In several ways, modern-day eating disorder behaviors are
manifestations of a quest for quasi-spiritual purity and transcendence. Like some
religious ascetics and saints attempting to attain spiritual elevation, anorectics
and bulimics inflict physical discomfort upon themselves to reach an ideal state
of being that is obtained through the body, but has as its goal a state beyond
material existence. Not only do they restrict their appetites and practice purging,
they often mutilate their flesh.' Although sociocultural analysis is vital to
understanding the near-epidemic appearance of eating disorders within the past
three decades, the characterization of these disorders as self-infliction of pain
has yet to be discussed. Starving oneself hurts. Consuming 15,000 calories in
one sitting and then vomiting for an hour to purge oneself hurts. What does it
mean when a human inflicts this kind of pain and discomfort upon herself? To answer
this question I will discuss anorexia as both an attempt to transcend the self
by becoming pure and self-controlled and a simultaneous attempt to create an autonomous
self. The implications of the relatively recent correlation of self-mutilation
with eating disorders is important to the analysis of eating disorders as attempts
to transform and initiate oneself into a new state.
As
one of humanity's most common daily acts, eating provides sustenance,
pleasure, social ritual, and social bonding. Eating is one of the most potent
ways individuals interact with the environment as they incorporate physical elements
outside themselves physically into themselves. Eating is one of our most basic
and primal ways to manipulate the world around us in order to survive. We are
fascinated with eating disorders because they refuse the exigency of nutrition
and underscore the power of eating as a real and symbolic crossing of body boundaries.
A search for literature on eating disorders results in hundreds of references.
Researchers have studied correlations between eating disorders and body image
distortion, family conflicts, adolescent separation anxiety, conflicted sexual
development, homosexuality, cultural pressure, obsessive-compulsive disorders,
and plasma beta-endorphin levels, to name only a handful. Anorexia and bulimia
are the two most commonly known eating disorders and have been labeled "modern
diseases" due to the dramatic increase in their diagnoses in the past three
decades.
Anorexia is also modern by virtue of its exclusivity to countries that are industrialized and have fairly affluent standards of living.
It was first diagnosed as a disease in the 1870s, a time of increasing industrialization,
urbanization, and concern of the developing American middle class for maintaining
civilized values against an onslaught of immigrants. In America, the association
of food with spirituality, morality, and sexual identity dates back to Sylvester
Graham's diatribes in the early 1800s against eating meat. Graham also preached
against the vice of masturbation and claimed that eating meat increased carnal
desire. Another early American health food missionary was John Kellogg, who in
Victorian times presaged the current health food trend with his invention of granola.
Middle-class and affluent Victorians considered appetite a sign of sexuality and
lack of self-restraint. Middle-class Victorian women felt pressured to uphold
an idealized image of women as frail, morally and spiritually superior beings
whose weak appetite and disdain for meat demonstrated purity and daintiness.
Opposing
the image of the ideal woman as one who languished in need of bedrest and water-cures,
and epitomized temperance and bodiless spirituality were women like Abba Woolson
in the "woman movement." In 1873, the same year that the starving disease
was labeled "anorexia nervosa," Woolson argued that women should develop
their physical stamina to aid in their moral and intellectual development. Perhaps
the women who starved themselves were perversely exercising their physical stamina
of self-denial. Or perhaps, caught in a cultural mélange of contradictory
options and messages, these women sought to create a well-defined identity for
themselves. Cultural historian T.J. Jackson Lears characterizes the late nineteenth
century as a time when "individual identities began to seem fragmented, diffuse,
perhaps even unreal. A weightless culture of material comfort and spiritual blandness
was breeding weightless persons who longed for intense experience to give some
definition, some distinct outline and substance to their vaporous lives."
Several
"fasting girls" did experience what was probably the most noteworthy
and attention-garnering experience of their lives by becoming weightless caricatures
of the Victorian ideal of womanhood. "Fasting girls" not only captured
the attention of their families but fascinated the public, and as late as 1910,
the popular American press continued to report their cases. The public read about
Sarah Jacobs, a Welsh girl known throughout Britain and the United States, who
reportedly began to fast in 1867 and finally died of starvation in 1869. While
many people, including Sarah Jacob's family, configured the emaciated girl as
evidence of a miracle, doctors were skeptical. The rising prominence of medical
authority and medicalization of the body that accompanied the Victorian hesitation
between science and religion permitted the medical community to pathologize the
anorectic body. Citing medical standards of expected bodily response to lack of
food, doctors decried fasting girls as pathologically aberrant, or considered
their prolonged fasting as fraud. The medical community considered Molly Fancher,
a mystic and clairvoyant who was well known in the 1870s and 1880s and allegedly
abstained from all but minute bits of food for fourteen years, hysterical, while
Spiritualists believed she exemplified the existence of supernatural realms. British
physician Sir William Gull preferred to discard the imprecise diagnosis of hysteria
and in 1873 described "anorexia nervosa" as a disorder of the central
nervous system. Concurrently, French physician Charles Lasegue described anorexia
hysterique as intimately connected to the dynamics and conflicts in the anorectic's
family.
