Although much of the behaviour described above is characteristic of anorexia nervosa, the question arises, is holy anorexia the same illness? Jantzen asserts that, ‘there is no doubt that by modern standards Catherine of Siena would be classified as suffering from anorexia nervosa’. It is certainly clear that sacred and profane anorexia do share many fundamental similarities. Both are marked by abstinence from food, though the motive is sanctity in the former case, and fashionable thinness in the latter. To summarize, anorexics in the fourteenth century and those in the twenty-first century do not want to eat because they loathe the consequences, while they both take pleasure in the effects of starvation.
With relation to Feinghner’s diagnostic criteria, clear similarities between holy anorexia and anorexia nervosa also become apparent when ‘holiness’ and ‘thinness’ are juxtaposed. For example, if ‘[a] distorted, implacable attitude towards holiness that overrides hunger, admonitions, reassurance and threats” is substituted for ‘a distorted, implacable attitude towards eating, food or weight that overrides hunger, admonitions, reassurance and threats,’ clear parallels are exposed.
It is not an exaggeration to say that as holiness was the ideal cultural state in medieval Europe, so contemporary conformity to bodily norms makes thinness the ideal physical state (with nothing, in most cases, assuming a similar religious importance). During the medieval period, the exceptional holiness of Catherine of Siena, amongst others, made her a model of sanctity, which other women aspired to emulate. Similarly in modern society, thinness is now understood as the ultimate feminine ideal, a notion that has become especially true during the last decade, revolving around the ever-increasing obsession with celebrity and diet. Just as Catherine led to a re-evaluation of female spirituality, so present-day obsession with dieting and thinness may be held responsible for the rapid and mass increase of anorexic behaviour patterns.
Other parallels can be drawn with reference to behavioural patterns. Both in the fourteenth and twenty-first centuries, anorexics appear to have boundless energy, and are never content with their efforts to be holy or thin, whilst constantly criticising what they have achieved, and striving for even more extreme results. They focus obsessively upon either holiness or thinness, and claim to be uninterested in ordinary human relationships, instead focusing solely on their ‘relationship’ with either God of food. Thus they appear to become, and indeed see themselves, as extremely self-sufficient and independent. (This is unusual, for according to modern physicians, anorexia nervosa is a cry for attention and help.)
Despite this evidence, I believe that in one very important way it seems the answer to whether medieval mystics can legitimately be labelled as anorexic, must be negative. While the available documentation supports the fact that Catherine of Siena and many other female mystics obviously starved themselves and suffered symptoms typical of anorexia nervosa, they did not include the key one – a desire for thinness, or a fear of putting on weight. Indeed, if extreme over-eating had been symbolic of austere piety in medieval times, instead of self-inflicted starvation, mystics would have relished it, and its effects, to the same degree as emaciation, which reveals a blatant difference between the two types of anorexia.
In an article reviewing reasons that anorexics offer for their refusal or claims of inability to eat, Szmukler and Tantam make the point that anorexics’ explanations have varied with the times, and perhaps, during the late twentieth and early twenty-first centuries, include what they think their doctors expect to hear. It is certainly no surprise nowadays to hear anorexics talk about their bodies in terms of celebrities, film, magazines and advertisements; contemporary preoccupations with diets, health scares, and hero-worship may all play their part. In medieval times, however, abhorrence of fatness was not offered by the ‘holy anorexics’ as an explanation.
In addition, one of Bell’s theses focuses on the fact that although anorexics provide a multitude of different histories (in both the medical and the narrative sense), and although their histories are often inconsistent with each other, one can still discern the common thread running through them – that they feel ‘better’ (sometimes physically, sometimes morally) if they starve themselves, and worse if they eat a substantial amount of food. Catherine of Siena’s experience is a classic example; Raymond of Capua wrote of how she, 'felt stronger and healthier when she did not eat, and grew ill and tired [when she was commanded to eat]… Not only did [Catherine] not need food, she could not even eat without pain. If she forced herself to eat, her body suffered greatly and she had to vomit'.
Extrapolating from this basic formulation helps to avoid the ethnocentric assumption that medieval mystics must have starved themselves for the same reason that modern anorexics do (primarily concern with weight and body shape).
Modern diagnostic insistence upon the etiological centrality of concerns about body shape and weight turn anorexia into a culture-bound phenomenon of late twentieth and twenty-first technological society, rather than a relatively rare but historically and culturally ubiquitous clinical syndrome.
In view of such evidence, the conclusion I have reached is that although holy anorexia and Anorexia Nervosa share similar psychological thought patterns, they must stand alone as separate illnesses: the principal discrepancy is too important to ignore. While Catherine of Siena, and many other mystics, clearly had very troubled relationships with food, their actions were still within their conscious control, and thus the ‘anorexic’ label cannot justifiably be applied to them. However, if this is the case, one might be tempted to ask, what does the female mystic gain from the acts of abuse they inflicted upon themselves? Aside from the previously discussed notion of purity, Petroff understands the answer to lie in the concept of power.
However, it should not be suggested that the medieval mystics ‘intended’ in any conscious way to seek their temporal or spiritual power, and instead I refer to Ricoeur’s ‘hermeneutics of suspicion’. While none of the mystics I have studied implicitly stated that their intention was empowerment, it is clear that the rigorous disciplines were designed to bring the body under control – to demonstrate that the physical would not stand between the mystic and the Holy. This is what Foucault meant when he spoke of “technologies of the self”, while practising such penances was often the only way for medieval women to assert their theological individuality. These “technologies of the self” are often self-devised, self-inflicted spiritual, physical or mental disciplines through which goals are achieved – whether happiness, perfection, oneness, or a state of spiritual elevation.Despite the reception met by the holy anorexics, it should be noted that the Church neither encouraged nor condoned their conduct. Although they were respected for their austerities, they were never held up, nor did they hold themselves up, as an ideal to be followed. Instead, they were regarded as being living examples of God’s grace. They were autonomous in their sufferings, and were thus able to define the significance of those sufferings on their own terms. To the Church, they were examples from whom the less observant could learn. And this is why Angela of Folino could desire such a violent and painful death, why Julian of Norwich begged God to inflict such terrible illness on her, and why Catherine of Siena starved herself to death. These were not acts of insane individuals, but the outcome of the logical thought processes of pious minds.
 Grace Jantzen, Power, Gender and Christian Mysticism, p.216.
 George Szmukler & Digby Tantam, Anorexia Nervosa: Starvation Dependence, pp.303-310
 Bell, R, Holy Anorexia, pp.25-26
 Vandereycken & Lowenkopf, Anorexia Nervosa in 19th Century America, pp.531-35
 Michael Foucault, Sexuality and Solitude, p.43.