Myth: Anorexia is a Modern Malaise
Once upon a time…
… well, sometime in the 1970s, people started to hear about a condition called anorexia nervosa. At the time, and for some years afterwards, it was considered a modern, societal phenomenon. Most believed that anorexia was a product of the prosperity of the late twentieth century and that rates were rising as our lifestyles changed.
In her excellent book, Decoding Anorexia (Routledge, 2012) Carrie Arnold cites two studies from 2000 which challenged this assumption. They reported that there had been minimal increase in the incidence of anorexia nervosa in the US since the 1950s, this despite curvaceous Marilyn Monroe being replaced as the ideal woman by the rather less substantial Kate Moss.
A publication this year shows similar findings, that the incidence of the disorder has been stable for decades, although it notes that more people under 15 are being diagnosed with the condition.
But anorexia nervosa is still a relatively new disease, right? A disease of affluence. Something that has arisen since humans have had access to food in such abundance that we’ve been able to choose whether to eat it or not?
Diet culture certainly isn’t helpful, and may perpetuate the disorder in some, but it’s not the cause. And there’s convincing evidence that anorexia existed long before the twentieth century, and that the characteristics of the illness have not altered for hundreds of years.
All that’s changed is how we understand it.
Human beings are storytellers. Since the dawn of time, we have told tales to one another as a way to make sense of the world. Myths, legends, gods, goddesses, devils, saints — all were created as a way of answering questions: Why are we here? Why do things happen to us? What is that great ball of fire hanging in the sky and what are those millions of tiny dots that replace it when the sky turns black? So. Many. Questions.
I think this is pretty wonderful. Humans’ ability to tell stories, to imagine and to create, sets us apart from all other species on the planet. I mean, those monkeys still haven’t written Hamlet, have they?
Over the ages, people have made imaginative leaps to try to make sense of many medical conditions: it was thought that ‘tooth worms’ caused dental cavities; ‘miasma’, or bad air, led to cholera and Black Death; if the ‘four humours’ were out of balance, any number of illnesses could result; and, of course, demonic possession was blamed for many mental illnesses and treated with exorcism.
But how did our ancestors describe and explain anorexia nervosa, and was it recognisable as the same condition centuries ago? Well, let’s take a trip back through time to see how those who lived before us wrote about and tried to make sense of this mysterious, confusing condition.
1973: Bad Mothers
Most people hadn’t heard of anorexia nervosa until 1973, when German psychologist Hilde Bruch published Eating Disorders: Obesity, Anorexia Nervosa and the Person Within.
In her attempt to explain the unexplainable — self-starvation — Bruch came up with a theory that the illness had developed from the child’s relationship with its mother. Most people now accept this idea to be false. (For any mothers reading, you most definitely did NOT cause your child’s eating disorder.) But many of Bruch’s ideas persist, most notably the notion that anorexia nervosa is caused by someone’s need to take control of their lives. (I plan to look at this idea in a future post. Stay tuned…)
1873: A Morbid Mental State
Sir William Gull was at the centre of a bit of creative storytelling in the 1970s when it was theorised that he may have been serial killer Jack the Ripper. This story has been widely discredited, not least because Gull was in his seventies when the crimes took place. What is more convincing is the popular belief that it was Gull who first coined the term ‘anorexia nervosa’ for a mysterious illness of self-starvation.
The son of a barge owner, Gull became physician to the royal family, including Queen Victoria. He wrote about anorexia in 1868 and again in 1873, when he gave the illness its modern name. In a work titled Anorexia Nervosa, he discusses three cases, all female. He notes that, although malnourished, all his patients seem energetic and insist on movement, described as a peculiar restlessness. One would not eat any animal food. Both these symptoms will be familiar to many: It’s common for people with AN to feel the need to exercise or move compulsively. Forgoing meat and dairy is also widespread among people with the disorder. I find it curious that this was an expression of anorexia nervosa long before the link was made between dietary fat and weight, and over a century before veganism went mainstream.
Gull concluded that the condition arose from a morbid mental state, but treatment focused on the body: a nourishing diet was prescribed along with the application of heat to the body — an idea that’s recently enjoyed a revival.
1860: Family Dynamics
French psychiatrist Louis Victor Marcé described anorexia in his work Note sur une forme de délire hypocondriaque consécutive aux dyspepsies et caractérisée principalement par le refus d'aliments. Again Marcé talks about one patient removing meat from her diet as well as violence and plate throwing at mealtimes, and self harm. The description is shockingly familiar. It could have been written about my daughter in the early months of her illness, over 150 years later. The disorder in this patient seemed to develop after a period of illness — still a route to anorexia, after weight is lost. In the text, like Hilde Bruch, Marcé hints at problems with families, especially mothers, as it was observed that recovery seemed to take place when the subjects were removed from the family.
