Formal Book Review Submitted for FN 611: Lifecycle Nutrition, Meredith College
Brumberg, J.J. Fasting Girls: The History of Anorexia Nervosa. New York, Vintage Books; 2000. Vintage Edition, 374 pages. Price: $15.95. ISBN: 978-0-375-72448-0
Ever present and dynamic are societal ideals of beauty. As a reflection of this, eating disorders continue to grasp our society while more recently they have become characteristic of young females all over the world. Fasting Girls: The History of Anorexia Nervosa details multiple case studies of young women, their varying motivations and consequences of purposeful starvation throughout history, and reveals cultural and biological evidence towards the identification of what is currently referred to as the modern disease of Anorexia Nervosa. For those that believe eating disorders are more a recent “fad” or “trend”, Brumberg’s writing is a stimulus for a broad discussion about why rather than the prevalence of self-deprivation. This text is focused on the social and historical evidence that accounts for the flourishing rates of eating disorders today. Brumberg achieves her thesis quite thoroughly by giving readers the multi-faceted historical evidence that has been built into a multi-faceted modern disorder.
Let me assure you that societal ideals of skinny models are not the sole creator of this illness suffered by many young females today but have played their part as you will find in Fasting Girls. The culture of American society, nevertheless, favors slim as a “good thing” for a female to be (p.17) in the 21st century as such in 1920 or more so a “miraculous” thing in the 19th century as Brumberg narrates. I agree, with Brumberg’s introduction, that there is little possibility and ample room for argument against a single causation of Anorexia Nervosa as it is a complicated disorder with biological, psychological, and cultural models.
Seemingly an epidemic, the general public’s familiarity of eating disorders rose greatly in the 1980’s described in the first chapter of Fasting Girls. Despite the recent awareness, the official number of cases remains low due to the nature of the disorder. The secretive processes of hiding food, deceptive behavior and emotional turmoil for the family keeps this number of official cases low. While official reports may stay low, the susceptibility of young adult and adolescent females to this disorder can be observed through the increase in statistical reporting as Brumberg states is due to the amount of mass media attention to the disorder (p.17). The vulnerability to eating disorders thus positively correlates with increasing social class, as classic anorectics appear to have always been young, female, white and from middle to upper-class families (p.15).
From Sainthood to Patienthood
In the second chapter, “From Sainthood to Patienthood”, Brumberg reveals that the fasting and restrictive behaviors characteristic of medieval spirituality did not engage males to the same degree or manner as females, making the female fasting a “miracle” (p. 43). My belief is that this female miracle gave birth to what ultimately has become the modern disease. Even though it is much more complex today, the disease remains a female experience in majority.
Brumberg discusses medievalist Rudolph Bell describing anorexia mirabilis of holy women such as Catherine of Siena as analogous to modern women with Anorexia Nervosa (p. 45). In both cases, appetite is not merely “lost” as claimed rather it is noted as under extreme control for whatever motivations are present in these women. Both women today and women of medieval times used food restriction as a means of control, whether it was to reach closer to God or further from their family.
The modern anorectic “is one of a long line of women and girls who have used food and the body as a focus of their symbolic language.” (Brumberg, p. 48). While I agree that anorexia mirabilis and nervosa could not possibly be the exact same, they originate in route from that symbolism and control. This symbolism and control is evident in the interesting case of Ann Moore, who gained “transatlantic fame” (p.57) after the publicity of her “anorexy” in the early 1800’s. Ann’s life is revealed as she married, separated, birthed out of wed-lock and became impoverished but also the way society reflected on her condition is importantly discussed.
The emaciated Ann Moore was claimed to be subsiding on air, having ingested only a few currants in over 4 years, which caused uproar by scientists, chemists, and clergy. Ultimately Moore was indeed secretly obtaining bites of food from her daughter, becoming a symbol of female deceit, “drawing substantial material gain from the earnest gifts of the pious.” (p.61). Brumberg details that society of that time was obsessed with the deception and few were interested in how Moore controlled her intake of such little food and lived. This fits with the obsession of society today, which contains a lack of regard for the how and why, instead focusing on quick fixes for maintaining a slender figure.
