hemfelt, Robert, and Richard Fowler, Serenity: A Companion for Twelve Step
Recovery (Nashville: Thomas Nelson Inc., 1990)
Hermes, Susan F., and Pamela K. Keel, The Influence of Puberty and Ethnicity on
Awareness and Internalisation of the Thin Ideal, International Journal of Eating
Disorders 33 (2003), 465-467
Hewitt, P. L., Gordon L. Flett and Evelyn Ediger, Perfectionism Traits and
Perfectionistic Self-Presentation in Eating Disorder Attitudes, Characteristics, and
Symptoms International Journal of Eating Disorders 18 (1995), 317-326
Hepworth, Julie, The Social Construction of Anorexia Nervosa (London: Sage 1999)
Hesse-Biber, Sharlene, Am I Thin Enough Yet? (New York: Oxford University Press, 1996)
Hofmann, Stefan G., An Introduction to Modern CBT (Chichester: Wiley-Blackwell, 2011)
Irenaeus, Fragments from the Lost Writings of Irenaeus XXXVI, in Alexander
Roberts, James Donaldson, Philip Schaff and Henry Wace (eds.), The AnteNicene Fathers (Peabody, MA: Hendrickson, 1994), vol. 1.
Israel, Martin, Healing as Sacrament (Cambridge: Cowley Publications, 1984)
Jackson, Gordon E., Eucharist: Feeding and Faith in Theology Today 31, no.1 (1974), 19
Jantz, Gregory L., Hope & Help for Eating Disorders (Colorado: Shaw Books, 1995)
Johnson, L., The Date of the Last Supper Scripture 9 (1957), 108-115
Johnson, Luke Timothy, The Creed (New York: Doubleday, 2003)
Jones, Kathleen, Women Saints, (Tunbridge Wells: Burns & Oates, 1999)
Joughin, Neil, Arthur H. Crisp, Christine Halek, and Heather Humphrey, Religious
Belief and Anorexia, International Journal of Eating Disorders 12 (1992)
Kaplan, Allan S. and Paul E. Garfinkel, Bulimia in the Talmud American Journal of
Psychiatry 141 (1984), 721
Kaffmann, M., and T. Sadeh, Anorexia Nervosa in the Kibbutz: Factors Influencing
the Development of a Monoideistic Fixation, International Journal of Eating Disorders 8
(1989), 33-54
Klein, Diane Alix, and B. Timothy Walsh, Eating Disorders: Clinical Features and
Pathophysiology, Physiology and Behavior 81, ( 2004), 359-74
Kendell, R. E., and A. K. Zeally (eds.), Companion to Psychiatric Studies (London:
Churchill Livingston, 3rd ed. 1983)
Kng, Hans, Women in Christianity (London: Continuum, 2001)
Kutchins, Herb, and Stuart A. Kirk, Making Us Crazy (New York: The Free Press,
1997)
Lartey, Emmanuel, Practical Theology as a Theological Form, in David Willows
and John Swinton, Spiritual Dimensions of Pastoral Care: Practical Theology in a
Multidisciplinary Context (London: Jessica Kingsley, 2000)

260

Larsen, Timothy, and David J. Treier (eds.) The Cambridge Companion to

Evangelical Theology (Cambridge: Cambridge University Press, 2007)
Lasgue, C. H., On Hysterical Anorexia, Medical Times and Gazette 2 (1873b),
265- 6
Law, William, The Works of the Reverend William Law: A Practical Treatise upon
Christian Perfection Volume 3 (Whitefish, MT: Kessinger Publishing, 2010)
Lelwica, Michelle Mary, Starving for Salvation (Oxford: Oxford University Press, 1999)
Levine, Michael P., Reducing Risk Factors, International Journal of Eating
Disorders 33 (2003), 384-7
Lewis, C.S., Miracles (San Francisco: Harper Collins, 2001)
Lifeline The Magazine of ABC, Autumn 2004 Winter 2010
Lindstrm, Harald, Wesley and Sanctification (London: Epworth, 1950)
Litchfield, K., Tend my Flock (Norwich: Canterbury Press, 2006)
Loughlin, Gerard, Telling Gods Story (Cambridge: Cambridge University Press,
1996)
Louth, A., St Athanasius and the Greek Life of St Anthony, Journal of Theological
Studies 39 (1988), 504-9
Lowes-Watson, David, Covenant Discipleship (Nashville: Discipleship Resources,
1991)
Lupton, Deborah, Food, the Body and the Self (London: SAGE, 1996)
Lysaught, M. Therese, Suffering in Communion with Christ, in John Swinton and
Richard Payne (eds.) Living Well and Dying Faithfully (Grand Rapids, MI: Eerdmans,
2009), 59-85
Mackenzie, Stephen, On a Case of Anorexia Nervosa vel Hysterica, The Lancet 131
(1888), 613-614
Martin, Dale B., The Corinthian Body (New Haven: Yale University Press, 1995)
Mays, James L., Psalms Interpretation: A Bible Commentary for Teaching and
Preaching, (Louisville: John Knox Press, 1994)
McKenny, Gerald P., To Relieve the Human Condition (New York: State University
of New York, 1997)
McLaren, Brian, A New Kind of Christian (San Francisco: Jossey Bass, 2001)
McLeod, Sheila, The Art of Starvation (New York: Schocken, 1987)
Methodist Worship Book (Peterborough: Methodist Publishing House, 1999)
Meyer, Joyce, Eat and Stay Thin (New York: Warner, 1999)
Minirth, Frank, Paul Meier, Robert Hemfelt, and Sharon Sneed, Love Hunger
(Crowborough: Highland, 1991)

