Few theologians in the history of Christian thought have considered so deeply the psychological motivations and moral aliments of a human life as Saint Augustine. In our current times, eating disorders appear to be an increasingly prevalent and deadly illness. The National Eating Disorder Association (NEDA) report that 30 million people (20 million women and 10 million men) in the U.S.A. suffer from an eating disorder at some point in their lives.Footnote 1 This set of disorders seems to be widespread and perhaps even epidemic in Western societies, as such it deserves serious theological reflection.
This paper seeks to explore the questions: What possible insights or resources can Augustinian literature bring to aid our understanding of this illness? What can our psychological work in the area of eating disorders bring to our understanding of Augustinian concepts? This paper consists of a sustained comparison between Augustine's complex examination of human sin and the contemporary literature of the nature of eating disorders. It must be admitted that both these areas of research are fairly vast and complicated in their own rights, and so the dialogue constructed here is necessarily limited in scope and, at points, depth. However, this paper remains an original exploration of this dialogue with strong possibilities of further research.
The first aim of this article is to highlight the significant similarities between these two, otherwise substantially different, discussions. The second goal of this interdisciplinary dialogue is to offer psychological insights as a helpful tool for reinterpretation of some of Augustine's arguments and terminology, and philosophical/theological insights which might aid psychologists seeking to understand eating disorders today. It should be stressed from the start that I do not wish to suggest that eating disorders should be judged as “sinful” in any simplistic sense (there is nothing simplistic about Augustine's view of sin, and the terminology is simply not appropriate) and this paper has no opinions on what counts a “sinful” and what does not.
Augustine never explicitly considered the condition we now call ‘eating disorders’, which emerged as a psychological category in 1873 and was officially categorised as a syndrome in 1992 (Slade, Reference Slade1984, p.10; Giordano, Reference Giordano2006, p.20; ICD‐10, 1992). However, Augustine's discussion of, firstly, the origin of human “sin” and, secondly, the consequences or cycles of destructive behaviour provides a compelling theological lens for understanding eating disorders today. In between these two sections is a discussion of a central tension within this paper; the entangled relationship between illness and choice. This entanglement is as problematic today as it was in the fourth and fifth centuries and represents one of the major obstacles to the integration of theology and psychology.
The Question of Origins and Causes
Augustine developed much of his hamartiology (doctrine of sin) through a narrative of “The Fall” and so this is the theological focus of this first section. I will proceed by examining Augustine's two alternative interpretations of Adam's decision to eat the forbidden fruit; the first being Adam's pride and the second Adam's love of temporal goods. Following this I will relate Augustine's assessment of Adam to two commonly cited causes behind, in particular, anorexia nervosa; desire for control and desire for thinness. However, it should be noted that the research on the aetiology of eating disorders is non‐conclusive so that, “rather than a single‐factor causal theory, anorexia nervosa [and the other eating disorders] is viewed as a multifactorial disorder with a symptom pattern representing a final common pathway.” (Mancini, Reference Mancini, Daini and Caruana2009, p.162; cf. Soros, Reference Soros, Volcker and Frampton2011, p.27; Giordano, Reference Giordano2006, p.88). As we shall see, Augustine's view of sin ends up being very similar to this complicated view of interdependence between cause(s) and symptom(s).
Augustine's Examination of Adam
Augustine saw the narratives found in the beginning of Genesis as myths, containing important truths, but not as historically documentation or literal descriptions. With this in mind, Augustine constructed his own interpretation of “The Fall” with a twofold commitment: (i) that God is the only God and sole creator of all things ex nihilo and (ii) that God created all things, including the physical human body, good (sol.1.1.2; CSEL 89:4). Therefore, Augustine holds that God cannot be responsible for the evil which we do and for which we are punished. This in turn led him to the innovative conclusion that the “sin” of humanity originated neither in our flesh nor in the fruit which Adam and Eve ate as these were both created by God. Instead, the origin of wrongdoing, for Augustine, must be found in the human mind or will for which humanity carries responsibility, even though the mind too was created by God (ciu, 14.3.50; CCL 48:417). This led Augustine, in his earlier writing, to depict Adam as making a wholly incomprehensible and spontaneous decision of his free will to go against God; “…nothing makes a mind give way to desire except its own will and free choice.” (lib. arb. 1.11.21; CCL 29:225. trans. Pontifex, ANW, 22, 57). However, Augustine was discontent with this explanation. In what scholars refer to as the writing of a more mature Augustine there is a deeper examination of the possible psychology behind Adam's decision. Here Augustine proposes two possible motivations: Adam's pride and Adam's love of temporal goods.
