Early Eating Disorders… are they actually Anorexia Nervosa?

Rebecca Salter is a senior anthropology major at Grinnell College. In her free time, she enjoys playing Ultimate Frisbee, exploring the outdoors, and playing with her dog, Boo Radley.

The red carpet at the annual Academy Awards shows off the height of fashion among celebrities who are idolized by society. Beyond the glitz and glamour, and the important debate about who was the best-dressed actress, the red carpet highlights a group of actresses who look unnaturally skinny. That’s because many of them are. Eating disorders have garnered significant attention because of their prominence among celebrities. From Sally Field, to Kelly Clarkson, to Katie Couric, to Lady Gaga, many celebrities have publicly shared their struggles with eating disorders. We live in a society where skinny is the desired norm, and eating disorders are an unfortunate, but accepted, reality.

So, when did this become the reality? Was in the 2000s, when the media followed young female celebrities such as Mary-Kate Olson and Amanda Bynes, and their hauntingly slim physiques, as they entered rehab?

Or was it in the 1980s, when anorexia Nervosa was suddenly widespread enough that it appeared all over the news, and many thought that it was a new phenomenon?

Perhaps it was in the 1960s, when Twiggy, with her thin, shapeless physique, was admired and idealized?

What about in the 1920s, when the flapper identity was all the rage, which reinforced the idea that young women should be skinny?

In fact, examples of disordered eating are recorded as far back as the middle ages. Oftentimes, disordered eating was not understood as anorexia nervosa, as it would be today. Instead, each case was understood based on its cultural context. Disordered eating was seen in some instances as miraculous, and in other instances as a symptom of a different disease. Today, many historians are researching these early eating disorders, in search of a link between these cases and the modern diagnosis of anorexia nervosa.

This research is complicated because the way that society understands and approaches eating disorders has changed over time. The anorexia nervosa diagnosis did not exist until 1694, and even so, the diagnosis did not gain any traction until a new paper on the disorder was published in 1873. Even after the diagnosis was more widely accepted among doctors, starting around 1900, many illnesses with symptoms fitting with anorexia were diagnosed as other conditions. Further, it’s difficult to look at anorexia nervosa as a discrete disease. William Gull, the author of the 1694 paper on anorexia, focused on the physical ramifications of the disease. He described the decreased appetite, amenorrhea, and emaciation associated with anorexia. He acknowledged that psychological factors were involved, but did not explore the nature or degree of these factors. Today, the psychological aspect of anorexia nervosa is emphasized. The Mayo Clinic defines the disorder as “an eating disorder characterized by an abnormally low body weight, intense fear of gaining weight and a distorted perception of body weight.” Still, even today, there is no single, widely accepted definition of the illness.

Despite changes in the diagnosis and perceptions of eating disorders, many things have remained constant. The demographics of people who are afflicted have largely stayed the same. Anorexia nervosa disproportionately impacts girls age 12-25 who come from middle or upper class families. Further, while the exact causes of the disorder are unclear, anorexia nervosa is acknowledged both today and throughout history as a disorder with psychological roots. Regardless of the exact definition of the disorder, all definitions agree that anorexia involves decreased body weight, decreased appetite, and a skewed perception of body size. These constants can be used to interpret early examples of eating disorders, and how they fit with the anorexia nervosa diagnosis.

Despite many similarities to anorexia, early examples of disordered eating were understood from a religious perspective. Devout Christians, especially female saints, would fast as a way of demonstrating their piety. Interestingly, the church tended to disapprove of this habit because it worried that the church’s authority might be questioned. Then, there’s the phenomenon of the “miraculous maids” of the mid- to late nineteenth century. These women did not appear to need food, a condition that was also understood in a spiritual context. There were miraculous maids in both America and Europe who gained significant public attention for their conditions.

In Wales, the most famous miraculous maid was a young girl named Sarah Jacob. She was so popular that people came from far away to visit her and bring her gifts. At the same time, people were questioning the legitimacy of her claims. Sarah’s family agreed to put her under observation so that an outside figure could attest to her fasting. At the beginning of this observation, Sarah was strong and healthy. She began to weaken during the observation, and died of starvation ten day later, in December 1869. This debunked the miraculous maids phenomenon for many Europeans.

Americans continued to be transfixed with the concept because their own miraculous maid, Mollie Fancher, was never refuted. She was also never challenged in the way Sarah Jacob was because Americans were well aware of Jacob’s passing and didn’t want Fancher to meet the same fate. All of these instances involved decreased appetite, and all impacted young women who, while their exact socioeconomic status is unclear, were not poor or lower class.