261

Mission and Public Affairs Council of the Church of England Support for All: The
Families and Relationships Green Paper (London: Church House, 2010)
Mitchell, James E., Michael Erlander, Richard L. Pyle, and Linda A. Fletcher, Eating
Disorders, Religious Practices and Pastoral Counselling, International Journal of Eating
Disorders, l9 (1990), 589 - 593
Moloney, Raymond, The Eucharist (London: Geoffrey Chapman, 1995)
Morgan, John F., Patricia Marsden, and J. Hubert Lacey, Spiritual Starvation?: A
Case Series Concerning Christianity and Eating Disorders, International Journal of Eating
Disorders 28 (1999), 476- 480
Morton, Richard, Phthisiologia: or a Treatise of Consumptions, (London: Smith and
Walford, 1694)
Morton, Richard, Phthisiologia, seu Exercitationes, de Phithisi (London: Smith,
1689)
Neufeld, Vernon H., The Earliest Christian Confessions (Leiden: E. J. Brill, 1963)
Newman, Deborah, Loving Your Body (Wheaton, Illinois: Tyndale House, 2002)
Northumberland, Tyne and Wear NHS Foundation Trust, Eating Disorders: Help is at
Hand (Northumberland, Tyne and Wear NHS Foundation Trust: 2010)
Oden, Thomas C., John Wesleys Scriptural Christianity (Grand Rapids, Michigan:
Zondervan, 1994)
O Donnell, James J., Augustine (New York: Harper Collins, 2005)
Orbach, Susie, Bodies (New York: Picador, 2009)
Orbach, Susie, Hunger Strike (London: Faber, 1986)
Orbach, Susie, Interpreting Starvation, in Sian Griffiths and Jennifer Wallace (eds.),
Consuming Passions Food in the Age of Anxiety (Manchester: Mandolin, 1998)
Otto, Michael W., and Stefan G. Hofman (eds), Avoiding Treatment Failures in the Anxiety
Disorders (NewYork: Springer, 2010)
Pacht, A. R., Reflections on Perfection, American Journal of Psychology 39 (1984),
386-390
Palazzoli, Mara Selvini, Self-Starvation: From the Intrapsychic to the Transpersonal
Approach to Anorexia Nervosa, trans. Arnold Pomerans (London: Human Context Books,
1974)
Palmer, Bob, Concepts of Eating Disorders, in J. Treasure, U. Schmidt and E. van
Furth (eds.) Handbook of Eating Disorders (Chichester: John Wiley, 2003), 2.
Parry-Jones, W. Ll, Archival Exploration of Anorexia Nervosa, Journal of
Psychiatric Research, 19 (1985), 95-100
Patton, John, Pastoral Care An Essential Guide (Nashville: Abingdon Press, 2005)

