I highly recommend Joan Jacobs Brumberg's book Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease. Thousands of women in the United States die each year by starving themselves to death to meet dominant cultural beauty ideals: thin is beautiful; fat is ugly. This book is valuable because it traces the origins of anorexia from the second half of the 19th century to the 1980s, and compares the disease with women's religious fasting during the European Middle Ages. This review will focus on the historical methodology Brumberg employs.

Anorexia is found mainly among upper middle-class women in the United States, Western Europe and Japan. It is uncommon in the Third World except among elite women educated in the United States or Europe. In the United States, it is rarely found among working-class white women, and almost never among Black women.(1)

Brumberg makes a number of observations concerning historical methodology that every reader ought to memorize because they are so important to critical social analysis. Some writers have made glib comparisons between religious fasting by women and anorexia today; these commentators have claimed that such behavior has a biological basis in "women's nature." Brumberg writes: "Just because a behavior occurs across cultures or times does not necessarily mean that it has the same cause or that it is biologically based."(2) She then explains: "The story of anorexia nervosa lays bare the extent to which disease is a cultural artifact, defined and redefined over time, and therefore illustrative of fundamental historical transformations. Consequently, my response to the frequent question, is anorexia nervosa a new disease must be somewhat ambiguous: anorexia nervosa is a historically specific disease that emerged from the distinctive economic and social environment of the late nineteenth century."(3) Brumberg shows that anorexia is not the same disease that it was 100 years ago because society has changed. "[T]here are significant new behavioral symptoms that mirror contemporary culture namely, pervasive hyperactivity and competitiveness. Among affluent young Victorians food and eating were at the center of a web of associations that had a great deal to do with gender and class identity. The same is true today, but broad social and cultural forces, particularly the intensification of messages about the female body, have prompted the urgency of appetite control and generated a new experience of the disease in the twentieth century. Anorexia nervosa used to be an isolated and idiosyncratic disorder; over the past few decades it has become both more familiar and more formulaic, and its physical symptoms are now more acute."(4) Brumberg quotes Charles E. Rosenberg in a pioneering study of cholera in the nineteenth century: "A disease is no absolute physical entity but a complex intellectual construction, an amalgam of biological state and social definition."(5)

There are three major explanations of anorexia: (1) biomedical; (2) psychological and (3) and socio-economic (what Brumberg calls the cultural model). Brumberg clearly emphasizes the socio-economic or cultural model. The only criticism I have of Brumberg is that she does not clearly explain the dialectical relationship between culture and economic institutions; although in practice she does emphasize the relationship between anorexia and class/gender social relations in a capitalist economy. Brumberg does an excellent job of tearing apart biomedical explanations of anorexia. Some doctors have linked anorexia to imbalances in hormones that occur mainly among women.(6) Brumberg agrees that women who are anorexic may well have hormonal imbalances, but she demonstrates that these biomedical indicators are the effect of anorexia rather than the cause. It is hard to argue that anorexia is primarily caused by genes or hormones when only upper class women in the United States, Europe and Japan get the disease. No one has seriously suggested that working class white women in the United States have different hormones than upper middle class women; although some bourgeois scientists probably would put forward genetic explanations for why Black women rarely contract the disease.(7)

Brumberg demolishes psychological categories of anorexia: "The psychological paradigm is incomplete, just as the biomedical model is, in that it fails to provide an adequate answer to the same thorny problems of social address, changing incidence, and gender. After reading the psychological literature, one still asks: Why is the anorexia nervosa "epidemic" restricted by class and confined to societies like our own? Why are we experiencing more anorexia nervosa today than we did fifty or one hundred years ago? Why is it that adolescent girls and not adolescent boys engage in this form of development struggle?"(8)

Brumberg shows anorexia has changed over the last 100 years as class/gender structures have changed in response to socio-economic developments in United States, English and French capitalist societies, although the main focus since 1900 is on the United States. During the second half of the 19th century prosperous middle class families could afford to keep their female children out of the labor force. Young women stayed at home until they married, typically in their early 20s.(9) What we now call adolescence was created by the burgeoning prosperity of middle-class families during the late 19th century. Before this time women married younger and all but members of the higher aristocracy performed at least some domestic work. Obviously, working-class women started laboring at a very early age. Middle-class adolescent women were privileged in one sense because they did not have to work or yet reproduce, but they were highly dependent and controlled by their parents unlike their brothers, who had far greater educational and employment opportunities. Starvation was one socially acceptable way for middle class young women to rebel against parental control.(10) To some extent Victorian women fasted to meet cultural values about beauty, but those social pressures were weaker then than they are today.(11) Ideal female body size in Victorian culture was larger than today and women were required to wear such bulky clothing it was more difficult to tell whether a woman was thin or not.(11)

Brumberg provides information on how Amerikan popular culture since 1900 has put pressure on women to be very thin. The ideal female body size as presented by mass media has become much slimmer than it was in 1920. Thin movie and television stars have become models for many young women.

Brumberg goes beyond mere generalities about cultural ideals in the mass media. She points out that food today is usually loaded with sugar and fat. Just go eat a Big Mac at McDonald's. Fast food and prepared food are loaded with calories.(12) People have the choice of getting fat or constantly dieting to stay thin. Dieting itself is big business with all kinds of pills and dietary supplements offered to help people lose weight. Some of the emphasis on changing diet and increasing exercise is positive, but all the media hype about getting in shape can lead at least some people into dangerous diets.

Brumberg makes a valuable point about the competitive aspect of modern anorexia in the 1980s. Women are entering the labor force in record numbers today; although on average they earn far less than men. Women today are educated in competitive behavior to get ahead in the business world, this is especially true among upper middle-class women. It is not surprising that competitive values spill over into dieting and beauty. Distorted capitalist values about individualism and competition contribute to anorexia.

Beware of bourgeois genetic, hormonal or psychological explanations for behavior that is really socio-economic in origin.

Notes:
1. Joan Jacobs Brumberg, Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease, Cambridge: Harvard University Press, 1988, p. 280 n. 14.
2. Ibid., p. 2.
3. Ibid., p. 3.
4. Ibid., pp. 5-6.
5. Ibid., pp. 6-7.
6. Ibid., p. 25.
7. Ibid., pp. 25-8.
8. Ibid., p. 31.
9. Ibid., p. 126.
10. Ibid., p. 188.
11. Ibid., pp. 188, 254.
12. Ibid., p. 260.

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