All mental illnesses are stigmatized in their own ways, but anorexics deal with a strange sort of stigma, wherein they’re not understood to be genuinely unwell. Rather, they’re too often perceived of as fashion victims, starving themselves to fit into trendy clothes, or to look like the women (girls) who model those clothes.

If casual dieting is viewed as a bit distasteful—a bit shallow, a bit trying too hard—then where does that leave someone who has full-on abandoned normal life in pursuit of slimness? People who are naturally slim often take umbrage at being ‘accused’ of anorexia, as though anorexia were not a mental condition but a form of almost criminal vanity.

The British-American journalist Hadley Freeman’s latest book, Good Girls: A Story and Study of Anorexia, is about getting to the root of what causes the disorder. But it is perhaps better understood as defence, not of anorexia itself, certainly, but of anorexics. The book, which examines her own history having been hospitalized anorexia as an adolescent in London, England, in the early-mid 1990s, asks readers to take anorexics, and their suffering, seriously.

But Freeman does not take herself too seriously, and the book is often quite funny. Recounting the intense exercising that preceded her descent into severe anorexia, she writes, “I joined a Bums & Tums class at my local gym and was the youngest attendee by at least three decades. I lifted weights—gotta tone those bat wings on your fourteen-year-old arms!”

The ground will be somewhat familiar to readers of Strangers to Ourselves, Rachel Aviv’s recent book about mental illness, which delves—also with occasional references to Jewishness—into her own anorexia. Written in short chapters, and in Freeman’s characteristically engaging style, Good Girls is rare study-citing, professor-interviewing non-fiction book that never feels like a homework assignment. She writes in a matter-of-fact way about her own socioeconomic background—relatively wealthy, but surrounded by the super-posh—without getting bogged down in privilege disclaimers.

Freeman points out that contrary to stereotype, it’s not just rich girls who become ill with the disease. (Mostly girls, though, and mostly white ones.) Whatever their origins, young women (and assorted others) with anorexia are ill, and in a way that alienates those around them. Anorexia is gruesome, and, as she writes about in blunt and moving terms, often deadly. And anorexics are definitely not, per Freeman, trying to win any beauty contests.

In view of the many theories floating around as to why some girls become anorexic (an entire chapter, “The Theories,” consists of a list of reasons Freeman herself was told she, personally, had, and it is… a lot), it makes sense that the book is as much about what anorexia is as what it is not. It’s not a form of autism or gender dysphoria, though it may relate to OCD. It’s not the result of childhood trauma or bad parenting, though it may be heritable. It is, and is not, about control. But most of all, it’s not about wanting to look pretty. According to Freeman, anorexics’ goal—insofar as it relates to physical appearances at all—is to look unwell.

What is the relevance, in 2023, of a plea to take anorexia seriously? The novelist and commentator Lionel Shriver suggests the topic is so last season, and relevant only insofar as it presages today’s trans debates. I’d disagree. It is un-woke, today, to be fatphobic. An enlightened parent of today is so body-positive, so non-judgmental where food is concerned, that they will let their kid eat unlimited cookies.

What this means is that today, an anorexic stands accused not just of self-destructive narcissism, but of valorizing thinness. Someone deeply afraid of becoming fat is, after all, phobic where fat is concerned. It’s courageous, in the current cultural climate, to offer a sympathetic interpretation of a disease that, on paper, no one who’d gotten the memo would suffer from.

Freeman’s central insight is that anorexia is a kind of misdirected anger. A certain kind of girl—hence the title, Good Girls—doesn’t feel capable of expressing anger in other ways, and so winds up directing it at herself, and those around her, by refusing to eat.

But it’s also, more specifically, about anger at gender roles. Girls realize what it means to be a woman in our society, and that this is coming for them, whether they like it or not. They correctly identify womanhood as an unappealing fate, full of drudgery and lechery. They don’t necessarily think it would be better to be a man (not generally, at least; more on that in a moment), but prefer the carefree androgyny of childhood. By not eating, they can return to a semblance of pre-pubescence. Almost like a puberty blocker.

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Which brings us, unavoidably, to the trans topic. Freeman is an extremely prolific author and journalist, and hardly a writer you could accuse of being one-note. She has investigated her family’s Holocaust history and profiled Keanu Reeves. But British feminism is somewhat dominated by a rift over transgender issues. Freeman’s stance on these topics—gender-critical feminism, or what its opponents call being a “TERF”—led to her parting ways with the Guardian.

It is thus expected that Freeman addresses the relationship between anorexia—which delays puberty for its young sufferers—and gender dysphoria. Other British feminists, such as Victoria Smith, have made this connection as well. But Freeman does not come to any pat conclusions here. While gender dysphoria and anorexia are both ways out of womanhood, anorexics do not, as a rule, want to be men. Freeman herself writes that this was never her goal. Anyone reading the book in the hopes of—or hopes of getting mad at—a “TERF” manifesto will be disappointed. The book is—refreshingly—not about that.

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Freeman writes regularly for the Jewish Chronicle, but does not delve into the relationship between Jewishness and anorexia. She writes that while there were some religious Christians among her fellow patients, observant members of other faiths, including Jews, were absent. This was doubtless true of specific London hospitals in the 1990s but does not necessarily track with broader trends from subsequent years. Indeed, Jews are, if anything, over-represented.

It’s easy to miss, but three of “The Theories” have to do with Jewishness: “I am Jewish,” “I had inherited trauma from the Holocaust,” and “I felt survivor’s guilt about the Holocaust.” It seems hard to imagine that if your formative education about your own identity involves seeing starved bodies of people who look like you, and hearing stories about people like yourself who had no access to food, this wouldn’t have some kind of impact.

And it hit me, while reading, that keeping kosher could play a role for some, if not for Freeman specifically. (She mentions having been a vegetarian since childhood, and the relationship between innocuous or even noble food restrictions along those lines, and eventual eating disorders.) Most children do not grow up with hard-and-fast rules about what they can and can’t eat, rules requiring looking at the small print on food packaging. Is this relevant? Seems like it would have to be.

That said, Freeman is clear that anything can function as a trigger. Hers was a classmate referring to her (Freeman’s) physique as “normal.” Circumstances that may be a catalyst for some will, for most others in the same environment, not lead to eating disorders. What Good Girls makes clear is that the essential is not the cultural specifics of a surrounding environment, but rather making sure that anyone inclined in this direction is able to get proper help.

The CJN’s senior editor Phoebe Maltz Bovy can be reached at [email protected] and on Twitter @bovymaltz