262

Peterson, Carol B., and James E. Mitchell, Cognitive-Behavioural Therapy for Eating Disorders
in The Outpatient Treatment of Eating Disorders, ed. James E. Mitchell ( Minneapolis:
University of Minnesota Press, 2001)
Platte, Petra, Joan. F. Zelten, and Albert J. Stunkard, Body Image in the Old Order
Amish: A People Separate from The World International Journal of Eating Disorders
28 (2000), 408-14
S. Plum and P. Hebblethwaite The Third Wave of Cognitive Behavioural Therapy (CBT) Can
it be Integrated into a Christian Context? Accord Autumn 2010, 24-29
Polivy, Janet, and C. Peter Herman, Undieting: A Program to Help People Stop
Dieting International Journal of Eating Disorders 11 (1992), 261-268
Porterfield, Amanda, Healing in the History of Christianity (New York: Oxford University Press,
2005)
Potter, Phil, The Challenge of Cell Church (Abingdon: BRF/CPAS, 2001)
Rampling, David, Ascetic Ideals and Anorexia Nervosa, Journal of Psychiatric
Research 19 (1985), 89-94
Ratan, D, D. Gandhi and R. Palmer Eating Disorders in British Asians International
Journal of Eating Disorders 24 (1998), 101-5
Richards, P.S., R. K. Hardman, H. A. Frost, M.E. Berrett, J. B. Clark-Sly and D.K.
Anderson, Spiritual Issues and Interventions in the Treatment of Patients with Eating
Disorders, Eating Disorders 5 (1997), 261-279.
Riley, Caroline, Michelle Cooper, Zafra Cooper, Christopher G. Fairburn and Roz
Shafran, A Randomised Controlled Trial of Cognitive-Behaviour Therapy for
Clinical Perfectionism: A Preliminary Study, Behaviour Research Therapy 45, (2007),
2221-31
Rogers, Carl, Client-Centred Therapy: Its Current Practice, Implications and Theory
(London: Constable & Robinson, 2003)
Rose, Hieromonk Seraphim, The Rule of Fasting in the Orthodox Church Saint
Herman Calendar 2008 (Platina, CA: Saint Herman Press, 2008)
Rosenberg, Charles E., The Cholera Years: The United States in 1832, 1849, and
1866 (Chicago: University of Chicago Press, 1962)
Rowland, C. V., Anorexia Nervosa: A survey of the literature and review of 30
cases International Psychiatric Clinics 7 (1970) vii-ix
Russell, G. F. M., Bulimia Nervosa: An Ominous Variant of Anorexia Nervosa,
Psychological Medicine 9 (1979) 429-448
Russell, G. F. M., The Changing Nature of Anorexia Nervosa: An Introduction to the
Conference, Journal of Psychiatric Research 19 (1985), 101-109
Russell, G. F. M., The History of Bulimia Nervosa, in David M. Garner and Paul. E.

263

Garfinkel, Handbook of Treatment for Eating Disorders (London: Guilford Press, 2nd ed.
1997), 21
Ryle, John A., Discussion of Anorexia Nervosa Proceedings of the Royal Society of
Medicine 32 (1939), 735-737
Sangster, W. E., The Path to Perfection (London: Hodder & Stoughton, 1943)
Schaef, Anne Wilson, Womens Reality (New York: Harper Collins, 3rd ed. 1992)
Schaefer, Jenni, with Thom Rutledge, Life without Ed (New York: McGraw-Hill,
2004)
Schumacher, Lydia, Augustinian Reflections on Christian Perfection The Expository
Times 121 (2010), 548-52
Shepherd, Victor, Can You Find Anything More Amiable Than This? Anything
More Desirable? Paper given at the Oxford Institute of Methodist Theological Studies,
Oxford, 1997
Silverman, J.A., Richard Morton, 1637 1698, Limner of Anorexia Nervosa: His
Life and Times, Journal of Psychiatric Research 19 (1985) 83-88
Simmonds, M., Ueber embolische Prozesse in der Hypophysis. Archives of
Pathology and Anatomy 217 (1914), 226-239
Smith, Dennis E., From Symposium to Eucharist (Minneapolis: Fortress Press, 2003)
Smith, Gordon T., A Holy Meal (Grand Rapids, MI: Baker Academic, 2005)
Smith, Melissa H., P. Scott Richards and Christopher Maglio, Examining the
Relationship between Religious Orientation and Eating Disturbances, Eating Behaviors 5
(2004), 171-80
Smith, Grainne, Anorexia and Bulimia in the Family (Chichester: Wiley, 2004)
Smith, W. Robertson, The Religion of the Semites: The Fundamental Institution (New
Brunswick, New Jersey: Transaction Publishers, 2 nd ed. 2002)
Song, Robert, Genetic Manipulation and the Body of Christ Studies in Christian
Ethics 20 (3), 399-420
Speck, Jane, Into the Lake of Lions: Medieval Women and Bodily Suffering,
Borderlands no.1 (Summer 2002), 36-7, 43
Spinks, G.S., Psychology and Religion (London: Methuen, 1963)
Stackhouse, John G., (ed.) Evangelical Futures: A Conversation on Theological
Method (Leicester: IVP, 2001)
Stookey, Laurence Hull, Eucharist: Christs Feast with the Church (Nashville:
Abingdon Press, 1993)
Stunkard, Albert, A Description of Eating Disorders in 1932 American Journal of
Psychiatry 143 (1990), 263- 268

