“AS TO myself, I do not know what other remedy to try, other than that I beg you to beseech the highest eternal Truth to grant me the grace of allowing me to take food,” St Catherine of Siena wrote. She died from self-starvation at the age of 33, and is often posthumously diagnosed with the eating disorder anorexia nervosa.
Like many medieval saints, Catherine was known for her restricted diet. In his book Holy Anorexia, Dr Rudolph Bell, a historian, found that half the 170 Italian medieval saints he studied exhibited symptoms of anorexia. Catherine herself is described as chewing only bitter herbs, and purging “any crumb of food” by “inserting stalks of fennel” down her throat to make herself vomit.
Indeed, one of the defining characteristics of anorexia is its presence in medical literature for more than a thousand years, Dr Alexandra Pittock, who specialises in the psychiatry of eating disorders, says. For these holy anorexics, starvation was penitential, and a way of suppressing sinful bodily desires, “allowing one to be more spiritually attuned to God”, she writes, in a paper produced for the Royal College of Psychiatrists.
Dr Pittock also points out that Catherine initially fasted as a teenager, in protest against her proposed marriage to her sister’s widower. Fasting, therefore, was “another form of control, taking power back for the individual; and, as such, it was similar to one of the underlying factors in anorexia today”.
Today, the illness, which has the highest mortality rate of all psychiatric disorders, affects up to ten per cent of the estimated 1.25 million people in the UK who suffer from eating disorders. Another 40 per cent are bulimic (an illness characterised by overeating and then purging through vomiting or the use of laxatives), and the rest fall into the category “binge-eating disorder”.
Yet “not all experts agree that religious ascetic self-starvation is the same as the anorexia present today,” Dr Pittock continues, “because holy anorexics did not have an obsessive fear of weight-gain as far as we can tell. . . It is only in cases in the last few hundred years that we have begun to see this phenomenon being described.”
For Dr Bell, however, “the modifier is the key; whether anorexia is holy or nervous depends on the culture in which a young woman strives to gain control of her life. In both instances, anorexia begins as the girl fastens on to a highly valued societal goal (bodily health, thinness, self-control in the 20th century; spiritual health, fasting, self-denial in medieval Christendom).”
Certainly, research into the relationship between religion and disordered eating has produced some interesting results. In a review of all the existing academic studies in the field (“Religiosity, spirituality in related to disordered eating and body image concerns: a systematic review”, Journal of Eating Disorders, 2015), Daniel Akwari found that “strong and internalised religious beliefs, coupled with having a secure and satisfying relationship with God, were associated with lower levels of disordered eating, psychopathology and body image concern.
“Conversely, a superficial faith coupled with a doubtful and anxious relationship with God were associated with greater levels of disordered eating, psychopathology and body image concern.”
DR LIZZIE MCNAUGHTDr McNaught and her father, Nick Pollard, at her graduation
THE conviction that spirituality and religion can protect against, and aid recovery from, eating disorders is held by Dr Elizabeth McNaught, a trainee GP who has written about her experience of anorexia in her recently published memoir Life Hurts. She feels that it was her faith that ultimately “carried her through”, and is grateful for the “very supportive” part played by the Anglican Evangelical church that her family attended. She is in the planning stages of a Ph.D. exploring “the therapeutic value of a biblical view of personhood as a protective benefit against body dissatisfaction”, which she hopes can be turned into an educational resource to be used in churches and youth groups.
Her own illness took hold in 2005, when she was just 14 (most eating disorders develop during adolescence). “I had broken my leg in a horse-riding accident, and had to have six weeks off school,” she recalls. “I put on some weight because I had basically sat on the sofa and watched television the whole time, and eaten a lot of comfort food. When I got back to school, I felt like no one liked me any more, and I experienced some bullying about the fact I’d put on weight.”
She points out that 86 per cent of young people with eating disorders say that bullying played a part in developing their illness.
Dr McNaught applied herself to losing weight with the same determination with which she tackled everything in life, “but the diet quickly became abnormal eating”. The decline was rapid: within 18 months, she was rushed to hospital, her body so thin and weak that the doctors feared an imminent cardiac arrest. That year — her GCSE year — she attended just ten weeks of school, and had to take one of her exams at Leigh House, a residential unit that provides acute adolescent psychiatric treatment. It has been a “relapsing-remitting” picture during the 12 years since, and she has considered herself to be fully recovered only in the past year.
But, she says, her faith remained strong throughout: “I knew that I was holding my eating disorder higher than God, but it had so much power. But I also knew God was with me the whole time.” For Dr McNaught, it was being from a “high-achieving family” and “struggling with a combination of high ideals and a thwarted desire to achieve, with overvalued ideas about rejection and a negative body image” which were the key contributing factors.
Although not a direct cause in her case, Dr McNaught is also conscious of “the perfectionism that can exist in the Church, the striving to be Christlike that can be a trigger for certain people. It’s easy for these people to feel that they are not a perfect Christian — people then control their food intake, because that is something you can control.”
One young woman interviewed, who did not want to be named, spoke of the blurring between spiritual and bodily perfectionism which she perceives in some churches, with particular reference to “The Daniel Fast”: a 21-day diet regime that is popular in churches in the United States, and is based on the fasting experiences of the Old Testament prophet. It claims to offer a “biblical approach to developing a lifestyle of health and well-being”, and is particularly aimed at tackling the obesity epidemic in the US.
“It’s definitely a growing trend in some Anglican churches, too,” she says. “But the problem is the people who are doing the fast for the wrong reasons. I know several young women who clearly struggle with their approach to food and body image, and who regularly do the fast as a cover for their eating problems.”
