The purpose of this chapter is to bridge the centuries that stand between medieval Italy and today’s world in order to explore the relationship between ‘holy anorexia’ and what we know as anorexia nervosa. I wish to attend to two points. Firstly, addressing the history of women and its psychological dimensions, I will seek to prove that a historically significant group of women exhibited a behaviour pattern consistent with anorexia nervosa. Secondly I am going to discuss the possible causes of anorexia and suggest that the existence of the historical reality ‘holy anorexia’ may indicate a need to re-evaluate certain modern approaches to the illness. I hope to draw a conclusion concerning whether medieval mystics can legitimately be labelled as anorexics in the modern understanding of the term, or whether they suffered from a different affliction.
The etymology of the word anorexia is the Greek prefix αν (meaning ‘without’ or ‘lacking’), and ορέζίς (appetite). Medically it can refer to any loss of appetite or aversion to food. Sometimes the cause is a physical illness (e.g. the end stage of many cancers), but sometimes it is psychological. The term anorexia nervosa should be treated with caution because many of those who suffer from the condition do not actually lack appetite; they may well be hungry, and their self-starvation, though it has psychological roots, does not arise from the mind having convinced the body that it is not hungry. However, whether or not their appetite is ever stimulated, sufferers of anorexia persistently starve themselves, which can sometimes be fatal.
The first accepted description in medical literature of a case of anorexia nervosa is found in the writings of the 17th century cleric and physician Richard Morton. Morton was a specialist in wasting disorders, and in his Phthisiologia: Or a Treatise of Consumptions he describes a twenty-year-old woman who came to him for treatment in 1686, complaining that for four years she had suffered from: ‘…A total suppression of her monthly courses from a multitude of cares and passions of her mind, but without symptom of the green-sickness following upon it. From which time her appetite began to abate, and her digestion to be bad’.
Morton’s description of her condition and its symptoms marks the first identification of anorexia nervosa as a separate condition, for until that time, many of the signs and symptoms had fallen into the category of tuberculosis or consumption. Baglivi further described the condition, using it as a marker for other mental conditions, which he said were almost invariably associated with gastrointestinal disorders.
It was only after two centuries of tentative exploration that the disease was given the description by which it is now recognised in the writings of Gull and Lasegue. In 1868 Gull wrote of a disorder peculiar to adolescent girls that he called Apepsia Hysterica, where sufferers voluntarily starved themselves to the point of emaciation. Six years later he renamed the disorder anorexia nervosa, and much like apepsia hysterica, it was characterised in young women in a refusal to eat, devastating weight loss and cessation of menstruation. He also noticed an association in some patients between anorexia and extreme physical activity.; a relationship that also fascinated Pierre Janet. Janet believed that this abundance of energy was a central element of the disease itself as it was evidence of overcoming the feelings of exhaustion. Suppressing fatigue was coupled with a heightened level of ‘physical and moral activity, a strange feeling of happiness, a euphoria’. His theory was that this elation, ‘as it is known in the ecstatic saints for instance, does away with the need for eating’.
By 1885 the medical profession had firmly identified anorexia nervosa as an illness of psychic origin. Janet concluded that ‘it is due to a deep psychological disturbance, of which the refusal of food is but the outer expression’. He saw basic physical desires and feelings as obstacles to fulfilment; if the body and soul could overcome them then the individual would be free to commune with God and accomplish great things. ‘Once the holy person has experienced this new and special reward system it does indeed become self-induced and self-perpetuating, a classic instance of affect/response.’ However, although the miraculous consequence is clear, the question arises: why did so many female ascetics initially choose to adopt the behavioural pattern of a holy anorexic (if it was a choice)? Pure starvation was not considered the catalyst for holy anorexia and the majority of documented cases concerned girls from comfortable, prosperous families, where involuntary under-nutrition was unlikely (similarly to modern statistics). The origins of their starvation are more varied and complex.
One such derivation for anorexia is the fact that sufferers see food as a means of control. Like the modern understanding of anorexia, control was a basic issue to medieval women who adopted fasting as a form of self-definition. ‘Obsession with food – either through binge eating or intense fasting – is often triggered by the nagging awareness of corporeality evidenced by the onset of menstruation.’ It is often believed that anorexics are trying to avoid becoming sexually mature and attempt to repress the onset of sexuality and retain a sense of childhood. In refusing to eat, a girl may feel that she is reclaiming power over a body that is developing out of her control into an unwanted womanly shape, or over a domineering family or society that allows her none.
The psychological symptoms are disturbances in bodily concept, disturbances in perception of bodily functions…and a “paralysing sense of ineffectiveness”. Anorexics typically feel themselves to be puppets, manipulated by others, unable to assert themselves against, or to please a controlling parent…Not eating is, for them, an experience of self-control of self, which they substitute for the control of circumstances they are unable to achieve.
For example, such extreme reactions to food are found especially in religious women who had undergone puberty and experienced intense conflict with family over their vocation. Mary of Oignies married at fourteen and moved immediately to extreme fasting, while Ida of Louvain’s adolescent conflict with her father led to bodily mortification and stigmata. A century later, after protracted conflict over vocation with her family, and as a reaction against her mother’s intentions to mould her into a conventional and feminine lady, Catherine of Siena became unable to eat anything except the Eucharist. (It is interesting to compare the saintliness associated with self-deprivation with that attached to charitable works: self-induced illness vs healing the sick; exposing oneself to the elements vs sheltering the homeless; and self-starvation vs feeding the hungry.) Although one should not claim that medieval women suffered from anorexia per se (since I believe that any such syndrome must be part of a particular culture and should thus not be transferred across cultures), they so show striking parallels to the modern disease. This suggests that the psychological and social matrix for anorexia plays a more important role among women that amongst men.
Self-starvation is commonly believed to make up the entirety of the anorexic condition, but it is also the key element in many other crises of autonomy. The temptation of Jesus in the wilderness was a prototype for early saints, who saw in his forty day and forty night fast a steadfast refusal to be tempted by Satan. The fact that Jesus was hungry during his temptation must be noted – a sensation to which ‘holy anorexics’ never admitted. They thus distinguished themselves from those who fasted as part of a controlled penance; holy anorexics claimed they were unable to eat, even though they were ordered to do so. They went beyond the belief in spiritual purification by penance (here, by starvation). Such penance was intended to cleanse the body of impurities, although holy anorexics claimed that their bodies could simply not be purified. They resultantly sought to destroy them – a belief with many parallels to modern day anorexia nervosa. In a letter written to a Religious in Florence in 1371, Catherine of Siena revealed herself to be one such mystic:
And I say to you in the light of God, that in every possible way I could, I always forced myself once or twice a day to take food; and I prayed continually, and I pray to God and will pray, that he will grace me in this matter of eating so that I may live like other creatures, if this is his will because mine is there, and I beg that you beseech me that highest eternal Truth to grant me the grace to take food.