264

Sutherland, M., Towards Dialogue: an Exploration of the Relations between Psychiatry and
Religion in Contemporary Mental Health, in James Woodward and Stephen Pattison (eds),
The Blackwell Reader in Pastoral and Practical Theology (Oxford: Blackwell, 2000)
Swinton, John, and Richard Payne (eds.), Living Well and Dying Faithfully (Grand Rapids,

Mi:Eerdmans, 2009)
Szasz, T. S., The Myth of Mental Illness, American Psychologist 15, 113-115
Tabraham, Barrie, The Making of Methodism, (Peterborough: Epworth, 1995)
Tait, Philippa, Mums Bulimia Victory Gateshead Herald & Post, 21 March 2007, 1
TeSelle, Eugene, Augustine the Theologian (Eugene, OR: Wipf and Stock, 2002)
Tertullian, An Answer to the Jews Alexander Roberts, James Donaldson, Philip
Schaff and Henry Wace (eds.), The Ante-Nicene Fathers (Peabody, MA: Hendrickson,

The Church of England , Protecting All Gods Children (London: Church House, 4th ed.
2010) 1994), vol. 4
The Church of England House of Bishops, A Time to Heal - A Contribution towards the Ministry of
Healing, (London: Church House Publishing, 2000)

The Methodist Church, Safeguarding Children and Young People (London: Methodist
Church House, 2010)
Tiggemann, M. and A. S. Pickering, Pole of Television in Adolescent Womens
Body Dissatisfaction and Drive for Thinness, International Journal of Eating Disorders
20 (1996), 199-203
Tilley, Maureen A., and Susan A. Ross, Broken and Whole: Essays on Religion and
the Body, 1993 Annual Volume of the College Theology Society (Lanham MD: University
Press of America, 1995) vol. 39
Towns, Elmer L., Fasting for Spiritual Breakthrough (Ventura, CA: Regal Books,
1996)
Tracy, David, The Analogical Imagination (London: SCM, 1981)
Upbeat: The b-eat supporters magazine, Spring 2009
Van Deusen Hunsinger, Deborah, Theology and Pastoral Counselling (Grand Rapids, Mi.:
Eerdmans, 1995)
Vath, Raymond E., Counselling those with Eating Disorders (Waco, Tx: Word Books, 1986)
Walker, Arianna, Mirror Image (Presence Books, 2011)
Walton, Roger L., The Teaching and Learning of Theological Reflection: Case Studies of
Practice(Ed.D Thesis, Durham University, 2002 )
Ward, Pete, Participation and Mediation (London: SCM, 2008)
Watson, Hunna J., Bronwyn C. Raykos, Helen Street, Anthea Fursland, Paula R.

265

Nathan, Mediators between Perfectionism and Eating Disorder Psychopathology: Shape

and Weight Overvaluation and Conditional Goal-Setting, International Journal of Eating
Disorders 44 (2011), 142-9
Webb, Heather P., Redeeming Eve (Grand Rapids, MI: Baker Books, 2002).
Webb, Stephen H., Good Eating (Grand Rapids, MI: Brazos, 2001)
Weber, M., The Sociology of Religion, trans. E. Fischoff, (Beacon: Boston, 1963)
Webster, John, Confession and Confessions, in Christopher R. Seitz (ed.), Nicene
Christianity (Carlisle: Paternoster, 2001)
Weil, Simone, Waiting on God, trans. Emma Crufurd (London: Fontana, 1965)
Weinberg. Darin, On the Embodiment of Addiction Body and Society 8 (2002), 1-19
Wiederman, M. W. and T. Pryor, Substance Use Among Women with Eating
Disorders, International Journal of Eating Disorders 20 (1996), 163-8
Willows, David, and John Swinton, Spiritual Dimensions of Pastoral Care: Practical Theology in
a Multidisciplinary Context (London: Jessica Kingsley, 2000)
Wesley, John, Forty-Four Sermons (London: Epworth, 1944)
Wesley, John, The Journal of the Reverend John Wesley (London: Epworth, 1938)
Wesley, John, The Works of John Wesley, 14 vols. (London: Wesleyan Conference
Office, 1872); (reprinted, Grand Rapids, Michigan: Baker Book House, 1979)
Williams, Rowan D., Postmodern Theology and the Judgement of the World, in
Postmodern Theology: Christian Faith in a Pluralist World, ed. Frederic B. Burnham
(New York: Harper Collins, 1989), 92-112
Wink, Walter Naming the Powers: The Language of Power in the New Testament
(Philadelphia: Fortress Press, 1984)
Wink, Walter, Engaging the Powers: Discernment and Resistance in a World of
Domination (Minneapolis: Fortress Press, 1992)
Witherington III, Ben, Making a Meal of It (Waco: Baylor University Press, 2007)
Witt, Doris, Black Hunger (Oxford: Oxford University Press, 1999)
Wolf, Naomi, The Beauty Myth (London: Chatto & Windus, 1990)
Woodward, J., and S. Pattison The Blackwell Reader in Pastoral and Practical Theology (Oxford:
Blackwell, 2000)
World Council of Churches Baptism, Eucharist and Ministry Faith and Order
Paper No. 111 (Geneva: World Council of Churches 1982)
World Health Organisation, The IDC 10 Classification of Mental and Behavioural
Disorders: Clinical Descriptions and Diagnostic Guidelines (Geneva: World Health
Organisation, 1992)
Yoder, John Howard, Body Politics (Nashville: Discipleship Resources, 1992)