Augustine's first and most famous suggestion for how to understand Adam's fall is pride (ciu 14.13; CCL 48:434‐436). This pride, or superbia, is articulated as “the craving for undue exaltation”, which “becomes a kind of end to itself” (ciu.,14.13).Footnote 2Adam's freedom was limited by one boundary that symbolised his dependence and submission to God. Augustine suggests that it was pride that caused Adam to defy the natural order and rebel against God (s. 340A.1; PLS 2:637).Footnote 3 In ciu. 14.15 Augustine describes the “single very brief and very light precept by which He reminded that creature whose service was to be free that He was Lord” (ciu, 14.15).Footnote 4 Unfortunately, pride “abhors equality with other men under Him; but, instead of His rule, it seeks to impose a rule of its own upon its equals.” (ciu. 19.12).Footnote 5 Hence, according to Augustine, Adam was prideful because he desired power more than he desired God's justice (ciu. 12.8).Footnote 6
Robert Markus has convincingly argued that Augustine's depiction of the nature of pride changed throughout his career. In Confessiones (conf.) pride is a violation of the divine order and the valuing of lesser goods above higher goods (see conf. 7.16.22; CCL 27:106). However, in De Genesi ad Litteram (Gn. litt.) Markus suggests that pride is a social evil which places the self and private goods above social benefit and common goods (see, Gn litt. 11.14‐15). Markus writes, “….the root of sin lies in the self's retreat into a privacy which is deprivation: the self is deprived of community…” (Markus, Reference Markus1989, pp.31‐32). Of course, these two interpretations of pride are not mutually exclusive. In fact in De ciuitate Dei (ciu.), they seem to be complimentary; by choosing his own power over God's justice Adam not only commits apostasy and violates the natural order, but he also chooses his own good over the common good and all creation suffers as a result of his choice. This choice alienates Adam from God, Eve and all creation, thus depriving Adam of community. As will be seen below, both these interpretations of pride are relevant when comparing Augustine's writing with contemporary discussion of eating disorders.
The second interpretation of Adam's sin is Augustine's suggestion that Adam chose and loved (libido) temporal goods (that could be inuitus amittare) instead of the one eternal good, God. (lib. arb. 1.35; CCL 29:235: trin. 12.15; CCL 50:377‐379).Footnote 7 Augustine writes that Adam's decision was not a choice,
from substantial good to substantial evil, for there is not substantial evil‐ but from eternal good to temporal good, from spiritual to carnal good, from intelligible to sensible good, from the highest to the lowest good.
(uera rel. 20.38)Footnote 8Adam's desire for a lesser good, his concupiscence within the mind, is the sin that is repeated in every area of every human life. As Augustine writes, “Sin in a human being is a disorder (inordinatio) or perversity, that is, an aversion to the more preferable creator, and a conversion to the inferior creatures” (Simpli., 1.2.18; CCL 44:45).Footnote 9 This brings us to the core of Augustine's thinking on the enjoyment versus the use of temporal goods (see, doctr. chr 1.30.31‐40.44; CCL 27:23‐32). Augustine's discussion of the appropriate relationship to temporal goods involves the distinction between enjoying and loving things for themselves, or using them as a means to enjoying and loving a higher end, God. For Augustine, God is the only proper object of absolute love and enjoyment so that temporal goods should only be used as a means to enjoy God (see, s. 36.6; CCL 41:438).
For Augustine, this is tightly tied to the perception of beauty. God is the one eternal Good, because God is also the truest source of Beauty. Augustine occasionally appropriated a phrase from Greek philosophy which expresses this, the right ordering of loves towards God (Rist, Reference Rist1994).Footnote 10 Thus, even the forbidden fruit was not evil, but it became a source of evil because it was used and enjoyed in separation from God (see, Gn. litt. 8.6.12; CSEL 28:239‐240). Adam perceived something as beautiful (whether this was the apple, Eve in her fallen state after eating the apple, or his own power) when it was separate from God, and therefore separate from the source of life and from the right ordering of the universe. Moreover, it is not just the perception of beauty that was important to Augustine, but the mimetic nature of that we consider beautiful (see, conf. 4.13; CCL 27:50).Footnote 11 We become like what we consider to be most beautiful. Augustine wrote, “For delight is a kind of weight in the soul. Therefore, delight orders the soul” (mus. 6.11.29).Footnote 12 One cannot separate appreciation for the beautiful with desire and personal transformation in Augustine's writing. This understanding of beauty as transformative has a clear comparison with distorted perception of beauty for those suffering from eating disorders.
