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Peripheral or Central? Disordered Eating in Clinical Medicine

Peripheral or Central? Disordered Eating in Clinical Medicine

(p.172) Nine Peripheral or Central? Disordered Eating in Clinical Medicine
Appetite and Its Discontents
Elizabeth A. Williams
University of Chicago Press

Chapter 9 surveys medical thinking about disturbed appetite from 1850 to 1900, exploring difficulties physicians confronted in defining the role of appetite in psycho-gastric ills. Psychiatrists and neurologists began asserting the primacy of psychic factors in ills of appetite, a shift seen in new descriptions of the condition called anorexia nervosa or hysterical anorexia and in debates over the origins of obesity. Charles Lasègue in France and William Withey Gull in Britain regarded lost appetite as a prime feature of anorexia nervosa, but by the 1890s diagnosticians argued that refusal to eat, whether caused by lost appetite or not, was its essential feature. Obesity was the subject of a rapidly expanding literature, with attention focused on the role of heredity and physico-chemical processes as well as the search for pragmatic cures. Unlike obesity, anorexia nervosa was attributed to moral and psychological failings of the young women and girls who chiefly suffered from it. Despite the high prestige of laboratory methods in this era, many physicians argued that a subjective condition like the state of the appetite could be comprehended only by practitioners with long bedside experience. In privileging subjective experience, they contributed to the further cerebralization of appetite.

Keywords:   psycho-gastric ills, anorexia nervosa, Charles Lasègue, William Withey Gull, obesity, heredity, cerebralization

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