Fasting of Saints and modern anorexia: perfectionism and disgust

In its medieval and modern forms, Anorexia Nervosa is a way of affirming one’s mental identity with respect to the physical one, the manifestation of a perfectionist mentality locked in a dimension of experience that penetrates the very core of the human being, that is the body. Mental resources are lined up for the battle against the body and self-loathing is motivation.

 

The relationship between man and food was characterized by peculiar modalities in different eras and societies: from the ancient Greeks who, according to Euripides, dedicated themselves to the most severe fasting to ingratiate themselves with the Gods, to the mystics of the Middle Ages who practiced fasting as an ascetic tool to reach God, as documented in the well-known case of Santa Caterina da Siena. For centuries the theme of fasting has been the subject of discussion between psychologists, sociologists, neurophysiologists and philosophers, interested in the development of etiological models. In particular, a question that arouses interest, arousing reflections still today, concerns the possibility or not that the mystics in the Middle Ages suffered from Anorexia Nervosa (AN), in an attempt to ascertain the presence of the pathology already in past times, to identify the value of the fasting,

At present, a reflection on the theme of fasting, in my opinion, can therefore contribute both to reasoning on the etiopathogenesis underlying voluntary fasting, and to make further contributions in terms of clinical practice.

Retracing some comparisons made between the mystical fast of the Middle Ages and the anorexic fast of modern times, we find the hypothesis of Prof. RM Bell (2002) according to which there is a connection between the medieval and the modern form of AN. Through a sociological explanation, Bell argues that both types of NA can be understood as forms of self-control and self-assertion exercised by young women trapped in oppressive patriarchal social structures, in order to free themselves from an intolerably suffocating world through the rejection of society, of the life and body.

In accordance with this thesis, Sassaroli, Ruggiero and Fiore (2016) argue that the fasting of the Saints and the fasting of modern AN could share the same psychological mechanism connected to an oppressive social environment. Furthermore, the authors highlight different aspects regarding the value of the fast, the objectives of the fast, the consequences that derive from practicing it. Therefore, the value of fasting for the Saints is linked to renunciation, mortification and self-discipline, instead for modern AN it is thinness that becomes a value in itself. The goal behind fasting in the Saints is linked to holiness or perhaps social affirmation, while in modern AN it is linked to self-affirmation and increased self-esteem. Finally, the consequences of fasting are positive in the Saints,

Paul Broks (2020), English neuropsychologist, proposes a fascinating interpretation of the meanings and anorexic behaviors in a Cartesian key, comparing the medieval AN and the modern AN and considering the former as a precursor of the latter. The question that moves the analysis carried out by the author is: “this bizarre disturbance, in some way, could be linked to those Cartesian concerns. Could it be interpreted as a battle between body and soul? ”. Through an examination of the analogies and differences between medieval AN and modern AN, the author comes to identify – in both forms – fasting as a control tool aimed at achieving high standards in pursuing an ideal (spiritual purity vs. thinness ), personological characteristics of perfectionism, basic emotion of disgust as a consequence of not being able to maintain certain cultural standards, which would thus conflict with body and mind and feed self-contempt and shame. In other words, according to the author, in its medieval and modern forms, the AN is a way of affirming one’s mental identity compared to the physical one, a self-destructive expression of the ‘mind on matter’, the manifestation of a perfectionist mentality stuck in a dimension of experience that penetrates the very core of the human being, that is the body. The experiences are fueled, in one way and another, by the basic emotion of disgust: from the grossest sensations of physical repulsion to the highest feelings of spirituality and awe. In summary,

Taking up the concepts of perfectionism and disgust highlighted by Prof. Broks, it is interesting the contribution of a recent meta-analysis (Dahlenburg, Gleaves, Hutchinson; 2019) where it was highlighted that subjects with AN show higher levels of perfectionism compared to a non-clinical sample and a sample with other psychiatric diagnosis; together with that of a study conducted by Bell (2017) in which it was found that people with Eating Disorders exhibit significantly higher rates of self-loathing than people who do not suffer from these disorders, although it is not yet fully understood the role of disgust in the onset and maintenance of Eating Disorder.

In conclusion, in etiopathogenetic terms, the various analyzes exposed confirm the validity of the multi-factorial model which takes into account different aspects (biological, psychological and socio-cultural), such as predisposing, precipitating and maintenance factors of the AN. It would be useful to conduct longitudinal studies on the deepening of the role of perfectionism: is it a risk factor, a maintenance factor or a consequence of the disorder?

In terms of clinical implications, however, the various analyzes presented seem to support the therapeutic work aimed at perfectionism (CBT-E, Fairburn; 2003), as it proves – albeit with questions still open – main factor associated with AN and also risk factor for the development of AN. While, regarding disgust it would seem that the treatment of this emotion shows limits, since disgust differs from fear and anxiety, in that it recruits the parasympathetic branch rather than the sympathetic branch of the Autonomous Nervous System, and could – for this reason reason – to prove more resistant to standard behavioral methods based on exposure (for more details see Polyvagal Theory).