The Golden Cage: The Enigma of Anorexia Nervosa
The Best Little Girl in the World
They float in slow motion, the young girls, across fields of spring flowers, advertising hair spray and deodorants. Girlhood means white muslin and lace, innocence and purity; jeunes filles en fleur, milkmaids in sprigged cotton from Laura Ashley, dreaming. Here is one of their dreams:
On my way from the convent, I stopped outside the hospital. A woman who had just given birth was being lifted off a stretcher. I was horrified by her swollen and distended stomach. I heard them say that she had been brought to the hospital because her belly was still full of urine.
Virginity (female virginity, a boy cannot really be a virgin) has almost everywhere been revered: an emblem of uncorruptedness, unfleshliness, as mythical as the unicorn who can only be tamed by a virgin, and yet powerfully moving. The myth has been briskly and only recently destroyed. But it survives, in demonically twisted form, in one place: among girls who themselves reject corruption, fleshliness, sexuality, who sacrifice health and sometimes their lives to a terrified passion for purity—the starving girls, trapped somewhere between the convent and the hospital, dreaming nightmares about the horrors of swollen, dirty, female flesh.
Though anorexia is a modern illness (all these books are short on statistics, but Hilde Bruch quotes a recent assessment of one case per 200 girls, in an English middle-class environment), it has a history. Descriptions of something resembling it come from as far back as the seventeenth century, but the most recognizable accounts date from the late nineteenth century. Lasègue, in Paris in 1873, published a paper “On hysterical anorexia.” His description is classic:
After a few months, the patient finally arrives at a state that can rightly be called one of hysterical anorexia. The family is in a turmoil. Persuasion and threats only produce greater obstinacy. The patient’s mental horizon and interests keep shrinking, and hypochondriacal ideas or delusions often intervene. The physician has lost his authority; medicaments have no effects, except for laxatives, which counteract the constipation. The patients claim that they have never felt better; they complain of nothing, do not realize that they are ill and have no wish to be cured. This description would, however, be incomplete without reference to their home life. Both the patient and her family form a tightly knit whole, and we obtain a false picture of the disease if we limit our observations to the patients alone.
A year later William Gull in London described the syndrome in similar terms. This was the great age of the hysterias, and much subsequent discussion centered around the relative role of hysteria, neurasthenia, or insanity; but it was not doubted that anorexia was a mental rather than a physical illness. Freud’s definition was “melancholia of the sexually immature”; later psychoanalytical work has probed into its origins. Pierre Janet, one of the neglected giants of nineteenth-century psychiatry, gave an acute description of an anorexic patient, “Nadia,” describing her illness in terms of a horror of …