False Neutrality and Anorexia Mirabilis

In the wake of New York’s legalization of gay marriage (Excelsior!) and the Pride marches happening around the country, I thought it might be a good time to take a look at the article in last week’s New York Times Magazine about therapists who help gay Christians stay in the closet. Here’s how one therapist approached the problem:

“Throckmorton’s approach was, first of all, not to argue. “If we try to subtly or directly advocate for our personal loyalties, then we’ve stopped doing the kind of therapy that we advocate,” he said. Rather than challenge Rob’s desire to marry a woman, as other therapists might have done, Throckmorton felt the important thing was to help him accept that his thoughts were his own. Rob’s language was, to Throckmorton, “a kind of religious imagery,” and he noted that religious clients with eating disorders use the same words. Throckmorton didn’t engage in a discourse about good and evil but simply said “this sounds like something that feels really out of control to you, something you haven’t been able to manage.”

I thought it was interesting that Throckmorton mentioned the eating disorders parallel. In an epidemics seminar in college, one of our course books was Fasting Girls: The History of Anorexia Nervosa, which is where I learned about the popularity of extreme fasting among some female saints and devout nuns during the Middle Ages. The phenomenon is known as anorexia mirabilis which translates as miraculous lack of appetite.

Despite the name, there was nothing miraculous about the prognosis of these girls. One model was St. Catherine of Siena, who ate only the Eucharist and a small portion of herbs each day and pushed a stick down her throat to induce vomiting if she ate anything else. The consecrated sisters who imitated her starved to death.

Religiously-tinged anorexia inverts the problem of suppression of homosexuality due to religious convictions. Homosexuality is now accepted by the medical community as a ordinary part of human experience; it is a cause for concern only insofar as the patient sees it as disordered through his religious framework. In contrast, anorexia is widely accepted as a serious pathology, but religious convictions may cause a patient to see it as a special vocation, an essential part of her identity.

Ultimately, I don’t buy the therapist’s contention that he can or should keep his personal loyalties out of his work. I doubt that when religious patients come to him content with their anorexia he only focuses on making sure they feel like they are in charge of their fasting. The value judgment Throckmorton has made is that repressing homosexuality is below some tolerable level of harm or risk. He can defend that judgment but he can’t divorce himself from the fact that he has made it. There’s no magical objective assessment of harm and distress in the DSM.

That’s my problem with Throckmorton, but this article also left me wanting to ask a question of some Christian commenters: How do you think the medical profession and/or the family and friends of patients should respond to anorexia mirabilis?

It has a place in the historic tradition of the Catholic Church and it was used as evidence for the holiness of some saints, so when, if ever, would you let a daughter or sister’s private revelation trump your own experience of anorexia as disease? Did Christians acquire a duty to try to quash this kind of devotion once they learned more about anorexia nervosa? Is there a frightening Pascal’s Wager for Christians that implies you shouldn’t interfere with someone’s chosen martyrhood because a life is a small thing to weigh against salvation?

About Leah Libresco

Leah Anthony Libresco graduated from Yale in 2011. She works as an Editorial Assistant at The American Conservative by day, and by night writes for Patheos about theology, philosophy, and math at www.patheos.com/blogs/unequallyyoked. She was received into the Catholic Church in November 2012."

  • http://www.blogger.com/profile/18351198791720067176 Jess

    My homoqueerness aside, I don't think I would die if I didn't get some lady-love. Just sayin'.The lesson I drew from that article is that creating a dichotomy between being pious (in the orthodox sense, which is the only way most orthodox religious people can conceive of piety) and being a homogay forces people to make choices that are really harmful to their psyches. I think the best therapy empowers people to realize that they can't just completely reject one aspect of their identity, and empowers them to choose how they want to live with those identities.Of course, I also think that it's the job of homoqueers & allies within traditional church contexts to try to end the homophobia there. That's the more important issue to me.

  • KL

    As a recovered severe anorexic (though not the mirabilis variety!), I can personally attest to the fact that most anorexics are not thinking in terms of religious devotion when it comes to their compulsions. However, it's quite possible that a person at risk of developing an ED or already in the throes of one may seize upon religious fervor as a framework upon which to superimpose their illness, if that makes sense. On the other hand, I also believe that anorexia mirabilis has the potential to be a legitimate grace.Ultimately, someone who aspires to anorexia mirabilis should proceed in the same way as someone desiring to undertake any other form of extreme penance or ascetism: under the close supervision and guidance of an experienced spiritual director, with psychological and medical monitoring as appropriate. I recognize that this would pose problems for, to use your example, St. Catherine of Siena, who was told by her confessor to eat normally (she insisted she was unable to do so). In similar cases I think careful and thorough psychological analysis should shed some light on the motivations behind the behavior in question.It's not always easy to separate pathology from honest but extreme religious convictions. We ought to use the tools available to us in the 21st century, including modern psychology and medical knowledge, to do our best to determine which we are dealing with on a case-by-case basis. In the situation you describe above, a therapist ought to make a good-faith effort to determine the source of her patient's beliefs and behaviors and treat appropriately. If there is no (or limited) evidence of pathological anorexia nervosa, and the patient is medically stable, then their choices should be respected, however odd they appear to the observer.Is there a frightening Pascal’s Wager for Christians that implies you shouldn’t interfere with someone’s chosen martyrhood because a life is a small thing to weigh against salvation?Small side note — martyrhood, via violence or penance, is never a requirement of salvation. It may be morally praiseworthy, but never necessary. If St. Catherine had obeyed her confessor she would not have jeopardized her sainthood in the least, and in fact could probably be commended for obedience. So a Christian need never be concerned about causing someone to "lose their salvation" by insisting that they care for their physical well-being.

