I enjoyed reading this very interesting book and
found it thought-provoking.  The author,
a journalist, tells the story of Mollie Fancher, who spent fifty years without
leaving her bedroom after an accident in 1865. 
She became a celebrity for her claims that she was in contact with the
spirit world and that she survived in spite of eating nothing.  The tale is told in a manner which is
sympathetic to all its participants and is especially well set in the
medical-historical context of the late nineteenth century, with implications
for the early twenty-first century.

Fancher was a well-educated 18-year-old who was
engaged to be married and living with her aunt in Brooklyn (her father had
remarried after Molly’s mother’s death, and had moved away).  In 1865, she had a terrible accident with a
horsecar and was dragged many feet.  She
was treated in her home for these serious injuries and then developed
dyspepsia, weakness and "failing health".  The author recreates the medical and psychological mise-en-scene
— Beard’s neurasthenia, the many train and horse-car accidents which occurred
and the post-traumatic stress disorders which developed after these incidents,
as well described by Freud, and the many protracted, disabling illnesses
without known pathology which were prevalent at the time.

The author develops the theory that Molly suffered
from la grande hysterie
of Charcot, as further developed by S. Weir Mitchell in the United States.  She had the arc en circle, a feature of hysteria which is rarely seen
today but which I have observed, many sensory findings, paralysis, and
trances.  Observers said that she had
five distinct personalities.  The author
cites feminist theories about this type of historical hysteria — but she could
have explored other theories as well. 
Molly was prescribed several somatic therapies, without much
response:  hydrotherapy, electrical
treatments, heat, and ice jackets. 
While classical hysteria may be gone forever, it is interesting that the
author cites Briquet on this topic; while Briquet subscribed to some classic
nineteenth century views of hysteria, he really described somatoform disorder,
which remains with us today, and a good case can be made that, at least today,
this would be Molly’s diagnosis. 
Irritatingly, the author provides all this rich information in a chapter
which also contains far more details about Molly’s house and neighborhood than
will interest most readers.

Thirteen years after her injury, Molly Fancher
became a public figure, claiming to be clairvoyant, involved in metaphysical
travel — including travel to the afterlife — and also claiming that she
existed without eating.  These
assertions were fomented in the newspapers, which found the situation
fascinating (and undoubtedly these claims sold newspapers!)

An excellent chapter on William Hammond
follows.  He had been Surgeon General of
the army during the Civil War and was a founder of the discipline of
neurology.  He wrote a fascinating book,
Fasting Girls
(1879).  He was a debunker of
spiritualism and is viewed in the book as a somewhat hostile man.  He tried hard to expose Mollie Fancher as a
fraud and said she was "a perfect humbug — a clear case of
insanity."  This chapter is flawed
because of the amount of unnecessary biographical detail about Hammond. The
author next includes a chapter on George Beard.  This great physician, who died at age 43, did many studies of
nervousness and so-called neurasthenia. 
He also studied many unusual syndromes such as the "jumping
Frenchmen" of Maine.  He was a
proponent of electrical treatments for patients like Mollie, and he, like
Hammond, debunked Mollie’s claims of surviving without eating.

The
next section of the book considers the background of anorexia nervosa and
develops the concept that in Victorian culture, meat and a hearty appetite were
associated with sexuality and were shunned by "proper" young women.  This is debatable, and the presentation is
one-sided.  The author provides an
excellent discussion of chlorosis, a syndrome which peaked in the 1870’s and
1880’s and which featured decreased energy, amenorrhea, weight loss, diminished
appetite, depression, and a faint, green tinge to the skin.  Chlorosis may have been related to iron
deficiency anemia.  It was NOT anorexia
nervosa — unlike patients with chlorosis, anorectic patients often have a high
energy level and a normal appetite, and they are certainly not always depressed
— but it may have been an eating disorder. 
She then discusses anorexia nervosa itself, including a good account of
the priority dispute between Lasegue and Gull, and fair credit to the usually
forgotten Chipley.  She raises the
question of whether Mollie Fancher might have had anorexia nervosa.

The
author goes on to discuss biological manifestations of starvation, including
death from starvation as described in the Warsaw Ghetto.  She discusses the strange attitudes and
eating behaviors of St. Catherine of Sienna and then provides case studies of
several "fasting girls" — adolescents who claimed not to eat.  Some of these fasting girls were displayed
at county fairs, etc., and several challenged the medical profession to
disprove their claims — which frequently happened.  This discussion strays quite a bit from the case of Mollie
Fancher.

At the end of the book, the author discusses modern
views of hysteria, and we learn of Mollie’s demise — after a party celebrating
her fiftieth year of living in one room of her house, attended by a great many
people.  (Molly had even invited
President Wilson, but he did not attend.)

I enjoyed the book tremendously, but it has serious
flaws.  Mollie Fancher’s story is not
really enough to hold the wide-ranging discursions together.  While it is interesting and troubling to
read of how starvation killed in the Warsaw Ghetto, this really has very little
to do with Mollie:  from a great many
photographs, she certainly appeared well-nourished throughout her lengthy
"fast".  We learn far more
than is relevant to her situation about Hammond, Beard, and the early
literature on anorexia nervosa.  The
discussion on hysteria is very interesting but does not include formative
modern views such as that of Slavney. 
Although Briquet is briefly discussed, there is no significant
consideration of Mollie’s case as an example of somatoform disorder.

On the positive side, the case of Mollie Fancher is
fascinating.  A journalist herself, the
author is at her very best when she is discussing the way the newspapers dealt
with this case and brought it into the public eye over many years.  We are left with a thought-provoking — even
haunting — account of one woman’s life and its meaning, in the context of the
late nineteenth century.  Reading this
book is time well spent, for mental health professionals, philosophers, and the
general reader.

The "father" of psychiatry, Johannes
Weyer, devoted a prodigious amount of time to the study of a young woman, who,
like Mollie, claimed not to eat.  He
exposed her as a fraud and wrote about it. 
These patients have been with us from the start of the profession.  It is interesting that the same issues crop
up in very different social climates — even today, in New Zealand, there are
"Breatharians" who claim to be able to maintain their weight and
health without eating at all.

We need to eat. 
I don’t think Mollie Fancher had an eating disorder, and I think she ate
well.  Kudos to the author for this fine
book, with all its interesting digressions.

© 2003 Lloyd Wells

Lloyd
A. Wells, Ph.D., M.D., Department of Psychiatry and Psychology, Mayo Clinic,
Rochester, Minnesota.

Categories: MentalHealth, Memoirs, ChildhoodDisorders