Tag Archives: Gull

A Brief History of Self-Starvation

15 Aug

During the Middle Ages, self-starving practices were commonly undertaken by both sexes as a form of religious observance, particularly during Lent where the control and reduction of food intake was culturally institutionalised. This provided women with the means of experiencing bodily suffering through spiritual fasting. Both Caroline Walker Bynum and Rudolph Bell have explored the role which women assumed in divine practices that involved abstinence from bodily desire. Bynum relates that nourishment was derived by means of prayer and the Eucharist rather than from earthly sustenance as women ‘fasted in order to prepare themselves for Christ’s body and blood.’[1] However, this religious potential for volitional female suffering became largely unobtainable in Britain with the advent of the Protestant Reformation. Worship of the saints was abolished and extreme, publicly demonstrative forms of female adoration such as ‘[t]he renunciation of food, once experienced and explained as a form of female holiness, was increasingly cast as demonical, heretical, and even insane.’[2]

This repression of what were deemed to be irrational forms of mortification attained a new dimension with increasing medicalisation of the female body. The first medical account of self-starvation is credited to the seventeenth century physician Richard Morton who distinguished rejection of food from the loss of appetite that was symptomatic of other illnesses such as tuberculosis and chlorosis, the latter of which Morton commonly terms as ‘Green-Sickness’.[3] In his Phthsiologica – or a Treatise on Consumption (1694), Morton described the case of an eighteen year old girl, resembling ‘“a skeleton only clad with skin”’[4] who

fell into a total Suppression of her Monthly causes from a multitude of Cares and Passions of her Mind, but without any Symptom of the Green-Sickness following upon it. From which time her Appetite began to abate, and her Digestion to be bad; her flesh also began to be flaccid and loose, and her looks pale.[5]

Even though Morton established a specific pathology of self-starvation, the condition would not be formally named for almost two hundred years.

By the nineteenth century, the social status and power of the physician increased as medical authorities had grown secure in the scientific validity of their own assumptions. Unchallenged, physicians increasingly began to compel the subjective experience of their patients to accord with their own doctrine. This was particularly noticeable with female patients and it was at this point in 1873 that an official medicalisation of appetite was elicited when anorexia nervosa was simultaneously diagnosed in England and France by Sir William Withey Gull and Ernest Charles Lasèque. While Lasèque named the condition anorexie hystérique, the term anorexia nervosa was coined by Gull whose description of the malady first appeared in Transactions of the Clinical Society of London (1874).[6] In an 1888 issue of the Lancet, Gull attributed ‘perversion of the “ego” being the cause and determining the course of the malady’,[7] crediting his patients’ refusal to eat to a psychological, rather than a physical affliction as he stated

[t]hat mental states may destroy appetite is notorious, and it will be admitted that young women at the ages named [sixteen to twenty-three] are specially obnoxious to mental perversity.[8]

Yet, in the processes of coercing patients’ subjective experience, while Gull noted the psychological cause and imension of anorexia, he chose not to engage with his patients’ subjective nuances. By concentrating upon the organic effects, rather than psychological causes, Gull failed to acknowledge the existence of the emotional states of his female patients, treating them as ephemera unworthy of the masculine empiricism upon which the evolving medical discourse was founded.

Even when Huchard and Deniau divided anorexia into the two sub-conditions of anorexie gastrique and anorexie mentale in 1883 – describing patients with the former as ‘those with many digestive complaints, in whom hysteria was believed to cause a physiological disturbance leading to impaired gastrointestinal absorption and function,’ and the latter as those with ‘“pure” psychiatric conditions and involved mental rather than digestive problems’[9] – this did not significantly alter treatment, or the way in which female mental phenomena were regarded. Patients diagnosed with anorexie mentale were still treated by controlled or forced feeding in order to overcome the physiological effects, rather than by engaging with the underlying causes that instigated the behaviour.