Although she differentiates medieval fasting
practices from modern eating disorders, Joan Jacobs Brumberg traces the
history of anorexia and details the evolution of medical and psychiatric thought
about anorexia in Fasting Girls: The Emergence of Anorexia as a Modern Disease.
As a cultural history of anorexia, Brumberg's book is invaluable in understanding
the contributions of Victorian norms and the ideas of Gull, Lasegue, Freud, and
Pierre Janet to the modern perception of eating disorders. In the first half of
the twentieth-century doctors continued to describe anorexia as a biological and
psychological disturbance, to be treated with change of environment, forced feeding,
and psychoanalysis. After World War II psychiatrists began to conceive of anorexia
as a developmental issue, and theorists in later decades began to analyze anorexia
as a reaction to cultural messages about the female body and gender roles. By
1988 the incidence of the diagnosis "anorexia" had increased to astounding
proportions. Although within the general population eating disorders are relatively
infrequent, and occur extremely rarely among African Americans, Chicanos, or many
first or second generation ethnic groups, the group at-risk for eating disorders
shows a high incidence. In the at-risk population of white, educated, middle-
or upper-class, adolescent girls, eating disorders may afflict from 5 to 20 percent
of individuals. There has been a gross increase in the number of cases diagnosed
since 1970.
Eating disorders have recently been seen
as a "me too" behavior, and a "group reaction,"2
which exemplifies the poignancy of these disorders as a search for social identity
Individuals do not seek an isolated identity but seek to establish themselves
in relation to their culture. Recognizing eating disorders as social behaviors
forces confrontation of questions central to this book. If enough people indulge
in a behavior, is it no longer deviant? If an action is greeted by a small accepting
community is it mainstream or subcultural? What does the epidemic of eating disorders
communicate about the culture in which it occurs?
Many works
have been published in the past twenty years interpreting anorexia and bulimia
as responses to cultural pressures on women. Factors that must be analyzed to
understand eating disorders include historical and cultural attitudes toward the
body, toward women, toward autonomy and the self, toward sexuality, and toward
food. These approaches have been amply discussed elsewhere, and I will instead
touch upon other, less acknowledged ideas, including a brief historical overview
of attitudes about eating, eating disorders as masochistic behavior, and eating
disorders as attempted self-transformation. An analysis of eating disorders will
ultimately provide an avenue to explore the significance of other forms of self-mutilation.
-
Hewitt, Kim, Mutilating the Body: Identity in Blood and Ink, Bowling Green State
University Popular Press: Bowling Green, 1997.
================================= Personal
Reflection Exercise #3
The preceding section contained information
about anorexia and self mutilation diagnosed as pathological. Write three case
study examples regarding how you might use the content of this section in your
practice.
Update Self-Harm in Eating Disorders (SHINE):
a mixed-methods exploratory study
- Lavis, A., McNeil, S., Bould, H., Winston, A., Reid, K., Easter, C. L., Pendrous, R., & Michail, M. (2022). Self-Harm in Eating Disorders (SHINE): a mixed-methods exploratory study. BMJ open, 12(7), e065065. https://doi.org/10.1136/bmjopen-2022-065065
Peer-Reviewed Journal Article References:
Garke, M., Sörman, K., Jayaram-Lindström, N., Hellner, C., & Birgegård, A. (2019). Symptom shifting and associations with mental illness: A transdiagnostic approach applied to eating disorders. Journal of Abnormal Psychology, 128(6), 585–595.
Smith, D. M., Wang, S. B., Carter, M. L., Fox, K. R., & Hooley, J. M. (2020). Longitudinal predictors of self-injurious thoughts and behaviors in sexual and gender minority adolescents.Journal of Abnormal Psychology, 129(1), 114–121.
Snir, A., Apter, A., Barzilay, S., Feldman, D., Rafaeli, E., Carli, V., Wasserman, C., Hadlaczky, G., Hoven, C. W., Sarchiapone, M., & Wasserman, D. (2018). Explicit motives, antecedents, and consequences of direct self-injurious behaviors: A longitudinal study in a community sample of adolescents.Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(4), 255–266.
Stice, E., Desjardins, C. D., Rohde, P., & Shaw, H. (2021). Sequencing of symptom emergence in anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder and relations of prodromal symptoms to future onset of these disorders. Journal of Abnormal Psychology, 130(4), 377–387.
QUESTION
17 In the first half of the twentieth-century doctors continued to describe
anorexia as a biological and psychological disturbance, to be treated with change
of what? Record the letter of the correct answer the Test.
