Challenging the enduring epistemic injustice of eating disorders: Critically re-reading Occupation food insecurity in the Trente Glorieuses with Elsa Triolet and the 1944–1945 ‘Minnesota Starvation Experiment’

Abstract

The intersection of food insecurity in occupied France with other risk factors and comorbidities thought to lead to eating disorders has been obscured. So have the profound emotional and functional impacts which occur right across the spectrum of these extremely serious psychiatric conditions, including the most prevalent, yet little-known diagnosis: other specific feeding or eating disorder (OSFED). This article challenges this nexus of neglect. It reveals how historians occlude key psychological impacts of semi-starvation in Vichy France and into the Trente Glorieuses. In the 1944–1945 ‘Minnesota Starvation Experiment’ and recent scientific research, it identifies epistemic injustice whereby testimony of lived experiences, the potential for making sense of them and access to knowledge are prejudicially undermined. Re-reading scientific literature fills some hermeneutic gaps, but Elsa Triolet's literary fiction provides a compelling representation of OSFED and powerfully communicates the impacts of the clinically significant distress or impairment experienced in all eating disorders. Entangling these critical re-readings demonstrates the Humanities’ potential for setting new agendas and for challenging narratives undermining understanding of all eating disorders.

Intersections of food insecurity in France during and after the Occupation with other risk factors and comorbidities thought to contribute to the development of eating disorders have been overlooked. So have the profound emotional and functional impacts which occur right across the spectrum of these extremely serious psychiatric conditions, the most prevalent of which are unjustly little known. In this article, I seek to challenge this nexus of neglect in entangled ways. I want to reveal how French historical narratives occlude the psychological impact of semi-starvation in occupied and post-war France. I also aim to reveal how past and present studies of semi-starvation and eating disorders perpetuate what Miranda Fricker (2007) describes as ‘epistemic injustice’: injustice done to someone in their capacity as a knower by prejudicially undermining their testimony and/or preventing them from making sense of their lived experiences. Filling some biomedical hermeneutic gaps through critical re-readings of scientific literature, I then turn to literary narratives by Elsa Triolet. These, by unknowingly including a compelling example of other specified feeding or eating disorder (OSFED), simultaneously demonstrate the potential for developing disordered eating as a result of food insecurity and other risk factors and comorbidities and powerfully evoke aspects of profound emotional or functional effects experienced across all eating disorders.

I begin by explaining how the most prevalent eating disorder – OSFED – is overshadowed by a focus on anorexia and bulimia, and how over-emphasis on diagnostic criteria of body mass index and behavioural frequency leads to neglect of experiences of clinically significant distress and impairment common to all eating disorder diagnoses. I identify similar gaps in examples of the cultural history of Vichy France and the so-called Trente Glorieuses. ¹ I then turn to the 25%-of-body-weight-reducing 1944–1945 ‘Minnesota Starvation Experiment’ which, aiming to inform post-war re-feeding in Europe, deliberately obscured knowledge and prejudiced testimonies of distress and impairment in ways which resonate with the perpetuating of gaps in knowledge of eating disorders and the full spectrum of lived experiences of them today. I then redress some of these gaps by re-reading two of Elsa Triolet's literary fictions set in contexts of wartime food insecurity: her short story ‘Les Amants d’Avignon’ (Triolet, 1945) and her novel Roses à crédit (1959). I show how Triolet's representations point to the likely prevalence of disordered eating in the Trente Glorieuses; powerfully communicate experiences of the clinically significant distress and impairment still unjustly overlooked across the full range of eating disorder diagnoses; and exemplify an experience of living with little-known OSFED.