Yet, while the authority of medical discourse was used to justify the coercion and restriction of female experience, self-starving behaviours continued to create uncertainty within this form of patriarchal control. Gull’s diagnostic security was undermined by the fact that a number of nineteenth century ‘conditions’ shared similar symptoms with anorexia nervosa including bulimia, pica, chlorosis, hysteria and neurasthenia:

“[b]ulimia, pica, and strange longings are morbid modifications of the appetite,” Thomas Laycock wrote in 1840, “and belong to the same class of phenomena as …anorexia…and, like it, are characteristic of the pregnant, chlorotic, and hysterical female.”[10]

Far from being derivations of anorexia, a number of these conditions were theorised and diagnosed prior to the work of William Gull. In 1838, thirty five years before the formal characterisation of self-starvation, the medical adviser in The Penny Satirist described a common disease ‘to which the tender sex is subjected, particularly in the large towns of over-refined countries’, which was identified as ‘chlorosis or green sickness.’[11] The masculine medical establishment responded by perceiving this susceptibility as a female trait and as further evidence that women were the ‘tender sex’. As the advisor continued to observe:

[y]ou can scarcely take a walk in the streets of large towns without meeting young ladies with a pale yellow complexion, mixed with a peculiar greenish tinge, a bluish circle around the eyes, an air of languor and debility.[12]

The cause of such symptoms was thought by Clark to result from the ‘capricious’[13] appetite of the patient, who often exhibited symptoms of pica during which they ‘craved strange substances such as chalk, dirt, ashes, or vinegar’,[14] yet at other times they lost their ‘appetite altogether, sometimes refusing to eat.’[15] As with anorexia, while the psychosomatic nature of chlorosis was noted, arising from ‘one principal source, namely, bad physical and moral education’,[16] the result of ‘[w]ant of proper exercise, improper dress, tight lacing, too much sitting, improper development of the imagination at the expense of the reasoning faculties, boarding-school education, play-going, and novel-reading’,[17] such observation disparaged female subjective experience and trivialised female activities. A further undermining of diagnostic certainty was caused by chlorosis and anorexia occurring within girls of a similar age, with Clark writing that there is ‘frequent occurrence of anaemia or chlorosis in girls between the ages of fourteen and twenty-four’,[18] compared to Gull’s theory of anorexia arising between sixteen and twenty-three. In addition, in cases of chlorosis the Lancet (1887) reported that ‘sometimes there is amenorrhoea’,[19] a symptom also associated with anorexia.

Confronted with such etiological confusion, physicians attributed this uncertainty to a consequence of dealing with the unpredictable, irrational and hysterical female, thereby evading questions regarding the clarity and consistency of the empirical science that formed the foundation of medicine.

Copyright © 2011 Victoria Fairclough


[1] C. Walker Bynum, Holy Feast and Holy Fast: The Religious Significance of Food to Medieval Women (Berkeley, 1986), p.117, James of Vitry, Life of Mary of Oignies, AASS, June, vol.5, p.517

[2] J.J. Brumberg, Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease (Cambridge: Harvard University Press, 1988), p.49

[3] R. Morton Phthisiologica: Or a Treatise of Consumptions 2nd edition (London, 1720), pp.8-9, in R. M. Bell, Holy Anorexia (London: University of Chicago Press, 1985), pp.3-4

[4] ibid, pp.3-4

[5] ibid, pp.3-4

[6] E.L. Bliss and C.H. Hardin Branch, Anorexia Nervosa: Its History, Psychology, and Biology (New York: Paul B. Hoeber, 1960), p.13

[7] W. Gull, ‘Clinical Notes’, The Lancet, March 17 (1888), p.517

[8] W. Gull, ‘Anorexia Nervosa’ (apepsia hysterica, anorexia hysterica), Transactions of the Clinical Society of the London 7 (1874), p.25, in J.J. Brumberg, Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease (Cambridge: Harvard University Press, 1988), p.118. Gull identified anorexia nervosa as a disease in its own right, rather than a symptom of another disease since upon examination one patient ‘was found to be extremely emaciated, but there were no signs of organic disease.’ W. Gull, ‘Clinical Notes: A Fatal Case of Anorexia Nervosa’, in Lancet, Jan 19 (1895), p.149

[9] E.L. Bliss and C.H. Hardin Branch, Anorexia Nervosa: Its History, Psychology, and Biology (New York: Paul B. Hoeber, 1960), p.18

[10] T. Laycock, A Treatise on the Nervous Diseases of Women (London: Longman, Orme, Brown, Green and Longmans 1840), p.73, in A. Krugovoy Silver, Victorian Literature and the Anorexic Body (Cambridge: Cambridge University Press, 2002), p.2.

