Five hundred years of eating disorders 'reflect women's lack of power': Liz Hunt reports that anorexia and bulimia are not just creations of the 20th century but have roots in history

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THE Princess of Wales focused the country's attention once again last week on the medical condition known as 'eating disorders'. Sufferers, she said in her most vivid metaphor to date, felt they wanted to dissolve, to melt away 'like a Dispirin'. She made her speech in London to the first international conference on the condition. Anorexia nervosa and bulimia have never enjoyed such publicity, and the temptation is to conclude that they are a purely modern phenomena, if not a fad.

Not so. St Catherine of Siena, living in the 14th century, is believed to have been one of the earliest known sufferers. In the early 1800s, young Catholic girls in rural areas commonly emulated her. They deprived themselves of food to achieve a 'saint-like' state. Anorexia mirabilis - holy or miraculous anorexia - was an early label for what we now know as anorexia nervosa.

By the mid-19th century it had been urbanised, and was appearing in young, middle-class women. Then, as now, researchers believed that deliberate starvation was a means of internalising circumstances outside their control. The semi-invalid state of the poet Elizabeth Barrett Browning has been attributed to anorexia; her way of dealing with the suffocating attention of an over-zealous father.

It is a misconception that anorexia (in which there is a morbid fear of fatness and an abnormally low body weight) and bulimia (characterised by binge-eating with normal body weight maintained through vomiting and laxative abuse) are creations of the late 20th century, the products of an image-conscious society where thinness and youth are good and fat is bad.

In fact, anorexia - meaning 'want of appetite' - was described as early as the 16th century. The name appears in medical literature for the first time in 1874, in Transactions of the Clinical Society, by Sir William Withey Gull. He described a girl, aged 17, who had lost 33lbs; 'It appears to be an extreme instance of what I have proposed to call 'apepsia hysterica' or 'anorexia nervosa',' he wrote.

Bulimia dates from much earlier - as far back as 1400 - and was defined as 'immoderate and unmeasurable . . . as it were a hound's appetyte'. The word 'bolismus' derives from the Greek bous for ox, and limos for hunger. It gained medical acceptance only in 1978, when the Journal of the American Medical Association proposed bulimia nervosa as a disease entity.

Joan Jacobs Brumberg, professor of history at Cornell University, New York state, and author of Fasting Girls: the emergence of anorexia nervosa as a modern disease, says that a 'starvation addiction' has historically been used by women to express feelings - such as anger - which were unacceptable to society in a woman. She attributes the proliferation of eating disorders in the past 30 years to the dominance of a capitalist culture which has 'unfleshed women, robbing them of their appetite for food and sex'.

The incidence of eating disorders is rising throughout Europe and North America, Japan and the developing countries of south- east Asia; increasingly they are being diagnosed in immigrants to these countries too. At the conference in London last week, comparisons were drawn with the Aids epidemic.

The writer Susie Orbach, author of Fat is a Feminist Issue, said eating disorders were as devastating in their effect on women - the majority of sufferers - as the practice of foot-binding on Chinese girls, or female circumcision in African countries.

But is the problem real, or is it the result of academic and media hype? Each month more than 100 new academic papers are published on eating disorders, while the rise of the celebrity victim - the Princess of Wales is the prime example - guarantees a regular supply of column inches.

In The Beauty Myth, Naomi Wolf says that 150,000 women die in the United States each year as a result of anorexia. Studies have shown that eating disorders affect between 5 and 15 per cent of female students on American college campuses, and bulimia nervosa may affect as many as a third of undergraduates.

According to Hubert Lacey, professor of psychiatry and director of the bulimia clinic at St George's Hospital, London, these figures are exaggerated. On the back of such research, however, eating disorders have become a growth industry.

Therapists - qualified or not - are directing their services to this area, while self-help manuals and diet books top the best-seller lists. Some of what is offered is good, but much is bad and unmonitored. Professor Lacey believes the health service must get to grips with the problem. There are only specialist hospital centres in London, Leicester and Edinburgh and the demand for places cannot be met.

The Department of Health does not keep figures on eating disorders. The best data (from the Royal College of Psychiatrists in 1992) suggests that just under 1 per cent of women aged 15 to 25 have anorexia, while a further 13 per cent have a serious eating disorder. Those affected are predominantly white and middle- class, although doctors are more likely to diagnose the condition in these girls than in those from a lower social class. Bulimia exhibits no class distinction, and up to 3 per cent of women between 15 and 45 are sufferers.

The rise in new cases is real and not due to a fashionable trend, Professor Lacey said. It can be dated to the 1960s - the era of pre-pubescent models such as Twiggy and Jean Shrimpton. Women began eating less to keep their body weight abnormally low because thin was in. The voluptuousness of stars of the 1950s, such as Marilyn Monroe and Jayne Mansfield, was rejected.

Eating problems have shown subtle shifts during this time, Professor Lacey said. 'In the Seventies the number of women with bulimia, who binge-ate and vomited to stay thin, began to increase. Then, in the 1980s, we saw more women with bulimia who had normal weight. Now we are seeing the development of multi- compulsive bulimia - a significant number of bulimics who cut their bodies, abuse drugs and alcohol and are sexually disinhibited. We really don't know why the condition is progressing in this way.'

Many factors - psychological and environmental - are significant in the development of eating disorders. But experts believe an absence of control is at the root; the victims can control their bodies, if nothing else, in their lives.

Victorian women had little control over their lives or their bodies, and invalidism, which became popular in the mid-19th century when women took to their beds to nurture a suitable frailty, was a consequence, according to Kathryn Hughes, who is researching a book on the subject. But she points out that as women's rights became an issue, and women became more active, invalidism was 'translated into the disease entity 'hysteria' '.

Susie Orbach perceives eating disorders as the late 20th-century version of hysteria. 'After Freud's time we can look back and see hysteria as the disease entity which epitomised the particular location of 19th-century women,' she said. 'Eating problems are the psychosomatic expression of women's and girls' perceived dilemmas today.'

(Photograph omitted)