I am inspired by Margaret Atack's ‘dynamic readings of the social’ (1989: 9) in Occupation and post-war literature, revealing paradoxes and bringing into question the ethical ramifications of dominant framing narratives: ‘[l]iterature re-sets the issues for its contemporary audience, […] serve(s) as frames for the past, setting new agendas […], combined with the ethical imperatives of the issues it raises’ (Atack and Lloyd, 2015: 15). ² My re-readings further extend my work on ‘leftovers’ in post-war French fiction, harnessing the interpretative power of ‘unthought-of ideological, historical and psychological meanings in representations of food and drink’ (Cruickshank, 2019: 3) to explore how aspects of profound distress and impairment symptomatic of all eating disorders can be identified in fiction. I entangle with these literary critical approaches with Miranda Fricker's conceptualisation of ‘epistemic injustice’ (2007). My re-readings of scientific literature on semi-starvation and eating disorders resonate with Fricker's ‘testimonial injustice’, when the credibility of a subject or group is prejudicially diminished because they are not being appropriately believed or consulted, and ‘hermeneutical injustice’, whereby flaws in interpretive resources put subjects and groups at a disadvantage by prejudicing their ability to understand, evaluate and communicate what they are experiencing. This entangling reflects my critical intention of ‘constructive engagement with current health research […] to question the status quo and also to establish a platform for understanding bodies and their environments in ways that escape the confines of clinical assumptions’ (Macnaughton, 2023). As well as offering fresh historical perspectives and new critical approaches to literary representations of (disordered) eating, I want to set new agendas by exposing the enduring prejudicing of the understanding and testimony of those who live with significant emotional and functional impacts which occur across all eating disorders.

Challenging epistemic injustice in knowledge and lived experiences of eating disorders

Epistemic injustice – both hermeneutical and testimonial – is endemic in interpretive resources on eating disorders. Although the second most fatal of psychiatric illnesses, eating disorders are significantly less researched than other psychiatric disorders (APPG/Beat, 2021). Moreover, their heterogeneity, severity and complexity; the prevalence of different diagnoses; and lived experiences of their significant emotional and functional impacts are neglected. Focus on anorexia and bulimia (Russell et al., 2023) perpetuates a lack of knowledge of the most prevalent diagnoses: OSFED (other specified feeding or eating disorder) and binge eating disorder, usually conservatively quoted as accounting for 47% and 21% of diagnoses against anorexia and bulimia at only 9% and 18% (Hay et al., 2017). Furthermore, diagnostic focus on criteria of body mass index and behavioural frequency leads to the neglect of symptoms of ‘clinically significant distress or impairment in social, occupational, or other important areas of functioning’ as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013). Although systemically overlooked, these criteria apply to all eating disorders. Indeed, they are the primary criteria for OSFED. However, since both this most frequent eating disorder diagnosis and the symptoms that span all eating disorders are massively under-researched and experiences of them unacknowledged (Byrne and Fursland, 2024), when OSFED and its ‘subtypes’ are diagnosed, they are not understood in terms of emotional and functional impacts. Instead, they are assessed in terms of their ‘failure’ to ‘meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class’ (American Psychiatric Association, 2013). Moreover, given that as few as 23.2% of individuals with eating disorders seek treatment (Bryant et al., 2022), this lack of knowledge can only lead to underdiagnosis and further silencing of lived experiences of OSFED. It also prejudices abilities to understand and give testimony to the breadth and depth of lived experiences of distress and impairment across the whole span of eating disorders, whilst perpetuating the lack of understanding of how eating disorders occur across genders, sexualities, communities, body shapes, economic categories, ethnicities and ages (Byrne and Fursland, 2024).

Amidst this epistemic injustice, I must stress that scientific research rarely reveals that, enduringly, the exact causes of eating disorders remain unknown, and that effective treatments are also lacking, as demonstrated by the little-broadcast fact that remission rates are only around 50% (Miskovic-Wheatley et al., 2023). A recent rapid review suggests eating disorders may result from ‘a myriad of variables ranging from sociocultural, to biological and genetic, and psychological factors’ (Barakat et al., 2023). I list these because such variables could be expected to impact those predisposed to the development of disordered eating during times of wartime semi-starvation. Risk factors include abuse, trauma, food insecurity, childhood adversity, significant family disruption, childhood trauma, exposure to the ‘thin ideal’, body dissatisfaction, gut microbiota and genetics. Comorbidities include personality, mood and anxiety disorders; a diagnosable childhood anxiety disorder such as obsessive-compulsive disorder (OCD) and diagnoses of post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). These recent hypotheses inform my critical re-readings as I identify and challenge some of the gaps in understanding of possible aetiologies, lesser-known diagnostic categories and the significant distress and impairment experienced across the diagnostic spectrum.

