Summary by Molly Klein and Natasha Weaver, Spring 1999

Joan Jacobs Brumberg, Fasting Girls: The History of Anorexia Nervosa

Anorexia Nervosa in the 1980s

Anorexia Nervosa was only recently introduced to the American public by the media. Publications in several well-known newspapers and magazines mentioned this disease and its severity. Before the 1980s, war times and depressions brought on famines and rationing so anorexia nervosa was hard to decipher and also treat. As the nation came out of war and harsh memories of hard times, anorectics came out and spoke or wrote about their struggles with anorexia nervosa. Today there are support groups for parents or friends and therapy sessions for sufferer. Doctors have come up with several explanations as to why young people are afflicted with this disease, one of which is society, another is psychological damage, and also a theory about the size of the hypothalamus.

From Sainthood to Patienthood

Beginning in Medieval Europe, author Joan Jacobs Brumberg focuses on female saints whose practice of food refusal and prolong fasting are considered miracles of survival and models of female holiness. This type of food refusal/fasting was given the name of anorexia mirabilis (miraculously inspired loss of appetite). It differs from anorexia nervosa on two grounds, firstly, Medieval society's strong association with women and the female body with food. Secondly, Jacobs-Brumberg describes the two stage process of anorexia nervosa, recruitment and career (see Ch. 1), clearly the recruitment is different in anorexia mirabilis.

Miraculous maids appeared in Continental Europe during the Protestant Reformation. Stories of miraculous maids circulated in the popular press, in one case it was well known over sees. Female fasting had been associated with the Catholic church so authority-hungry Protestant clergymen were interested in having miraculous fasters in their church. By the seventeenth century, one sees a shift in thoughts of female fasting, once considered an expression of holiness, it now is often see by some as a sign of possession by Satan. American Puritan Cotton Mather believed it was demonic adding, "one sex may suffer more trouble...from the invisible world than the other."

John Reynolds, a Protestant with ties to London's Royal Society of Physicians dismissed the religious interpretations and reasoned instead that faster's survival is due to Fermentation Theory. Fermentation theory is that the blood ferments, allowing survival without food, and therefore the faster isn't a miraculous maid. Erasmus Darwin (grandfather of Charles Darwin) stated that food abstinence was a problem associated with young ladies. Darwin created three categories for women without appetites; anorexia epileptica (loss of appetite with fits), anorexia manicalis (loss of appetite with insanity), and cacositis (general aversion to food).

The Debate over Fasting Girls

The term "fasting girls" was used by Victorians when any women stopped eating regardless of the cause. The term fasting meant different things to different people, to some it was eating irregularly, to others it was eating small amounts or eating outside of the normative food categories. There still remained a split between scientific and religious thought. Often fasting girls became "pilgrimage" destinations, the pious brought offerings of money or gifts. Which in some cases caused family members became mercenary. Explanation and care of the fasting girl became caught between to male dominated spheres, medicine and church.

Medical men believed that adolescent girls, with the onset of puberty, ran a high risk for metal as well as medical problems. The medical community always seem to tie fasting behavior with hysteria.

Somatic neurologists, forerunners of early psychiatry, catered to nervous disorders who tended to be from middle and upper class women. Neurologists believed that the male body operated rationally. When the press discussed fasting girls they would tie it to anorexia mirabilis in understandable terms as superstition, chicanery and mental illness. Neurologists used medieval religious women as demonstrating a history of metal illness. Around the 1870's new female fueled religious movements began in America such as Spiritualism, Seventh-Day Adventism and Christian Science. Each of these religions openly questioned medical authority. The somatic neurologist basically suggested that there is no spirituality in women, rather it is merely irrational thought. It wasn't the fasting girl who identified the history of religious fasting but those around her.

The nineteenth century marks a dividing line in female fasting behavior, from religious empowerment to mental illness, by the emerging psychiatric profession. This time period marks a shift to secularization and medicalization, with a transfer of authority from clergymen to medical men. This shift is also notable on the basis that there is no recorded case of a fasting boy, suggesting that some women hung on to the religious aspect of fasting far longer than the men.

Emergence of the Modern Disease

In the nineteenth century, disease becomes identified and classified. Medicine was also highly class stratified. The poor went to public institutions, asylums and hospitals, the middle and upper class sought private physicians.

The first crude classification of eating disorders were provided by the superintendents of the American asylums and the British alienists (alienist=psychologist). Most asylums and alienist practiced force-feeding and continue the practice of removing the girl from her family.

Middle and Upper class families who sought help for their daughter at an asylum only as a last resort. The term sitophobe appears from asylum doctors at this time. Sitophobia, intense fear of food or a phase of insanity, had no special powers associated with it and rarely attracted press coverage. Doctors saw sitophobia as an excuse to draw attention and to manipulate parents, to become a martyr. Due to their class situation, girls who refuse to eat annoyed the doctors at the asylums. Generally doctors thought of them as neurotic not psychotic. If not too emaciated, they were often viewed within the context that Victorian women cultivated the image of fragility. The doctor, William Withey Gull, is credited with transforming the condition into a disease. Gull focused on the medical aspects, while french doctor Charles Lasegue dealt with the disease as psychological. Lasegue was the first to suggest that anorexia had a component of family conflict.

Love and Food in the Bourgeois Family

With the bourgeois concept of family, sons and daughters lived at home until they would marry, lengthening parental dependency. Young women received the greatest rewards of the middle-class lifestyle, by dealing marriage and child birth. But few considered the problems of allowing women to lead a sheltered life and prolong dependency on parents. Charles Lasegue suggested that anorexia nervosa was associated with frustrations with the transition of adolescence to adulthood such as, inappropriate romantic expectations, blocked educational or social opportunities, struggles with parents. The bourgeois family countered the daughter who refused to each by either making her favorite meal or asserting that eating was a way of expressing love of your family. Anorexia nervosa can be seen as a dysfunction of the bourgeois family system. For the young bourgeois woman the pressure to marry, and marry well, were intense.

