Page 72 - Humanism 2019

Smokescreen:

a Story of Anorexia

Nervosa

By Megan MacDougall, COMP student

t is hard to understand how one can reject the basic human instinct of
Iappetite and embrace emaciation in the face of growing mortality, yet
various forms of self-inflicted starvation have existed for centuries. Food
refusal — which for some is a spiritual act of purity and sacrifice, self-
control and devotion — took a new shape by the late 19th century.
Embodied by starving girls and first observed by the Victorian physicians
who diagnosed it, anorexia nervosa is a complex illness, as much a disease
1
as a manifestation of cultural ills. What are the various social and cultural
causes that give this disease such a unique history? Do anorexic girls today
refuse food for the same reasons they did a century ago? I will trace the
medical understanding and approach to this disease over the course of a
century, and examine the cultural pressures common to these fasting girls,
to answer these questions.
In the late 19th century, exhibiting sharp diagnostic techniques by
differentiating one disease from another gave physicians academic and
2
social prestige. As an established physician, made a baronet by Queen
Victoria after saving her son from typhoid fever, Dr. William Withey Gull
was a pioneer in differential diagnosis. In fall 1873, Gull stood before his
fellow members of the elite Clinical Society to present case reports on a
new “peculiar form of disease” he had encountered among young females. 3

He discussed three patients — Miss A, Miss B, and Miss C. His
determination in differentiating this disease from other illnesses of
emaciation and starvation is evident in the emphasis he placed on physical
signs and indicators unique to anorexia. Gull’s attention to physical
4
manifestations of the disease as positive medical indicators meant that the
patient needed a thorough medical examination to rule out the possibility
of an intestinal disease. The case studies were described in terms of
menstrual cycles, heart sounds, respiratory function, pulse, urine output,
bowel movements, and tongue morphology. Emaciation, depressed
5
breathing, pulse, and body temperature held true for all of the patients.

Photos and illustrations courtesy of shutterstock.com

69 HUMANISM IN THE HEALTH SCIENCES 2019 • VOL. 22