The phrase is a blend of gratitude and irony, for her collaborators, mostly teenage girls from well-to-do families, were victims of a bizarre disease called anorexia nervosa. Bruch, 74, a professor of psychiatry at Baylor College of Medicine in Houston, is perhaps the nation's foremost expert on what she terms the "psycho-social illness" that impels young girls—boys are almost never affected—to starve themselves compulsively. They come to look like "walking skeletons" but think of themselves as attractively slender.
Most victims eat only minuscule amounts of food. One of Bruch's patients stood 5'9" and weighed 62 pounds. Another, 14, told the doctor: "Of course I ate breakfast. I had my Cheerio." She wasn't joking. Others pretend to eat but hide the food in their clothes or surreptitiously feed it to pets. Sometimes they go on eating binges, then induce vomiting or take massive doses of laxatives, upsetting the body's metabolism even further. Some anorexics die from such side effects.
Bruch is currently treating 18 patients, several referred to her by frustrated therapists in other parts of the country. She believes there may be "tens of thousands" of cases, most undiagnosed, in the U.S. A British study estimates that one of every 200 girls in private schools in that country is afflicted. "It has become," Bruch says, "the hottest illness to have right now."
Born to wealth in Germany herself, Bruch earned an M.D. from Freiburg's Albert Ludwig University in 1929, but to escape the rise of Nazism emigrated to England in 1933 and to the U.S. in 1934. She lost her brother, sister and the man she hoped to marry in the concentration camps of World War II. She never wed but adopted and raised an orphaned nephew—Herbert Bruch, 45, a research mathematician—while practicing and studying in Baltimore and New York. After specializing in the treatment of obese children at Manhattan's Babies Hospital, Bruch turned to psychiatric aspects of child care. She began to encounter anorexia nervosa in the early '60s.
She took the title of her book from a patient who called herself "a sparrow in a golden cage," because she considered herself unworthy of her affluent family. Such attitudes are common among anorexics. Bruch says a basic cause of the disease is the patient's delusion of failing to live up to her own and her parents' expectations.
"During the 1950s," Bruch argues, "it was acceptable to be a compliant, nice, sweet girl. If she was bright enough, and from the upper class, she was supposed to go to college and meet a nice Harvard man and settle down. Now this same girl goes to college to write a Ph.D. thesis and get a job in Washington. Girls with conforming personalities feel obliged to do something that demands a great degree of independence in order to be respected and recognized. When they get stuck, the only independence they feel they have is to control their bodies."
Anorexia nervosa (literally "nervous loss of appetite") was first observed in France and England around 1870, a time Bruch sees as marking the first emancipation of women. "I am convinced," she declares, "the illness goes together with the women's movement, because this is what the girls want: to show that they are something special." (She also says the modern emphasis on slimness is a factor; many anorexics are former crash dieters.)
For parents of potential victims, she cites the following signs of incipient anorexia: severe dieting, strenuous solitary exercise, fanatic perfectionism at school, menstrual cessation, social isolation and sleeplessness. "There is no time to fool around and think it will go away," she warns.
Bruch treats her young patients (for two to three years) by trying to convince them they have their own abilities and don't need to starve themselves to attract attention. "They feel that if they gave in to their normal drives, they would reveal themselves as absolutely low, gross, base, inadequate, evil persons," the doctor says. "You have to convince them they are capable, honest, lovable, warm people. When they feel that good about themselves, treatment is finished. It's a pretty big job."
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