Historical epistemic injustice: Food insecurity, trauma and overlooked disordered eating

Given that widespread experiences of semi-starvation and food insecurity in France during and after the Occupation (rationing continued until 1950) will, in some, have intersected with risk factors and comorbidities, it is probable that a proportion of the population would develop disordered eating and related distress and impairment. Yet few historians have explored this likelihood. Kristin Ross alone links food scarcity, post-war consumerism and dysregulated appetites in her analysis of the psychological effects of the Second World War as they intersect with the shock of swift post-war modernisation and the shift from ‘a literal hunger for food to a more general appetite for consumption per se’ (1996: 72). Ross's metaphor ultimately applies to what she argues is a hunger for washing away wartime and (post)colonial guilt, but she nonetheless suggests that ‘the hungry, deprived France of the Occupation could now be sated; the starving organism, lacking all nourishment, could gorge on newfound abundance and prosperity’ (1996: 71). Here, the possibility of satiation is overridden by gorging, pointing towards the potential of eating distress arising out of the impact of wartime food insecurity intersecting with other trauma.

In other historical accounts, however, where questions of psychological impact of food supply issues are raised, the focus is on institutional failures: ‘[l]e plus gros sujet de mécontentement des Français durant la guerre et jusqu'au tout début des années 1950 fut celui de la pénurie et des restrictions alimentaires’ (2012: 4). There are analyses of German and Vichy requisition of food and its means of production and of the failure of Vichy ‘ravitaillement’ policies (Grenard, 2012). By the end of the war, it was difficult to scrape 900 calories in Paris (Veillon, 1995: 116), and throughout France, normal adult rations were of particularly low calorific value:

League of Nations figures […] show that French rations offered less nourishment than those in any other Western country, averaging 1180 calories per day over the period 1941–44, compared with 1400 calories per day in Belgium, 1800 per day in the Netherlands. […] In France, the physical impact of malnutrition was clear. (Mouré, 2010: 263)

Symptomatically, here, the psychological ramifications of widespread semi-starvation are ignored or understated.

Where food and shame are connected in historical narratives, focus remains on divisively wide variations in food supply (rationed and unrationed); different official rationing categories; and differential access to profiteering grocers, the black and grey markets and farmers seeking social revenge on cities (Mouré, 2023). Food supply and shame are also bound up with accounts of co-implication in the radical starvation of the Holocaust and with studies revealing tens of thousands of deaths from systematic under-provisioning of French internment camps (Rousso, 1992: 87) and of more than 40,000 patients in French psychiatric institutions in the ‘hécatombe des fous’ (Von Bueltzingsloewen, 2007). Psychological weight is, of course, also central to Henry Rousso's contested post-Freudian narrative of the ‘Vichy syndrome’:

Le syndrome de Vichy est l’ensemble hétérogène des symptômes, des manifestations, en particulier dans la vie politique, sociale et culturelle, qui révèlent l’existence du traumatisme engendré par l'Occupation, particulièrement celui lié aux divisions internes, traumatisme qui s’est maintenu, parfois développé après la fin des événements. (1987: 18–19)

In and beyond the Trente Glorieuses, Rousso figures time-bound psychopathologies arising from Vichy's shameful past, moving from grief to repression through recognition and, ultimately, obsession. Obsession may resonate with historians’ focus on relating food to Vichy's political failure and fractured community, but experiences of distress and impairment linked to semi-starvation in and beyond the period remain repressed. This paradoxical ‘passé qui ne passe pas’ (Conan and Rousso, 1994) suggests a failure to digest how the experiences of semi-starvation may have had profound psychological leftovers before and after the Liberation.

Testimonial and hermeneutical injustice and the ‘Minnesota Starvation Experiment’

In seeking to redress these gaps by critically re-reading scientific literature, I have identified a nexus of failures to link conflict-related trauma, semi-starvation and, notably, binge eating behaviours. In fact, and, moreover, in France, specifically relevant research has been available since 1941 in a medical thesis, ‘Les psychoses du ravitaillement’ (Benzaïed, 1941). This study of psychological effects of semi-starvation in psychiatric institutions explicitly points to the likelihood of similarly profoundly distressing impacts in the general population. More recent examples of research on eating disorders include increased incidence of binge eating in former prisoners of war (Polivy, 1994) and in Lebanese civilians during and after conflict (Aoun et al., 2013). While the effects of imposed starvation and trauma bound up with the Holocaust are incalculable, one study finds upwards of 30% of survivors developed lifetime occurrences of binge eating (Favaro et al., 2000).

