Recensioni / What Can Be Learned From One of the First Known Eating Disorder Patients

The case of Ellen West, the first documented patient with anorexia nervosa, triggered the curiosity of psychiatrists, poets and cultural researchers throughout the 20th century. That interest in her has continued undiminished into the 21st century, when anorexia is no longer the subject of whispers and is part of the public conversation.

Ellen West, whose case is famous in the annals of psychiatry, was not her real name. Even now, 100 years after her death, nobody knows what it really was. What is known, though, is that she was born in the United States in 1887 to a Jewish businessman. She had two brothers, one of whom was placed in a psychiatric institution at the age of 17. Two of her father’s brothers died a violent death; one of them committed suicide. The family was not unaccustomed to tragedy and hospitalizations before Ellen West’s decline.

When she was 10 years old, Ellen’s family left America and moved to Germany. At the age of 21, she traveled to Sicily. She returned from the trip heavier than usual, and it was then that her extreme dieting started, triggering her anorexia. Despite her illness, she commenced studies at the University of Munich. She had several love affairs throughout her youth and during her college years, which often came to an end due to parental pressure. In 1916, she married her cousin, Karl West, whom she had known since childhood.

The psychiatrist who rose to fame and published Ellen West’s case in the mid-20th century was Dr. Ludwig Binswanger. His writings were for years a respectable source for debate surrounding this woman, who committed suicide at the relatively young age of 33, because she could not stand her mental anguish and her obsessive relationship with food and dieting.

The Italian cultural researcher Antonella Moscati has recently joined the ranks of people delving into the life of this figure. She published a new, fascinating book on Ellen West titled “Ellen West: Una Vita Indegna di Essere Vissuta” (“Ellen West: A Life Unworthy of Living”). Her approach fundamentally differs from the generations of male writers who examined the woman’s life. Moscati, 66, treats her subject with clear empathy, and has no interest in judging West or pinning the label of “mentally ill” on her.

The conversation in this case is different; Moscati’s presentation of this famous patient is less critical – and less masculine. Moscati argues that the men who treated Ellen West cannot claim full ownership of this case. There is also the voice of the patient herself.

How did you come to the story of Ellen West? Psychiatry is not usually your field.

“Yes, that isn’t a field that I usually research,” Moscati says. “I have dealt mostly with German philosophy – for example, Immanuel Kant and Hannah Arendt. But about a decade ago, I came across Binswanger’s book, where there were fragments of texts that [West] had written herself and which mesmerized me. I wanted to delve into them.

“Her writing is very special, very powerful. I understood that from her own texts, the ones she left behind, I could learn just as much as I could from the writings of Binswanger, who published his research into the case 20 years after West’s death. In my opinion, he was also waiting for Freud’s death, because he attacks Freud in his text, and he would not have dared to do so while Freud was alive. He tended to think that psychology should be close to philosophy, while the father of psychoanalysis had a more scientific approach. It was a debate on matters of principle that he preferred to avoid.”

The title of your book is rather cruel. On the cover, under Ellen West’s name and the name of the author is the sentence, “A life that was not worth living.” Is that your view of her life?

“No, no. That sentence was said by the psychiatrists who treated her, and who determined after just a few months that her life was not worth living. They reached this conclusion after a short period of therapy and without any psychoanalysis. If you look at how long this famous patient was in therapy, you’ll learn that it was no more than three months. That is astonishing! At least to me.”

For me as well, as a reader of your book, this was quite incredible. The psychiatrist built his career on a patient who was basically abandoned to her mental illness.

“It is even more surprising when one knows that she did not come to this therapy as an anonymous figure. She came on the recommendation of [poet Rainer Maria] Rilke’s wife, no less! It was a very expensive clinic with a beautiful garden where the patients could sit. They didn’t even pay attention to the fact that she hardly ate, even in their prestigious clinic.”

Is it this abandonment by the psychiatrists that led to her suicide?

“No, that would be an exaggeration. She had tried to commit suicide even before that. She didn’t have good luck with the psychological treatments she sought out. The first psychologist to treat her, with whom she was to have undergone psychoanalysis, stopped the meetings after six months because he had a mystical crisis. He stopped working as a psychologist and joined a mystic cult under a guru by the name of Leonard Shtark.”

In your book, you write that a hearing on her situation, held in the presence of three psychiatrists familiar with the case, including of course Binswanger, resulted in her release from the clinic on March 30, 1921. On the night between April 4 and 5, Ellen West committed suicide by swallowing poison. You are basically writing about a tacit agreement by the doctors and her husband to this act.

