Saintly Sickness: Catherine of Siena as a Prototype of Holy Anorexia

In the Medieval period in Europe, a large number of religious women, many of them monastics, engaged in extreme fasting and deprivation. As a form of asceticism and with the purpose of purifying themselves and their world from sin, such fasting women believed that through self-denial and even self-torture, they could achieve perfect unity with God, and that giving in to their human needs was indeed selfish, greedy, and gluttonous. These women have collectively been given the name the holy anorectics because they starved themselves for prolonged periods of time for penitential reasons and because many of them were made saints on account of their unusual behavior and self-denial. However, debates circulate as to whether it is legitimate to diagnose this group with a modern psychological and physical disorder. Many people believe that the religious motives of the Medieval ascetics negate these women’s classification as anorexic and that the self-starvation that occurred during that age is a completely different phenomenon. Furthermore, they argue that anorexia nervosa has only emerged in the modern day and is defined by cultural values. However, the motives for anorexia nervosa vary even today, but the physical symptoms and psychological phenomena provide the common denominator between cases. By comparing modern-day diagnostics with the case of Catherine of Siena, a saint who starved herself to death in the Middle Ages, the classification of “holy anorexia” describes accurately both the physical and psychological symptoms of anorexia as it applies to female Medieval ascetics as well as the religious motivations and phenomena that accompanied these women’s self-deprivation.
Anorexia nervosa, a relatively new diagnosis, refers to severe weight loss and refusal to eat caused by psychological disturbance. Most common in females, anorexia nervosa is characterized by extreme loss of weight, refusal to gain weight, and distorted body image. Though generally associated with believing oneself to be over weight, a distorted body image could also refer to a fear of being gluttonous and belief that heeding bodily signals of hunger is a sign of weakness or sin. However, the anorectic rarely, if ever, undergoes a complete loss of appetite. According to the DSM-IV, the diagnostic manual for psychology and psychiatry, anorectics may lose weight through the reduction of their total food intake, resulting in a restricted diet with only a few foods, through increased and excessive exercise, and through purging. In some cases, they repeatedly chew and spit out food without swallowing it. Further physical symptoms include abdominal pain, constipation, cold intolerance, and either lethargy or excess energy. The anorectic also may become emaciated, jaundiced, or hypothermic.

To the anorectic, whose disorder may begin as early as childhood, weight loss means self-discipline and achievement, while weight gain symbolizes failure and lack of self-control. Thus, she might experience feelings of entrapment due to her constant battle to suppress her bodily needs yet her body’s continual signals of hunger. This dilemma can lead to depression. The mental and psychological effects of anorexia nervosa vary from insomnia to obsessive-compulsiveness and preoccupation with food. Oftentimes, the anorectic undergoes feelings of ineffectiveness, a strong need to control her environment, inflexible thinking, perfectionism, and emotional expression.

In response to the rise in cases of eating disorders, mental health professionals have conducted extensive research into the cultural settings, familial backgrounds, and personal attitudes of their patients, unearthing common themes that apply even to the cases of Medieval women. First, anorexia is associated with certain societal trends and is more prevalent in affluent societies where food is abundant and widely available. During the 13th and 14th centuries, famine spread throughout Europe, but the monasteries became providers of food for the community. The vast majority of the women labeled as holy anorectics came from families of some financial means. Secondly, anorexia occurs in cultures in which thinness is attractive. While this sounds like a modern phenomenon, in the monastic period, asceticism – the practice of self-denial – became a central tenet of devout religious practice. Therefore, thinness represented the opposite of gluttony and was thus a manifestation of asceticism.

On personal and familial levels, anorexia is an attempt by the individual to control her life and world. The anorectic generally feels unable to affect her future, perhaps due to her social circumstances or to her familial dynamic. In the case of the Medieval anorectics, their patriarchal society limited their roles to either the domestic world or, on occasion, the convent. However, daughters had little voice in family decisions, and parents arranged marriages and their daughters’ futures to benefit the family. Many parents denied their daughters wishes to enter a convent. Unusual though it may seem, the parent with whom the daughter has the most strained relationship is usually the overbearing mother, a commonality in both Medieval and modern cases. Anorexia involves a constant quest for perfection, in which the anorectic continually sets for herself impossibly high goals. As Morgana Steinbach quotes in her essay on eating disorders and religion, those suffering from anorexia are “‘very strict with themselves, and have practiced the discipline of self-denial, so they are able to achieve their “perfect” solution to many of life’s problems and challenges.'” Whether they come from achiever-oriented families or whether they naturally have perfectionistic tendencies, anorectics possess a bent towards setting for themselves high expectations yet retaining a constant sense of guilt.

