Academic journal article Health Sociology Review

The Quantification of Gender: Anorexia Nervosa and Femininity

Academic journal article Health Sociology Review

The Quantification of Gender: Anorexia Nervosa and Femininity

Article excerpt


This paper is part of a larger project of writing a genealogy of male anorexia nervosa (MAN), although the focus here is on anorexia nervosa (AN). Formulations of AN in the psy sciences1, which are analysed here, are seen as a contribution towards the construction of the modern self by revealing human subjectivity in certain ways with implications for how people should be governed and how they should govern themselves.

The 'discovery' and naming of AN will be briefly discussed and the differences between the initial clinical picture and that later developed by Hilde Bruch will be outlined. The feminist response to Bruch's approach will be outlined focusing on how they made the individualising and victim-blaming tendencies of the accepted clinical picture harder to maintain. The subsequent development of gender identity scales will be framed as a reaction by the psy sciences to the challenge from feminists and the anti-psychiatry movement. Gender identity scales, although initially developed in the 1930s, did not come into wide usage until the 1970s when they provided psychiatrists with a way of studying gender quantitatively and thereby seemingly sidestepping political considerations. The subjective, qualitative notion of gender thus came to be considered as an objective, quantitative phenomenon. When applied to AN gender identity scales accentuated an existing tendency towards perceiving femininity as causative of the condition. The seemingly objective data of the scales strengthened the relationship between femininity and AN and helped to position masculinity as a protective agent with femininity as a risk factor.


Anorexia nervosa was named and given an extensive clinical picture by William Gull in 1874. Gull was a physician and approached his conceptualisation in a manner appropriate for his profession; he observed the symptoms of emaciation and could not find any biological aetiology so deduced that it must be a mental disorder (Gull, 1894, pp. 310-311). In the early twentieth century AN was diagnosed rarely and attracted limited scientific or academic interest with Gull's conceptualisation remaining dominant until psychoanalysis grew in stature and it was reconfigured as a psychosomatic disorder. From around 1940 to 1960 the psychoanalytic model of AN reigned, this was built on the notion that it was the result of phantasies2 usually of oral impregnation (Lorand, 1941; Waller, Kaufman, & Deutsch, 1940). Psychoanalysts interpreted such phantasies in an oedipal manner and helped to produce a new relation between feminine sexuality and self-starvation while simultaneously making the clinical picture more complex and less standardised.

Hilde Bruch, probably the most influential writer on AN in the twentieth century, mourned the loss of clarity in the clinical picture of AN since psychoanalysis had taken hold (Bruch, 1962, p. 287). In order to regain some of the clarity of Gull's clinical picture Bruch proposed some persistent observable characteristics that occurred in AN patients, as behaviourists such as Watson (1913, 1970 [1924]) had been calling for since the early twentieth century. The move towards observable phenomena rather than the somewhat subjective and amorphous interpretation of psychoanalysis was gaining momentum across psychiatry in the 1960s (Horwitz, 2002) and would be codified into the 'Feighner criteria' in 1972 (Feighner et al., 1972) and subsequently institutionalised with the introduction of the DSM III in 1980 (American Psychiatric Association, 1980).

Specifically, Bruch reformulated the picture of AN as a relation between inside (psyche) and outside (society/culture) with the two in conflict. For Bruch, AN, and eating disorders in general, occurred in an individual who was 'deficient in his sense of separateness with diffuse ego boundaries, and will feel helpless under the influence of external forces' (Bruch, 1973, p. 56). Too much external influences was a theme latent in psychoanalytic accounts but was here reformulated from dependence on the family to dependence on social institutions and cultural products such as media texts. …

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