The mature Augustine no longer suggested that Adam spontaneously willed perversely, for such voluntarism presupposes an unrealistic separation of the will from desire and knowledge. But in the mature account, Adam's desires influence his will and behaviour, so that he acted against his knowledge of what was good and best. Thus, in this later description of Adam by Augustine, there is a more holistic psychological picture where all the mental faculties are involved in Adam's behaviour.
Paradoxically, Augustine considered Adam and Eve to have been created whole and perfect, so that such a separation of faculties (i.e. to act against his knowledge) was considered a symptom of humanity's diseased state, and so cannot logically be the cause of Adam's sin. It seems, in his search for the cause, that Augustine can only see the symptoms and cannot get behind or before these symptoms. As one author writes when discussing the difficulty in identifying the origin and cause of an eating disorder, Augustine's search might be described as, “like the cook who peals back the leaves of an artichoke in search for the artichoke. You're left with nothing.” (Giordano, Reference Giordano2006, 231)
The change in Augustine's approach is important because it transforms the figure of Adam into a mirror for the “sins” of humanity, rather than the unique and unexplainable originator. Indeed, Augustine seems to have held Adam in both roles, as a unique progenitor of the “sinful” state and as a template which all humanity has since imitated. Adam “is one thing as an example to those who sin because they chose; and another thing as the progenitor of all who are born with sin…” (pecc.mer. 1.9.10; CSEL 60:11).Footnote 13 It might be seen that the two sections of this paper, examining the origins (Adam as example) and the consequences (Adam as progenitor) of sin and eating disorders, builds upon Augustine's used of each of these “Adams”.
Pride as Control; Beauty as Thinness
Apart from a superficial affinity in the eating of food, how does this Augustinian account of “The Fall” correspond to the phenomenon of modern day eating disorders? The two suggestions by Augustine that pride (as both self‐exaltation and privation) or the desire for the lesser goods and false beauty motivated Adam's decision eat the forbidden fruit, is used as a lens for examining two commonly perceived motivations/causes for anorexia nervosa, the desire for control and the desire for thinness, respectively.
The role of pride in Augustine's narrative of “The Fall” provides a strong comparison to the central need for control within eating disorders; “Eating disorders are always characterised by a strain towards control” (Giordano, Reference Giordano2006, pp. 214–215). Walter Vandereycken, argues that the “main problem” involved in eating disorders is “self‐control regarding weight/shape and the fear of losing it” (Vandereycken Reference Vandereycken and Van Deth1994, pp.214‐215).This is particularly clear in the case of anorexia nervosa. It is important to note that this ‘pride’ is not, in the case of Augustine or in the case of eating disorders, the swelling of over‐confidence as it has come to mean in modern speech. Instead, quite to the reverse, it is a need for control born of insecurity and fear.
For many who suffer from anorexia nervosa there exists a rejection of the physical as inherently evil, and this entails a denial of basic needs. However, this is often combined with an obsession or fascination with nutrition and the body (Giordano, Reference Giordano2006, p.18; Bruch, Reference Bruch1980, 90). The result is that the denial of physical needs is prioritised over all other concerns. There is, therein, a desire for control and self‐determination over and against the natural order. As Rene Girard as shown us, the denial of a need (food or, in Adam's story his need for relationship with God) is “the ultimate demonstration that one is superior to that something and to those who covet it.” (Girard, Reference Girard and Anspach2013, p.22) Likewise, Giordano gives an account of how the exhibition of suffering in the anorexic body “empowers” the sufferer and “give[s] her control over others and the surrounding environment.” (Giodano, Reference Giordano2006, pp.160‐161; Cf. Giordano Reference Giordano2002, pp.3‐8).
Of course, it is impossible to paint all sufferers of anorexia nervosa with exactly the same brush. However, for many there is a desire to separate oneself from, and exhibit control over, physical needs. This can also be a way of separating from and controlling all those who still submit to their body's requirements. This is often the case when the sufferer feels an acute lack of control in some other area of their life. According to Augustine, Adam pridefully willed against his natural need to feast the soul in relationship to God by acting against the natural order and so separated himself from communion with God and from the community of creation. Similarly, many have seen that by denying the need for food, sufferers of eating disorders symbolically separate themselves from friends, family and even the rhythms of the natural world more widely.
