1904: The Analyst Who Noticed Anorexia Is Born

The 'relentless pursuit of thinness' was the opposite end of the same spectrum as obesity, Hilda Bruch showed.

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Advertisement showing Isabelle Caro, Milan September 24, 2007: Caro (13 September 1982–17 November 2010) was a French model and actress from Marseille who suffered from anorexia nervosa, and appeared in the controversial advertising campaign "No Anorexia". At the worst of her disorder, at the height of 1.65 meters, she weighed only 25 kilograms. Anorexia was first categorized by Hilde Bruch.
Isabelle Caro in the ad campaign "No Anorexia". Unable to overcome, Caro would die from the condition on November 17, 2010.Credit: Reuters

March 11, 1904, is the birthdate of the German Jewish-born Hilde Bruch, who became perhaps the first psychoanalyst to devote her career to the subject of anorexia – which she defined as “the relentless pursuit of thinness." Not only did Bruch provide sympathetic assistance to hundreds of young women in distress, she also educated the public about a medical problem that was in the process of becoming an epidemic. (By 1996, it was estimated that anorexia was the third-largest cause of death among teenage girls.)

Hilde Bruch was born in Duelken, a village in the North Rhine-Westphalia region of Germany. Her father, Hirsch Bruch, was a cattle dealer. He and her mother, the former Adele Rath, met at a synagogue dance in Duelken. Hilde was the third of their seven children.

As a young child, Hilde attended a one-room Jewish school in her town, and later was sent to a nearby town to attend a girls' high school that prepared students for university study.

She wanted to become a mathematician, but the uncle who financed her education after the death of her father told her that, as a woman, she’d find more opportunities for work if she pursued a medical career.

Bruch obtained her medical degree in 1929, from Albert Ludwig University, in Freiburg, and then held successive clinical appointments at the Universities of Kiel and Leipzig. In 1932, already feeling the growing wave of hostility that would soon force the resignations of Jewish academics from their positions, she entered into private practice as a pediatrician in Ratingen, near Dusseldorf.

Soon enough, her private practice was targeted with a boycott, like all Jewish-owned businesses and offices in the country, and a short time after that, Jewish doctors were forbidden from serving on health insurance panels. It was clear that from there it would be a short step to prohibiting Jews to practice medicine altogether.  

Thus, in June 1933, Bruch left Germany for England, where she spent a year working at London’s East End Maternity Hospital, before emigrating in September 1934 to the United States.

No kowtowing in Texas

Settling in New York, Bruch took a job at Babies Hospital, associated with Columbia University. Gripped with fears about her family back in Germany, however, she attempted suicide in 1935. Later, in fact, she succeeded in getting her mother and several siblings out of Germany, and after the war, she adopted a nephew, Herbert Bruch, who had been orphaned by the war. Still, many of her family members perished.  

After a lengthy hospitalization and recovery, in 1937, Bruch began investigating something called “Froehlich Syndrome,” a condition characterized by obesity, lassitude and, in boys, small genitals, and assumed to be caused by pituitary deficiency. She concluded that sufferers had no pituitary disorder, and instead proposed a psychological explanation, connected to overeating and lack of exercise, which she attributed to family dysfunction.

In 1941, Bruch moved to Baltimore, where she began to study psychiatry at Johns Hopkins University, and trained as a psychoanalyst. In 1943, she was back in New York, where she then held successively senior positions in psychiatry at Columbia University. By now, she was as interested in excessive thinness as she was in obesity, which she saw as being at opposite ends of a single psychological spectrum

Bruch really made her name when she accepted an offer to become professor of psychiatry at Baylor University, in Houston, in 1964. Many friends and colleagues found it hard to understand how a refined German Jew, a psychoanalyst no less, could choose to go to Texas, but Bruch thrived there.

Before leaving New York, she bought a slightly used Rolls-Royce, explaining to friends that she would “never kowtow to Texans in Cadillacs.” In fact, once she arrived in Houston, she seems to have been regarded with great deference and affection, as she created a discipline around the disorder of anorexia nervosa.

Through her clinical treatment, she developed significant insights into the psychological and social – particularly familial – factors that seemed to nurture what she now believed was a learned disorder.

Bruch received requests to consult from all over the United States, and in addition to her direct treatment of patients in Houston, she wrote several books that became standard references on anorexia. These included, for professionals, the 1973 collection titled “Eating Disorders: Obesity, Anorexia Nervosa and the Person Within," and, for the general public, "The Golden Cage: The Engima of Anorexia Anorexia."

Hilde Bruch suffered from Parkinson's Disease, but continued to see patients until shortly before her death, on December 15, 1984.