Louis Charland: Anorexia Nervosa as a Passion
Hector Warnes’ Comments
The author should be congratulated for the excellent summary of the relevant clinical features of Anorexia Nervosa and for citing Théodule-Armand Ribotwho wrote: Essai sur les Passions, apparently the inspiration for their original Power Point presentation (Ribot 1907). Ribot gives examples of Passion in long-term states of jealousy, guilt, ambition, drunkenness (I would say alcohol addiction) and collecting (I would say hoarding). Passion is acomplex state of long duration which, based on Ribot’s definition, is: “an affective syndrome centred on a fixedidea that directs and organizes a person’s life in the pursuit of a goal… It primes the individual for specific feelings and emotional responses as they engage in those ideas.” Further, the authors rightly pointed out that the illness “is so consuming that you can’t see past it, it is everything you can think about all the time.” There is a relentless pursuit of thinness and a distortion of the body image by some which, in spite of even cachexic appearance, results in their feeling “like a fat blubbery, nasty lard bag.”
The classic book on the subject, “The enigma of Anorexia Nervosa,” was written by Hilde Bruch and after 20 years was reprinted by Harvard University Press in May 2001 (Bruch 2001). Hilde Bruch emphasizes the perceptual deficit, the disturbance in the body image to the point of repulsion “of delusional proportions,” the self-denial (even of hungerpangs), the lack of recognition of bodily states, poor awareness of feelings and an all-pervading sense of ineffectiveness. In one of her original publications, “Perceptual and conceptual disturbances in anorexia nervosa”, she does not refer to affective disorders except to depressive and obsessive trends (Bruch 1962).
On the opposite side, recent research found not passion but alexithymia,lack of emotional empathy and an absence of self-regulation of affectiv estates. They studied 26 patients and compared them with normal controls. They use drating scales during the self-starvation and during weight restoration phases. The scales used were the Yale-Brown-Cornell Eating Disorder Scale (which also measures obsessions and compulsions, both the Hamilton rating scales for depression and anxiety, Twenty-Item Toronto Alexithymia Scale (TAS-20), which measures the patient’s ability to identify feelings, to describe them and the external and concrete orientation of the cognitive trends. Additionally, they used a scale to measure the degree of empathy: Interpersonal Reactivity Index (IRI). They found a high level of alexithymia and lack ofemotional empathy during the self-starvation phase and after weight restoration (Beadle, Paradiso, Salerno and McCormick 2013).
French Psychiatry has brought into focus the study of “passions,” even to the point that we are aware of the Délires passionnels (erotomanie, jalousie) and the Délires de revendication (idéal istespassionnés, inventeurs, etc). I would like to quote Lewis Carrol (Through the Looking Glass): “When I use a word, Humpty Dumpty said in rather scornful tone, it means just what I choose it to mean- neither more nor less…The question is, said Alice, whether you can make words mean so many different things…the question is, said Humpty Dumpty, which is to be master-that’s all.” The word passion fits precisely into this query. The Merriam-Webster of fered several definitions, including an urge to do something inadvisable, an insatiable desire, a mania, vehemence, greediness, craving, an incurable passion. The Greek word Kakoethes (from kakos: bad and unethical character) reflects what in the French psychiatry used to be called monomania. There isa German word that best describes this condition and relates it to anaddictive personality: Magersucht, with traits of obsession and fixation. The thinner the patient is, the better she feels even to the point of euphoria. I have not come across a paper investigating the levels of endorphins or cannabinoids during the self-starvation phase. We can also think of another key trait of this patient (ruling out bulimia) which is ascetism or contempt for the body and the rising libidinal trends during puberty.
References:
Beadle JN, Paradiso S, Salerno A, McCormick LM. Alexithymia, emotional empathy, and self-regulation in anorexia nervosa.Ann Clin Psychiatry. 2013;25:107-20.
Bruch, H. Perceptual and conceptual disturbances in anorexia nervosa.Psychosomatic Medicine. March 1962; 2 187-94.
Bruch, H. The Golden Cage. The Enigma of Anorexia Nervosa. Cambridge: HarvardUniversity Press; 2001.
RibotT-A.Essai sur les passions. 1907.Paris: F. Alcan; 1907.
February 7, 2019