[11] Anon., ‘The Medical Adviser’, The Penny Satirist, iss.43 (London, 1838)

[12] ibid

[13] A. Clark, ‘Observations on the Anaemia or Chlorosis of Girls, Occurring More Commonly Between the Advent of Menstruation and the Consummation of Womanhood’, Lancet, vol.130, issue 3351, 19 November (1887), 1003-1005, p.1003

[14] Victorian Literature and the Anorexic Body, p.2, Noted by Samuel Ashwell, in A Practical Treatise on the Diseases Peculiar to Women (Philadelphia, PA: Lea and Blanchard, 1845)

[15] ibid

[16] Anon., ‘The Medical Adviser’, The Penny Satirist, iss.43 (London, 1838)

[17] ibid

[18] A. Clark, ‘Observations on the Anaemia or Chlorosis of Girls, Occurring More Commonly Between the Advent of Menstruation and the Consummation of Womanhood’, Lancet, vol.130, issue 3351, 19 November (1887), 1003-1005, p.1003

[19] ibid

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The Invention of Anorexia

14 Aug

Prior to its diagnosis, anorexia, or loss of appetite, had been thought to be a symptom of another, primary disease. It was given the status of an independent condition by the eminent physician Dr William Withey Gull, who asserted that anorexia was distinct from the weight loss that resulted from a separate disorder such as organ disease or tuberculosis. Gull first introduced anorexia to the British Medical Association in 1868, referring to it as ‘apepsia hysterica’:

[a]t present our diagnosis is mostly one of inference, from our knowledge of the liability of the several organs to particular lesions: thus we avoid the error of supposing the presence of mesenteric disease in young women emaciated to the last degree through hysteric apepsia by our knowledge of the latter affection, and by the absence of tubercular disease elsewhere.[1]

In his footnote to hysteric apepsia, Gull writes that ‘I have ventured to apply this term to the state indicated, in the hope of directing more attention to it.’[2]  He did just this since five years subsequent to this address, on 24th October 1873, Gull presented a lecture to the Clinical Society of London, an elite group of medical consultants, entitled ‘Anorexia Hysterica (Apepsia Hysterica)’ in which the 1868 diagnosis of ‘apepsia’ was replaced by ‘anorexia’. Gull explained this substitution since ‘“what food is taken, except in the extreme stages of the disease, is well digested.”’[3] A paper based on this lecture, ‘Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica)’, was published the following year. In this report, the original title of the lecture, ‘Anorexia Hysterica’, was altered to ‘Anorexia Nervosa’ because Gull had come to believe that anorexia was nervous, rather than hysterical in origin given that ‘hysteria’ implied a gendered disease affecting only women:

we might call the state hysterical without committing ourselves to the etymological value of the word, or maintaining that the subjects of it have the common symptoms of hysteria. I prefer, however, the more general term “nervosa,” since the disease occurs in males as well as females, and is probably rather central than peripheral.[4]

Two years after Gull’s publication, a paper delivered at the Royal College of Physicians was printed in The British Medical Journal that offered a detailed description of the symptoms of anorexia nervosa, concurring with Gull’s earlier diagnosis:

the appetite fails, food is not taken, and the body wastes to an extreme degree, the countenance has a distressed appearance, the eyes are sunken, the cheeks hollow, and the whole system impoverished: the body has fed upon itself, and all superfluous fat has become absorbed.[5]

