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Fat is a Feminist Issue was published twenty years ago—a refreshingly passionate book that challenged the status quo view of women. In it Orbach described the social and cultural expectations for girls and women of having little direct power, of learning to deny their own needs, but instead facilitating the needs of others. Eating disorders were seen as an area where women might express power and control over their own bodies. The book met with great success, and it seemed to strike a chord for many women. Orbach and colleagues set up the Women's Therapy Centre, which was accessible and ‘user-friendly’. The barrier between status of ‘patient’ and student’ on a self-awareness course was blurred. It has been successful in bringing into treatment deprived and isolated women who might never of gone to traditional organisations, and who may not have been seen as able to use psychoanalytic psychotherapy.
The first of these books is a compilation of introductory seminars on women's psychology run by the Women's Therapy Centre. It seems that a range of views has developed. Orbach summarises very much the same views as twenty years ago, with a particular focus, the vicissitudes of over-closeness and lack of differentiation between mother and daughter. The technique that stems from this is, broadly, a supportive psychotherapy where patients are given much encouragement and support to recognise their own needs and wishes, and take a more active stance in relation to them. Ernst and Maguire take a more recognisably psychodynamic stance, arguing that the first approach goes only so far. They point out that the risk is of endorsing the woman as victim, as locating anything ‘bad’—aggression, envy, desire, sexuality—‘out there’, and that a woman therapist as well as a woman patient may particularly wish to be seen as ‘good’ and have difficulty recognising the negative transference.
The book is at its best in a number of clinical papers that address specific issues of