THE CHANGING NATURE OF ANOREXIA NERVOSA: AN INTRODUCTION TO THE CONFERENCE

Abstract

MY AIM in this introduction to the Swansea Conference on Anorexia Nervosa is to argue that the illness we shall be discussing in this issue has undergone major transformation over the course of recent decades. The transformations have affected not only the frequency of anorexia nervosa, but also its form and its manifestations. We should not be too reluctant to contemplate the possibility that a mental illness may undergo major changes, except perhaps to wonder at their rapidity in the case of anorexia nervosa. Medical historians have prepared us for the phenomenon of changing mental illness, particularly in studies of their variations in severity during the 19th and early 20th centuries. HARE (1981), for example, has suggested that the major psychoses have altered, becoming less severe during the 19th century, especially during its second half. These changes may have continued during the past few decades: there is evidence that the prognosis of schizophrenia began to improve before the advent of effective drug treatment (ODEG~RD, 1967; classical involutional melancholia has become rarer; catatonic stupor has almost disappeared. Thus mental illness may “evolve” over the course of time, and an analogy has been drawn with the progress of Darwinian evolution (HARE, 1981), though the differences in time scale are such that this analogy should not be pressed too far: ‘L . . . diseases, like species, represent the balance of a process by which living organisms struggle to adjust to a continually changing environment. The main difference is that diseases change much more quickly than species do. And perhaps psychiatric diseases change much more quickly than others because their expression is largely psychological and follows changing fashions.” (kL~an, 1981) It is even more probable that neurotic disorders have undergone changes over time, a view accepted by Karl Jaspers. “From (a history of illness) we can learn how the picture of illness shifts though scientifically the illness may be identical; the neuroses in particular have a contemporary style-they flourish in certain situations and are almost invisible in others.” JUPERS (1959, p. 732) Jaspers goes on to say that the manifestations of the various neurotic disorders have become transformed: “At the turn of the century neurosis was repeatedly hailed as the typical illness of our times, appearing far more frequently than before. The American, BURD (1880), fust described it summarily as neurasthenia . . . The older medical literature shows that individual symptoms were known under different names in those times as well. The general impression nowadays regarding neurosis is as follows: hysterias have greatly