Anorexia Through the Ages: From Sainthood to Psychiatry

Depictions of impossibly slim bodies in the media are often seen as a cause of modern eating disorders. While attending Elizabeth Lawson’s Conte Center lecture on the role of hormones in anorexia earlier this month, I began to wonder: what happened before mass media? Have eating disorders always existed? And if so, did they appear in the past in the same forms as today?

Ancient Times: Meal Purging

Ancient Egyptian hieroglyphs hold the first known record of abnormal eating behavior: purging after meals, then considered a health ritual⁴. Purging was also common in Ancient Rome, where the rich would sometimes vomit during banquets in order to make room to continue a lavish feast. Even in the Middle Ages, the wealthy classes purged so they could eat more, seeing excessive consumption as a mark of prestige. These records reveal a surprising prevalence of behavior that today would be seen as pathological. Clearly the norm of eating behaviors is capable of radical shifts under cultural control.

At the same time, records from early dynasty China and Persia describe binging and purging behaviors⁴. Also, African tribal lore tells of adults fasting during times of famine in order to feed their children. Sometimes these individuals continued fasting after the famine, even to the point of death by starvation–suggesting that prolonged fasting lastingly transformed their relationship to food.

The Middle Ages: Fasting Saints

The middle ages saw the rise and fall of a very particular form of anorexia sometimes called “anorexia mirabilis”, tied to the contemporary cultural ideal of spiritual asceticism. Throughout the 13th century, women partook in extreme fasting behaviors as part of religious practice, some even dying of starvation. St. Catherine of Siena, one famous anorexic figure of the time, refused all food but the Eucharist, cold water, and bitter herbs that she would chew and spit back out ¹. When forced to consume food, she experienced pain and swelling in her stomach.

In a 1373 letter, Catherine attributed her extreme fasting to “God who by a most singular mercy allowed me to correct the vice of gluttony”¹. Although the saint’s symptoms resemble those of modern anorexia nervosa—loss of appetite, inability or unwillingness to eat, and stoppage of menstruation–they were couched in a context of extreme religious practice, alongside self-flagellation, scalding, and sleeping on a thorny bed¹.

The Derbyshire Damsel: From Mystic to Sick

In the 16th century, anorexics went from saintly figures to witches in the public eye, and were often burned at the stake³. Luckily, by the 17th century, perceptions were again shifting. The case of the “Derbyshire Damsel”, a 19 year old girl who ate nothing but stewed prune syrup, roasted raisin juice, water, and sugar, reveals the conflicting views of the time: some proclaimed her a wonder of the world, but a popular riposte by surgeon John Reynolds debunked such supernatural origins, analyzing her case as one of disease.Twenty years later, in 1689, the medicalization of anorexia understandings culminated in physician Richard Morton’s “A Treatise of Consumption”, often taken to be the first medical description of anorexia nervosa⁶.

A notable case of male anorexia from this time is that of Yale professor Timothy Dwight, who nearly died of anorexia in the 1770s. A dedicated worker, Dwight studied 14 hours a day, slept 4 hours a night, and began to get the idea that too much food was dulling his mental acuity. Dwight reduced his food intake to twelve mouthfuls a meal for six months, then cut out meat from his diet, until he weighed only 95 pounds and was taken home by his father. There, a doctor saved his life by prescribing a strict studying ban and a daily bottle of Madeira wine⁵.

19th – 20th century: Psychiatry and Anorexia Nervosa

In 1860, French psychiatrist Louis-Victor Marcé described his patients’ anorexia as psychiatric in origin, treating them with forced feeding, a change of scene, and moral teaching ⁴. Still, anorexia nervosa remained relatively unknown until it came to the attention of Sir William Gull, royal physician to Queen Victoria. It was he who coined the term “anorexia nervosa” in an 1873 paper, grounding eating disorders firmly in the field of psychiatry.

From the 1920s to the 1930s, anorexia nervosa once again dropped out of psychiatric discussion, in part due to the diagnosis of a newly discovered endocrine disease whose symptoms resembled those of anorexia nervosa⁷. Pathologist Morris Simmonds had described a case of cachexia (physical wasting) in 1914 that he attributed to a lesion in the anterior lobe of the pituitary gland. Both cases of anorexia and of the “Simmond’s Disease” it was confused with were given endocrine treatments.

The 1970s marked a sizeable increase in diagnoses of anorexia and bulimia. Hilde Bruch’s influential book Eating Disorders in 1973 observed common emotional pathologies of these diseases– body image delusions, problems sensing nutritional needs, and a pervasive sense of ineffectiveness. In the 80s, counseling and support systems began to appear on college campuses, and the death of anorexic singer Karen Carpenter by cardiac arrest spurred public awareness and sympathy.

From singers to saints, narratives of anorexia surround many important figures throughout history. Although the cultural context conducive to fasting or purging has varied widely, these narratives reveal a common set of symptoms accompanying the deregulation of eating patterns across different eras and continents.

References

(1) Bell, Rudolph M. Holy Anorexia. Chicago: University of Chicago, 1985.

(2) Bruch, Hilde. The Golden Cage: The Enigma of Anorexia Nervosa. Cambridge, MA: Harvard UP, 1978. Print.

(3) Brumberg, Joan Jacobs. 2000. Fasting Girls: The History of Anorexia Nervosa. New York, NY: Vintage Books.

(4) Engel, Bridget, Natalie S. Reiss, and Mark Dombeck. “Eating Disorders: Historical Understandings.” Mental Health, Depression, Anxiety, Wellness, Family & Relationship Issues, Sexual Disorders & ADHD Medications. Mental Help, 2 Feb. 2007. Web. 18 Feb. 2013.

(5) Kendall, Joshua C. The Forgotten Founding Father: Noah Webster’s Obsession and the Creation of an American Culture. New York: G.P. Putnam’s Sons, 2010. Print.

(6) Gordon, Richard A., and Richard A. Gordon. Eating Disorders: Anatomy of a Social Epidemic. Oxford, U.K.: Blackwell, 2000. Print.

(7) Hepworth, Julie. 1999. The Social Construction of Anorexia Nervosa. Thousand Oaks, CA: Sage Publications, Ltd.