During the Victorian period one also finds the surfacing of advice book. The advice book was targeted to the middle-class mother, providing tips on how daughters should eat, exercise, bathe, fix their hair and how and what to tell daughters about menstruation and adult heterosexuality. The Victorian middle-class mother also allowed the medical profession to take over the role as midwife to her daughter. The Victorian daughter was seen as merely an extension of her mother.

After 1873, medical journals were in agreement that anorexia's medical characteristics were: lack of appetite, emaciation, amenorrhea (loss of menstrual cycle), low body temperature, and hyperactivity. Hyperactivity in anorexia was the patient's will to assert her good health, which doctors felt was just spitefulness. The widely held belief was that the anorexia nervosa patient merely wanted attention and sympathy, which was especially strongest in women.

Therapeutic Intervention

Treatment still focused on removing the girl from the family, after telling the parents to leave as quickly as possible. The doctors felt that removal lead to the greatest success, but given the bias of the middle class towards asylum, individual treatment usually consisted of traveling to an aunt's house, a sea voyage with a nurse or adult friend. When this strategy failed the asylum was taken into consideration. If one was upper class a private asylum or hysterical home was an option.

In discussing treatments doctors often felt that the stresses of modern society played a part in anorexia nervosa. One pressure that the medical profession felt that was too much for the delicate condition of the adolescent girl was education. Asylum superintendent T.S. Clouston stated, "Why should we spoil a good mother by making an ordinary grammarian?" Intellectual activity was thought to be to draining for females. One doctor published a book wherein he claimed education drained the nerves of women, disrupted ovarian development, inhibited reproduction and often lead to infertility. Amenorrhea was linked to intellectual activity. Other doctors felt that anorexia behavior was tied to class, represented by "thin blooded emotional women who make weak health a cherished habit."

The Appetite as Voice

Early examinations of patients included body appearance, emotional status, "listening to the body through a stethoscope, manipulation of the body parts, and tactile probing of the body" (Brumberg 167). In these exam, doctors almost always directed their questions of history and a patient's current state at the mother, who was present in the room. Doctors felt that the young girl's information was unreliable. Society believed that as long as an unmarried girl resides at home, her parent's have unquestionable authority over her. It was unlikely that a mother would ever be dismissed and a young girl would talk with the doctor about what was troubling her. After the diagnosis of anorexia nervosa was given, doctors began a treatment of overfeeding, weighing, and isolation from the family.

Social standards at this time reinforced the ideal of eating very little to show femininity. The "wasting" look was in. Society felt women were slaves to their bodily appetite. A woman's appetite was representative of her sexuality. The women of the higher classes, shunned meat because it was thought to stimulate sexual development and activity. Meat eating, in female adolescence, often was tied to insanity and nymphomania. Female discomfort with the act of eating implied digestion, defecation as well as sexuality. Constipation was incorporated into the ideal of Victorian femininity. Food was also to be feared due to its link with gluttony and physical ugliness. The symbol of status for men was a frail and thin woman, because she was unfit for productive (and reproductive) work. Food was tied to femininity. These social ideas brought forth a fear of becoming fat in young women.

Hormones and Psychotherapy

As the twentieth century drew closer, new treatments for anorexia nervosa were tried. Along with the overfeeding, doctors added hormone therapy. Hormones from animal and human organs were injected into the patient in attempt to stimulate the appetite. This treatment was not always successful.

Slowly anorexia nervosa was labeled as a psychological disorder. According to Freud, food was linked to sex, and the appetite to the sexual drive. Therefore some connection was made that those afflicted with anorexia nervosa were sexually repressed or had an extreme fear of sex. Freudian theory cast the anorexia nervosa patient as sexually repressed and puritanical. The girl was seen as one who prefers reading to boys, never masturbated, easily disturbed by overtures or touches by the opposite sex. Modern Dieting The emergence of ideal body types put women into a frenzy to diet. Fat was, and still is, shown as a health hazard. This brought forth the opportunity for businesses to make money off women's fear. Fashion also gave an extra push to the dieting rush by presenting ready to wear clothing, now the women had to fit the clothing and not the clothing fitting the women. Calorie counting also added it's extra kick to dieting, portions were now thought of in terms of calories and not servings. Movies and magazines also shaped the minds of women, only thin women made their appearances as models or movie stars.

Afterward

Today many people who have overcome their eating disorders have written books to inform people of the dangers and warning signs of these diseases. There are support groups all over the country dedicated to helping parents, friends and the victim themselves work towards an absolution and a peace of mind.

Critique #1

I think that this book was very informative and insightful. It was quite easy to read and understand. Brumberg gave a good background into the history of anorexia nervosa. There were a few things that I would have liked explained a little further in detail.

Critique #2

As an historical approach to anorexia nervosa Joan Jacobs Brumberg does a fantastic job. One can follow the social construction of the disease through society's obsession to construct women in relation to food. However, I think the book needs to give more of the medical construction of anorexia and the anoretic as patient. It does little to discredit the feminist construction of the environmental influence shaping eating disorders.

Questions for Discussion

1. Given the historical perspective and societal construct of Jacobs-Brumberg's discussion of anorexia, why don't more modern young women suffer from eating disorders?

2. How is this book and the disease of anorexia related to the Rosenberg article and the Kleinman article?