The Talking Disease: Hilda Bruch and Anorexia Nervosa

Abstract

In this note on anorexia nervosa, it is assumed that the sociology of health and illness must adopt a three-level model of explanation. We have to understand the phenomenology of illness within the world of the patient. The problem with 'positivistic' approaches (based upon a medical model) is that they examine the condition independently of its constitution by a knowledgeable agent. Anorexia is not just a question of having anorexia; it is fundamentally about being anorexic. Secondly, there is the sociology of illness behaviour which examines the sick role. Finally, there is a political economy of health which is broadly concerned with the distribution of resources (including health) in a society. It can also be argued that a'condition' as complex as anorexia requires a multidisciplinary perspective to understand the various levels in which this disorder can be conceptualised in terms of its various social and cultural mean ings. Existing approaches to anorexia are typically under developed because they adopt uncritically an unidimensional view of the etiology of anorexia behaviour. Hilda Bruch's clinical work is important in this context as a multi-discipli nary interpretative approach. As a supplementary theoretical strategy, this note extends the therapeutic insights of Bruch by considering anorexia in terms of a phenomenology of the mouth as a 'talking disease' about familial interaction in societies which place an emphasis on individual competition. Being sick involves a special type of linguistic membership through socialisation in a sick role. The understanding of the meaning of sickness in medical practice can be seen consequently as a version of the methodology of verstehende soziologie.