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(7) Anorexia

What is the history of anorexia nervosa?

The Encyclopedia of Obesity and Eating Disorders” records that Simone Porta of Genoa, Italy, wrote the first medical account of anorexia in 1500.

However, several hundred years would pass before the literature would offer detailed descriptions of the illness. Sir Richard Morton, a British physician, is credited with the first English-language description of anorexia in 1689. He reported of two adolescent cases, one female and one male, which he described as occurrences of “nervous consumption,” a wasting away due to emotional turmoil.

In 1874, anorexia nervosa was introduced as a clinical diagnosis by two different physicians, Sir William Gull, of England, and Charles Lasègue, of France. Each emphasized varying aspects of the condition in their clinical reports, yet they both described anorexia as a “nervous” disease characterized by self-starvation. They were the first to recognize the illness as a distinct clinical diagnosis. When Gull reported about his work to the Clinical Society of London, he used the term anorexia nervosa, which literally means “nervous loss of appetite,” to describe the condition. He was the first to do so.

Gull’s reports were published by the Society the following year, and the term later gained broad acceptance. Several prominent physicians of the nineteenth century described anorexia as a psychological condition, typically considered a form of hysteria or mental depression. However, it was not until the 1930s that physicians began to emphasize, for the first time, the value of psychotherapy in treating anorexia.

It is not as though extreme measures of weight control are new to the last few centuries of history. Accounts of self-starvation have been described at various points in the historical record. According to “The Encyclopedia of Obesity and Eating Disorders,” the ancient Greeks and Romans of the Classical period frowned upon obesity. Women of the upper social classes fasted in order to appear slim. Young people in ancient Sparta were said to have been examined in the nude monthly, and those who had gained weight were forced to exercise.

According to Joan Jacobs Brumberg, author of “Fasting Girls: The History of Anorexia Nervosa”, in medieval Europe it was considered a miracle for a woman to engage in prolonged fasting. Religious literature of this era contains the accounts of many saints, mostly women, who restricted their eating out of spiritual concern. Fasting was considered a godly pursuit, while being overweight was often considered sinful and equated with gluttony. Today, according to Brumberg, the modern person with anorexia strives for aesthetic perfection to achieve a physical ideal, rather than a spiritual beauty.

According to Richard A. Gordon, author of “Eating Disorders: Anatomy of a Social Epidemic”, a watershed period of understanding the illness came with the modern 1970s work of noted eating disorders specialist, Hilde Bruch. Bruch argued that anorexia centered on issues of body image as well as disturbances in psychological development. She also proposed a third influence: a deficient “sense of self,” which she characterized as a personal “ineffectiveness” that contributes to a struggle for personal autonomy, competence, and control.

Bruch went on to comment on the process of therapy, which she perceived as helping a patient discover a “genuine self.” In later works, she emphasized the importance of recognizing, defining, and challenging “erroneous assumptions and attitudes” and correcting errors in thinking that contribute to the onset and maintenance of the illness. In this way, shecontributed immensely to modern approaches of psychotherapy and treatment for anorexia.

Additional modern influences in the understanding of anorexia nervosa are Arthur Crisp, who describes anorexia as an attempt to control fears associated with maturity into adulthood, and Gerald Russell, who emphasizes the fear of fatness as a central component to the condition (Silverman 1997; Vandereycken and van Deth 2001).

Anorexia has only been a household word for a few decades

 In 1983, the news of Karen Carpenter’s death by heart failure resulting from anorexia fueled national attention. Television dramas, such as “Fame”, and made-for-TV movies, such as “The Best Little Girl in the World”, gave viewers the chance to learn about the impact of the disease. It was around this time that the doors opened at the Renfrew Center, the nation’s first residential treatment facility devoted exclusively to eating disorders.

Since that time, numerous recognizable names have been associated with anorexia. In the past few decades, research has dramatically increased our knowledge of the physical effects of starvation as well as the psychological and social components of anorexia. Precise, effective treatments have emerged, although there is much more work yet to do.

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