Aboulia

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Diseases of the Will

T oday there seems still to be an assumption that "fat equals lazy, weak-willed and unattractive" (Large 2006: 1). According to this view "obesity [is] the fault of weak-willed, gluttonous individuals" (Metcalf 2006: 53). Yet are the "3.2 million New Yorkers who are overweight or obese ... all lazy, weak-willed people?" (Louis 2006: 21). For many it is clearly the obese who are at fault for their state: "Fat people are thought to be gluttonous, lustful, greedy, lazy, weak-willed, and lacking any kind of self-control. If fat people are targets of our contempt, it is only because they have brought this on themselves with their unwillingness to take responsibility for their own actions" (Oliver 2005: B01).

"You have no self-control!" has long been the charge against the severely over- and the severely underweight. Such views of the "will" and its diseases were first formulated in the nineteenth century when psychology turned obesity and extreme thinness into a truly voluntary act in which (according to the psychologist Thomas Reid [1710-96]) "every man is conscious of a power to determine, in things which he conceives of to depend upon his determination" (Reid 1854). This faculty could become ill, and pathologies of the will resulted. The major psychiatrists wrote of this, from J.E.D. Esquirol (1772-1840) to Theodule Ribot (18391916) in his The Diseases of the Will (1884) and Henry Maudsley (1835-1918) in his Body and Mind: An Inquiry into their Connection and Mutual Influence (1870). The psychiatric diagnosis that resulted was "aboulia," the inability to execute what one wants to do, without any sign of physical impairment. In this, there is no ability to move from motive and desire to execution.

Fat people suffer from "aboulia" once they acknowledge their impairment. "Obesity," as the French writer on taste Jean-Anthelme Brillat-Savarin (1755-1826) states in his handbook on food and diet at the beginning of the nineteenth century, "is not actually a disease, it is at least a most unpleasant state of ill health, and one into which we almost always fall because of our own fault" (Brillat-Savarin 1999: 245).

By the middle of the nineteenth century, "aboulia" had become a sign of a disease of the will, but it is a disease more of men than of women. It affects the strength of men and the beauty of women disproportionately, according to Brillat-Savarin. This is the new illness that is ascribed to the obese and it is in the promise of execution, of being able to act, that the fat man now shows his masculinity.

Contemporary psychiatry does not consider "simple obesity" as "consistently associated with a psychological or behavioral syndrome" (American Psychiatric Association, DSM-IV-TR 2000: 583). Today, we popularly speak of obsessive-compulsive disorders or addiction to food (Miller 1980; Kassel and Schiffman 1992). In all cases, it places the desire to eat beyond the control of the individual. In such cases, behavioral therapy, such as a twelve-step program (Food Addicts Anonymous) has been proposed in analogy to the control (rather than the treatment) of alcoholism (Wilson and Brownell 2002). Such therapies aim at modifying eating habits, as if habituation were the sole cause of obesity or thinness.

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One of Food Addicts Anonymous's goals is that "we will no longer attempt to fill our emotional and spiritual needs through our mouths. Instead, we will use our mouths along with our hearts to ask for what we need and deserve as children of God" (<http://www.food addictsanonymous.org>).

Here, the move to a metaphysics of cure is borrowed from Alcoholics Anonymous, which places "food addiction" as possible only if self-willed self-control is a possible response to a weakness of "will." My will is weak, the argument goes, but knowing that, I have control over my life. Diet advocates argue quite differently. The assumption underlying dieting is often the overcoming of a lack of will:

Those who have been on any sort of diet will know that common buzzword, "will power." When I went down the diet track, I believed I had to manage what I ate, how much I ate and when I ate. All fine, except that diets are usually embarked on in isolation, without addressing other major issues i.e. our general health and levels of fitness, our levels of activity, or the attitudes we have about our food.

Eat right, and the illusion that you have a disease of the will vanishes!

Yet, we know well that one form of "self-control," in the form of an awareness that one is full (satiety) is a feature programmed into us. In some genetically transmitted disorders such as Prader-Willy Syndrome and other chromosome-15q-deletion syndromes, affected individuals do not feel the same sense of satiety as people without the genetic error (Prader et al. 1956). But the question of how an individual who has the ability to "feel full" is able to deal with food is as much a question of the cultural meanings attributed to eating (and over- or undereating) as it is to individual psychology. There are over forty different complex syndromes listed in the online "Mendelian Inheritance in Man" database that include "obesity" as one of their diagnostic criteria. In each, the meaning of obesity reflects the culture in which the gene is expressed as much as the ability of the gene to express obesity (Bray and Alison 2001 : 9). Self-control is the model that any given society superimposes on the eating patterns of individuals in that society. What for one moment in history is excessive, is for another appropriate behavior (Offer 2006).

See also Binge-eating; Brillat-Savarin; Genetics; Men

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