Throughout the subject Minds and Madness, we have had discussions of transient mental illness (meaning illnesses that appear during one period of history and then virtually disappear, such as 19th century fugue states). Interestingly, symptoms of mental diagnoses can also change over time. At least that is the logic underlying historian Edward Shorter’s concept of the symptom pool. The symptom pool is essentially a collection of symptoms (behaviors, thoughts and feelings) that people engage in/experience, in order to signal their distress to others (Shorter, 1987). These symptoms, according to Shorter, constitute cultural expressions of distress, not underlying organic illness. They are thus subject to historical change.
Shorter described early presentations of anorexia to illustrate his concept. Although Shorter suggests that self-starvation has been a part of the symptom pool since early religious fasting practices, he suggests that anorexics have historically shown different symptoms, such as simply losing your appetite (contrasted with the often hungry, modern anorexic). He cites the case of 19th century French woman who completely lost her appetite and simply stopped eating, putting her health as serious risk. Her physician prescribed eight sequential half-an-hour cold baths, upon which she apparently promptly recovered her appetite. Shorter believes this case, as well as many others, constituted presentations of anorexia with different symptoms from today’s anorexics, and that the woman’s rapid recovery was evidence that she was suffering from a psychological disorder, not an organic illness.
Today, loss of appetite is not part of the diagnosis of anorexia nervosa in the DSM. Rather, the manual focuses on the fat phobia (being terrified of gaining weight) and distortions in the perception of one’s body (commonly denying that one is getting dangerously skinny). Thus, it seems that the symptoms of anorexia have changed over time, although self-starvation has been a consistent expression of distress.
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Shorter, E. (1987). The First Great Increase in Anorexia Nervosa. Journal of Social History, 21(1), 69-96.
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