  • http://www.whyimcatholic.com Steven Lawson

    Hey Leah I know this may not be the place but I couldn't find an email so here it goes. I'm a young adult (23) who reads your blog from time to time and finds a lot of what you write relatable and interesting. I also run a website called http://www.whyimcatholic.com which I started after reverting to Catholicism from agnosticism. I've been listening to this series from Fr. Thomas Dubay on St. John of the Cross and it made me think of you. I encourage you give it a listen and let me know what you think. It isn't really about apologetics or miracles or anything just about the man and his teachings on prayer. Fr. Dubay is kind of dry and nerdy but in the best way possible. Feel free to email me if you have any questions or feedback stevenvlawson@gmail.comhttp://www.ewtn.com/vondemand/audio/seriessearchprog.asp?seriesID=6023Sorry for the graffiti on your comment wall.-Steve

  • http://www.fleshbot.com Kogo

    *How do you think the medical profession and/or the family and friends of patients should respond to anorexia mirabilis?*With complete incredulity: The person is clearly eating secretly, otherwise they would die. This isn't medicine, it's physics.

    • kjsdhfg

      Are you stupid? Starvation doesn’t mean instant death. I’m sorry, but if you’re going to be ignorant and condescending, expect the same.

  • http://www.fleshbot.com Kogo

    *It's not always easy to separate pathology from honest but extreme religious convictions.*As atheist, I agree completely.

  • http://www.noforbiddenquestions.com/ NFQ

    Nice post, Leah. It's particularly interesting to me that throughout history, any sort of exceptional behavior has tended to be attributed to supernatural causes. I'm sort of amazed that these saints and nuns were revered for their anorexia rather than denounced as being demon-possessed, but there's really not that much difference in the thought processes.

    • ciao

      These women usually lived around 1200/1300, before Inquisition and Witch hunts. In those days they were not saw with suspicion but with respect and awe by laics and clergy, they also attribuited them some kind of miracles. In 1500 and after a woman fasting and eating blood and pus from the sicks and talking about visions of the holy land was probably put on the stake. The things after 1300/1400 changed drammatically,if before these women lived like hermits and were respected for living only for and with jesus, at the beginning of Renaissance the clergy prefer to consider them for the things they did for the poor and sick not for the lives they lived.

  • KL

    @NFQJust as an aside: There are a number of signs that are recognized as evidence of demonic possession in the Church, and the patterns of behavior associated with it could not easily be mistaken for the patterns associated with anorexia mirabilis and other forms of asceticism. As a brief example, one of the classic hallmarks of demon possession is aversion to sacramentals (holy objects and materials, e.g. holy water and crucifixes — hence their appearance in Hollywood exorcist movies) and especially the Eucharist. It would be totally contrary to demon possession, especially in extreme cases, to consent to receive the Eucharist at all, much less subsist solely upon it. Since the holy fasters in question were deeply devout, with continued discipline and faithfulness in prayer and observance, demonic possession would be an unlikely culprit.

  • http://www.daylightatheism.org/ Ebonmuse

    "Anorexia mirabilis"? Girls were starving themselves to death? And the Catholic church accepted this as a potential sign of sainthood? And some Catholics still accept this as a potential sign of sainthood?I can't… I don't even… Wow. Just wow. I honestly didn't think the church could have more things in its history that would make me shudder in revulsion, but there it is.

  • Michael Haycock

    The LDS missionary handbook includes an interesting rule that prohibits missionaries from fasting for over 24 hours, in part to combat the idea that self-starvation and piety are directly proportional.

  • dbp

    Ebonmuse:Asceticism definitely has a place in the Church, just as it has in other religious (and non-religious) societies. By and large, the effect of the Church has been simply to direct the zeal of the believer and, where necessary, to temper it.Even rigorously ascetic policies (like the Benedictine Code, see here) have always had exceptions for the health of individuals, as well as they understood them. And in many cases the effect of the Church was to check overzealousness when nothing else would.Chesterton writes of asceticism in the middle ages:In truth, this vividly illuminates the provincial stupidity of those who object to what they call "creeds and dogmas." It was precisely the creed and dogma that saved the sanity of the world. These people generally propose an alternative religion of intuition and feeling. If, in the really Dark Ages, there had been a religion of feeling, it would have been a religion of black and suicidal feeling. It was the rigid creed that resisted the rush of suicidal feeling. The critics of asceticism are probably right in supposing that many a Western hermit did feel rather like an Eastern fakir. But he could not really think like an Eastern fakir; because he was an orthodox Catholic. And what kept his thought in touch with healthier and more humanistic thought was simply and solely the Dogma. He could not deny that a good God had created the normal and natural world; he could not say that the devil had made the world; because he was not a Manichee. A thousand enthusiasts for celibacy, in the day of the great rush to the desert or the cloister, might have called marriage a sin, if they had only considered their individual ideals, in the modern manner, and their own immediate feelings about marriage. Fortunately, they had to accept the Authority of the Church, which had definitely said that marriage was not a sin. A modern emotional religion might at any moment have turned Catholicism into Manichaeism. But when Religion would have maddened men, Theology kept them sane.That's not to say that people didn't do crazy or ill-advised things or take unhealthy attitudes. However, many of those have their sources in crazy, ill-advised, or unhealthy elements already present in the culture at large.