In the ancient world the same sort of self‐starvation that is today referred as anorexia nervosa was often celebrated as a marvellous achievement, whereby an individual denied the transient temptations of this world (Brown, Reference Brown1988, pp.285‐304; Soros, Reference Soros, Volcker and Frampton2011, p.2). Indeed, with remarkable similarities to this ancient asceticism, one contemporary research group of anorexia nervosa writes, “Thinness becomes a marker of those who are in control of themselves, those who are able to rise above the “base” domination of appetitive desire, who can resist and stand firm against temptation.” (Soros, Reference Soros, Volcker and Frampton2011, p.13) Through the rejection of food, anorexia nervosa is often a rejection of human mutability, vulnerability and dependency upon others (see, Bell, Reference Bell1985).Footnote 14 It is the desire to be without the nutritional needs that govern all other people as a form of “control” of one's own body and the world around them (Jantz, Reference Jantz2002, p.41). This is a form of control through disconnection and separation.
It has also been argued that food to the anorexic sufferer is a “weapon” to control the people closest to them (Gilbert, Reference Gilbert and Commerford2000, p.32; Girard, Reference Girard and Anspach2013, x). This desire is manifest through such a determined will that not only are sufferers alienated from friends and family, but even from their own bodies. Likewise, in Augustine's narrative, not only is food the symbolic weapon used by Adam, but Adam's pride alienated him not only from God, but also from his companion and, as shall be explored more fully below, from his own body.
Some Augustinian scholars have interpreted Adam's pride as a rejection of paternal authority (Wetzel, Reference Wetzel and Hoffmann2008, p.70). Similarly, anorexia nervosa has been considered a rejection of parental expectations and maternal influence (Turner, Reference Turner1984, pp.184‐185; Gilbert Reference Gilbert and Commerford2000, 10–12, Mancini, Reference Mancini, Daini and Caruana2009, p. 163). This is often seen where the sufferer is a young female as is often, but not universally, the case. Typically, our mothers meet the basic need for food throughout our childhood. Thus, as an act of self‐differentiation a young girl denies the need for her mother through denying her need to be fed. The problem with this reading in Augustinian scholarship is that by articulating Adam's sin as self‐individuation from God, Augustine might be read as implying that to be most himself Adam must sin (For example of such a reading see, Freecero, Reference Freccero, Heller, Sosna and Wellbey1986, pp.16‐29). This is clearly not what Augustine thought, for as soon as Adam does sin he loses himself and his place in the world. However, this too is the very deceit innate to eating disorders, the so called “control paradox”, whereby the very thing which is meant to grant control and a sense of self, is the same thing that negates them (Lawrence, Reference Lawrence1979, pp.93‐101).
Augustine's suggestion that Adam sinned because he desired a lesser good over God, and thus had a false perception of beauty which cause a negative transformation in Adam, relates even more clearly to anorexia nervosa. It is most explicitly in the case of anorexia nervosa that the desire to be thin, over the desire to be healthy, is a conscious motivation. One notable psychologist described anorexia nervosa as “not primarily a lack or a perversion of appetite, but an impulse to be thin, which is wanted and completely accepted by the sufferer” (Palazzoli, Reference Palazzoli1998, 46; taken from Giordano, Reference Giordano2006, p.18; see also, Burch, Reference Bruch1980 p.4). Some even think the German term is the most precise (at least for many cases), pubertätsmagerucht, “adolescent mania of thinness” (Gordon, Reference Gordon1990, chapter 5). In many such cases there is a misconception of the beautiful, which leads to the transformation of the body into that which is insufficient to sustain life.
Augustine's thoughts on the mimetic nature of beauty offer a sharp critique to contemporary society's unrealistic representations of bodily beauty. This is even more pertinent when we consider Augustine's emphasis in on the power of aliquod uisum (fantasy images) to draw the will to perform an action (lib. arb. 3.25.74; CCL 29: 319). Eating disorders have been described as the sacrificing of millions of young girls to the gods of societal beauty, whereby slenderness represents “the ultimate good” and obesity the ultimate shame (Gilbert, Reference Gilbert and Commerford2000, p.13). It has been called “a social epidemic” and is largely confined to Western or Westernised countries (Giordano, Reference Giordano2006, pp.20‐21). This is increasingly worrisome as neurological research into eating disorders cannot rule out the effect of culture to be “incorporated into the neural circuitry of our brains” (Soros, Reference Soros, Volcker and Frampton2011, p.12). This brings us to the central tension in this paper, the delicate question of the relationship between choice and illness in contemporary discussions of eating disorders and Augustine's hamartiology.