“You read this correctly. The psychiatrist and the husband also collected parts of her diary, poetry and letters, and published them in a book in 1922. It’s a shame that the psychiatrist didn’t read them while she was still alive.”

Another thing I learned from your book is that the respected psychiatrists didn’t talk about anorexia in her case. It was not a diagnosis they offered for her condition.

“Yes, they went in other directions that were perhaps more convenient, given the era. They discussed schizophrenia, clinical depression and melancholy in their poetic language, but not about anorexia. I think that Binswanger didn’t understand that she was anorexic. He simply didn’t recognize the patient in front of him. If you read the fragments that she wrote, she was a lot clearer than those who treated her, that is, in her awareness of the situation and of the problems that troubled her mental health.”

Was the case of Ellen West the first time that psychiatry came across an eating disorder?

“No, there were European precedents that German psychiatrists should have been familiar with from the professional literature. In 1856, a French colleague of theirs treated a woman who suffered from such problems. At first, he focused on stomach issues, but after a few meetings with this patient, he understood that the problem was psychological. By the way, during those years, psychologists were already talking about force feeding and separating girls with such symptoms from their families. All this knowledge was not put to use in the case of Mrs. West.”

Your approach to the whole case is quite innovative. You aren’t telling the usual story.

“I must admit that I am not the first person to choose this direction. There was an Israeli researcher by the name of Naamah Akavia who wrote about Ellen West’s case and unfortunately died at a relatively young age. She heavily influenced my thoughts and my writing and I must thank her for this.”

At your recommendation, I read West’s texts that appear in your book. Her attitude to the concept of an idée fixe (a preoccupation that cannot be changed) amazed me. She reads her disease through this concept.

“My choice to translate these fragments into Italian expresses my desire to make others hear her voice, hear what she had to say about her disease and how she spoke about it with such clarity. She understood her disorder far earlier than everyone else.

“Reading these texts is not an easy experience. Ellen West describes in great detail how thoughts about thinness have taken over her life. How the focus of her suffering is this thought, which she cannot let go of, which gnaws at her mind. ‘My idée fixe is the passion to be thin. The fear of being fat or being fatter than I am now.’

“Elsewhere in the texts, West shows again the destructive force of the idée fixe that governs her mind. ‘Do I wish to eat something now? What do I wish to eat? Nothing? Yes, but this afternoon, I will want to eat something. And in the evening and tomorrow morning.’ And two sentences later she says, ‘until the summer of 1920, it was the idée fixe that tortured me. It took over my life. It became a focal point through which I examined all my actions. The idée fixe gives me no reprieve, neither internally nor externally.’”

Moscati notes that in this patient’s idée fixe there are two stages: first, the thought about not putting on weight; and second, incessant thoughts about food itself. In fact, the fixation prevented her from being able to live her life or to think about things that are not food and everything surrounding it.

West’s texts almost negate the writings of the psychiatrists who treated her – the latter contain no sign of such observations. It would seem that it would have been enough just to speak to her or ask her if she had ever written about her feelings. Had the psychiatrist done so, the range of baseless diagnoses such as schizophrenia or depression would have disappeared and her eating disorder would have emerged at the forefront, allowing them to treat it properly.

A reflection of the soul

Moscati surprises me by asking a question of her own: What awakened my curiosity about this figure? I admit that I had been waiting for this and even hoped it would come, because Ellen West’s story has piqued my curiosity for over 30 years.

I became familiar with Ellen West through the long and beautiful poem written by the American poet Frank Bidart. It was translated and published in Hebrew in 1985 by the poet Zali Gurevitch, together with a story about meeting Bidart after a poetry reading, in which the American poet read his work about the tragic patient. Gurevitch recalls that Bidart read his poem with great empathy, as if he were Ellen West herself. His voice was a combination of anger and a plea for help. The two dined together and had a conversation that Gurevitch described as having been held in an “Ellen Westian atmosphere.”

The opening lines of Bidart’s poem, called quite simply, “Ellen West,” have never left me in the decades that have passed since I first read it: “I love sweets,— / heaven / would be dying on a bed of vanilla ice cream.”

Frank Bidart, in his poem from the end of the 20th century, and Antonella Moscati in her new book, enable Ellen West to speak in her voice and remind us, the readers, that her life was most definitely a life worth living, even if she fell into the hands of three psychiatrist who thought otherwise, and did not prevent her death.