Anorexia in the Archives: Documenting the Late Twentieth Century Rise in Eating Disorders

Alice Weinreb, PhD will give the 15th annual James H. Cassedy Lecture in the History of Medicine  on Thursday, February 8, 2024 at 2:00 PM ET. This talk will be live-streamed globally, and archived, by NIH VideoCasting and live-streamed on the National Library of Medicine YouTube Channel. Dr. Weinreb is an Associate Professor of History at Loyola University Chicago. Circulating Now interviewed her about her research and upcoming talk.

Circulating Now: Please tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?

Alice Weinreb: I’m from Berkeley, California, and am currently an Associate Professor of History at Loyola University Chicago. My schedule is a typical academic mix of teaching, grading, and trying to squeeze in a few hours of work on my own research. One great change in my work rhythm recently has been the ways in which my new project involves a lot of student engagement and collaboration because so many young people are interested in learning more about eating disorders.

For example, I’ve been working with groups of student interns to produce a digital archival database on eating disorders—thus far we have over 1500 primary sources uploaded, including medical journals, teen magazines, student newspapers, and dissertations. These sources are an incredible way to trace the ways in which medical and popular culture responded to the rise in anorexia and bulimia during the last decades of the twentieth century.

Several students have already used this database to develop original research projects. It has been a big time commitment to manage so many interns and student projects, but it has been wonderfully productive (student ideas and work have changed my initial project in unexpected and exciting ways) and I love having my teaching and researching so intertwined.  These days I spend more time doing on-line research, writing emails, and setting up meetings than I used to, but this work feels productive and energizing.

CN: What initially sparked your interest in the History of Medicine?

AW: My first book used food as a way of thinking about the history of gender and the body.  Modern Hungers: Food, and Power in Twentieth Century Germany explored the ways in which hunger shaped relationships between German states and the German people during the World Wars and the Cold War. Although my focus was on state policy and everyday life, nutritionists were key intermediaries who shaped ideas about the healthy and desirable body in terms of hunger and obesity.

So, I have always been interested in the ways in which medicine defines and then grapples with health crises, but these stories were part of a larger social and cultural history. My new project does feel different because of the shift to psychiatry, and the emphasis on a specific set of medical diagnoses (anorexia nervosa, bulimia nervosa, compulsive overeating.)  What I’m still interested in, however, is the way in which medical discussions and discourse influenced and were influenced by the larger social, economic, and cultural sphere.

Eating disorders are especially interesting medical entities because they have long been understood by the medical establishment as both cultural and biological. When doctors grappled with the question of causality for anorexia, they came (and still come) back to questions of culture and society, especially the ways in which modern society negotiates categories of race, class and gender. Thus, clinical discussions of anorexia often include a discussion of advertising, second wave feminism, adolescent dieting culture, high fashion, and other cultural concerns rarely found in medical writings on other diagnoses.

CN: Your talk, “Anorexia in the Archives: Documenting the Late Twentieth Century Rise in Eating Disorders,” explores the rapid proliferation of eating disorders in the 1970s and 1980s. What impact did this epidemic have on medical practice?

AW: While anorexia nervosa was named and clinically described in the late nineteenth century, it remained an obscure and mysterious disease for decades. Diagnoses slowly increased in the 1950s and 1960s, but most doctors in the U.S. had still not heard of it, let alone treated it. By the 1980s, it had become, as psychiatrist and eating disorder specialist Hilde Bruch put it, the “hottest disease to have.” The International Journal of Eating Disorders was founded in 1981. Between 1975 and 1985, hospitals across the US, Europe, Asia, and in many other countries opened clinics and hospital wards specifically dedicated to treating eating disorders. Doctors played a key role in disseminating information about these new illnesses to the public, and they gave countless interviews on TV talk shows and documentaries and published essays that circulated in magazines and newspapers.

What I find especially interesting about eating disorders is that awareness of them grew almost simultaneously amongst the medical and lay communities. Psychiatrists believed that informing the public would ensure earlier diagnosis and thus earlier treatment, but they also believed that information might serve as a prophylactic, protecting against developing these potentially deadly diseases. Dr. Hilde Bruch, believed anorexia was rooted in a drive to be special or unique—and she thought that as the disease became better known and thus more ordinary it would become less appealing and thus fade away. As diagnosis rates continued to skyrocket, however, medical experts began to worry that communicating with the public about the disease was in fact causing it, by teaching people how to “do” anorexia and bulimia.

CN: In the National Library of Medicine (NLM) collection you examined materials related to medical education. What did these documents add to your understanding of the proliferation of eating disorders?

