An old blog post: Historical ideations of starvation and amputation.



The book I read yesterday was Joan Jacobs Brumberg's study of the history of anorexia nervosa, Fasting Girls. In it, she explores the nature of the disease by examining the different ways it has manifested itself through history. Not only is the book itself definitive, interpreting cases in their own contemporary idiom rather than imposing modern explanations, it also sheds light on the general question of why certain mental ill

Ian Hacking uses the term 'semantic contagion' to describe the way in which publicly identifying and describing a condition creates the means by which that condition spreads. He says it is always possible for people to reinterpret their past in light of a new conceptual category. (Emphasis added.)

An old blog post: Historical ideations of starvation and amputation.The book I read yesterday was Joan Jacobs Brumberg's study of the history of anorexia nervosa,. In it, she explores the nature of the disease by examining the different ways it has manifested itself through history. Not only is the book itself definitive, interpreting cases in their own contemporary idiom rather than imposing modern explanations, it also sheds light on the general question of why certain mental illnesses appear more frequently in specific times and places.Brumberg begins her discussion with holy women and saints of the late middle ages, many of whom fasted and experienced ecstatic visions. Catherine of Siena, for example, stopped eating except for taking the Eucharist (and by the theory of transubstantiation, I don't suppose this would count as eating at all). Another saint, Columba of Rieti, actually died of starvation. Their condition was referred to as "anorexia mirabilis" by their contemporaries; their decision not to eat was seen as holy rather than pathological and thus no attempt was made to 'treat' them.That attitude carried over into the 19th century, the next period that saw many cases. These sufferers were called "fasting girls," because, then as now, nearly all were adolescent girls. The fasting girls claimed to takesustenance at all or to subsist on flower petals or tea. They attracted a great deal of attention (the New York Times covered one case extensively), and the public wanted verification that they truly did not eat. Thus doctors would watch over the girls to substantiate that they ate nothing--effectively supervising the deaths of anorectics who had been sneaking tiny morsels of food all along.Only in the late Victorian period did doctors make the breakthrough of seeing through patients' misleading descriptions of their symptoms: they realized that the anorectics were in fact hungry, after all. Theydoctors that they weren't hungry, but it was fruitless to pursue the matter as a digestive complaint because the primary cause was psychological. This opened the field to the Freudians (who had some interesting theories about the rejection of the father's phallus). More plausible investigations centered on family dynamics, and how adolescent girls could disrupt their bourgeois families' domestic routines with their refusal to eat.Brumberg's analysis of how the perception of anorexia nervosa changed from a voluntary expression of holiness to a dangerous pathology, led me to re-examine an article, " A New Way to be Mad ," that has long haunted me. A discussion of people who voluntarily amputate their limbs, it also broaches the question of why certain psychiatric disorders become prevalent in certain societies, though it frustratingly fails to reach a firm conclusion.The author of the article, Carl Elliott, posits that the availability of a diagnosis either (a) causes people to interpret their pre-existing feelings accordingly or (b) actually spawns new incidences of the disorder. His example is the disorder called apotemnophilia, whose sufferers are so obsessed with the belief that one or more parts of their body arethat many eventually attempt to amputate the offending parts. The condition was not named until 1977, but now newsgroups and websites flourish, offering sufferers support and advice on how to effect the amputations. He compares the phenomenon to the late 19th century mini-epidemic of amnesia, or the more recent wave of multiple-personality disorder cases.Elliott writes:This is where the article begins to worry me, since the idea of language creating concepts is dangerous territory. The strong version of the Sapir-Whorf hypothesis would suggest that people whose languages have different words for light and dark blue should be more able to tell the difference than we, who call them both 'blue,' but of course that's not the case. So it seems that Elliott is saying something a little different and more believable: that the description and official sanction of apotemnophilia by doctors, not the mere concept of self-amputation, is what leads people to consider it.Brumberg's explanation of why anorexia nervosa is prevalent in our society may help with this. She identifies two stages of the disease: the first, when the sufferer experiments with the restriction of her diet, and the second, where she becomes addicted to starvation as changes in her body actually lessen the hunger pangs she initially experienced. Once a "fasting girl" has reached the second stage, it is difficult to reverse the condition's pernicious effects on the body and mind. Brumberg shows that post-war American society became preoccupied with weight as an expression of health. Millions of Americans diet--more young women dieting means many more young women who are susceptible to sliding into the second phase of anorexia. Furthermore, America's interest in aerobic exercise masks one of the disease's other primary symptoms, hyperactivity. Sufferers have progressed farther into the disease when they are identified; those who are admitted to the hospital weigh ever less at the time of admission. Our society does notyoung women to refuse food, but it makes the disorder more dangerous.Does all this mean that young Americans are expressing what might otherwise be a more generalized sort of depression or neurasthenia through anorexia nervosa? Brumberg's book led me to re-examine Elliott's article in a slightly different and more careful way: both appear to take the position that historical factors can create populations susceptible to interpreting their problems a particular way. The difference is in the disorder: Brumberg says that anorectics use the condition as a tool to make a point about their place in family and society; whereas Elliott suggests that the apotemnophiles turn within and use the diagnosis as a way to express their dissatisfaction with their bodies.Elliott has written a book about how disorders becoming treatable makes them more prevalent, which I will now have to read. Obviously I am still trying to wrap my mind around this one; but in any caseuses its historical basis to present a particularly lucid description of anorexia nervosa and is well worth reading.