Indeed, critical re-reading of various studies of semi-starvation and re-feeding reveals 70 years of epistemic injustice, simultaneously legitimising and deploying the selectively reported outcomes of unrepresentative, testimony-silencing research. Just as France was being liberated, the 1944–1945 ‘Minnesota Starvation Experiment’ initiated a long legacy of hermeneutical and testimonial injustice that endures in eating disorder research, diagnosis and care today. Led by Dr Ancel Keys, this American study aimed to research the effects of wartime semi-starvation to determine effective methods of re-feeding European populations. The ‘Experiment’ recruited 36 subjects from Civilian Public Service labour camps for conscientious objectors, predominantly from ‘Peace Churches’. Selection criteria included being white, male and single; having good physical and mental health; getting along well with others under trying circumstances; and interest in relief work. Subjects spent three months on a then ‘normal’ daily maintenance diet of 3200 calories, before a six-month semi-starvation ration of 1570 calories a day plus walking at least 22 miles per week. Although outstripping the 1180 kcal ration in occupied France, the semi-starvation diet supposedly mirrored European wartime food conditions. The aim – further imposed by individual calorie reductions – was to achieve a 25% reduction of body weight in all subjects. A three-month rehabilitation period followed, testing different re-feeding diets of between 2000 and 3200 calories. During a ‘follow-up’ eight-week period of eating ad libitum, bingeing and weight over-shooting were recorded. Following an interim 70-page booklet in 1946, The Biology of Human Starvation (Vols. 1–2) (Keys et al., 1950) was published in 1950. Only one chapter – relegated to the second volume – very selectively records psychological outcomes, and the eight-week follow-up was too short to assess persistent psychological effects.

Subjects' strong convictions about relief work no doubt incidentally facilitated the systemic testimonial injustice of the ‘Experiment’. What is more, the study's results only featured 32 of the pre-screened 36 volunteers. Four – so no fewer than 11% – subjects were expelled for not meeting weight loss goals, binge eating and stealing food. Here, I note epistemic injustice – then, and now – in this clear evidence of the obstruction of knowledge and in the undermining of the credibility of testimony that could increase understanding of the diagnostic criteria common to all eating disorders: ‘clinically significant distress or impairment in social, occupational, or other important areas of functioning’ (American Psychiatric Association, 2013). Moreover, although the ‘Experiment’ would now clearly contravene the 1949 Geneva Convention, subsequent twentieth- and twenty-first-century scientific studies cite it as a key reference and downplay its epistemic injustice. This, in turn, prejudices understanding of experiences of distress and impairment across all eating disorders and perpetuates a systemic focus on anorexia whilst legitimising use of deeply problematic results in re-feeding programmes seeking to treat it.

Epistemic injustice after the ‘Experiment’

These historical injustices persist, as subjects continue to be implicitly blamed even where clinically significant distress and impairment are acknowledged:

The psychological effects were significant as well. Hunger made the men obsessed with food. […]. They reported fatigue, irritability, depression and apathy. Interestingly, the men also reported decreases in mental ability, although mental testing of the men did not support this belief. For some men, the study proved too difficult. Data from three subjects were excluded as a result of their breaking the diet and a fourth was excluded for not meeting expected weight loss goals. (Baker and Keramidas, 2013: 6)

The undermining of the credibility of the men's testimony and the suggestion that four subjects failed the experiment rather than being its victims is symptomatic. Meanwhile, 57 years after the ‘Experiment’, a peer-reviewed follow-up by University of Minnesota researchers included only 19 of the original subjects, and continues the erasure of experiences of distress and impairment:

Observations from the Keys study suggest that food restriction does not lead to binge eating in everyone. Personality and temperament seem to play a part. […] the 4 participants who failed to complete the experiment due to their significant dietary violations and developed binge eating and kleptomania, showed marked psychological worsening during semistarvation. (Eckert et al., 2018)