Similarly in France in April 1873, Dr Ernest Charles Lasègue published ‘De l’anorexie hystérique’ in the Archives Générales de Médicine, in which anorexia was described as ‘“hysteria of the gastric center”’.[6] Although Lasègue believed that the condition derived from hysteria, ‘anorexia’ (lack of appetite) is used in place of ‘hysterical inanition’ since he states that anorexia ‘“refers to a phenomenology which is less superficial, more delicate, and also more medical.”’[7] In 1884, however, T Clifford Allbutt opposed the idea of a hysterical cause owing to the variety of symptoms produced by anorexia. Based upon six cases collected prior to the reports from Gull and Lasègue, Allbutt found that in some instances, ‘there is great pain on the ingestion of food; in others, there is no pain, but simply a distaste for food.’[8]

In his account, Lasègue identified three stages of l’anorexie hystérique. During stage one, he reports that the patient experiences physical sensations, a ‘“vague sensation of fullness” and ‘“suffering after commencement of the repast.”’’[9] Certain foods are omitted from the diet and there is evidence of hyperactive behaviour. In stage two there is physical deterioration, yet the patient becomes the centre of attention owing to her food refusal and is thereby pleased with her condition and does not wish to ‘get better’. This is what Lasègue termed ‘“pathological contentment”’.[10] In the final stage, he noted severe emaciation and amenorrhea and ‘“[t]he young girl begins to be anxious from the sad appearance of those who surround her, and for the first time her self-satisfied indifference receives a shock”’.[11] From this report, it can be seen that since the anorexic girl is respondent to others, her family and friends act as a reflection of her own physical condition. The patient’s body image becomes distorted to such a degree that she only realises the extent of her emaciation when others exhibit signs of alarm.

By classifying the behaviour and symptoms of anorexia, Gull transformed an existing condition into a disease. Taking control of the patient’s volitional self-starvation, he translated the behaviour as a ‘mental perversity’[12] subject to treatment, indicating his wish to regulate undesirable female conduct by diagnosing it as an abnormality. This objective to manage disease is evident in Gull’s lectures and writings, the language of which is couched in terms of control. In his ‘Address on the Internal Collective Investigation of Disease’ delivered in 1884, he states that medical investigation requires a ‘combination of exact observation and record, with refined criticism and analysis’.[13] Meticulous in his diagnosis, Gull advised his fellow physicians that:

we must, in many instances, have the life-histories of the parents or more remote ancestors, before we can fully unravel the course of irregular menstruation, hysteria, anorexia, uterine flexions, and the like.[14]

Gull stressed the need for medical practitioners to carry out diagnoses in a uniform manner, in order that illnesses could be systematically classified and the problem of disease ‘settled’. Allbutt also suggests a way in which control should be exercised, especially in the case of anorexia which displays ‘objective symptoms’ that can be measured, treated and brought within patriarchal power: ‘[t]his anorexia nervosa is no whimsical malady, no inconsistent nor irregular indisposition, but is a definite complex, consisting, in part, of objective symptoms.’[15]

Thwarting Gull’s desire for a neat and methodical diagnosis, however, anorexia resisted classification. Firstly, its cause was problematic. Allbutt writes that ‘[s]ometimes, the distaste has taken its origin in a mere shirking of food – in the fear of growing stout, or in a nobler avoidance of self-indulgence’,[16] while Lasègue believed that anorexia occurred ‘as the result of some “emotional cause” which the patient might either “avow or conceal.”’[17] These emotional causes outlined by Lasègue included ‘inappropriate romantic expectations, blocked educational or social opportunities, struggles with parents.’[18] Adding to this catalogue of possible origins for the condition, in an 1888 issue of the Lancet Gull attributed ‘perversion of the “ego” being the cause and determining the course of the malady’,[19] crediting his patients’ refusal to eat to a psychological, rather than a physical affliction:

[t]hat mental states may destroy appetite is notorious, and it will be admitted that young women at the ages named [sixteen to twenty-three] are specially obnoxious to mental perversity.[20]

A decade later, William Smoult Playfair asserted that lack of appetite is caused by neurasthenia: ‘“the excessive disgust for food, which is so striking a feature, is only one of many coexisting indications of a profound alteration of the nervous system.”’[21]

