Childhood Disorders

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The Fasting GirlReview - The Fasting Girl
A True Victorian Medical Mystery
by Michelle Stacey
J. P. Tarcher, 2002
Review by Lloyd A. Wells, Ph.D., M.D.
Jun 6th 2003 (Volume 7, Issue 23)

I enjoyed reading this very interesting book and found it thought-provoking.  The author, a journalist, tells the story of Mollie Fancher, who spent fifty years without leaving her bedroom after an accident in 1865.  She became a celebrity for her claims that she was in contact with the spirit world and that she survived in spite of eating nothing.  The tale is told in a manner which is sympathetic to all its participants and is especially well set in the medical-historical context of the late nineteenth century, with implications for the early twenty-first century.

Fancher was a well-educated 18-year-old who was engaged to be married and living with her aunt in Brooklyn (her father had remarried after Molly's mother's death, and had moved away).  In 1865, she had a terrible accident with a horsecar and was dragged many feet.  She was treated in her home for these serious injuries and then developed dyspepsia, weakness and "failing health".  The author recreates the medical and psychological mise-en-scene -- Beard's neurasthenia, the many train and horse-car accidents which occurred and the post-traumatic stress disorders which developed after these incidents, as well described by Freud, and the many protracted, disabling illnesses without known pathology which were prevalent at the time.

The author develops the theory that Molly suffered from la grande hysterie of Charcot, as further developed by S. Weir Mitchell in the United States.  She had the arc en circle, a feature of hysteria which is rarely seen today but which I have observed, many sensory findings, paralysis, and trances.  Observers said that she had five distinct personalities.  The author cites feminist theories about this type of historical hysteria -- but she could have explored other theories as well.  Molly was prescribed several somatic therapies, without much response:  hydrotherapy, electrical treatments, heat, and ice jackets.  While classical hysteria may be gone forever, it is interesting that the author cites Briquet on this topic; while Briquet subscribed to some classic nineteenth century views of hysteria, he really described somatoform disorder, which remains with us today, and a good case can be made that, at least today, this would be Molly's diagnosis.  Irritatingly, the author provides all this rich information in a chapter which also contains far more details about Molly's house and neighborhood than will interest most readers.

Thirteen years after her injury, Molly Fancher became a public figure, claiming to be clairvoyant, involved in metaphysical travel -- including travel to the afterlife -- and also claiming that she existed without eating.  These assertions were fomented in the newspapers, which found the situation fascinating (and undoubtedly these claims sold newspapers!)

An excellent chapter on William Hammond follows.  He had been Surgeon General of the army during the Civil War and was a founder of the discipline of neurology.  He wrote a fascinating book, Fasting Girls (1879).  He was a debunker of spiritualism and is viewed in the book as a somewhat hostile man.  He tried hard to expose Mollie Fancher as a fraud and said she was "a perfect humbug -- a clear case of insanity."  This chapter is flawed because of the amount of unnecessary biographical detail about Hammond. The author next includes a chapter on George Beard.  This great physician, who died at age 43, did many studies of nervousness and so-called neurasthenia.  He also studied many unusual syndromes such as the "jumping Frenchmen" of Maine.  He was a proponent of electrical treatments for patients like Mollie, and he, like Hammond, debunked Mollie's claims of surviving without eating.

The next section of the book considers the background of anorexia nervosa and develops the concept that in Victorian culture, meat and a hearty appetite were associated with sexuality and were shunned by "proper" young women.  This is debatable, and the presentation is one-sided.  The author provides an excellent discussion of chlorosis, a syndrome which peaked in the 1870's and 1880's and which featured decreased energy, amenorrhea, weight loss, diminished appetite, depression, and a faint, green tinge to the skin.  Chlorosis may have been related to iron deficiency anemia.  It was NOT anorexia nervosa -- unlike patients with chlorosis, anorectic patients often have a high energy level and a normal appetite, and they are certainly not always depressed -- but it may have been an eating disorder.  She then discusses anorexia nervosa itself, including a good account of the priority dispute between Lasegue and Gull, and fair credit to the usually forgotten Chipley.  She raises the question of whether Mollie Fancher might have had anorexia nervosa.

The author goes on to discuss biological manifestations of starvation, including death from starvation as described in the Warsaw Ghetto.  She discusses the strange attitudes and eating behaviors of St. Catherine of Sienna and then provides case studies of several "fasting girls" -- adolescents who claimed not to eat.  Some of these fasting girls were displayed at county fairs, etc., and several challenged the medical profession to disprove their claims -- which frequently happened.  This discussion strays quite a bit from the case of Mollie Fancher.

At the end of the book, the author discusses modern views of hysteria, and we learn of Mollie's demise -- after a party celebrating her fiftieth year of living in one room of her house, attended by a great many people.  (Molly had even invited President Wilson, but he did not attend.)

I enjoyed the book tremendously, but it has serious flaws.  Mollie Fancher's story is not really enough to hold the wide-ranging discursions together.  While it is interesting and troubling to read of how starvation killed in the Warsaw Ghetto, this really has very little to do with Mollie:  from a great many photographs, she certainly appeared well-nourished throughout her lengthy "fast".  We learn far more than is relevant to her situation about Hammond, Beard, and the early literature on anorexia nervosa.  The discussion on hysteria is very interesting but does not include formative modern views such as that of Slavney.  Although Briquet is briefly discussed, there is no significant consideration of Mollie's case as an example of somatoform disorder.

On the positive side, the case of Mollie Fancher is fascinating.  A journalist herself, the author is at her very best when she is discussing the way the newspapers dealt with this case and brought it into the public eye over many years.  We are left with a thought-provoking -- even haunting -- account of one woman's life and its meaning, in the context of the late nineteenth century.  Reading this book is time well spent, for mental health professionals, philosophers, and the general reader.

The "father" of psychiatry, Johannes Weyer, devoted a prodigious amount of time to the study of a young woman, who, like Mollie, claimed not to eat.  He exposed her as a fraud and wrote about it.  These patients have been with us from the start of the profession.  It is interesting that the same issues crop up in very different social climates -- even today, in New Zealand, there are "Breatharians" who claim to be able to maintain their weight and health without eating at all.

We need to eat.  I don't think Mollie Fancher had an eating disorder, and I think she ate well.  Kudos to the author for this fine book, with all its interesting digressions.


© 2003 Lloyd Wells


Lloyd A. Wells, Ph.D., M.D., Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.


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