Problematic food concerns are far from a modern phenomenon

Saint Catherine of Siena may have been the world’s first documented case of anorexia. Catherine was a fourteenth century nun from Tuscany, who wrote extensively about her own experiences with fasting, starting from when she was a child. She eventually died, aged 33, of starvation after long periods of eating very little bar herbs and communion wafers. Elizabeth Barrett Browning (1806-61)

Catherine’s writings reveal she regarded her eating problems half as a testament of her self-denial, and half as an illness over which she had little control – just as today’s insights into eating disorders recognise that the compulsion to avoid eating, or to binge eat with or without later vomiting (bulimia), can be overwhelmingly powerful and long-lasting.

Later religious writings document cases of extreme fasting in a number of religious and cultural traditions, sometimes justified as a means of battling worldly desires in order to achieve spiritual enlightenment. Later, ‘wasting disease’ was documented in medical texts from the middle ages up to Victorian times and beyond, predominantly affecting women. It is likely that some of these cases were what we would now call anorexia.

In fact, a number of commentators have ‘diagnosed’ anorexia retrospectively in many prominent women, especially writers and poets – notably Elizabeth Barrett Browning, who ‘stubbornly’ ate toast and not much else and weighed just six stone at the time of her marriage, and Emily Bronte, whose journals and work have been analysed from this perspective, and whose death was caused by consumption probably aggravated by anorexia.

For the past 100 years or so, eating disorders have become accepted as resulting from emotional, psychological, cultural and social factors. More recent dimensions have been added to the discussion from gender studies in particular: while men do acquire food issues, of all types, their numbers are much smaller. It is estimated that 90% of all people with eating disorders of all types are female.

The rise in eating disorders since the 1970s and 1980s may be linked with greater recognition and diagnosis, but this isn’t going to be the whole story. There’s ample evidence that the fashionable ideal of slimness, even thinness, is part of the cultural context for eating disorders, and the way the ideal has spread around the world along with a rise in incidence is a big clue to this. But there are other personal factors, too, in individual situations.

Food issues can be long-lasting – and very painful to endure – but they can be resolved successfully with the right kind of therapy. Research suggests that Cognitive Behavioural Therapy (CBT) and interpersonal psychotherapy (IPT) are effective at reducing symptoms of anorexia and bulimia. Antidepressant medications are also useful, but are less likely to result in long-term remission of symptoms than CBT.

Acceptance-based therapies for food issues are receiving increased attention, and several interventions that incorporate mindfulness based training and acceptance-based procedures are becoming more and more popular. For example, Acceptance and Commitment Therapy (ACT) is based on an experiential avoidance model, which suggests that many forms of our behaviour (which can often give rise to distress manifested as anxiety, depression or food issues) are related to attempts to avoid or escape aversive internal experiences. ACT emphases non-judgemental acceptance of these thoughts and feelings, while working to change our behaviours towards valued goals and life directions.

Roman myth

There’s a well-known idea that the ancient Roman word ‘vomitorium’ is the part of a public building intended for purging after over-eating, in order to make room in the stomach for more feasting – as if the Romans suffered from some sort of culturally-approved bulimia.

This is a persistent myth. The vomitorium is well-documented as no more than the exit passage for audiences to use as a means of leaving the theatre – nothing to do with eating or vomiting at all. At other times and in other cultures, deliberate vomiting has been thought to bring health benefits and to ward off disease, but this is not bulimia or an eating disorder in the way we understand it today.

The House Partnership, 4th May 2011

Image credits   Brooklyn Museum