Another illness that presented similarly to anorexia nervosa was chlorosis, known as “the green sickness,” of the 1870s and 1880s. Chlorosis presented itself in middle-class girls, right around when they reached puberty. These girls limited their food intake in order to prevent their bodies from taking on the physical manifestations of womanhood [1]. Nancy Thierot, in her article about this illness, hypothesizes that these girls were trying to distance themselves from their mothers and avoid the womanhood that their mothers represented by taking control of their bodies through self-starvation. However, both the demographics of people affected and the symptoms of chlorosis are often attributed to anorexia.

Meanwhile, the diagnosis of neurasthenia was rampant across America from the 1870s to around 1920. Neurasthenia was a very general diagnosis coming from the concept that people felt dreary and unmotivated because of a lack of nervous energy. Neurasthenia was also a fashionable disease, as the diagnosis indicated that the person lived a stimulating and mentally rigorous life, which led to their condition. Most cases of neurasthenia did not present symptoms associated with eating disorders. However, the definition of neurasthenia is very broad, and people with a wide range of symptoms were diagnosed with the disease. For some, this meant that their eating disorder symptoms were understood at the time as a manifestation of neurasthenia. Further, anorexia had a negative societal connotation because of the psychological aspect of the disease. It made sense, then, for doctors to diagnose their upper class patients with the fashionable neurasthenia over the embarrassing anorexia.

There are likely many more people and societies that, throughout history, have dealt with disordered eating that was not recorded, or not understood as such. But historians continue to grapple with the question of how to define early examples of self-starvation. Were all the illnesses outlined above actually examples of anorexia nervosa, simply before this diagnosis existed? While this question must be examined on a case-by-case basis, many experts reject comparisons between cases of early eating disorders and anorexia because some symptoms do not match up. This is especially true for fasting that occurred in a religious context, as the motivation for this fasting seems altogether different from the ways we understand anorexia today. Still, this religious fasting occurred in a completely different culture with completely different norms from modern America.

Anorexia is a culture-bound disorder. Its causes, though not completely understood, are related to the culture that the patients live in. This ranges from the lack of control that many girls have over their lives to a cultural norm of thinness. As a result, it is difficult to argue about whether certain cases fit under the umbrella of anorexia nervosa, as with different cultures the disorder would likely manifest in unique ways. The records of early self-starvation are documented through the lens of the presumed cause at the time, meaning that cases understood as religious fasting made the women seem miraculous and saintly. Consequently, it is hard to ascertain the psychological state of the patient, a key tenant in the anorexia diagnosis. The changing definition of anorexia over time certainly complicates the matter, because even some early diagnoses of anorexia might not be viewed as such today.

The best way to understand anorexia is to look beyond the binary of what is and what is not anorexia. Helen Malson explains that “the object ‘anorexia nervosa’ did not exist independently of medical discourse, ‘waiting’ to be revealed by scientific progress. Rather, ‘anorexia nervosa’ was constituted through the medical discourses and discursive practices that defined and treated it” [2]. Therefore, looking at cases of disordered eating prior to the anorexia diagnosis, and trying to frame these situations in the lens of anorexia, is impossible. Disordered eating remains a problem in our society, regardless of the labels we put on the condition, past and present. The continuous existence of eating disorders, dating far into history, indicates that more research is required into understanding this phenomenon in order to best help the many people affected with disordered eating.

[1] Theriot, Nancy M. “Psychosomatic Illness in History: the ‘Green Sickness’ among Nineteenth Century Adolescent Girls.” Journal of Psychohistory 15.4 (1988):461-480

[2] Malson, Helen. The Thin Woman: Feminism, Post-Structuralism and the Social Psychology of Anorexia Nervosa. New York: Routledge, 1998. Pp. 49.

For Further Reading:
Bemporad, Jules R. “Self-Starvation through the Ages: Reflection on the Pre-History of Anorexia Nervosa.” The International Journal of Eating Disorders 19, no. 3 (1995): 217-237.
Brumberg, Joan Jacobs. Fasting Girls: The History of Anorexia Nervosa. New York: Vintage, 2000.
Vandereycken, Walter and Ron van Deth. From fasting saints to anorexic girls: The history of self-starvation. New York: New York University Press. 1994.

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