Copyright © 2011 Victoria Fairclough


[1] W.W. Gull, ‘Clincal Observation in Relation to Medicine in Modern Times’, Address dekuvered at a meeting of the British Meidcal Association at Oxford, August 7th, 1868, in Theodore Dyke Acland (ed.), A Collection of the Published Writings of William Withey Gull (n.p., September 2010), p.54

[2] W.W. Gull, ‘Clincal Observation in Relation to Medicine in Modern Times’, Address dekuvered at a meeting of the British Meidcal Association at Oxford, August 7th, 1868, in Theodore Dyke Acland (ed.), A Collection of the Published Writings of William Withey Gull (n.p., September 2010), p.54

[3] W.W. Gull, ‘Clinical society of London, Friday October 24 Sir William Gull read a paper on anorexia hysterica (apepsia hysterica)’, Medical Times and Gazette, 2, (1873), 534-6, in Vandereycken and Deth, From Fasting Saints to Anorexic Girls

[4] W.W. Gull, ‘Anorexia Nervosa’ (apepsia hysterica, anorexia hysterica), Transactions of the Clinical Society of the London 7 (1874), pp.25-6, p.25, in Brumberg, Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease (Cambridge: Harvard University Press, 1988), p.118

[5] S.O. Habershon, ‘Lumleian Lectures on the Pathologies of the Pneumogastric Nerve (Concluded)’, The British Medical Journal vol.1, no.805 (Jun 3, 1876), pp.681-682, BMJ Publishing Group, p.681 [accessed 30.06.10] <http://www.jstor.org/stable/25237255&gt;

[6] Ernest Charles Lasègue, ‘On Hysterical Anorexia’, Medical Times and Gazette (September 6, 1873), pp.265-266, Original French report in Archives Générales de Médicine (April 1873), p.266, in Joan Jacobs Brumberg, Fasting Girls, p.125

[7] Ernest Charles Lasègue, ‘De l’anorexie hystérique’, Archives Générales de Médicine, 21, (1873), 385-403. Translation: ‘On hysterical anorexia’, Medical Times and Gazette (2), 1873, 265-6, 367-9, in Van dreycken and Deth, From Fasting Saints to Anorexic Girls, p.157

[8] T. Clifford Allbutt , ‘The Gulstonian Lectures, on Neuroses of the Viscera’, The British Medical Journal vol.1 no.1212 (March 22, 1884), pp.543-547 BMJ Publishing Group, p.546 [accessed 30.06.10] <http://www.jstor.org/stable/25265955&gt;

[9] Lasègue, ‘On Hysterical Anorexia’, in Brumberg, Fasting Girls, p.127

[10] Lasègue, ‘On Hysterical Anorexia,’ in Brumberg, Fasting Girls, p.130

[11] ibid, p.131

[12] W.W. Gull, ‘Anorexia Nervosa’, p.25, in Brumberg, Fasting Girls, p.118

[13] William W. Gull, ‘An Address on the Internal Collective Investigation of Disease’, The British Medical Journal, Vol. 2, No. 1233 (Aug. 16, 1884), pp.305-308 published by BMJ Publishing Group, p.305 [accessed 30.06.10] <http://www.jstor.org/stable/25267200&gt;

[14] Gull, ‘An Address on the Collective Investigation of Disease’, p.143

[15] Allbutt, ‘The Gulstonian Lectures, on Neuroses of the Viscera’, p.546

[16] ibid>

[17] Ernest Charles Lasègue, ‘On Hysterical Anorexia,’ Medical Times and Gazette (September 6, 1873), pp.265-266, Original French report in Archives Générales de Médicine (April 1873),  Brumberg, Fasting Girls, p.127

[18] ibid

[19] W. Gull, ‘Clinical Notes’, The Lancet, March 17 (1888), p.517

[20] Gull, ‘Anorexia Nervosa’, p.25, in Brumberg, Fasting Girls, p.118

[21] William Smoult Playfair, “Note on the So-Called Anorexia Nervosa,” Lancet (April 28, 1888), p.818, in Brumberg, Fasting Girls, p.147

Copyright © 2011 Victoria Fairclough