The Debate over Fasting Girls
Whether its emotions you are controlling to obtain a slender figure or spirituality you desire to express, the question of why any young females would fast or starve themselves seemed unanswered to those during Ann Moore’s chronicles. Brumberg really morphs into an architect in her third chapter, by adding control and family complexity with the cases of Sarah Jacob and Mollie Fancher to the foundation of medieval fasting and symbolism of Ann Moore.
The case study of Sarah Jacob, a fasting girl affected by “hysteria” chronicles the repercussions of actions before her (the deceit of Ann Moore) and controlling food intake as a means of gaining attention. The case of the “Welsh Fasting Girl” set the template for challenging the interpretation of Sarah’s behavior as opposed to just being fascinated with the wonderful girl who lived without eating. Food is required to live, although that is and was scientific knowledge, it is interestingly communicated in Brumberg’s description of the fate of Sarah Jacob.
Author and now architect, Brumberg, built an additional component to the map of Anorexia Nervosa: a family that was such a powerful influence in their daughter’s illness that it prevented her treatment and contributed to her fate, as a ”pattern of parental coaxing and indulgence that reinforced her behavior” (p.72). In the additional cases described such as Fancher’s, family complexity lies in the premature death of her mother and social status of her father. Family issues are clearly established as having a role in eating disorders in this chapter and further examined in following chapters.
Modern Dieting
In the late 19th century, Anglo-American medical advice encouraged parental supervision of diet, clothing, exercise…and moral training of female adolescents (p.71). Unfortunately, the final chapter of Fasting Girls reveals that female adolescent weight control is still being promoted fifty years later in the 1920’s (p.248). The slender figure became a sign of heterosexual interest in the 1920’s because it was fitting in a society that could now separate sexuality from reproduction. Brumberg states most women were eager for a thin body because it conveyed an instrument for fashion; it distinguished her from the matronly plump figures and ideals of service or self-sacrifice (p. 242).
The early female film stars are an example of this “new slim body” as described by Brumberg of swimmer- turned actress, Annette Kellerman. With figure measurements of 35-26-37(chest, waist, hips in inches), Kellerman was considered to have a slender body and correct proportions slightly under 5’ 4” and 137 pounds. Today, this is considered normal weight for height (based on CDC charts for body mass index) and is interestingly a bit heavier than myself today at the same height. Kellerman did not appear to defend her stature as average or normal as many starlets feel the need to do today. Instead, she made statements regarding fat as clumsy, unhealthy, and ugly (p. 243), advocating a rather vain concept of exercising nude in front of a mirror to fuel the strive for ultimate beauty.
Kellerman is depicted in Fasting Girls as a significant twentieth-century figure, encouraging women to improve themselves through cultivation of their physical appearance. This further led to detrimental claims Brumberg discloses such as the lack of feminine beauty (per a slim figure and cultivated good looks) as the cause for increasing divorce rates in the late 1920’s (p.244). Brumberg describes the massive complication for women unable to handle the pressures of sexual allure and weight control through measuring their self-worth by restricting calories and now seeking additional compensatory mechanisms such as purging and drug use.
This final chapter in Fasting Girls is the cultivation of Brumberg’s architectural mapping of the history of Anorexia Nervosa. Brumberg had eloquently built upon case studies in each chapter, adding the role of female nature, parental supervision, societal reactions, and medical opinions throughout this book. In later chapters, weight control and sexuality are tied in as well into what could now only be referred to as Anorexia Nervosa, a drastically different disorder from Anorexia Mirabilis or Hysteria as we might have thought before reading Fasting Girls.
