Bruch Hilde 190484

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B ruch was a German Jewish physician who escaped the Nazis to England and then America and ended her career as Professor of Psychiatry at Baylor Medical School. Her claim to fame is that she popularized the diagnosis of anorexia nervosa and was an often-cited specialist on obesity who revolutionized the debate between those who saw exogenous or endogenous causes for obesity (Heitkamp 1987; Brumberg 1988). She provided the first complex psychological theory of obesity—linking both developmental forces with the external world of the pathological family. Her interest seems to have begun with her arriving in the U.S.A. in 1934, where, according to her own account, she was amazed at the huge number of fat, truly corpulent children, not only in the clinics but also on the street, in the subway and in the schools (Bruch 1957: 5).

Her work on the "psychosomatic aspects of obesity" was funded by the Josiah Macy, Jr. Foundation; the results from this began to appear in the i940s and were summarized in her 1973 book. She argued that obesity was caused by psychopathological interactions within the family. The core is her view of the child's struggle to develop autonomy in the family setting, a view championed by Theodore Lidz (who created the "schizophrenegenic mother") with whom she had worked in Baltimore between 1941 and 1943. Undergoing a training analysis with Frieda Fromm-Reichmann in Washington at the time, she began to see more complex readings of the work on obesity that had brought her to Fromm-Reichmann's initial attention.

Typical of Bruch's readings of obesity is the case study of a 4%-year-old female child weighing 90 pounds. The child had been accidentally conceived during the war and was initially rejected by the mother (Hilde Bruch 1997: 138). For the mother, "feeding showed love and expiation of guilt" (Hilde Bruch 1997: 140) for rejecting the very idea of bearing the child. The mother is a compulsive fabulator, always embellishing the tales she tells about her daughter's treatments in order to manipulate the physicians. Bruch thus provides obese children with a childhood of rejection that explains their obesity. Now, Bruch's child is female as, following World War I, the exemplary patient in questions of obesity shifts from the male (where it had been since the Ancient Greeks) to the female with the construction of the image of the "New Woman." But this has a special role in Bruch's system. Here, too, it is the mother who is the cause of the obesity. Indeed, the child's obesity is a neurotic response to her mother's "unnatural" rejection of her.

Yet, Bruch's initial work on obesity is little known. In her dissertation of 1928, written under the renowned pediatrician Carl Noeggerath at Freiburg i. Br., she tested the stamina and lung capacity of children with the new instrumentation of the spirometer (Bruch 1928). She traced how their respiration increased with increased work (turning a weighted wheel). One of the children, Maria O., was, according to Bruch, chronically obese, weighing 129 pounds at the age of twelve. She "speaks tiredly and in a monotone, complains about constant tiredness and weakness of memory. There is neither determination nor a joy for work" (Bruch 1928: 10). This case study provides all of the negative images about desire and work and intelligence found in classic images of obese children. But it is also the classic racist image of the nonproductive "fat" Jew that haunts the medical texts of her time.

See also Jews

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