Victorian Mental Health and Women, Part Two: Eating Disorder Treatments

Hello, again, loyal readers, editor Kevin here welcoming you to guest writer Isabel DuBois' second installment in a three-part series examining the history of mental health treatment for women in the 19th century. If you haven't read part , I encourage you to check it out.

Disability and mental illness hold a very negative stigma and have for hundreds of years. Recent social trends of greater acceptance and understanding have caused us as a society to look back on past treatments for mental illness with dismay. What was life really like for those living with disabilities and or mental illness?

This question is surprisingly hard to answer. Much of this history has been lost or forgotten along with the lives the patients left behind upon entering the halls of a sanitarium.

Today 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime (National Association of Anorexia Nervosa and Associated Disorders (ANDA) 2020.) Modern treatments for these disorders include psychotherapy, behavioral therapy, family-focused therapy, and medically monitored food consumption. In the modern day, it is understood that these disorders are about more than food, in fact, they have deep roots in other mental health issues and body image issues. This modern form of treatment centers around compassion and understanding and is in stark contrast to the seemingly harsh treatment options available in the past.

In 1689, English physician Richard Morton described two cases of “nervous consumption” —one in a boy and one in a girl. Due to Doctor Morton’s inability to find a physical explanation for the loss of appetite and “wasting,” he determined “this consumption to be nervous.” Although there is no record of the treatment used, these two cases are considered to be the earliest modern cases of the illness we now know as anorexia nervosa. The next reported cases of anorexia nervosa were about 200 years later in 1873 by Sir William Gull, who coined the term “anorexia nervosa” in his published case reports.

In the late 1800s, American neurologist Silas Weir Mitchell developed the rest cure for the treatment of hysteria , neurasthenia and other “nervous” illnesses. The rest cure involved strictly enforced bed rest and isolation from friends and family for 6 to 8 weeks, massage and electro therapies, no creative or intellectual activity or stimulation, as well as a fatty diet, rich in milk and meat. Especially in the case of his female patients, Mitchell believed that depression was brought on by too much mental activity and not enough attention to domestic affairs. Refusal to eat would result in the patient being force-fed either by the staff or, in some cases, by Weir himself. It became widely used in the US and UK but was prescribed more often for women than men and was frequently used to treat anorexia nervosa. The treatment kept some patients alive and others out of asylums, though some patients and doctors considered the cure worse than the disease.

The rest cure has found modern day fame through Charlotte Perkins Gilman’s 1892 feminist publication, “The Yellow Wallpaper,” in which the reader follows a young woman’s rapid descent into insanity while undergoing the rest cure treatment. Gilman’s story was not entirely fictionalized and, although some exaggerations had been made, drew largely from Gilman’s own experiences. (Gilman, Why I Wrote The Yellow Wallpaper? 86) In 1886 early in her first marriage and after the birth of her first child, Charlotte suffered from what is now known as postpartum depression, a condition described by Perkins as causing her “utter prostration” by “unbearable inner misery” and “ceaseless tears.” Due to this she was sent to Philadelphia for treatment under “the greatest nerve specialist in the country”: Weir Mitchell. For Gilman, Mitchell’s treatment was a disaster. Having been prevented from working, she soon had a nervous breakdown and, at her worst, is reported to have been reduced to crawling into closets and under beds, clutching a rag doll. After abandoning Mitchell’s treatment Gilman managed to recover from her ordeal, but she still claimed that she felt the effects for the rest of her life. For this mistreatment she held special derision for the doctor for the rest of her days, and Mitchell is referred to by name in the book. (Gilman, The Living of Charlotte Perkins Gilman 95)

An album of photographs presented to Mitchell by William S. Playfair, the British obstetrician responsible for introducing the rest cure to England in the early 1880s, captures patients' physical states before and after undergoing the rest cure. These portraits show in great detail the states of patients suffering from different eating disorders. The before pictures highlight the patient’s gaunt features and tired expressions, the after pictures highlight the patients plump and healthy features. However, these images do so while denying us access to the most significant part of the transformation: the treatment process.

Sources:

Harvard Health Publishing. December 19, 2014. Accessed August 20, 2021.

Eating Recovery Center. February 24, 2018. Accessed August 20, 2021.

Science Museum. June 12, 2019. Accessed August 20, 2021.

Stiles, Anne. Branch. Accessed August 20, 2021.

HCC Learning Web. Accessed August 20, 2021. https://learning.hccs.edu/faculty/peggy.porter/authentic-voices/the-yellow-wall-paper-the-rest-cure

Pictures obtained from the library of congress public domain and Wikimedia Commons

Image one: Charlotte Perkins Gilman circa 1900
Image two: Woodcuts showing Miss C before and after treatment artist unknown