Neuroses of the stomach: eating, gender, and psychopathology in French medicine, 1800-1870.

In the period 1800-1870, French physicians approached psychic illness (Philippe Pinel's "neurosis") within competing "cerebralist" and "visceralist" frameworks. Cerebralism, which dominated the specialty of mental medicine, sought the origins of psychic illness in lesions of the brain and central nervous system. "Visceralism," upheld by generalists, clung to the view of the ancients that psychic disorder was seated in the abdominal viscera. The distinction enjoyed credibility thanks to widespread acceptance of Xavier Bichat's "two lives" doctrine, which demarcated functions of the central and the "vegetative" nervous systems. Once the "two lives" conception was undercut after midcentury, cerebralists sought to draw disturbances of appetite, digestion, and eating within the domain of the central nervous system. This essay suggests that historical study of "hysterical anorexia" and related disease entities that displaced "neuroses of the stomach" has overemphasized sociocultural determinants to the neglect of the internal dynamics of biomedical science.