266

Young, Katharine, The Memory of the Flesh: The Family Body in Somatic
Psychology Body & Society 8 (2002) 25-47

Internet Sources
http://www.12stepgroups.com/about (accessed 16 October 2010)
http://www.aedweb.org/Prevalence_of_ED.htm (accessed 2 March 2011)
http://www.anad.org/site/anadweb/content.php?type=1&id=6982 (accessed 16
February 2011)
http://www.baaps.org.uk/content/view/404/6/ (accessed 30 September 2008)
http://www.b-eat.co.uk/Home/PressMediaInformation/Somestatistics (accessed 30 October 2010)
http://www.disordered-eating.co.uk/eating-disorders-statistics/eating-disorders-statistics-uk.html
(accessed 30 October 2010)
http://www.dove.co.uk/campaign-for-real-beauty.html (7th March 2011)
http://www.eatingdisordercentre.co.uk/what.htm (accessed 11 March 2011)
http://www.eating-disorders.org.uk (accessed 28 August 2010)
http://www.guardian.co.uk/uk/2006/jun/16/health.foodanddrink (accessed 30 September 2008)
http://www.nationaleatingdisorders.org (accessed 14 March 2011)
http://www.nimh.nih.gov/health/publications/eating-disorders/complete-index.shtml (accessed 30
October 2010)
http://www.pro-thinspo.com/proanareligion.html (accessed 28 August 2010)
http://www.settingcaptivesfree.com/courses/his-image/ (accessed 11 March 2011)
http://www.weightwatchers.co.uk/plan/mtg/index.aspx (accessed 20 October 2010)
http://women.timesonline.co.uk/to/life_and_style/women/fashion/article6874826.ece (7th March
2011).

Abstinence

Definition

of

in

Ask-it

Basket

Archive

http://www.oa.org/wp-

content/uploads/legacy/docs/Ask-It_Archive.pdf (June 1 2009)

Christian

Passover

Meal

for

Your

Family.

www.nazarene.org/files/docs/passover_traditions.pdf (2nd March 2011).

Candela, Emily,Disaggregating the Experiences of Medieval Female Fasting Saints
Janus. http://www.janus.umd.edu/completed2002/Emily/13.html
Eating

Disorders

Anonymous,

12

Step

Workbook

http://www.eatingdisordersanonymous.org/publications.html (accessed 1 March

2011)

267

Lange,

Katherine

Eating

Disorders:

Mothers

Perspective,

http://www.nowwhat.cog7.org/Articles/SocialIssues/Addictions/Eating_DisordersA_Mothers_Perspective.htm (accessed 11 March 2011)

Northern Centre for Eating Disorders, Annual Report 2009 http://www.yced.nhs.uk
(accessed16 September 2010)
Norton, Cherry, Media blamed for rise in eating disorders Independent Online, 31
May 2000 http://www.independent.co.uk/life-style/health-and-families/health-news/mediablamed-for-rise-in-eating-disorders-718088.html
Taylor,

Jeremy,

Rules

and

Exercises

of

Holy

Living

http://ww.anglicanlibrary.org/taylor/holyliving/index.htm (accessed 11 March 2011)

268