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Joan Jacobs Brumberg Lecture

Joan Jacobs Brumberg spoke at my school yesterday. The title of her lecture was "Anorexia Nervosa Past & Present: How a Disease and Concerns about Body Image Can Change Over Time". She is the author of "Fasting Girls: The History of Anorexia Nervosa" as well as "The Body Project". During her lecture, I took notes. Note that her perspective is more of a historical view or social commentary rather than medical. The notes might be a little disorganized but I thought it might interest some of you.



1965->1980
- shift from anorexia nervosa being an unknown disease to much-discussed disorder

Is AN a new disease?
-identified in 1870's in several places simultaneously
-two doctors credited with discovery - Gaul and Lasègue - patients who stopped eating for no biomedical reason, adolescent women who had stopped menstruating

1st reported death from AN: 5'4", 49 lbs

Gaul, English doctor
-before/after photos, prescribed food regimen, little discussion of psychology behind the cessation of eating
-treatment was nursing, food, heavy clothing
-believed physician should not pander to patient's unhappiness or parent's desire to not cause a scene, thought patient needed to be separated from parents
-inconsistent practice, seemed to have little understanding of disease

Lasègue, French doctor
-more interested in psychology of disorder
-interested in family dynamic, roots of family systems theory
-focused mainly on mother/daughter power struggle at the table

during 19th century, wasting diseases such as TB common - must find source of emaciation
-beginnings of differential diagnosis

AN described as "hysteria of the junior miss" or thought to come from the "perverse morbidity" of adolescent girls
---> treatment focused solely on weight gain

so if media influences didn't exist, why did AN?
-must analyze the Victorian emotional mindset
cultural setting:
- food gave girls a voice
- negative attitudes about food/eating for the middle/upper class
- symbolized sexuality, lack of self-restraint
- pure, ascetic lifestyle idealized
- slim body seen as symbol of distance from working class
- appetite becomes social/emotional instrument - is this even more true today?


AN remained rare and exotic disorder until 20th century
1932: first pictures in New England Journal of Medicine, treatments started to include psychology and minor hormonal treatments
1940's: more full-body shots
1960's: most physicians had rarely seen sufferers, only specialists had experience
1980's: many physicians have seen disease in person, more attention because of work of Hilda Bruch - "The Golden Cage" - focus on role of adolescent development, sexuality, and "me-too" anorexia
-#'s of those who are diagnosed increasing, symptomotology changing


Has the experience of having AN changed over time?
-shift in language of presentation
old: somatic response - no hunger felt
new: preoccupation with weight/fat, denial of having a problem

-addiction of ritualistic exercise, not true in 19th c.
- socially sanctioned in modern world?
- patients now more likely to be sicker, have more compromised health
- comparison of admission weights to Mayo Clinic - much lower in 1980 than in 1930
- more cultural tolerance for thinness?

-introduction of bulimia
- no historical evidence - WHY?
- little privacy to support b/p-ing (chamberpots as bathrooms)
- eating fixed in social setting



-emphasis on the slim body is very intense now, a shift from "good works" (19th c.) to "good looks"
-epidemic of self-scrutiny
WHY?
-invention of calorie
-introduction of personal scale, mirrors for commonpeople, modern bathroom, mass-produced clothing with standard sizing, diet plans, viewing overweight as a psychological problem
-weight built into marketing (cigarettes cause loss of appetite)
- triumph of celebrity/movie culture
-increasing body exposure of fashion
-focus on specific body parts (tone your abs/butt!)
-cosmetic surgery - 465% increase from 1997 - 2006
-marriage of health and body imperatives


what does AN do for sufferer?
-provides sense of identity - pro-ana movement, ana psalm

recent changes in demographics?
-not just white upper-class girls, now spreads among ethic/class groups
-connection of ED's with globalization
-growing age range - young children and adult-onset anorexia
-more men with ED's


does information make ED's catchy?
-studies have shown people more likely to develop ED if they know a sufferer personally
-must consider if information does more harm than good
ex: is Thin or Wasted an example of a how-to?





sorry that wasn't more organized but i hope at least some of you found it interesting. I wish I could get her powerpoint, she had some really stunning visuals. Very good lecture, very intelligent woman.
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