The treatment for the condition was food. Marcé writes that the subject should be re-nourished, forcibly if necessary, and…
When using these precautions, the amount of food is raised to appropriate proportions, the sick are seen transforming, the forces and overweight return and the intellectual state change in the most striking way. But it will be appropriate to exercise rigorous surveillance for a long time to come and vigorously combat the slightest sickly tendencies, if they were to happen again. Here relapses are easy…
Back in 1860, Marcé saw an improvement in mental health with re-nourishment. Sadly, relapse remains a problem.
1859: Hysteria
William Stout Chipley, an American psychologist published a paper in which he mentions sitomania, an intense dread of food, considering it a type of ‘hysteria’ and thus a disease of women.
1689: Passions of the Mind
British physician Richard Morton described anorexia nervosa way back in 1689, reporting on two cases in adolescents, one male, one female. He describes a nervous consumption — a wasting away as a result of emotional distress. The cause was thought to be passions of the mind — so mental rather than physical in Morton’s opinion. When various medicines failed, he advised the male patient to stop studying, get some fresh air and drink milk. He did, and his condition greatly improved. From what I’ve read and observed, for full recovery, animal fats, particularly dairy, may still be key.
1613: Malevolent Fruit
Jane Balan was known as the ‘French Fasting Girl of Confolens’ and described by Pedro Mexio in 1613. The young girl could not be persuaded to eat, and her condition was blamed on the evil power of an apple given to her by an old woman.
1300s: Saintliness
Catherine of Siena was a young Italian woman who began to forego food and drink in the name of religious purity. She was one of a number of women recorded as undertaking extreme fasting as a spiritual act. She was canonised in 1471 by Pope Pius II. In his book, Holy Anorexia (University of Chicago Press, 1987) Rudolph Bell made the connection between the self-starvation of Catherine and others with anorexia nervosa.
To me, this seems perfectly plausible. The unusual behaviour was framed as spirituality because that made sense in the times Catherine lived in. That was the story that was told. We know that some people with anorexia can experience a rewarding sensation when they decline food. It’s easy to imagine how someone with the condition in the Middle Ages could explain what was happening to them in religious terms — that it was what God wanted them to do because it felt right.
342 AD Godliness
A millennium before Catherine of Sienna, and almost two millennia before Hilde Bruch wrote about anorexia, it is recorded that another woman practised self-starvation in the name of religion. She was a member of a spiritual group led by Saint Jerome, and her fasting was ostensibly driven by her Gnostic religious beliefs.
The New Dark Ages
One thing that struck me while investigating the history of anorexia nervosa was that while doctors and others through the centuries have come up with all kinds of creative explanations for the self-harming behaviour of people with the condition — from bad apples to bad mothers — there was a golden period between the 1600s and the twentieth century when anorexia nervosa was mainly treated by re-nourishing the body with good, wholesome food.
This approach has been taken up again in recent decades by practitioners of Family-Based Treatment and has proved successful in many cases. We now understand that undernourishment can have a huge impact on the brain, and that the first thing to do when treating someone with anorexia is to restore their weight. This, in turn, should reduce the unhealthy thoughts around food.
After the advent of psychoanalysis towards the end of the nineteenth century, all kinds of other weird and wonderful approaches were tried in which the deep, dark recesses of the mind were mined in an attempt to uncover the ‘underlying cause’ of the condition in each individual. This could be anything from childhood trauma to a fear of growing up to an overbearing mother. The thinking was that if the person could figure out what psychological issue was causing them to behave in the way they were, and deal with that in some way, they’d be able to start eating again.
This, in my opinion, was a return to the Dark Ages in terms of treatment. Of course, it’s possible that some people have trauma in their past which may contribute to the development and maintenance of the illness — and talking therapy may be useful to deal with this — but this won’t be true for everyone. And re-nourishing the body should come first, or at least in parallel with any talking therapy, because recovery is impossible until the body is repaired. And the mind will never function properly until the body is healed.
Let’s hope that with new research into the biological causes of anorexia, the mechanism that triggers the disorder in some will be fully understood; new, more effective, treatments will be found to ease people’s path to recovery; and we will finally, after at least 2,000 years, be able to see…