Brumberg strongly distinguishes her stance on the medieval fasting behavior from modern anorexia when describing the miraculous loss of appetite in females (anorexia mirabilis) occurring because Christ or prayer provided these saints with alternative nourishment (p.47). This spirituality driven motivation provides evidence for Brumberg’s argument; There are different terminal routes of the ancient anorexia mirabilis and modern Anorexia Nervosa, as there is no alternative source of nourishment in the modern disease. Further supporting her argument, the modern female strives for physical beauty more so noted in the chapter “Modern Dieting”, rather than the quest for spiritual beauty in “From Sainthood to Patienthood.” Through her intricate mapping skills and architectural building, Brumberg builds the history for the reader piece by piece.
Brumberg claims the birth of anorexia nervosa in the 19th century, yet reveals fasting and restrictive behaviors were ever present from 1300 to 1800. This confliction was a weakness and confusing. Generalizing the existence of female food avoidance behaviors dating back to medieval times if not earlier in my opinion is the only way to find common origins. Of course, in time it gained further complications such as religion, hysteria, emotional control, family tension, physical cultivation to the ideal sexual image and finally became what the current diagnosis is today. Brumberg may be correct that just because a behavior occurs across a culture does not mean the behavior has the same origin, nonetheless, the behavior has occurred. The adolescent human learned it from somewhere. I feel that Brumberg was implying that medieval behaviors had no relevance in what developed in the 1870’s, to the 1920’s, and currently , which I find hard to fathom.
Another weakness is that the illustrations provided in the text are grouped in the middle on pages 185-204. As a reader, I would have attached myself more to the case descriptions such as Catherine of Sienna, Ann Moore, and Mollie Fancher had I seen their photographs in their respective chapters. My defense for this is that I am a modern female concerned with visual images of beauty.
Personal Reflection
The stigma that revolves around eating disorders is present today as it was in the 1870’s. When I mention to anyone that I am interested in researching eating disorders or treating eating disorders as an R.D., I receive expressions of confusion and often a plethora of misinformation. In a recent assignment, I researched the career of R.D’s that specialize in eating disorders. When I presented the position to an audience of adolescent (white) females, I was met with near silence and awe.
I have had an interest in the field of eating disorder research since earning my Bachelor of Science in Neuroscience, fascinated by the interaction of brain and behavior. Not many dietitians have such a background, which makes being aware of issues that face eating disorder treatment such as insurance coverage issues, the lack of care environments, and complexity important. I feel that Fasting Girls contributes this to the field of nutrition and dietetics because it provides this insight into the fantastical history of eating disorders.
The fascination and stigma surrounding eating disorders quite possibly contributes to the lack of treatment-seeking; only one in ten individual’s suffering are actually in treatment (xvi). It is noted in Brumberg’s first chapter, various kinds of therapeutic services are now offered to treat anorexia ranging in cost for outpatient services at $25 a session upwards of $100 per session or over $30,000 for residential treatment in a special facility such as Renfrew Center or The Carolina House. Fasting Girls gives the premise for professionals entering the field as to why these facilities even originated and their importance in fully treating individuals.
Fasting Girls is a reminder that we as Dietitians eager to counsel patients on food and nutrition must be aware that these individuals are controlling and using their appetite for food as a means of expression. It should be our hope but is not our sole responsibility to treat them, as it will require a team of professionals and family guidance or counseling as well. Just as with Sarah Jacob, family issues and psychological concerns can supersede nutritional nourishment and belabor treatment. Fasting Girls is a cautionary note for professionals in the field of nutrition and dietetics that are employed by families to “make this girl eat”. There are many factors that will need to be addressed in persons with Anorexia Nervosa and this should always be kept in mind of the professional and family. Brumberg was hopeful this book would stimulate an inter-generational discussion and indeed it has.
because it is proof to me that I am in the right field, that I know what I am talking about when it comes to Nutrition and that I should most definitely be a Registered Dietitian.
She offered me the entire basket but I shared all of the muffins with the rest of my class. There is my humbleness returning. The coffee below was a “gift” from my friend KC Mo, she and I finally caught up this week and got our nails done. Oh la la.