Although making links between semi-starvation and binge eating, this testimonial injustice invalidates the devastating experiences of the four subjects expelled, instead attributing potential risk factors and comorbidities to ‘personality and temperament’. Here too, subjects are prejudicially blamed for failure, yet it is implacably reported that one subject self-mutilated and ‘two of the four men who failed to complete the experiment […] had to be hospitalized psychiatrically because of severe decompensation and “pre-psychotic” symptoms’ (Eckert et al., 2018). Despite these extremely significant symptoms of distress and impairment, the ‘Experiment’ is vaunted as ‘the most systematic, ethically justified study of experimental semi-starvation to date’ (Eckert et al., 2018). Studies using data from the ‘Experiment’ likewise position it as peerless, for example as ‘the classic […] undisputed source of scientific reference about the impact of long-term starvation’ (Dulloo, 2021) or ‘an accurate description of both the physical and the mental changes taking place in starvation, which also occur during the development of restrictive-type anorexia nervosa’ (Sarró, 2018). A paper on Holocaust survivors’ attitudes to food describes the ‘Experiment’ as ‘classic and well documented […] benchmark research’, despite detailing psychological trauma and binge eating in survivor-participants which resonate with the lived experiences Keys and his team silenced (Sindler et al., 2004).

Other studies strategically recognise that the ‘Experiment’ would contravene the 1949 Geneva Convention before unquestioningly using its results: ‘we cite the Minnesota Starvation Experiment despite it being an unethical study from today's perspective in light of the unique descriptions of “semistarvation”’ (Hebebrand et al., 2024). Similar raising and foreclosing of ethical questions recur, for example, in the admission that the ‘Experiment’ ‘raises questions about the ethics of human experimentation’ followed by an exonerating assertion that it ‘[m]ostly reminds us that […] studies of mind and body, science and practice can converge to deal with real problems’ (Baker and Keramidas, 2013: 6). Similarly, the 2006 trade book The Great Starvation Experiment: Ancel Keys and the Men who Starved for Science downplays psychological distress (whilst shifting ethical focus onto Nazi eugenics):

Whilst the weight loss of the men followed a neat mathematical curve, the psychological deterioration was less predictable […] To prevent atrocities of the kind committed by the Nazi doctors, international law now prevents this kind of experimentation. (Tucker, 2006: np)

Meanwhile, the website of The Renfrew Center, a prominent private US eating-disorder treatment provider, claims subjects went on to lead ‘interesting and productive lives’, ‘without any permanent repercussions’, so the ‘Experiment’ continues to ‘educate those in eating disorder recovery and offer hope that the refeeding process, however challenging will provide similar relief to the distressing cognitive, emotional, medical, and behavioural symptoms’ (DeCaro, nd). Here, modes of epistemic injustice multiply. The focus on re-feeding exemplifies how eating disorder research, care and resources are unrepresentatively concentrated on anorexia and how diagnostic attention remains on body mass and behavioural thresholds. This leads to systemic and prejudicial flaws in collective knowledge of OSFED and to the undermining of the credibility of lived experiences of those who make up the largest and unjustly overlooked cohort of individuals living with eating disorders. The imposition of narratives of positive outcomes for follow-up ‘Experiment’ subjects and the erasure of the testimony of those who were expelled exemplify epistemic injustice, further prejudicing understanding of transdiagnostic symptoms of severe emotional and functional impacts and compounds the systemic neglect of eating disorders compared to other psychiatric disorders (APPG/Beat, 2021).

Critically re-reading OSFED and lived experiences of distress and impairment in Triolet's fiction

