Medicine: Food First

When people lose all desire to eat, for no apparent physical or emotional cause, doctors call it anorexia nervosa (nervous lack of appetite). For three generations they have argued about how best to treat it, with recent opinion favoring an analytic type of psychiatry. Now in the British Medical Journal, a brusque, no-nonsense Welshman indicates that it is time to boot the psychiatrists out and pump the patient full of food. His simple reasoning: the only treatable aspect of the baffling disorder is starvation, and the cure for starvation is food.

Dr. Eirian (rhymes with barbarian) Williams made a study of 53 cases treated since 1897 at the London Hospital in Whitechapel. All were women. More than half did poorly, and several died in the hospital or soon after leaving. Outstanding exceptions: seven who had feeding tubes shoved into their stomachs so that they had to take nourishment. Some physicians argue that with an emaciated, enfeebled patient, aggressive forced feeding may be dangerous. Not so, says Dr. Williams: the feebler the patient, the less resistance she can offer. The starved body (some adult women patients weighed as little as 50 Ibs.) soon responds to food. Sometimes the mere fact of being well fed helps the patient to shuck off the emotional problem. In any case, a starving patient is not a proper subject for any other treatment.

Why have general physicians let anorexia nervosa slip away to the borderlands of psychiatry? Probably, suggests Dr. Williams, because patients often have emotional symptoms suggesting schizophrenia, and the G.P. feels out of his depth. But none of the 53 patients in this study ever needed long care in a mental hospital. And 23 of them recovered completely—some of them spontaneously, others after routine follow-up attention and reassurance. "Specialized psychotherapy," says Dr. Williams firmly, "is not indicated."