The fast’s website says that “thousands of people with health and weight issues experience success as they submit all of who they are to the Lord and change from the inside out.”
TASTE FOR LIFETastelife training under way
THE Revd Ali Hogger-Gadsby, a former mental-health nurse who now serves as an assistant curate in the diocese of Coventry, where she is also a school chaplain, runs the charity Keeping Health in Mind, which equips churches with the skills to help people with mental-health problems. This issue presents, she feels, “a real challenge for churches: of how to teach that we are made in the image of God, and that God has given us our physical bodies to look after, and yet not promoting faith too much in terms of what we should be doing, as a constant striving, which can compound the sense of perfectionism for some people rather than that God loves us just as we are”.
She also believes that Christians have shown “insensitivity” in the past, often characterising eating disorders as a lifestyle choice made by young people who give too much credence to our image-obsessed culture: a view that ignores the growing body of evidence about the neurological and genetic causes of eating disorders.
“We do, indeed, live in a culture surrounded by images of idealised bodies, but, for certain young people who are high achievers and over-thinkers, it’s not vanity but a way of gaining contro,” she says. “It’s a coping mechanism, but also a form of self-harm.
“I think the Church has an important role to play in promoting well-being before people get to a time of crisis, particularly helping young people by giving them good skills in their formative years through really good youth work and school chaplaincy.”
Dr McNaught and her father, Nick Pollard, are also keen to see better education for church and youth leaders, “very few of whom are aware enough to look out for the warning signs”. Their response has been to create an educational presentation, “From Risk to Resilience”, which is aimed at schools, businesses, and churches. Mr Pollard trained as a psychologist, but “even with my academic training, I still failed to identify the signs: I just rationalised it away as a dieting phase.”
The presentation sets out risk factors, “like the fact that there is greater risk if you have a first-degree relative with a mental-health issue, and for those who display above average self-orientated perfectionism, and for those involved in certain activities, such as ballet and gymnastics, where there is a lot of emphasis on controlling the body. When these factors are combined with ‘stressors’ such as exam pressure or weight-based bullying, that’s when an eating disorder can develop.”
One of the Christian organisations that works specifically in this area is Tastelife, a Christian charity founded in 2014. It provides tools for recovery for those who struggle with eating disorders, and for those supporting them. Its course, which is accredited by the University of Brighton Health Sciences, is for people “of all faiths and none”, the charity’s co-founder, Di Archer, says, “but there are three carefully worded occasions when we encourage people to ask their own questions about accessing their spirituality, whatever that means to them.
“We also make it clear that we offer prayer for people if they want to stay behind after the sessions. And there is also a supplement for churches at the back of the training manual.”
Canadian copyright collectionSt Gemma Galgani of Lucca, who never made it into a convent, once prayed for the sins of priests and was said to have vomited for 60 consecutive days. She died aged 25.
Ms Archer is clear that the course falls “very much in the educational, motivational stable” rather than offering clinical expertise, “although we will regularly signpost to psychiatric and counselling services. But, on the other hand, the NHS funding in this area is appallingly limited — you have to be extremely ill to qualify for NHS help; so there is a gap there that the Church can help fill.”
This month, the Royal College of Psychiatrists reported that a quarter of children with eating disorders at a critical point were waiting longer than a week for treatment. “There is also the real risk that a child will lose faith in the whole system if they’re not seen within a week,” a psychiatrist, Dr Louise Theodosiou, warned in The Times.
Ms Archer speaks from experience, having tried to support her eldest daughter, who was diagnosed with bulimia, during a summer when, in terms of treatment, everything ground to a halt. She recalls: “We were essentially told by the eating disorder unit, where she was a day patient, to keep her alive until September.”
Her daughter was studying at university at the time the illness developed. “She told me that she’d thrown up a couple of times, but, if I’m honest, I hadn’t a clue what to do. So I left it for a bit, and then asked her again, and she claimed she was fine. But then I received the call that’s every parents’ worst nightmare, saying our daughter was in hospital with her life hanging by a thread. We found out that she’d been throwing up 25 times a day, and had huge potassium deficiency.”
Ms Archer’s daughter has now recovered, but the experience has led Ms Archer to believe that the Church should be playing more of a part in prevention and support. So, in addition to the Tastelife course, the charity runs training programmes for church representatives who are equipped to return to their communities and deliver the course.
One of those trained is Jo, who attended the Tastelife course as a sufferer before eventually becoming a course leader. Her eating disorder stemmed from a lifetime of carefully controlling her weight on health grounds, having been diagnosed with renal damage in childhood. “It was a time-bomb waiting to explode, and, in my forties, this disordered approach to food and weight-monitoring became an eating disorder.
“Many tricky life events also hit together . . . everything felt out of control. As someone who has perfectionist tendencies, this was unbearable; and so I turned to controlling food and my weight. It seemed so logical at the time.
“I was truly terrified [to attend the Tastelife course], but the members were non-judgemental, and a variety of ages and difficulties with food were represented. I began by wanting the chair to swallow me whole, but, as I listened, and observed, I started to understand what had happened to me.
“I learned how to take baby steps forward towards recovery, using the new ways of thinking and the tools handed to me. It was also the catalyst for going to my GP and receiving help there, too.”
Life Hurts by Dr Elizabeth McNaught is published by Malcolm Down Publishing (£9.99)
The next Tastelife training session for leaders is on 27-29 April and 12-14 October. Visit www.tastelifeuk.org for more information.