Sickness and Choice
The difficulty when considering whether a certain phenomenon is the consequence of choice or of illness is that it is much harder than it first appears to pin down what “choice” and “illness” mean in this context. This is especially clear in the literature concerning the ethics of treatment for eating disorders, and it is at the centre of Augustine's wrestling with the nature of sin. In addition, developments in philosophy and medical science means that the concepts “choice” and “illness” have changed radically since the fourth and fifth centuries. It is also worth noting that, the methodological naturalism of the natural and medical sciences, have very little room for the concept of “choice”, and tend to prioritise deterministic or mechanistic explanations. Although this has harvested wonderful advancements in many medical and technological areas, it (so far) seems unable to deal with the challenges of many psychological diseases, which cannot be fully reduced to neuroscience. This is one of the reasons interdisciplinary dialogue in these areas, such as this paper offers, is worth pursuing. Therefore, we shall start this section by digging a bit deeper into Augustine's understanding of “choice” or, in his language, the will.
It is important to remember that when Augustine examines Adam, he is seeking to speak of the only human being who had real choice and freedom (c. Fort. 22; CSEL 25:104).Footnote 15 As William Babcock noted, Augustine “has now restricted the free exercise of will to the first instance, the first sin of the first human being” (Babcock, 1988, p.40). Augustine maintains that Adam not only had the ability to act differently, but also to be different; i.e. through his will he could have rejected sinful desire, and thus, been a morally different person (ciu, 14.15; CCL 48:436‐438, ciu. 12.9;CCL 48:363‐364, ench. 15; CCL 46:79‐81, corrept. 31–33; CSEL 92:255‐259). In this way, despite his pride, love for lesser goods or any other possible motivations, he was not compelled by these desires (see, Gn. litt. 11.7.9.).Footnote 16 This is an important difference between Augustine's discussions of pre‐fallen Adam and the rest of humanity.
In light of this, Eric Springsted, R.C. Sproul and Sarah Byers have each independently suggested that Augustine holds to two distinct modes of freedom, libertas and libera voluntate (Springstead, Reference Springsted1998; Sproul, 2001; Byers, Reference Byers2006). The first is closer to our modern understanding of autonomy of choices and actions (an occurrent will), and the second is more of a moral centre or moral liberty (a dispositional will). This second dispositional will is the ability to make the right choices, particularly in reference to the beliefs and images we let affect and mould us (lib. arb. 3.25.74; CCL 29: 319).Footnote 17 In this way, the dispositional will is at the very core of who we are (lib. arb. 3.1.12; CCL 29:276).Footnote 18 Thus, libera voluntate refers to the power (potestas) both within the self over its’ own internal desires, whereas libertas is the power to act (or not) in a certain way externally (Kirwan, Reference Kirwan1989, pp.85‐86). Springsted calls these different notions of will as being towards “subjective intentions” or “objective intentions” (Springsted, Reference Springsted1998, 80).
An example of these two notions of the will can be seen through a comparison in what would otherwise appear to be an unnecessary contradiction in Augustine's writing. At one point in The Confessions (conf.8.5.10; CCL 27: 119), Augustine writes that the will, as an orientation of the self and moral centre (libera voluntate), gives rise to appetites, from which follows habits and necessity (or addictive behaviour).Footnote 19 In a different text Augustine gives a contrary narrative, whereby the will as the ability to act and make choices is the consequence of (and so determined by) seeing, appetites and habits (diu. qu, 40: CCL 44A: 62).Footnote 20 This (second) occurrent will, which Augustine sees as the only type of will to be fully intact after The Fall, is not a powerful and self‐directing moral force, but results from our actions and desires and thus is circumscribed by previous behaviour. In these two examples show how different the nature of these two types of will are and their different roles within the human person.
The concept of “choice” in discussions of eating disorders is equally as complex because the individual appears to make “deliberate and reasoned” decisions about food intake in a “strong‐willed, dominant and intransigent” manner, and yet “her suffering and difficulty to escape the trap of her condition are apparent” as she “appears to be completely unable to alter course…” (Giordano, Reference Giordano2006, pp.31‐32; cf. Duker, Reference Duker and Slade2003, 17). This contradiction expresses the conflict inherent in an eating disorder: “the sufferer seems to want to defend her abnormal eating habits, on the one hand, while, on the other, feels compelled to maintain those habits” (Giordano, Reference Giordano2006, p.88). From the perspective of others who know the sufferer of an eating disorder, it that appears as “an ‘unnecessary self‐imposed disease.’” (Beumont, Reference Beumont and Vandereycken1998, pp.4.5) This condition can only be described as “both the result of a choice and the result of factors that are beyond the individual's conscious control” (Giordano, Reference Giordano2006, p.88). Thus, whilst in the U.K. anyone diagnosed with an eating disorder can be sectioned and undergo enforced treatment, suggesting a complete lack of legal autonomy, (see, Section 63 The Mental Health Act 1983 and Scotland Mental Health Act, 1984) there is also a growing “Pro‐Ana” online community (estimated over 400 websites) advocating eating disorders as a “lifestyle choice” and a “philosophy”. (Mancini, Reference Mancini, Daini and Caruana2009, p.166; Atkins, 2002; Giles, Reference Giles and Brotsky2007).