According to research on the possible connections between religion and eating disorders, devout religious practice can in fact contribute to the development of anorexia nervosa. In Christianity itself, food symbolism and practices concerning food pervade the faith. For example, Helen Baxter in her article “Nibbles: Religion and Eating Disorder” identifies themes of self-denial, asceticism, and abstinence in religious rituals as means of penance for sins. In fact, gluttony is listed as one of the seven deadly sins according to the Catholic Church. To the Medieval Catholic Church, fasting potentially cured diseases, united Christians, earned forgiveness and the right to go to heaven, and led to spiritual revelations. Furthermore, fasting hypothetically allowed the individual to achieve spiritual perfection by renouncing the flesh. The emphases in religion on self-denial, morality, dualism between body and spirit, and abstinence possibly contribute to feelings of guilt and of the need to restrict her food intake as a means of denying the body and perfecting the spirit. Oftentimes, the anorectic views God as punitive, and she must sacrifice in order to acquire God’s love and forgiveness, writes Steinbach. Thus, religious and especially Christian values may create in the mind of one predisposed to guilt and perfectionism a reason to engage in self-starvation.

In order to determine if the term “holy anorexia” can indeed correctly be applied to certain Medieval female saints, the life of Catherine of Siena will serve as a case study to prove the applicability of the label. One of the best-known examples of women recognized for their prolonged fasts and holiness, Catherine of Siena referred to her inability to eat as an infirmity, yet she also believed it to be a means of penance not only for her own sins but the sins of her family and the Roman Catholic church as well. Born in Italy to a family of dyers in 1347, Catherine was a twin, both sisters born weak and frail. Catherine’s mother, Lapa Piacenti, could only nurse one baby and chose Catherine; the other daughter died. As a child, Catherine expressed deep religious devotion. When she was only six or seven years old, she received her first vision of Jesus Christ, yet she told no one. Her controlling mother, intent on preparing Catherine to be a worldly girl in order to attract a husband, apparently opposed Catherine’s devout religiosity, constantly reminding her that she had an obligation as the favored surviving child to filial devotion first and foremost. However, Catherine was a strong-willed child and grew adept at accepting a suffering-servant mentality, taking upon herself the punishment of her mother when Catherine opted to exercise her spiritual desires instead of obeying her mother’s wishes.

The watershed that allowed Catherine to fulfill her pledge she made as a youth to remain a virgin and never marry occurred with the death of her dear older sister, Bonaventura. Upon this occasion, Catherine’s mother determined that the girl should marry Bonaventura’s widower Niccolo, to which sixteen-year-old Catherine refused with stubborn finality. Just prior to Catherine’s demonstration of determination, Lapa fell gravely ill. Catherine pledged to God that in exchange for the extension of her mother’s life, Catherine would engage in a life of “hard penance and solitude.” At this time, Catherine astounded her parents by defying their wishes to marry and proclaimed herself bound to God alone, to which the Benincasas reluctantly gave her permission to practice her extreme pursuit of holiness. She constructed for herself what she called “a cell in her mind”, consumed only raw vegetables, bread, and water, and wore rough wool and an iron chain around her hips. In addition, she slept only half an hour nightly on a wooden board and flagellated herself three times a day for her sins, for the sins of the living, and for the sins of the dead, and adopted a vow of silence which she kept for three years. When she contracted smallpox, her one desire was to join the mantellati, a group of widows who acted as Dominican tertiaries. Once she overcame her disease, Catherine opted to live at home as a member of the mantellati and began an even stricter regimen of self-denial and starvation. Apparently, Catherine acted as a servant to her family and went about her work with disturbing hyperactivity, doing other people’s laundry and cooking their food in the middle of the night. Young Catherine readily and willingly associated herself with practices of servitude and penitential asceticism. The total suppression of her hunger did not come easily, and apparently, Catherine fixated on the Eucharist, which testifies to her need to mentally suppress feelings of hunger. If Catherine forced herself to swallow even a mouthful, she vomited and claimed that she was unable to eat; according to Catherine, eating would kill her, so she would rather die of starvation than gluttony. In order to refute accusations of demon possession and witchcraft, Catherine tried to eat once a day but only chewed bitter herbs and spit out the substance. If she did ingest any food, she would purge it immediately, claiming that her vomiting was a means of penance.

Upon her father’s death when she was twenty-one, Catherine underwent an impressive conversion experience, at which time she supposedly received the mark of a ring on her finger to indicate that she was the bride of Christ. At this time, Catherine began ministering to people publicly and articulated her belief in the significance of her penance. According to Catherine, the Virgin Mary promised her that her suffering would free souls from purgatory. Catherine ministered to the sick and needy in Siena for years, but soon she took seriously her perceived ability to save souls and began to travel around Europe. She composed several hundred letters, as well as her Dialogue in 1378, and authoritatively gave instruction to clergy at all levels, including the pope. Catherine urged the pope to return from Avignon to Rome to correct the deterioration of the papal center. When Urban VI came to power and refused to listen to Catherine, her inability to solve the problems within the Roman Catholic Church precipitated a long bout with depression and feelings of guilt for its deteriorated state. Catherine believed that the ruin of Rome would rest on her shoulders because of her advice to Gregory XI to leave France and return to Italy. This broken-heartedness, combined with her self-torture and starvation, led to her death in 1380. However, in 1970, Catherine, now a saint, was recognized as one of the first two women Doctors of the Church, and her legacy embraces a commitment to suffering and a confidence that the practices of her life were indeed efficacious for the salvation of souls and of the Church.

