Fasting girls: the emergence of anorexia nervosa as a modern disease

JOAN JACOBS BRUMBERG, Fasting girls: the emergence of anorexia nervosa as a modern disease, Cambridge, Mass. and London, Harvard University Press, 1988, 8vo, pp. 366, illus., £19.95, $25.00. Anorexia nervosa has attracted enormous attention over the past 20 years-a level of attention that is arguably out of all proportion to its importance, at least in quantitative terms. It is still a relatively uncommon condition, though its consequences can be very severe (one authoritative source puts the mortality rate at 15 to 21 per cent of cases). The interest in anorexia nervosa is undoubtedly linked to its class, age and above all its gender specificity-for although male cases are identified, the ratio of female to male patients is said to be in the order of 20 to one. The fact that anorexic patients are typically, though not exclusively, young, middleor upper-class, intelligent women constitutes an ideal combination for ensuring clinical and academic attention. Parental anxiety and demand for action and the professional interest of clinicians coincide with the fascination of feminist writers, who see the condition almost as a barometer of women's position in present-day society. Yet, for all the numerous studies of anorexia nervosa that have been published over recent years, there has been relatively little historical study of the condition. Most book-length studies make some reference to Sir William Gull's introduction of the term "anorexia nervosa" in a paper published in 1873 and to Charles Lasegue's contemporaneous discussion of the illness, but, apart from some reference to Freudian claims that the disease is motivated by a denial of sexuality, there is little interest in ideas and practice prior to the 1970s. Joan Jacobs Brumberg's history of the disease is, therefore, welcome. Significantly, however, this is a history constructed even more strongly than usual with the present in mind, whose stated objective is to account for the current prominence of the disease. One consequence is that, after a brief introduction, the book begins, a little surprisingly, with a detailed discussion of anorexia nervosa in the 1980s. However, this lengthy chapter clearly sets out the author's understanding of the condition, which she see as a product of biological, psychological, and cultural factors, with culture determining the mode of expression of the individual's psychological problems. Her own concern, because of the historical nature of her study, is with matters of culture, not biology or psychology, a bias that reflects and is informed by much recent feminist writing on anorexia. Once she turns to her historical task, Brumberg is faced with the problem of determining how far and in what directions the history of anorexia nervosa should be traced, given the relatively late introduction of the concept and her definite, and surely correct, view that earlier cases of fasting cannot properly be identified as cases of anorexia nervosa. There is no simple equivalence between earlier fasting behaviours, which had very different significances, and anorexia nervosa, as some have assumed. Brumberg nonetheless sets the boundaries of her study quite broadly, drawing links between earlier fasting behaviours and anorexia nervosa and portraying it as a history "of those who have used control of appetite, food and the body as a focus of symbolic language" (p. 2). A key word here is control and, following present-day understandings, Brumberg's terrain is not loss of appetite, the literal meaning of the term anorexia, but motivated control of eating. Brumberg argues that, historically, fasting has been a largely female activity and she begins her history with medieval anorexia mirabilis, the miraculously-inspired fasting in women and girls, such as Catherine of Siena (1347-80) in the medieval period, seeing this fasting as part of female religious asceticism and not as any sign of pathology. This tradition of religious fasting did not entirely disappear in the next two or three centuries, and Brumberg describes a number of cases of prolonged abstinence in the seventeenth century-"miraculous maids", who tended to be young and of humble origin. In the eighteenth and nineteenth century these miraculous maids were replaced by the "fasting girls" that give the book their title-a term used "to describe cases of prolonged abstinence, where there was uncertainty and ambiguity about the etiology of the fast and ambiguity about the intention of the faster" (p. 61). The next five chapters, which concentrate on the final three decades of the nineteenth century, constitute the core of Brumberg's study. The first examines the debate about fasting girls during these decades, describing the conflict between religious and medical interpretations