Men and Anorexia

To the Editors:

In his January 30, 1986 review of Holy Anorexia (University of Chicago Press, 1985), Norman Cohn expresses serious reservations about its analysis of male authority and female self-assertion in the etiology of anorexia, both the “holy” and “nervosa” varieties. The inaccuracies and flawed logic of his demurral justify some response.

Had he followed the usual route of checking Index Medicus, instead of reporting only the personal experience of one émigrée informant, Professor Cohn might have told readers that anorexia nervosa is known and written about in the Soviet Union, although it lags far behind the West in this area. Had he given due attention to the recent work of Caroline Walker Bynum, Arnold Esch, Sofia Boesch Gajano, Michael Goodich, Richard Kieckhefer, Anna Benvenuti Papi, André Vauchez, and Donald Weinstein, he might not have asserted that “in almost every respect, medieval men and women in pursuit of holiness followed identical courses.” These scholars’ findings show profound gender differences in religious behavior, as well as in popular and official church responses to that behavior. Even Pope John Paul II agrees. Only males may be priests and control the eternal miracle of transubstantiation. It is the men who preach, command, condemn, and grant pardon; holy women express themselves primarily through the medium of probing confessors and must watch out lest they be charged as heretics by male prelates.

Along with its inaccuracies, Cohn’s review contains some curious reasoning. According to the logic of his Soviet Union foray, one would have to conclude that the greater frequency of women’s protest and assertion movements in the United States means that these activities have nothing to do with equality of opportunity, since self-evidently females are better off here than there. With regard to medieval holy women, even if one were to take the extreme position that their spiritual experiences—mystical ecstasy, stigmata, exchange of hearts—were purely gender-neutral gifts from God, would it not be worthwhile to explore how men and women responded to these gifts?

Obviously anorexia is but one aspect of a complex pattern of medieval asceticism, and the review itself leaves no doubt that Holy Anorexia does treat the wider milieu, but whether deaths of self-starvation are “such tiny events in the vast panorama of medieval self-torture” is hardly the issue. Professor Cohn closes with thoughts of “physiological differences between the sexes” and “the role of fashion” as alternative explanations of what I present. Holy anorexia certainly is not the only way to understand these women, and perhaps it is not even the “best” way. Caroline Bynum’s work, for example, published and in progress, usefully sets compulsive fasting and veneration of the host in a cultural context involving more than anorexia alone. From the perspective of a study in historical psychology, however, I hope readers will find much to ponder in my suggestions concerning female self-assertion and male patriarchy.

Rudolph M. Bell

Rutgers, The State University

New Brunswick, New Jersey

Norman Cohn replies:

I have read Professor Bell’s letter with amazement. In my review I said of the material offered in Holy Anorexia that it was “fascinating, and most skillfully presented”; and of one of his two interpretations I said that it was “wholly convincing.” As for his other interpretation, the misgivings I felt (and still feel) were expressed in as serious and considered a manner as I could command. When one of my own books receives a comparably responsible review I am always agreeably surprised. Certainly it would never occur to me to make a public protest about such a review—let alone one as discourteous as Professor Bell’s letter.

I feel some embarrassment about replying—especially as you have already published one letter from me [NYR, March 27], in which I tried to explain, for the benefit of a distressed reader, why Professor Bell had treated Catherine of Siena as he did. But as anorexia and its etiology are, rightly, matters of widespread interest and concern, I hope I shall not be abusing your hospitality or overtaxing the patience of your readers if I offer some further comments.

To start with the contemporary world: I know of no evidence suggesting that the incidence of primary anorexia is greater in strongly patriarchal societies than in societies that are less patriarchal. My reason for comparing the Soviet Union with the West is simply that as an Englishman who has lived for many years in various other Western countries, including the United States, and who has also been intimately involved with life in the Soviet Union for almost half a century, I feel qualified to make the comparison. In the mass of the Soviet population (I am not thinking of the small political and intellectual elites) women are in practice far more severely disadvantaged as compared with men than they are in the United States or Britain or France. Professor Bell doubts whether that can be the case, for if it were, women would surely organize protest movements. Well, women and men in the Soviet Union are equal in one respect: they are equally keen not to go to jail.

As for anorexia in the Soviet Union—I never said there is none at all. My point was that if anorexia were really a byproduct of male dominance, there should be more of it in the Soviet Union than in the West—and very much more than in the privileged social strata in the West. But the opposite is the case. This is amply confirmed by the very work that Professor Bell cites, the Cumulative Index Medicus. Of the 160 or so works on anorexia listed in the 1984 issue, the Soviet Union, with its vast population, is responsible for just two. Even France produced ten times as many, while the figure for the English-speaking world is around 120. All this fits perfectly with the result of my personal inquiry. If, as I pointed out, a highly qualified and widely experienced psychiatrist, in the course of thirteen years’ practice in the Soviet Union and seven years’ practice in England, met with not a single case of anorexia there and has met with several here, that is surely a most significant fact, and deserving of less dismissive treatment than Professor Bell accords it.

Specialists are by no means unanimous about the etiology of anorexia, and even less so about the causes of its ever-increasing incidence in the West. It is widely agreed that the availability of abundant food on the one hand, and the commercially fostered cult of slimness on the other, are major factors. The relationship between anorexia and patriarchy is less generally accepted. On the strength of my own reading and observation I am inclined to think that there is indeed such a relationship, but that it is an indirect and negative one. With the decline of male dominance during the present century, and particularly during the last twenty years or so, more and more adolescent girls have found themselves confronted with prospects and opportunities almost unknown to girls in earlier times. But along with the prospects and opportunities goes the need to make choices, accept responsibilities, “succeed.” Most girls possess adequate emotional resources to cope with these problems—but of those who find the strain too great, some may well turn to anorexia as a way of remaining childlike and therefore exempt from the burden of adulthood. And it is only natural that these problems, and this solution, should be most frequently found among the relatively prosperous and privileged.

The etiology of “holy anorexia” in medieval Europe will presumably be of less interest to your readers, so I shall confine myself to clarifying the major point of disagreement between Professor Bell and myself. If does not lie where he says it does. As a trained historian, he really should know better than to base an argument on a single sentence taken out of context: when I wrote that medieval men and women in pursuit of holiness followed much the same course I was obviously referring to the feats of asceticism described in the preceding sentences. It is no news to me that women could not be priests, or that female mysticism differed in some respects from male mysticism, or that outstandingly devout women were even more liable to be accused of heresy than were their male counterparts; indeed, my thirty-year-old book The Pursuit of the Millennium has quite a lot to say about these matters. But that is not the issue here.

My misgivings in the present context are about one specific hypothesis. When one finds both men and women depriving themselves of sleep, wearing hair shirts, beating themselves bloody, and going very short of food, is one really justified in detecting a female protest against male dominance in the fact that women rather then men sometimes actually managed to starve themselves to death? Professor Bell has no doubts about it. To me the evidence seems insufficient.