Having identified mechanisms of epistemic injustice in biomedical literature, I now want to turn to wartime and post-war French fiction. Here, my re-readings offer case studies which instead evoke aspects of distress and impairment endemic to eating disorders and feature complex nexuses of risk factors and comorbidities that may predispose individuals to eating disorders, including OSFED. Returning to Vichy France and the Trente Glorieuses, then, I identify in the work of Elsa Triolet ideological, historical and psychological ‘leftovers’ in representations of disordered eating. A communist Russian emigree active in the Resistance in Lyon and Paris, Triolet published ‘Les Amants d’Avignon’ clandestinely in 1943, then in her Goncourt-winning collection Le Premier Accroc coûte deux cents francs (Triolet, 1945). Her ideological aim was to demonstrate the imperative of Resistance amongst ‘everyday’ folk. The short story is ‘firmly grounded in the everyday reality of shortages and food queues’ (Holmes, 1999: 20). Here I identify a powerful evocation of psychological impacts missing from historians’ reports of Occupation food insecurity, representing a ‘psychose du ravitaillement’ that might tip, in some, into eating disorders. Certainly, typist Juliette's exemplary ‘ordinary’ Resistance is food-focused, involving trafficking cartes d’alimentation, walking vast distances unfed between farmhouses and cafés selling only ersatz lemonade, hiding contraband under a rabbit and missing family Christmas to end up eating stockpiled sardines with titular ‘amant’/Resistant Célestin. Juliette is buoyed, perhaps, by her own romantic psychodrama, but at home, work and in the Resistance network, there are comments on her pallor and empty eyes, to which she responds: ‘Je ne suis pas malade, je me ronge’ (1945: 95). Resistance activity and food insecurity do have a psychological impact which might, with a different set of risk factors and comorbidities, manifest in disordered eating and concomitant significant distress and impairment. However, despite experiencing the stress of resistance activity and periods of semi-starvation akin to Minnesota subjects, Triolet's exemplary heroine does not develop an eating disorder.

Triolet has different deterministic intentions in Roses à crédit (1959), a novel which demonstrates through protagonist Martine the deleterious effects of consumerism. However, in the light of my previous analyses, I believe that this novel can be re-read as showing how wartime trauma and food insecurity, intersecting with risk factors and comorbidities, may, in a proportion of individuals, lead to the development of an eating disorder. Triolet herself describes Juliette and Martine as appearing to ‘sortir des magazines féminins’ yet describes ‘le décalage entre leurs habitudes de penser, de rêver, de faire et leur force secrète’ (1965: 16). Both may experience the ‘thin ideal’ and personal and wartime trauma, but Martine has a different set of comorbidities and risk factors. Born in a rat-infested rural shack, the oldest in a famille nombreuse, with racist speculation over which of her single mother's consecutive lovers is her father, Martine's wartime teenage years are consumed by love for Resistance hero Daniel, whom she marries after being introduced to consumer comforts by her friend Cécile's mother. Martine thus seems to escape her multiply traumatic, food-insecure childhood, only to fall prey to consumer credit and beauty ideals, leading to divorce, unemployment, an intensification of disordered eating and death in her childhood home.

Critics’ responses to Roses à crédit as a cautionary tale about rampant consumption intersect with historians’ occluding of the potential for Occupation food insecurity and semi-starvation to be a causal factor in developing disordered eating. The focus is on consumer culture, as exemplified by Susan Weiner's discussion of credit's seductive powers and consumerist psychology (1995). For Alain Trouvé, the novel denounces the illusory promise of consuming ‘des objets que le mécanisme mercantile […] promet trompeusement’ (2006: 81). Geneviève Sellier sees Martine as addicted to ‘the society of consumption like a drug, sacrificing to it everything else’ (2008: 19). Kristin Ross figures her as ‘enslaved to an endless spiral of debt, and if anything, newly and more inextricably colonized’ (1996: 94). Only David Walker footnotes eating distress by (mis)diagnosing Martine ‘in terms of Julia Kristeva's notion of the abject’ (2011: 29 ftnt). Whilst Triolet's own commentary on the text emphasises the massive impact of consumer culture: ‘le confort moderne asservit ceux qu’il devait servir’ (1965: 9), the story also draws attention to Martine's vulnerabilities: ‘Martine était moins bien protégée que Daniel contre l’inquiétude métaphysique’ (1959: 268). Indeed, it can also be re-read beyond authorial intention as a novel which reveals responses to trauma – including of war and the impact of consumer culture – as they intersect with food insecurity, long-term semi-starvation and with other comorbidities and risk factors for developing eating disorders. A story, then, not just of consumer culture, but one where the impact of consumerism is one of a set of risk factors and comorbidities that contribute to the development of an eating disorder. Here, I contend that intersecting predispositions and circumstances parallel to those affecting fictional Martine may also have been present in the 11% of Minnesota subjects who developed binge eating and psychosis.

