BMJ No 7123 Volume 315
The muses Saturday 20/27 December Christmas 1997 issue
Commentary: Ambivalence toward fatness and its origins
Arthur Crisp
At this distance the diagnoses cannot be absolutely certain, despite the extraordinary details Hugh Baron has so splendidly mustered. Anorexia nervosa is supposed to be a modern disease. I believe it has been around for a long time, probably ever since postpubescent humans were capable of contemplating their newly awakened adult destiny, experiencing it as unwelcome and linked to their recent growth. One response, then as now, might have been, through the mechanism of reversal of that growth, to eliminate the related burgeoning panic stemming from a sense of imminent alienation, disgrace, or longer term danger and decay. Then again, the condition is rare indeed in males, though one of Morton's two original case descriptions, which are almost certainly of what today we would call anorexia nervosa, was in a male subject.(1)
Byron undoubtedly had a persistent severe eating disorder. Moreover, it was clearly powerfully driven and maintained by his fear of fatness and self loathing in this respect.
There is a devastating family history of severe psychiatric morbidity;
he was obese as a child; seems to have been physically, socially, and
sexually abused in childhood; was bisexually promiscuous in
adolescence - all these are common, recognisable antecedents of the
severe end of the spectrum of eating d His repugnance of his obesity at the age of 18 (body mass index around
30) probably led to his first major weight loss through his electively
restricted food intake, excessive exercise, and dehydrating strategies
at that time. The lowest reported body mass index in the article is
about 19; not quite low enough for a textbook diagnosis of anorexia
nervosa. Also unusual is his awareness of and acknowledgement that he
was so thin. Perhaps this was the burning insight and necessary honesty
of a great poet. More typically, so far as anorexia nervosa is
concerned, it is apparent that he relished his extreme thinness.
Moreover, as this report indicates, he probably lost yet more weight at
times thereafter. I think, therefore, that he is very likely to have
had full blown anorexia nervosa then and at subsequent intervals.
However, it is noteworthy that he seems to have sired children, an
impossibility with concurrent anorexia nervosa. His paternity of
various offspring seems beyond reasonable doubt. Perhaps dehydration
contributed importantly at times to his lowest recorded body weights;
lean body mass would then have been relatively greater than was
apparent, as also would have been his reproductive potential.
His disgust with his fatness equates, in his own mind, with his
licentiousness and his intense ambivalence towards it and its origins.
I would attribute the foundation of his eating disorders to this
biological and psychopathological link. The case for anorexia nervosa during (long) periods within the second
half of Byron's life is strong. He sought the ascetic ideal and
achieved it at times only through his anorexia nervosa. Then he found
himself free from the distractions of his "baser" impulses and the
related social life and able instead to foster and express his
intellectual and poetic self.
At other times he considered himself
corrupted, when losing control over his food intake and suffering some
slight or greater weight gain. His fear was not just of obesity but of
any weight gain at all. Self disgust and despair erupted at such times.
When up to or above normal weight, but with his continued bingeing and
purging, he would nowadays be diagnosed as having "bulimia
nervosa." Poor Byron, to be reduced to our labelling.
It is typical of public attitudes to the eating disorders that Byron's
own eating disorders - which reflected his most basic flaw in personal
adolescent development, and which underwrote most of his daily concern,
distress, and behaviour thereafter - are once again largely ignored in
the latest biography.(2)
Baron has given a vivid 18th century account almost certainly of both
anorexia nervosa and bulimia nervosa, and in a male. This is also the
story of a renowned and desperate poet - and reveals the kind of price
that sometimes must be paid for such creativity.
Psychiatric Research Unit,
References
1 Morton R. Phthisiologia: or, a treatise of
consumptions. London: Smith and Walford, 1694.
2 Grosskurth P. Byron, the flawed angel. London:
Hodder and Stoughton, 1997.
Probably prompted by his underlying impulse-ridden nature and tendency
to obesity, as well as in reaction to his starvation, he also seems to
have binged hugely at times. At such times he attempted to defend
against consequent massive and doubtless terrifying weight gain due to
the high dietary calorie loads and associated fluid retention, by the
variety of strategies by then at his disposal. These included reported
recurrent severe vomiting. Nevertheless, there were also times when he
was obviously overweight during this second half of his
life.
A scene from Byron's Don Juan
St
George's Hospital Medical School,
London SW20 0NE
Arthur
Crisp,
emeritus professor of psychological medicine
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