Anorexia nervosa historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Historical Perspective

Terminology

The term anorexia is of Greek origin: an (privation or lack of) and orexis (appetite) thus meaning a lack of desire to eat. A person who is diagnosed with anorexia nervosa is most commonly referred to with the adjectival form anorexic. The noun form, as in 'he is an anorectic', is used less commonly. The term "anorectic" can also refer to any drug that suppresses appetite.

"Anorexia nervosa" is frequently shortened to "anorexia" in both the popular media and scientific literature. This is technically incorrect, as strictly speaking "anorexia" refers to the medical symptom of reduced appetite.

In popular culture, and especially with anorectics themselves, the term is often shortened to "ana" to avoid sounding clinical and impersonal. "Pro-ana" groups often use the terms "ana" and "mia" (referring to bulimia nervosa) to describe their conditions, as it has less negative connotations than the full medical term. Some pro-ana groups discourage or deride the use of colloquial abbreviations.

Background

The history of anorexia nervosa begins with the first recognition and description of anorexia as a disease in the late 19th century. It became widely known, particularly in the United States, in the 1980s.

In the late 19th century, the public attention drawn to "fasting girls" provoked conflict between religion and science. Such cases as Sarah Jacob (the "Welsh Fasting Girl") and Mollie Fancher (the "Brooklyn Enigma") stimulated controversy as experts weighed the claims of complete abstinence from food. Believers referenced the duality of mind and body, while skeptics insisted on the laws of science and material facts of life. Critics accused the fasting girls of hysteria, superstition, and deceit. The progress of secularization and medicalization passed cultural authority from clergy to physicians, transforming anorexia nervosa from revered to repulsed.

Early Diagnosis and Treatment of Anorexia Nervosa

During the period when this disease was first named "anorexia nervosa", in the early to mid 19th century, as opposed to its original title that assumed it was a type of hysteria, doctors began to emphasize and isolate what procedures and techniques contributed to the most successful recoveries in the young women afflicted. One of the most commonly shared opinions in treatment was the isolation of the patient from family, friends, loved ones, and any social connections which in technical terms is termed as a parentectomy. Theories of the reasons for the development and spread of the disease in Victorian society is rooted in the idea of a close-knit and involved family, and especially mothers in their young privileged daughter's life. Women were expected to behave eloquently and were controlled and under constant supervision. It is hypothesized that this was a daughter's way of controlling her life and of trying to look better in society; having control of what was going into her body was the one aspect in her life she fully dominated. It was documented by many physicians that most often as soon as girls were isolated from their social pressures they made quick and successful recoveries from the diseases. Also it was stated that it was the professional and moral authority of doctors and nurses that forced anoretics to begin eating again, and that they did so out of fear of the doctors.

Early treatment of anorexia nervosa is illustrated in the novel Second Star to the Right by Deborah Hautzig. In the story, an anorexic girl named Leslie is placed in the behavior-modification ward in a hospital. She is required to drink at least of liquid food per day, or else she is involuntarily force fed by hospital wardens. While the story does fall short in depicting the harsh reality of hospitalized anorexic, it does provide an accurate description of one of the first medical procedures against anorexia nervosa - Force feeding. Other forms of early treatment included "drug therapy, psychoanalysis, dynamic psychotherapy, family therapy, behavior modification, peer counseling and support groups social skills training, assertiveness training, projective art therapy, hypnosis, relaxation techniques, movement therapy,nutritional education, and even sex education." Early treatment was usually a combination of a monitored eating program and psychological instruction which aimed to raise the patients awareness of the disorder and also to promote psychological growth. However, treatments varied on the amount of emphasis placed on the eating program or the psychological instruction. Some programs regarded immediate weight gain as the first step in recovery and psychological growth second, while others emphasized the psychological treatment of the patient over the weight gaining program. Forced feeding was reserved for the most dangerous cases of anorexia nervosa, where a patient becomes so emaciated that his/her life may be in jeopardy. A patient undergoing forced feeding would have invasive tubes placed in his/her nose where food would pass into the body, or could undergo a relatively new process called total parenteral nutrition (TNP). TNP is best described as the process where "an intravenous catheter is inserted so that the tip lies in a large vein near the heart, where blood flow is relatively rapid. Then a concentrated fluid containing a balance of nutrition is infused at a steady rate." The cost of these medical procedures is very high, their success or effectiveness is not guaranteed, and the procedures can vary greatly from doctor to doctor, making anorexia nervosa one of the more difficult disorders to treat.

Changing Attitudes about Body and Diet

Anorexia nervosa is thought to be a new disease by most people of today’s society. This disease, however, is known to have existed since the late 19th century. Today anorexia nervosa is classified as a disease. During the Victorian Era, the disorder was thought to be a form of hysteria that affected mainly women of the middle and upper classes. Obesity during this era was thought to be a characteristic of poverty. In general however, the ideal woman’s body type during the Victorian era was one that was curvy and full- figured. Many women attempted to achieve this body type through the use of corsets. The role of restrictive corsets during the Victorian era shows the early focus on body type and exemplifies how women, as early as the late 18th century, have been taking extreme measures to achieve the believed ideal body type. (Brumberg, "Fasting Girls"), (Carol Lawson, "Anorexia: It's Not a New Disease")

Anorexia Nervosa in Contemporary Culture

Although the medical facts of anorexia nervosa have been documented since the 1870s, personal details of anorexics' lives are more publicized today than ever before. Since Karen Carpenter's death in 1983, which resulted from complications of the disorder, people recognize and casually label overly thin women as anorexics. Since the late 1980s, many special eating disorder clinics have opened, but it may be difficult to change the eating behavior and mindset of an anorexia victim, especially when they are surrounded by numerous other thin women who have similar eating behaviors. Today, many young women are obsessed with dieting as a form of cultural expression and a way to look as thin as models and celebrities. Anorexia nervosa seems to be more prevalent as the ideal female body image becomes thinner; however, the disorder may have always been this widespread but just less publicized.

In the 1980s, slimness embodied the ideal of feminine beauty. It is this that caused many women to incessantly diet in order to keep up with the demands of modern fashion. In a 1984 survey carried out by Glamor magazine of thirty-three thousand women between the ages of eighteen and thirty-five, 75 percent believed they were fat, although only 25 percent were actually overweight (Palm Beach Post, December 26, 1985). Indications of being thin was important to women of the upper class, and this class specific cultural model was pervasive throughout the media including television, film, magazines, and advertising After Growing Pains actress Tracey Gold nearly died from severe complications caused by self-starvation, anorexia in children and adolescents became a more serious issue than in adults. Various pediatric organizations now focus on this issue with methods of counseling designed for the under-18 age groups.

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