Roses à crédit opens with poverty, food insecurity and chaotic parenting when, having narrowly averted being hit in the face by a rat flung out by her mother, Martine faints into her first post-Occupation pot-au-feu:

- Je n’ai pas faim… […]

- Tu vas manger […]

Martine prit la cuillère et regarda la soupe dans l’assiette ébréchée et fêlée les fleurs roses disparaissant au fond, sous le liquide, la couche épaisse de graisse, un morceau de bœuf, un os … […] Martine enfonça la cuillère dans la graisse, la porta à sa bouche, et s’écroula. (1959: 5)

Martine is described as representative of ‘la jeune génération, sous-alimentée pendant l’Occupation’ (1959: 20), where children are expected to raise the alarm at the approach of German soldiers whose threat of sexual violence causes Martine's mother to lock the door ‘à double tour tous les soirs’ (1959: 33). Psychological calm does not come after the Liberation, or the end of rationing: ‘la disparition des tickets … on y comprenait encore moins que pendant la drôle de guerre’ (1959: 46–47). Modernization and consumerism also have decisively disturbing effects: ‘“Le confort moderne” lui arriva dessus d’un seul coup […] elle ne s’y habitua jamais tout à fait’ (1959: 37–38).

Indicative perhaps of Triolet's own internalised misogyny, Martine is subjected – and falls prey – to the ‘thin ideal’. Her mother comments that at fourteen ‘t’as déjà des petits seins mignons, et une jolie taille, et des petites fesses à croquer!’ (1959: 17). She is forced to enter – and wins – the Miss Vacances 1946 competition, and soon afterwards considers herself ‘peut-être pas si loin des pin-up américaines’ (1959: 65). She chooses a career as a beautician despite her academic success and repeatedly encounters leering men: ‘Quand on vous voit, Madame, on regrette que le strip-tease ne soit pas d'usage plus courant’ (1959: 118). As her disordered eating gathers pace, so does commentary on weight gain, including from her adopted mother: ‘Tu t’engraisses trop … dit-elle. Tu devrais faire un peu attention’ (1959: 284). Unsurprisingly, and significantly expressed in terms of food, the internalised beauty ideal manifests in fear of ageing and of changing body shape: ‘Qui était cette femme au teint bileux? […] Le ver est dans le fruit, la vieillesse était dans elle, la suçait, la perçait comme un fruit mûr à point, beau sucre’ (1959: 257). Then, in addition to her spiralling debt, loss of job, revenue and home, Martine has a traumatic miscarriage: ‘elle se dégoûtait […] un objet de répulsion. […]. Martine souffrait inexprimablement’ (1959: 212). Divorce is profoundly wounding and causes vomiting and ‘un violent coup de rasoir au foie’ (1959: 257). In short, on top of food insecurity and semi-starvation, Martine experiences many potential triggers for (complex) PTSD.

Moreover, representations of Martine evoking neurodivergence appear to intersect with comorbidities for eating disorders including ASD. Standing out from her siblings, ‘Martine ne leur ressemblait pas’ (1959: 31). She displays hyperfocus: ‘Quand Martine se mettait quelque chose en tête…’ (1959: 43) and ‘une détermination presque sinistre tant on la sentait irrévocable’ (1959: 103). She is further represented as not showing empathy: ‘Les histoires des autres m’embêtent […] j’ai déjà assez de mal avec la mienne’ (1959: 97). There are also traits associated with OCD. Martine describes herself (and is described) as ‘née dégoûtée’ (1959: 92, 275); ‘une maniaque’ (1959: 261); an obsessive cleaner who vomits on encountering ‘[l]es draps sales, la morve, les rats, les excréments’ (1959: 45); and ‘ne pouvait supporter les bavures, les ratures’ (1959: 34).

It is unsurprising, then, in the light of my critical re-readings of historical and scientific literatures, that from being a sketchy eater with an idealised physique, with childhood experiences of trauma and food insecurity, and possibly with neurodivergent traits, Martine develops disordered eating patterns as her marriage collapses and consumerist debt closes in. She binges on biscuits instead of lunch until, along with debt and unemployment, comes more profound dysregulation. Martine then eats ‘à n’importe quelle heure, n’importe quoi. Sa commode était bourrée de sucreries, de biscuits, et elle se levait la nuit pour aller chercher un bout de pain, un morceau de sucre, du fromage’ (1959: 282–283). She binges before a dinner with her adopted family, throughout which she eats compulsively: ‘Martine suçait un sucre. Elle avait déjà mangé presqu’à elle seule la tarte et tous les sablés’ (1959: 285). As the legacies of food insecurity, shame and trauma intersect, Martine returns to her village following her mother's death to her worthless inheritance, the rat-infested hovel. On this final journey, she binges on sweets:

