Letters to the Editors

To the Editors:

Offering unsolicited criticism ranks among the most unpromising forms of discourse, but it would be too disconcerting and ultimately, I believe, detrimental to the patient, to have the misconceptions contained in Natalie Shainess' article, “The Swing of the Pendulum: from Anorexia to Obesity,” (Vol. 39, No. 3, 1979) go unchallenged. Actually to remedy this highly speculative lecture is difficult; nevertheless, I think an attempt to correct the most conspicuous errors may not be futile.

Dr. Shainess states (p. 228): “in anorexia nervosa-there is considered to be a pituitary factor.” This erroneous opinion, held around the turn of the century, has been refuted in many excellent studies (see Vigersky, R., Editor, Anorexia Nervosa, New York: Raven Press, 1977). In fact, the pituitary gland is functioning normally. To what extent impairment of hypothalamic function results from malnutrition or the syndrome itself is still being investigated.

In the second paragraph (p. 228), Dr. Shainess mistakenly perpetuates the notion that hunger is not experienced by patients with anorexia nervosa. Quite to the contrary (Garfinkel, et al. Psychol. Med., 4: 309-315, 1974; Casper, et al., Arch. Gen. Psychiatry, in press) such patients starve themselves, contending with strong hunger feelings. Occasionally in advanced stages of emaciation, there is loss of appetite; but generally the presence of hunger is an important differentiating symptom from depression or organic illness.

On page 230, Dr. Shainess says: “Unconscious fantasies connected with food are that it is poison,” and “The efforts not to eat can be seen as a phobic avoidance of poison.” Such a description implies a diagnosis of a particular form of paranoia. Unfortunately, no evidence is offered for this hypothesis and, furthermore, there is no evidence for the association of food with poison from working with patients. The diagnostic problem is much more complex and if one wants to call anorexia nervosa a phobia,