In light of the recent increase in eating disorder cases, speculation has been raised as to whether or not Catherine of Siena can correctly be diagnosed as an anorectic. Although Caroline Walker Bynum, author of Holy Feast and Holy Fast, insists that the information about such women is too fragmentary to diagnose, the connections between Catherine’s behavior, symptoms, and historical context seem clearly to represent a case of anorexia nervosa cloaked in religious incentives and themes. Physically, Catherine’s appearance and behavior are that of an anorectic. She was extremely underweight, credited her restrictive diet to an inability to eat and an infirmity, and vomited frequently, an indication that she had so ruined her digestive system that it was no longer able to accept food. Furthermore, anorectics often chew food and spit out the substance, a practice that Catherine engaged in daily.

On the cultural and psychological levels, Catherine’s experiences fit the pattern of those of anorectics. The Medieval monastic culture taught that suppression of physical urges and basic feelings freed the soul to commune with God and that death was total liberation from the flesh. Thus, the religious culture of Catherine’s day contributed to the idea that anorexia, disguised as devotion to God, was saintly and holy. Furthermore, food was a main symbol of both good and evil in Catholic teaching. For one, eating was an occasion for union with others and with God, epitomized in the Eucharist, and holy anorectics renounced ordinary food in order to prepare themselves for “consuming and becoming Christ through the Eucharist.” On the other hand, food was associated with gluttony, one of the main sins against which the monastic communities fought.

Banned from the priesthood, many women, like Catherine, experienced feelings of helplessness in that they could not save themselves nor anyone else. However, Catherine reacts to this in a typical anorexic manner by attempting to control her own salvation and by believing that she could indeed pay for the sins of others through fasting. Men virtutally controlled the lives of women, leading women like Catherine to attempt to become masters their inner struggles if they could not control their outer lives. Like modern anorectics, Catherine and other devout females believed that suffering and self-denial is the only way to earn love and to control their world. In the patriarchal world, food was the one area in which women were placed completely in charge. Women’s duties included preparing and serving food, providing food from their own bodies for their babies, and abstaining from eating with men. Food issues allowed women to control their bodies and their worlds in an era in which they were given away in marriage and forced to fill certain roles against their wills. Therefore, to deny the world in which they had authority, namely in the area of food, meant that women finally achieved control over some segment of their lives.

In Catherine’s own life, her struggle for control against her mother, a representative of typical patriarchal views and practices, ended when Catherine turned to religious devotion and renunciation of her physical needs. Typical of anorectics, Catherine experienced bouts of deep depression and guilt, often caused by feelings of helplessness and also by her status as the favored child who survived at the expense of her twin sister. She demonstrated an obsession with food, speaking of God in terms of nourishment as a nursing mother and emphasizing devotion to the Eucharist, and her primary miracles revolved around healings and food multiplication. Catherine also exemplifies the personality characteristics of anorectics, both holy and modern-day. She was a happy and obedient child with a sense of her own specialness, and she expressed a deep interest in holiness early in life. Thus, she rejected her parents’ “worldliness” for the religious life. Aside from this divergence from conformity to others’ wishes, she appeared outwardly to be docile, uncomplaining, and servile.

Catherine’s inner guilt and need for control was associated with food and with nursing, writes Bynum. Apparently, Catherine Benincasa argued that her infirmity, that is, her inability to eat was a gift sent from God to cure her “gluttony.” She viewed hunger pangs as “greed” and blaimed herself for the sins of the world, yet felt helpless to alter this state of guilt unless she refrained from eating. These notions of culpability for others’ sins, perfectionism and holiness as a means of earning love, and need for control over her own world correspond closely with the beliefs of modern anorectics, many of whom also defend their behavior with religiosity.

Upon analysis of Catherine Benincasa’s life and legacy, if she can indeed be considered a legitimate case study to represent other female ascetics, the term “holy anorexia” reasonably applies to women who for extreme religious reasons found it necessary to restrict their diet to the point of starvation. Vandereycken and Deth compare holy anorectics with today’s equivalent, positing that “although fasting saints, miraculous maidens, hunger strikers and anorexics differ in many respects they have on thing in common: all have relatively little power. Self-starvation is one means of acquiring it.” While the cultural context perhaps influenced the religious motivations in these women’s actions and attitudes, the similarities between the nervosa experienced by modern-day anorectics and by Medieval ascetics provide ample evidence that the psychological dynamic, physical symptoms, and family and cultural patterns are typically anorexic. Therefore, the term “holy anorexia” accurately describes the lifestyle of many of the most devout Christian women during the Medieval period.