As in Augustine's work there seems to be two types of will under discussion here: the will of accepting and rejecting false beliefs regarding the self (those who think anorexia is a lifestyle choice would claim, I believe falsely, to have this type of will) and the ability to choose external goals and actions (the ability to reject food in order to lose weight, but not the ability to reject the desire to lose weight). The second remains formidably strong, whereas the first is scarcely identifiable. The discussions regarding whether a person suffering from an eating disorder has free will has reached an impasse because the concept of “will”, often taken from Hume, is too monolithic and action orientated. It seems that Augustine's bifocal view of the will, in this interpretation, provides a way forward in these contemporary discussions.
Augustine often used the concept of “illness”, infirmitas (sickness) and aegritudo (infirmity/disease) in his hamartiology (for a prime example, nat.et grat. 67.80; CSEL 60). When Augustine is lamenting and berating his divided and indecisive will, he refers to it as an “infirmity of the mind” (conf. 8.9.21; CCL 27:127). Augustine refers to the dual problem of ignorance (ignorantia, which is discussed further below) and sickness (infirmitas) as that which weakens the will against temptation (pecc. mer. 2.2.2; CSEL 60:72).Footnote 21 Similarly, infirmity and ignorance can lead to “weaknesses of the mental faculty” and “irrational desires” (pecc. mer. 2.29.48; CSEL 60:119).Footnote 22 Thus, Augustine seems to be using words pertaining to sickness and illness to express the damage done to the will through the inheritance of a “sinful nature”. This sickness does not remove the occurrent will or the power to make choices, but removes the ability of the dispositional will to be the directing moral centre of humanity and thus, limits the scope of our choices drastically.
This is very different to how we understand infirmity or sickness today. Sickness often refers to coercive alien forces working against the body or mind of an individual (viruses, bacteria, cancer or chemical imbalances etc.). This is particularly relevant when discussing mental illness as the diagnosis of a mental illness often expresses a loss of autonomy and the idea that an illness, rather than the individual, is solely responsible for behavioural symptoms. Thus, “pathological” behaviour is understood in deterministic terms and “normal” behaviour in teological terms (Sass, Reference Sass1992, p.182, this is a modern conceptualisation that Sass sees as deeply problematic and limiting the care and help given to patients, see Sass, Reference Sass1992, p.68.). Yet, contrary to such clear‐cut categories there appears for those suffering from eating disorders to be teological behaviour towards a deterministic end. Thus, terms such as “intention” and “motivation” remain viable concepts. However, the concepts of “cause” and “illness” are also accurate because the possibilities available to an individual are greatly curtailed or even determined.
Despite these differences, in both modern day views on sickness and Augustine's description of infimitas and aegritudo of the mind, there is in both the concept of conflict. For Augustine, however, this is a conflict within the self which results in moral weakness and the inability to act in a coherent or resolute manner. In contemporary medicine more widely, there is often the perception of a conflict against an external malevolent disease. Contemporary discussions on eating disorders, however, often point out that the sickness of an eating disorder is not a conflict against any external forces that we can yet find; “the “disorder” is not an entity that the sufferers perceive as distinct from themselves.” (Giordano, Reference Giordano2006, 230). Instead, closer to Augustine's view, it is an internal conflict concerning the desires, knowledge and will within an individual. Modern medicine continues to struggle under the dichotomy of “choice” and “illness” and the impossibility of placing eating disorders squarely in just one category. Beyond this contemporary impasse, Augustine's hamartiology seems to hold some insight into the non‐mutually exclusive nature of these terms when discussing seemingly incomprehensible behaviour.
