My friend Lizzie, who is a regular commenter here, gave me a copy of Fasting Girls: The History of Anorexia Nervosa by Joan Jacobs Brumberg.
I was skeptical about reading it, only because it’s twenty years old. I figured most of the information would be out of date. That’s because I hadn’t paid real attention to the subtitle. What Brumberg did two decades ago is exhaustively research and examine the (Western) history of women and girls who eat nothing or almost nothing, and follow the different implications of that behavior over several centuries. She takes a complex view of anorexia throughout, trying (and very largely succeeding) to keep a balance of medical, psychological, and cultural factors in mind.
After a brief overview of “contemporary” anorexia nervosa at the time when she was writing, Brumberg starts by discussing a syndrome I was completely unaware of: anorexia mirabilis (“miraculously inspired loss of appetite”), which was at least somewhat common or familiar in medieval times, and was considered to be about sustaining oneself through the life of God and the spirit, rather than through food. While some historians believe that anorexia mirabilis and anorexia nervosa are the same condition, viewed through different lenses, Brumberg (and I) see it differently.
they would have us believe that Karen Carpenter and Catherine of Siena suffered from the same disease. Advocates of this view naively adopt and apply the biomedical and psychological models of anorexia nervosa as if there was absolute certainty about the etiology of the disease and as if there were complete, verifiable case histories available on historic subjects. … It may well be that … particularly after chronic starvation has set in, the medieval ascetic and the modern anorectic have the same biomedical experience–that they are actually unable to eat. But it is abundantly clear that on the issue of recruitment, the routes to anorexia mirabilis and anorexia nervosa are quite different.
After a detailed examination of anorexia mirabilis, Brumberg spends most of the rest of the book tracing the transition from eating as a choice of flesh over spirit to eating in the modern world. To do this, she has to wander down many historical paths, looking at the difference between plentiful and scarce food, the transition from religious to scientific models, the social role of eating in different times and classes (anorexia nervosa is still primarily a syndrome of middle- and upper-class girls and women, though its scope has broadened since Brumberg was writing.
Of particular interest is her discussion of the pressure on mothers to feed their children appropriately, and the way this creates an opportunity for an otherwise powerless adolescent girl to take power by refusing to cooperate.
[In Victorian times], in America, the feeding of middle-class children, from infancy on, was a maternal concern that was considered inappropriate to delegate to wet nurses, domestics, or governesses. … When an adolescent daughter became sullen and chronically refused food at table, the behavior was therefore very threatening and confusing. On the one hand, the girl was perceived as willfully manipulating her appetite as a younger child might do. … As emaciation became visible and the girl looked sick, many [parents] violated the canon of prudent child rearing and put aside their moral objections to pampering the appetite. Eventually they begged their daughter to eat whatever she liked–but eat she must, “as a sovereign proof of affection” for them. From the parents’ perspective, a return to eating was a confirmation of filial love.
She also examines the growth of modern medicine, the role of asylums and asylum heads as opposed to private physicians, changes in views of general mental illness, and much more. In the excellent chapter “The Appetite as Voice,” Brumberg traces in more detail what little first-hand information there is about Victorian anorexia nervosa from the point of view of the patient, and also the wider relationship between women and food in Victorian and Edwardian times.
She returns frequently to the point that all kinds of anorexia (except for those associated with other physical and psychological illnesses) are much more common in girls and women than in men. She concludes that this is evidence that the issues are primarily cultural; I did wish that she had given more thought to the possibility of hormonal influence on this discrepancy, and I’m now very curious about whether the gender-linked pattern is true in non-Western cultures.
Towards the end of the book, she begins to trace the advent of “obesophobia,” and the medicalization of obesity. From 2009, or even from 1979 when I was a young adult, it’s hard to imagine that underweight and thin-ness in children was a highly disturbing disease, and a source of guilt to parents, for at least a century before the question of overweight was ever raised as a child-rearing issue. Because she is interested in the medicalization eating patterns in general, she also discusses how and when obesity became “linked” to various diseases, and the creation of height/weight charts.
Unsurprisingly, as the book gets closer to the time in which Brumberg was writing, it becomes somewhat less interesting to the reader from 2009, except to note how much has not changed in the intervening twenty years. Nonetheless, there’s room for an updated version of this book, covering such topics as the spread of anorexia nervosa to some boys and some girls from different classes, the changing attitudes of the African-American community toward weight, the “pro-ana” websites on which girls reinforce each others’ choice not to eat, and much more.
From a reluctant start, I found myself not only glad I was reading this book but ready to recommend it to anyone interested in the social history of these times, whether or not anorexia is a particular interest.