Anorexia

Cas de Julie « Délire de maigreur chez une hystérique », Nouvelle Iconographie de la Salpêtrière. Clinique des Maladies du Système Nerveux, 1894. Gallica, BNF.The medical supervision of anorexia responded to political and scientific stakes in order to normalize puberty. 

As a result of the secularisation of European societies by the end of the 19th century, voluntary food restriction ceased to be interpreted as a manifestation of religious fervour. On the one hand, feminine slimness was considered a social prestige, but psychiatry, then a rising discipline, considered it a symptom of mental illness. The British doctor, William Gull, in 1868 presented several cases of young women affected by a disease he called “anorexia nervosa” (nervous anorexia). In 1873, a French psychiatrist,  E.C Lasègue published in Les Archives Générales de la Médecine, a clinical description of  “hysterical anorexia” which he defined as “one of the forms of hysteria in the gastric area”. These articles increased the interest of the French scientific and medical community in anorexia. 

Reinforced by the demographic and political stakes of the fight against tuberculosis and infant mortality, the digestive system and its disorders were, at the beginning of the 20th century, a major medical concern. Physiologists published dietary rules and nutritional standards relative to infant and female bodies. In medical and scientific reviews, most doctors agreed to define anorexia as a “voluntary” loss of appetite. This “desire” is characterized by a “systematic refusal to feed” and is considered a criterion to distinguish a “true” or “primary” anorexia from a “secondary” one caused by a gastric disease. Mainly described for female patients, ultimately anorexia was defined as specific to teenagers and young women, the appearance of which coincided with the first signs of puberty. Based on previous work on “hysterical” anorexia, Debove described the “true nervous anorexia” in his book, L’Aide mémoire thérapeutique (1908) as a “psychopathology affecting rather young patients, between 15 and 20 (particularly young girls)”. 

First defined as a symptom, then as a form of hysteria, anorexia and its diagnostic criteria were conceived along new symptoms, specific to teenagers and young women. In the early 20th century, the catholic clergy and the laity disputed over the surveillance of the youth. 

Age, associated with gender and social class, provided an administrative tool for the government of the 3rd Republic.  Medical and generalist press, as well as  books on the hygiene and education of young girls, presented puberty as a particularly dangerous period requiring surveillance by parents and educators. The idea that young girls were inclined to develop a mental illness justified the expansion of medical instruments for the control and measurement of bodies beyond the medical field.

In this context, the diagnosis of anorexia was based on anthropometric maps (height/weight, menstruation, photographs) and clinical examination of female pubertal signs (menses and pilosity). Although doctors defined anorexia in various ways (“juvenile”, “mental”, “adolescent”), they considered it curable and characterized by a physical mismatch between the patients’ age and their biological measures. For example, the physician Pierre Nobécourt published the article “L’anorexie mentale ou psychique”(1935)  in the medical review La Pédiatrie Pratique, where he described the case of Simone, a young patient of 18 years old suffering from anorexia: she was measuring “160 cm instead of 155 cm” and weighting “38 kilograms 300 grams instead of 58 kilograms”. According to him, the patient had “an adult height” but “a weight reduction of 33%”. 

The medical treatment aspired to help patients to attain a “normal” ratio of age/height/weight. Therefore, alienists and then psychiatrists strongly recommended isolation at the onset of symptoms. As some young women refused to eat, doctors had to force-feed them with a stomach tube. 

In the 1900s, isolations mostly took place in private clinics or care homes and no longer asylums because they were dedicated to nervous illnesses and for a more prosperous clientele. Isolation aimed to normalize eating habits through increased medical surveillance and separation with families, often perceived of as triggering. 

Weight gain and the return of menstruations, in the case of amenorrhea, were the clinical criteria of pubertal body development and thus the healing of patients. 

Read more in the dictionary : The Corset

Read the paper in french : Anorexie