Page 76 - Humanism 2019

What was also revolutionary in Bruch’s new
psychiatric approach was the emphasis on
active participation of families in the anorexic’s

recovery. Because the development of anorexia
nervosa is closely related to the patterns of

family interaction, usually excessive closeness
and codependency, recovery is only possible if
the underlying family problems are addressed.

own. She argued that anorexic patients must play an active role in their
recovery. “It is important that the patient makes the discovery on his own
and has a chance to say it first.” This way the patient could develop their
own ways to handle stress, besides food restrictions, that best suited their
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personal needs:
“The main thing I’ve learned is that the worry about dieting, the worry
about being skinny or fat, is just a smokescreen. That is not the real illness.
The real illness has to do with the way you feel about yourself …You have
great fear, namely that of being ordinary, or average or common — just
not good enough …The peculiar part of it is that it makes you feel good
about yourself, makes you feel ‘I can accomplish something …’ You start
to think you are a little bit better because you can look down on all these
people who are sloppy and piggish and don’t have the discipline to control
themselves …The paradox is that you have started to feel good for being
unhealthy.”
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In line with this method, Bruch and other doctors in the post World War II
era paid closer attention to the patient’s relationship with food as opposed
to reinterpreting their behavior to reveal unconscious motivations. After
paying closer attention to their patient’s routine with food, psychiatrists
realized that the diagnostic term “anorexia nervosa,” derived from the
Greek for lack of appetite and the Latin for nervous origin, was an
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inappropriate name for the disease. Anorexics did not lose their appetite
or interest in food; they only acted as if they had. In reality, food was the
center of their world. Their fixation on food was “revealed by their
making cooking for others a hobby, their knowledge of recipes and
delicatessen shops, compulsive reading of menus.” With these insights,
psychiatric literature was able to distinguish anorexia nervosa from other
illnesses characterized by weight loss and malnutrition. Patients who lost
weight from other reasons were quick to admit their emaciation, perhaps
even complain about it, but the anorexic patient denied their starved
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“Flapper” fashion of the 1920s emphasized thin hips, appearance, some may have even felt fat.
flat chests, and long legs. Photos courtesy of
What was also revolutionary in Bruch’s new psychiatric approach was the
shutterstock.com
emphasis on active participation of families in the anorexic’s recovery.
Because the development of anorexia nervosa is closely related to the
patterns of family interaction, usually excessive closeness and
codependency, recovery is only possible if the underlying family problems
are addressed. She stressed that “psychotherapy is not a process that takes
place in a vacuum” and therefore therapeutic work involving the people
35
the patient is in daily contact with is critical.

73 HUMANISM IN THE HEALTH SCIENCES 2019 • VOL. 22