The Divided Self
In the section above, we saw how Augustine's discussion of the will might aid contemporary struggles of understanding eating disorders as in one sense a choice and in another sense an illness. In this section, I compare Augustine's account of the divided self and the discontinuities or chaotic behaviours of eating disorders. This comparison focuses on two aspects of the fragmented self: loss of knowledge and the loss of control. Conversely to the section above, this section shows how eating disorders, and contemporary understandings of them, can provide a poignant physical example of Augustine's views, and so bring greater clarity to our understanding in a particular difficult area of his writing.
Loss of Knowledge
Augustine commonly described “sin’” as consupiscentia. A part of the meaning of term is the loss of true knowledge of God (ignorantia). The more subtle result of this loss of knowledge is the divorce between knowledge and desire, which is an infirmitas (discussed above). Therefore, we can will that which we do not want to will, and not will that which we know we should (see, Augustine's discussion of Romans 7:15, perf. iust. 11.28; CSEL 42:27). In order to recover rationality, consistency and harmony within the human person these conflicting faculties of knowledge and desire (and, therefore, will) have to be re‐directed towards God and unified once again.
However, when only one faculty (say, knowledge) has been converted, an even greater level of chaos may follow whereby the self is more consciously at war with itself. This is seen in Augustine's description of his time in the garden between his two conversions (one of the intellect and the other of the will). In The Confessions (in particular, conf. 8.7.16.) Augustine tells us that his first conversion (or the first stage in his conversion), is of his intellect so that he realised his state of “sin” and need for God. However, because his will had not yet been “converted”, this new knowledge led to an increased state of chaos and inner‐fragmentation. He describes, “great strife in my inner dwelling”, whereby “I was mad that I might be whole…” (conf., 8.8.9; CCL 27:125).
For many, the most shocking symptom of an eating disorder is the loss of self‐knowledge. This can be the loss of knowledge about hunger or satiety (damage to the body's homeostasis), loss of knowledge about how one is feeling (alexithymia) and loss of knowledge regarding the body's appearance, often referred to as “Body Image Disorder” (Soros, 2000, 14–15; Giordano, Reference Giordano2006, 218). In addition to perception of one's own appearance or external shape, the perception of hunger and satiety internally is particularly problematic because, as Hilde Bruch as shown, measuring these feelings is not innate but is the result of a complicated learning process (Burch, Reference Burch1974, chapter 4).
This loss of perception of their own bodies is a central component in how and why sufferers feel compelled into starvation. When an individual is suffering from anorexia nervosa, there remains a level of unity in wrongful perception and unhealthy desire. This creates a formidable will which disregard the cost of achieving the desired weight or body (Slade, Reference Slade1984, p.96). In anorexia nervosa it might appear that there is a loss of knowledge, but not of control. Although loss of knowledge and control is the symbol for sin for Augustine, it is not the whole problem of sin, so that exercising control is not the whole cure (see, pecc. mer. 2.36). Hence, it was not a loss of control which caused Adam to sin and it is not control that he needs to regain. For this reason, it is possible to affirm, from an Augustinian perspective, the statement from a psychologist discussing eating disorders:
Although the person with an eating disorder typically considers the loss of control as the major problem, probably the loss of control is only a part of the problem. The person with eating disorders has an eating disorder not only when she, for example, overeats and vomits, but also when she calculates calories, over‐exercises, and when she is satisfied with herself because of the control that she has been able to exert on herself…The fact that the anorexic exerts control does not make anorexia unproblematic.Footnote 23
(Giordano, Reference Giordano2006, 214).Bulimia nervosa, which often occurs after anorexia nervosa, might be understood in light of this discussion to be the regaining of knowledge but the loss of control (Kaye, Reference Kaye, Klump and Strober2001, pp.215‐225). This has lead to the creation of another categorisation: bulimarexia (Gilbert, Reference Gilbert and Commerford2000, 65). Vandereycken has referred to bulimia as a “healthy protest” and as the “sane” self that “protests” against the “tyranny” of the anorexic “perfectionist” (Vandereycken, Reference Vandereycken and Van Deth1994, 98). To use the language of Augustinian scholarship, there has been a conversion of intellect, whereby the individual can no longer ignore the reality of their emaciation; but there has not yet been a conversion of the will whereby the individual is freed from the previous habits of starvation. Thus, the will is divided, resulting in unstable and opposing behaviours.This then can lead to “chaotic eating” (Slade,Reference Slade1984, 60). Thus, someone suffering from bulimia nervosa or chaotic eating may fluctuate frequently between binge eating, night eating, purging through vomiting, laxatives or exercise and starvation.
