Holy Anorexia : <i> by Rudolph Bell; epilogue by William N. Davis (University of Chicago: $22.50; 280 pp.) </i>

“Holy Anorexia” focuses on restrictive eating or fasting, a widely noted component of ascetic practice and spirituality in the Middle Ages. The author, Rudolph Bell, who teaches medieval history at Rutgers University, offers a medical diagnosis from a distance of as much as seven centuries: Holy women such as Catherine of Siena, Veronica Giuliani (1677-1727) and Margaret of Cortona (1247-97) were engaged in “anorexic behavior patterns” that closely resemble the modern disorder anorexia nervosa . The author claims a psychological continuity across the centuries: “holy anorexia” and anorexia nervosa , he says, are “psychologically analogous” states in medieval and modern women.

Of the 170 holy women for whom he has some documentation, Bell concludes that more than half “displayed clear signs of anorexia.” But, by the author’s own admission, the documentation needed to support in-depth psychological and physiological study of these distant figures is fragmentary and erratic. Much of what survives about the lives of saints is hyperbolic and folkloric rather than literal or documentary. For only “several dozen” fasting women is the documentation admittedly “extensive and highly reliable.” From the outset, then, the historian turned clinician has conspicuous problems with the nature of the evidence. One method of finessing lapses in the record is to suppose that universal patterns exist, that human nature is everywhere the same, that the past and present are no different.

In order to take the psychological measure of medieval women, Bell turns to two familiar diagnostic tools: Freudian and feminist analysis. Catherine of Siena is his first and best-known patient. Bell uses Raymond of Capua’s biography of the 14th-Century holy woman to argue that self-starvation, then and now, is part of a larger quest for liberation from a patriarchal family and society as well as a struggle over psychosexual development. Great emphasis is put on Catherine Benincasa’s early life and on her family constellation: She was the 23rd child; her twin sister died after being sent out to a wet nurse while she was kept at her mother’s breast; she was weaned relatively late when yet another child was born. According to Bell, Catherine’s frequent rhetorical use of maternal imagery, including references to nursing and weaning, was a subconscious recounting of her own early experience rather than a pervasive medieval religious metaphor.

In adolescence, Catherine sought to avoid sexuality. To the chagrin of her parents who hoped to see her marry, she attached herself to the Sisters of Penance, a branch of the Dominican order. Catherine clearly intended to take Christ as her bridegroom rather than any man selected by her father, a successful Sienese dyer. But she continued to live at home, where she was enmeshed in and devoted to her family. In her 15th and 16th years, she experienced the death of both a beloved older sister and a younger sister, events which Bell believes left her “guilty” over her own survival.

At this point, her anorexia began. A life of hard penance and solitude was the best way to assuage personal guilt and insure the spiritual welfare of the family that remained. Catherine began to fast--eating only bread, water and raw vegetables as part of a larger program of personal austerities that included self-flagellation, scalding and other penitential rituals. Catherine’s efforts to tame her “unruly flesh” continued throughout her lifetime but, Bell attributes their origin to her early life experience and her adolescent crisis.

Ostensibly, this is a book of medieval history. Yet, “Holy Anorexia” reflects the social, cultural and political concerns of the 1980s as much as those of the 1380s: our preoccupation with disease; our skepticism about the “real” sources of religious faith; our confidence in psychological interpretations of behavior and our increased sensitivity to gender roles. All of these factors shaped the conception of this book, as well as the author’s starkly modern reading of medieval women’s lives. “Holy Anorexia” would not have been written even two decades ago before the contemporary “epidemic” of eating disorders.

Although this is a lively and interesting book of history, its thrust is misdirected. As a clinician, Bell mistakenly casts all cases of female refusal to eat as anorexia nervosa . In fact, food refusal is quite common in a wide range of psychiatric disorders and has many clinical aspects and various etiologies. Furthermore, to argue that there is a consistent psychological pattern that underlies both medieval and modern food refusal is to believe that modern medicine knows exactly what anorexia nervosa is.

This is not the case. There is little agreement within the medical community as to what constitutes anorexia nervosa . There are different sets of symptom criteria and not all patients show the same symptoms in the same degree. The research and therapeutic communities continue to debate the cause of this “popular” disease: Is it biological, psychological or cultural?

The most sophisticated authorities posit that anorexia nervosa is a multidetermined disorder that involves the reciprocity of individual biological and psychological factors, family dynamics and the cultural environment. As a historian, Bell understandably avoids doing biomedical research. His inattention, however, to medieval culture--particularly the larger pattern of asceticism in both sexes and the role of ideas about food and the body in medieval spirituality and theology--will strike both physician and historians as odd. It is not that Bell is wrong in suggesting that personal life stresses promote exaggerated eating or not eating. What is surprising (for a book of history) is the almost exclusive concentration on individual psychodynamics at the expense of the cultural context. The author fails to bring to bear his own ample skills as a historian and avoids questions of historical significance: What was there about medieval culture that promoted control of appetite as a higher morality? Why did so many medieval women, both youthful and adult, participate in strenuous ascetic behavior particularly in the 13th-15th centuries? Why was this behavior associated primarily with men until then?

Bell’s argument for the consistency of anorexia does not explain why, at certain moments in time, there is more or less food-refusing behavior and why the population “at risk” can vary with age or gender. And although he is clearly sympathetic to feminist analysis, Bell’s historical approach ultimately does women an injustice because it discredits female spirituality, casts their religious experience as an epiphenomenon and flattens differences in their experiences across time. Although Catherine of Siena and the modern anorexic do have something important in common--the use of food as a symbolic language--it seems as misleading to cast the former as an anorexic as it would be to cast the latter as a saint.