Voici l’auberge, Au coin du bois, où avait eu lieu sa noce. Martine sortit de son sac un bonbon […] elle avait perdu l’habitude de voyager en car […]. Martine sortait un autre bonbon de son sac […] la ‘gendarmerie national’ était la première maison du village. Martine croqua son bonbon, l’avala et mit un autre dans sa bouche […]. Elle fit quelques pas, tout engourdie … Fouilla nerveusement dans son sac, pour chercher un bonbon. (1959: 287–289)

Before dying in her childhood home, a premonitory recap underscores experiences that resonate with those identified as possibly contributing to developing an eating disorder:

Martine, née dégoûtée, couchant sur de la paille pourrie, avec des rats qui courraient sur les corps des dormeurs, des corps jamais lavés … Martine qui resta dehors, en attendant que sa mère en ait fini avec un homme ou un autre. (1959: 275)

From the potential risk factors and comorbidities listed at the beginning of this article, here I note experiences of poverty, food insecurity and stressful life events, family disruption, childhood adversity, trauma and PTSD. These, along with possible ASD and OCD, might predispose Martine to developing an eating disorder. The intensity of emotional and functional impairment Triolet brings to life just as her protagonist meets her end, further resonates with the experiences of binge eating obscured by the ‘Experiment’ as well as research linking food insecurity (Abene et al., 2023), childhood trauma and PTSD (Keski-Rahkonen, 2021) with binge eating disorder.

Of course, it is vital to acknowledge that all diagnostic labels and attempts to assign them are problematic (all the more so here in the light of the epistemic injustice already revealed). I do want to stress, however, that it is highly unlikely that, even today, Martine would know which eating disorder diagnosis to seek, given the flaws in interpretive resources which prejudice individuals′ understanding of their lived experiences of OSFED. Given systemic failure to give credibility to transdiagnostic criteria of significant distress or impairment, it is also highly likely today that Martine would not be diagnosed with an eating disorder at all. Moreover, it is even less probable, even now, if Martine was to seek help, that she would be diagnosed with the nearest diagnostic label appropriate, one of the five examples of OSFED: ‘Binge eating disorder (of low frequency and/or limited duration)’ (American Psychiatric Association, 2013).

Here, then, OSFED itself emerges as a case study of epistemic injustice. It is, moreover, worth stressing that not only is OSFED the most prevalent of eating disorder diagnoses, but also that it is as serious as better-known eating disorders. Yet the aforementioned studies recently linking the ‘Experiment’, food insecurity and trauma to binge eating disorder do not cite OSFED. Other specified feeding or eating disorder is further othered by name. The hermeneutical injustice of defining experiences by not meeting less prevalent eating disorders’ thresholds bolsters the construction of anorexia and bulimia as ‘norms’, perpetuating knowledge gaps around OSFED (and, to a lesser extent, binge eating disorder). Furthermore, the framing of OSFED diagnoses in terms of falling short of thresholds for body mass and behavioural frequency, positioned as the ‘full criteria’ (Amercian Psychiatric Association, 2013), prejudices the credibility of testimonies of the clinically significant distress and impairment which Triolet evokes so powerfully, exemplifying experiences which, unjustly little known, occur across all eating disorders. My entangled critical re-readings – historical, literary and biomedical – thus offer new perspectives on the potentially significant impact of overlooked eating distress and impairment during the Occupation and the Trente Glorieuses. What is more, exposing and countering the epistemic injustice that prejudices abilities to bear witness to and understand not only OSFED, but also all eating disorder diagnoses and lived experiences of their emotional and functional impacts, I demonstrate how ‘the knowledge and methods of the arts and humanities are not just an add on […] they have serious things to say about how ill-health is produced across a range of sites and scales’ (Macnaughton, 2023). Today, these critical re-readings offer ways of ‘re-framing the past, setting new agendas and foregrounding ethical imperatives in the issues it raises’ (Atack and Lloyd, 2015: 15). Indeed, revealing the enduring leftovers of epistemic injustice in the field of eating disorders could not be more serious, as their prevalence increases and as conflict-driven starvation resurges.