Loss of Control
Despite the overwhelming desire for greater control, as mentioned above, in the case of eating disorders what often results is a greater loss of control, and this is most clearly seen in the case of bulimia nervosa. Some psychologists’ have defined eating disorders as, “physical compulsions driven by mental obsessions.” (Gilbert Reference Gilbert and Commerford2000, 16). The term “compulsion” in this context is further defined as “an irresistible inner force‐ to commit an irrational act.” (ibid., 6). This definition from the psychology of eating disorders can be used to illuminate Augustine's use of the term, consuetudo (often translated as bad ‘habits’).
Augustine's account of the loss of control starts with irrational appetites (libido), which are repeated to form petrified habits or compulsions (consuetudo), and these in turn can come to control an individual (necessitas) (see, conf. 8.5.10; CCL 27:119).Footnote 24 We normally think of the term “habit” (as consuetudo is often translated) as a voluntary, repeated behaviour which leads to an ease of action. Thus, certain behaviours become habitual, for example driving a car or waking up early. In the normal usage of the term, the will is teaching the body a certain action or series of actions. This is not the sort of “habit” that Augustine meant when he wrote of consuetudo, which appears to be the uncontrollable actions of the body without the consent or training of the will. Hence, Augustine describes consuetudo as the law of sin, which does violence to the will by holding it in captivity (conf. 8.5.12; CCL 27:120‐121). It is for this reason that I think the concept of compulsions, that are both willed in a highly qualified sense and unstoppable or uncontrollable, as used in much of the literature concerning eating disorders, is a better interpretation of consuetudo than “habits”.
The decline from consuetudo to necessitas is comparable to modern‐day accounts of Binge Eating Disorder, Compulsive Eating or Bulimia Nervosa. To characterise these illnesses in Augustinian terminology, such appetites and habitual/compulsive behaviours exhibit injustice and unrest in the body. Here, the necessity for eating due to internal compulsion, regardless of the needs for health or survival, negates the enjoyment or proper use of food. It is part of the diagnostic criteria for bulimia nervosa that bingeing is experienced as being “out of one's own control.” (Giordano, Reference Giordano2006, 22). Most visibly, in the case of bulimia nervosa, there are not only these chaotic cyclical behaviours, but also the physical loss of control whereby purging, particularly in the case of vomiting, can become completely involuntary. This is the decline into necessitas, whereby even the appearance of a will is overcome. Similarly, in the case of anorexia nervosa, even after the sufferer has started to recover psychologically the body can have difficultly absorbing nutrients. The difference between healthy eating habits, where the body has been taught to expect food three times a day (for example) is very different to the compulsive behaviour of habitual vomiting of food, which can become unforced and involuntary. This is, therefore, an example where contemporary psychology can be used as a lens to understand a theological (or Augustinian) concept.
Conclusion
This article has sought to show that Augustine's examination of human “sin” provides an interesting and at certain points deeply insightful comparison with contemporary understandings of eating disorders. The difficulty for psychologists to categorise and explain the aetiology of eating disorders has been paralleled to Augustine's own difficultly in understanding the fall and Adam's “motivations”. Secondly, it was shown that there are parallel central issues (misplaced desire for pride/control and lesser goods/ thinness) in both areas of discussion. The central tension in this paper, the blurred relationship between choice and illness was next examined. In this area, I argued that the complexity and multifaceted nature of “the will” within Augustinian literature might give new insight into the difficulty of categorising an eating disorder and so might provide a way forward in discussions surrounding policy making and the legal status of those suffering from an eating disorder. Thirdly, it was seen that many of the symptoms involved in developing an eating disorder are well matched to Augustine's depiction of fragmented humanity. In particular, I focused on the loss of knowledge and the loss of control. In this section, it was suggested that modern day understandings of eating disorders as compulsive behaviour, provided a helpful insight and example of Augustine's notion of consuetudo (a term which theologians have struggled to translate and understand). The overall comparison examined in this paper, between Augustine's discussion of sin and contemporary understanding of eating disorders, could have formed the theme for a whole series of papers.For example, other comparative themes might be Augustine's critique of the Donatist's moral perfectionism and the perfectionism that is often intrinsic to an eating disorder; the debate surrounding the use of coercion in Augustine's political writings and the enforced treatment of anorexic patients; the unexplained phenomenon that eating disorders appear to be non‐genetically inherited and Augustine's idea of inherited sin. However, what has emerged from this select comparison is the mutual benefit of interdisciplinary dialogue, and the relevance that Augustine's thought remains to have as we seek to understand and heal the evils facing us today.Footnote 25