AW: The NLM collection has an incredible array of materials for me to work with, but some of the most exciting was related to medical education.  Some of the very first primary sources that I gathered for this project were psychiatric training films that NLM’s amazing Sarah Eilers (former manager of the Historical Audiovisuals Program) scanned for me during the Covid lockdown, mostly recordings of real or scripted therapy sessions of anorexic patients.  Previously, I had never thought about how psychiatrists learned how to do therapy, especially in the case of a new disease. The performative aspect of therapy fascinated me. And these videos drew attention to bodies, movement, and interpersonal interactions—exactly the aspects of therapy that cannot be conveyed in text and that were central to how doctors were taught about anorexia at the time.

These educational films also reflected the influence of second wave feminism on medical discourse. This is a still from an educational documentary about anorexia aimed at nurses, which included a feminist parody music video of a fictitious pop song “Dyin’ to be Thin.”

The NLM archives also hold materials for continuing education modules for doctors, including recorded lectures, pamphlets, and slides, that would circulate among hospitals, clinics, universities and practitioners looking to learn about new developments in the field. Such material is especially interesting in the case of new or obscure diseases like anorexia nervosa. Being able to access these materials, which literally taught doctors what anorexia nervosa was—what it looked like, how to diagnose and treat it—was fascinating. Such material allowed me to see how, medical students might hear about or see an anorexic patient for the first time.

For example, this was the opening slide from an OSU Continuing Education unit on anorexia. The young patient, a frail blond girl in a flowered nightgown facing away from the camera, was described as having checked in to the hospital on “Easter Sunday,” weighing only 45 pounds and too weak to swallow.  The 45-minute lecture concludes with an image of the same patient fully recovered, wearing an elaborate blue dress, facing the camera with a small smile on her face. The speaker concludes his talk by telling his audience of doctors that “…it is all worth it. She weighs 80 pounds, is happy, cheerful and is doing well.” Such images allowed me to think about the ways in which experts learned about a disease, by learning about the “typical patient.” In the case of anorexia, I’m especially interested in the way in which medical education constructed anorexia as a sickness that afflicted white middle-class Christian girls.

CN: The epidemic had wide ranging social and cultural ramifications. In researching this subject, were you drawn to any particular event or individual’s story?

AW: My first archival trip for this project was to the Texas Medical Center, to work with the personal archive of Hilde Bruch.  Dr. Bruch was the world’s leading specialist in anorexia nervosa during the 1970s and 1980s—the first psychiatrist who built her reputation on the disease. I knew her archive would be incredible—and it was—but I did not realize how interesting or how instructive her biography would be.

I was struck by how international her career and correspondence was. She was deliberate in crafting a network of specialists around the world who corresponded, attended conferences together, shared medical literature, criticized treatment trends, and gave advice to one another on difficult cases. The fact that medicine does not develop along national lines is perhaps obvious, but her archive forced me to conceptualize the “anorexia epidemic” as an Italian-German-British-Israeli-New Zealand-American-South African phenomenon right from the beginning of my research, and that was invaluable.

More specifically, like many important mid-century psychiatrists and psychoanalysts, Bruch was a Jewish refugee from Nazi Germany who lost most of her family to the Holocaust. Her  correspondence gave me some insight into the ways in which this biographic fact—rather than being simply a tragic fact about her life—was intertwined with her psychiatric work in multiple ways. To give just a few small examples: Dr. Bruch refused to participate in conferences alongside psychiatrists who had supported Hitler, and she believed that some of her work was not translated into German because she had dedicated a book to family members who had been “murdered by the Nazis.”

The Holocaust and Nazism also impacted the language that she used when discussing her patients. While describing an anorexic body as looking like someone from a concentration camp is a familiar metaphor today, her archive made clear that it originated in the writings of Jewish doctors like Bruch, who were themselves Holocaust survivors. For example, the first international congress on Anorexia Nervosa, hosted in Germany in 1965, included an essay by the Jewish doctor and Auschwitz survivor Leo Eitinger, who presented his research project on “Parallels between Concentration Camp Syndrome and chronic Anorexia Nervosa,” a connection that seems bizarre if not offensive today, but was perfectly reasonable at the time. This is another way of understanding how diseases are part of their historical context, in this case how the postwar rise of anorexia nervosa was part of a new post-Holocaust world as well.

Watch on YouTube

Alice Weinrebs’ presentation is part of our NLM History Talks, which promote awareness and use of the National Library of Medicine and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities. All talks are live-streamed globally, and subsequently archived, by NIH VideoCasting. Stay informed about the lecture series on Twitter at #NLMHistTalk.