"We've lost the plot where bodies are concerned," Susie Orbach says. Our bodies have always been shaped by cultural factors as well as nature, but now one culture rules the world. We pay lip service to diversity, but millions crave the made-over, surgically enhanced western body, whose image saturates the media. We valorise democracy, but the aesthetic we export is narrowing all the time, excluding more and more people: so the Chinese put rods in their legs to make themselves taller, Koreans have their eyelids westernised, and behind their veils Iranian women hide remodelled noses. Biology is no longer destiny. The modern body is a work in progress, a site of perpetual fret and effort. We are encouraged to think of ourselves as perfectible; with enough money, enough pain, enough time and exercise we can make ourselves over - men and women both - so that we are like models on billboards, Oscar winners on the red carpet. We know these images are lies, but we dare not turn away from them. What would happen to us if we let our bodies simply be? We might grow fat. We might be mocked and frozen out. We might be taken as lower class. Our anxiety to be acceptable, to ourselves and others, paralyses critical thinking. A huge industry exists to sell us discontent, and we are eager to buy. We think we are in control, making choices, self-determining agents of our own improvement. In fact we are victims and dupes.
Nothing new there, perhaps. But Orbach has a deft way with grim examples. There are websites, she says, that will digitally enhance pictures of your children, so that later you can "remember" the beautiful baby you never had. Win a men's magazine competition, and you can present your girlfriend for breast surgery, to get her sliced about and stuck together to match the celebrity whose breasts you most desire. Yet sex and desire are becoming estranged; sex is something we watch ourselves perform. How, she asks, do bodies form their own image of themselves? Where do we stand to look at ourselves? Can there be any stability in our self perceptions, when the nutrition industry thrives on contradiction, last year's feel-good food becoming bad for us overnight? She queries the severity of the obesity "epidemic", pointing out that the body mass index is a crude and manipulated tool of measurement. It was adjusted by WHO in 1995, so that thousands of Americans went to bed normal and woke up fat. "Brad Pitt and George Bush, for example, were now overweight, and George Clooney and Russell Crowe were obese."
It is difficult to pick our way through the paradoxes of the modern body. It's hard to make sense of a world in which some women are shuffling around in burkas, while others offer flashes of knickerless vulva; where some are relishing organic "slow food" while others dine on powders and shakes; where some starve themselves for vanity, and others simply starve. When moral panic sets in, we should ask who benefits? The large food manufacturers don't lose if we turn away from eating; they sell us their low-fat ranges, often topped up with sugar to make them taste better. Our perpetual failures to remake ourselves are what set the tills ringing; and we are doomed to fail, if we take it as our duty to appear younger each year. We look up at the billboards with their poreless, hairless, elongated sci-fi beings; we creep beneath them, short, squalid, and suffused with shame.
Orbach draws examples from her clinical practice as a psychotherapist, showing how bodily hatred is transmitted mother to child, generation to generation. She is an eloquent advocate for her discipline, with interesting (and sometimes creepy) things to tell us about how the therapist's body mirrors that of her patient. She speculates on the technologically aided "transhumans" of the future. Maybe bad memories will be wiped out by drugs, pain signals cancelled? These are dubious benefits, Orbach thinks. If we erase experience how will we learn? If we block pain, how will we know we are damaged?
These are fascinating topics; but perhaps they are not urgent ones, in a sordid present where we can't even keep hospital floors clean. Orbach's new book is unlikely to make the impact of Fat Is a Feminist Issue, 30 years old and still a life-changing work. Bodies is a book of hints and provocations, which doesn't complete its own vast agenda. The reader cannot help but see Orbach with tilted head and wise smile, perching in a golden glow of empathy; why isn't she dancing with rage? Nothing estranges us from reality, nothing damages the body and how we think of it, so much as the violent pornography even children know how to access; but the book has little to say here, perhaps because the topic of pornography and censorship poses so many difficulties for the liberal imagination.
Orbach's long career as activist, writer and therapist means no one can question her commitment to the cause of helping people make sense of their lives and bodies. But if the present book is timid, perhaps it is because she feels compromised. Orbach, her book jacket tells us, is '"consultant and co-originator" of the Dove Campaign for Real Beauty, which is a smart marketing campaign with a veneer of feminist concern. Just like the usual ad-fodder, those bonny, bouncing lasses of the Dove posters have something to sell us, products to shift. The brand is owned by Unilever, which will fatten you up with Ben & Jerry's ice-cream and streamline you with Slim.Fast; which makes "Fair and Lovely" skin lightening products, so that black and yellow buyers can be whiter. What is most odious about the Dove campaign is its assumption of sympathy with its prey, the way it pats you on your dear little head as it takes your money. Orbach's involvement suggests we must now look elsewhere for radical thinking on sex, self and society.
• Hilary Mantel's next novel, Wolf Hall, will be published by Fourth Estate in May.