  • KL

    @EbonmuseA few points: The term "anorexia" has a lot of connotations today, given our understanding of anorexia nervosa. But the word "anorexia" simply means, literally, "lack of appetite." Although I'm sure some of the women who demonstrated anorexia mirabilis had psychological issues, I think that the word anorexia attaches pathological overtones to the term right off the bat, which may or may not be justified. As someone who barely survived anorexia nervosa herself, please be assured that I take eating disorders extraordinarily seriously and am in no way trying to downplay the danger of disordered eating and deliberate self-starvation.That said, the cultural milieu of a 13th-century Italian nun is wildly different from that of a 21st century American teenager, and we cannot project our own experiences upon the former. While most 21st century ED sufferers are reacting in some way to extraordinary pressure to conform to a strict ideal of beauty and femininity, the medieval fasting girls were aspiring to spiritual discipline and holiness (which was itself a cultural value at the time, I will grant). Asceticism, in the forms of solitude, silence, fasting, and physical deprivation, have a history dating back to the earliest centuries of Christianity and is not restricted to women. In fact, fasting was probably one of the few ways that women could practice asceticism, since they were unlikely to receive ecclesial permission to, say, spend months in solitude in the desert or wilderness, as many monks did. Medieval men and women engaged in many, many forms of what we would today consider extreme forms of asceticism (hair shirts, sleeping on floors, sleep deprivation, vows of silence, extended periods of fasting, etc.), but today we react particularly strongly to female fasting precisely because of our awareness of modern anorexia nervosa, which is a different creature altogether.

  • http://www.daylightatheism.org/ Ebonmuse

    While most 21st century ED sufferers are reacting in some way to extraordinary pressure to conform to a strict ideal of beauty and femininity, the medieval fasting girls were aspiring to spiritual discipline and holiness…I suggest that those two compulsions are a lot more similar than you think. Both of them involve an overriding desire to subordinate the body in the pursuit of an allegedly higher goal. And, of course, psychological illnesses adapt to the cultural milieu in which they exist, which is why sleep paralysis sufferers in the Middle Ages thought they were being attacked by succubi and incubi, while sleep paralysis sufferers today often attribute their symptoms to alien abduction.…today we react particularly strongly to female fasting precisely because of our awareness of modern anorexia nervosa, which is a different creature altogether.Well, that's very much the point at issue, isn't it? Are you saying that if two people had exactly the same symptoms and behaviors, one could be diagnosed as having anorexia and one wouldn't, based only on their self-reported reasons for that behavior?

  • http://www.blogger.com/profile/07095873709252976052 Dominick Lawton

    If you're enough of a determined ascetic to take up anorexia for God, surely you've also ceased to care much about whether the medical profession at large is on your side? Isn't extreme asceticism, or martyrdom, supposed to involve a certain degree of struggle against wordly waywardness?

  • KL

    @EbonmuseI see your point, but mine is that context is everything, and we simply can't make psychological diagnoses at the distance of centuries because we don't know the full story.For instance, say you hear that a woman you know doesn't have a social life anymore because she spends five hours every day scrubbing down and disinfecting every surface in her house. You'd (rightly) suspect that she may be suffering from severe OCD. But then you find out that her son just got home from the hospital after an organ transplant and is on extremely powerful immunosuppressants. Suddenly her behavior doesn't look pathological anymore (even though it might be a little overenthusiastic), despite the fact that it's the exact same behavior in both cases.Are you saying that if two people had exactly the same symptoms and behaviors, one could be diagnosed as having anorexia and one wouldn't, based only on their self-reported reasons for that behavior?Diagnosing psychological illness is extraordinarily complicated, and as we see above, identical behaviors can have very different mindsets behind them. No, I don't think it would be enough to diagnose one person with anorexia and one without based only on their self-reported reasons. But since that's all we have, I don't think it would be accurate to make any diagnosis at all in the absence of other information. We can be concerned about the behavior, and note its external similarity to modern anorexia nervosa, but we can't say with any certainty that these girls were experiencing the same thing.

  • http://www.fleshbot.com Kogo

    *We can be concerned about the behavior, and note its external similarity to modern anorexia nervosa, but we can't say with any certainty that these girls were experiencing the same thing. *Of course we can: As is becoming increasingly clear, mental illnesses are largely neurological.


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