Page 74 - Humanism 2019

During the early 20th century physicians’ approach to this Like his Victorian predecessors, Berkman was aware of
disease evolved with advancements in medical science and psychological disturbance in his patients. He noted that
psychiatric practice. Physicians of anorexic patients used for several of his patients the onset of anorexic symptoms
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biological means and psychoanalytic approaches, and almost always followed some psychic disturbance. His
ideals about gender shaped the medical understanding of description of the patients is comprehensive, noting that
the anorexic. they often “appear preoccupied, sit with the head bent
and gaze at the floor.” Berkman’s patients answer his
The biological model was more influential than the questions quickly and then promptly resume an apathetic
psychotherapeutic in the years after World War I due to manner characterized by “negativistic tendencies.”
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the advances in organotherapy in the medical field.
Organotherapy was a science that explored the role Although his attention to psychological details about his
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organs and secreting glands had in disease. Physicians patients was an important step forward in patient-doctor
could now evaluate basal metabolic rate, and better relations, only 40% of his patients received neurologic
research endocrinologic explanations for disease and and psychiatric examinations to determine the cause of
health. In 1914, Dr. Simmonds, a pathologist from the the illness, and of that 40%, only 20 cases received a
University of Hamburg, published his findings on a death definite psychological basis for the anorexia. Berkman
from extreme emaciation caused by an infarction of the admitted it was likely that psychological factors were the
pituitary gland. The diagnosis, pituitary cachexia, or more basis for anorexia in more than these 20 cases, but he
commonly referred to as Simmond’s disease, provided a could not come up with a definitive mental etiology
biological explanation for rapid because of the reticent
and unexplained weight loss. demeanor of his patients. When
Consequently, physicians questioned as to the cause of
diagnosed many patients their symptoms, most of his
exhibiting extreme emaciation Physicians in the 1920s and patients were either unable to
with Simmond’s disease even in 1930s continued to favor the express an opinion or refused
the absence of any other to do so.
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pituitary deficiencies. Thus endocrinogical approach to
hundreds of anorexic patients anorexic treatment, however Physicians in the 1920s and
during this period were treated over time, it became clear that 1930s continued to favor the
with pituitary hormone extracts endocrinogical approach to
that naturally proved to be there was no uniform response anorexic treatment, however
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ineffective. By 1942 it was among anorexic patients to over time, it became clear that
found that, out of 595 reported there was no uniform response
cases of Simmond’s disease, hormonal extracts. among anorexic patients to
only 101 were correctly hormonal extracts. Some
diagnosed as Simmond’s experienced elevated metabolic
disease. The remaining 85% rates but for others treatment
were falsely diagnosed and likely had other diseases also was ineffective.
characterized by extreme emaciation, one being anorexia Diagnosis and treatment of anorexic patients took an
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nervosa. entirely new shape after the biological model was
abandoned for the psychosomatic approach that began
Dr. John Mayo Berkman documented 117 cases of treating
rising in popularity in the 1930s after the publication of
American anorexic patients with various hormonal
Helen Dunbar’s Emotions and Bodily Changes.
therapies from 1917 to 1929. Doctors at the Mayo Clinic
Previously, psychosomatic theories relied heavily on
noticed that the anorexic’s metabolism lowered after a
ambiguous anecdotal evidence, but Dunbar brought
long period of food restriction and emaciation. If the
scientific methodology to the practice that emphasized a
physician didn’t account for the patient’s metabolic uptick
holistic approach in patient care. Shortly after, the first
in response to therapy then weight loss would continue as
issue of the journal Psychosomatic Medicine was
quickly as it had in the initial period of starvation and thus
published outlining the goals of the field: “To study in
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death would occur rapidly. Therefore treatment required
their interrelation the psychological and physiological
a delicate balancing act by the physician; raising the
aspects of all normal and abnormal bodily functions and
metabolic rate of an already emaciated patient needed to
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thus to integrate somatic therapy and psychotherapy.”
be combined with a steady increase of nourishment and
In other words, psychosomatic medicine explored the
caloric intake.
intricate relationship between psychological factors and

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bodily processes.
71 HUMANISM IN THE HEALTH SCIENCES 2019 • VOL. 22