A Jewish girl from the Lower Rhine
Hilde Bruch was born on March 11, 1904, in Dülken, a small German town on the Lower Rhine near the Dutch border. She was the third of seven children, with two sisters and four brothers. Her father, Hirsch Bruch, was a successful cattle dealer, and he and her mother, Adele Rath Bruch, belonged to the local Jewish community. Like her brothers and sisters, Hilde went to a one-room Jewish elementary school before commuting to a girls’ high school in a nearby town to prepare for university.
She wanted to be a mathematician. After her father’s death, an uncle who paid for her education persuaded her that medicine was a more practical career for a Jewish woman. She studied in Würzburg, Freiburg, Cologne and Munich, and received her doctorate in medicine from the University of Freiburg in 1929.
Driven out of Germany
After qualifying, Bruch took an assistantship at the University of Kiel and in 1930 moved to the University of Leipzig, where she did research and trained until 1932. Rising antisemitism in the university forced her to give up hopes of an academic career, and in October 1932 she opened a private pediatric practice in Ratingen, near Düsseldorf.
Within months the Nazis took power. After the anti-Jewish boycott of April 1, 1933, and new laws that severely restricted Jewish doctors and lawyers, she decided to leave. In June 1933 she went to England, where she worked for a year at the East End Maternity Hospital, which served the Jewish immigrant community in London’s poor East End, and at a child guidance clinic. In September 1934 she sailed for the United States.
A new life in New York
In New York she quickly found a job at Babies Hospital, part of the Columbia-Presbyterian Medical Center. She obtained her pediatric license in 1935 and became an American citizen in 1940. In 1937, with a fellowship from the Josiah Macy, Jr. Foundation, she began research on obesity in children. It was the start of a lifelong study of the ways people eat, and fail to eat, for reasons that have little to do with hunger.
Her work on overweight children was among the first to bring the problem to public attention. She rejected the idea that fat children were simply greedy or lazy, and looked instead at their families and emotional lives. She summed up this research in The Importance of Overweight, published on March 4, 1957, by which time she was already recognised as a leading researcher on childhood obesity. The book’s approach, looking past the scales to the child, the family and the meaning food had taken on in their lives, became the method she would apply to a far more dangerous illness.
From pediatrics to psychiatry
Bruch became convinced that the eating problems she saw could not be understood without psychiatry. From 1941 to 1943 she studied psychiatry at Johns Hopkins University in Baltimore and trained in psychoanalysis with some of the leading figures of the day, including Frieda Fromm-Reichmann, Harry Stack Sullivan, Theodore Lidz and Lawrence Kubie.
Back in New York in 1943 she opened a private psychoanalytic practice and joined the College of Physicians and Surgeons at Columbia University, where she became clinical associate professor in 1954 and professor in 1959. Besides eating disorders she published scholarly and popular studies on schizophrenia and on the training of psychotherapists. She also wrote for parents: Don’t Be Afraid of Your Child, a guide for perplexed parents, appeared in 1952. In 1964 she became professor of psychiatry at Baylor College of Medicine in Houston, Texas, where she remained for the rest of her life. Before leaving New York she bought a Rolls-Royce, saying she would never kowtow to Texans in Cadillacs.
Understanding anorexia nervosa
Over the decades Bruch’s research focused more and more on anorexia nervosa, the illness in which people, most often adolescent girls and young women, starve themselves, sometimes to death. When she began, it was little studied and poorly understood. Bruch observed patients closely over many years and came to see the self-starvation not as a simple disorder of appetite but as a desperate struggle by the patient for control and identity.
Central to her thinking was the idea that hunger awareness is not entirely innate but contains important elements of learning. She believed this learning takes place in the earliest interactions between child and parent. When a child’s signals are not met with appropriate, confirming responses, for instance when food is offered to soothe every upset, or withheld as punishment, the child may grow up unable to tell hunger from other needs and feelings, and feel helpless in controlling her own body and impulses. In her letter to The New York Review of Books in 1979 she stressed that, in the cases she had observed, the roots of the illness go back to the earliest experiences in life, and that her whole treatment approach was based on correcting their consequences. The same letter shows how seriously she took the public’s understanding of the illness. Anorexia, she wrote, was a tragic illness striking the daughters of intellectual and sophisticated families in ever-increasing numbers, so it mattered that families receive accurate information. She objected that the review had lumped her together with the Italian family therapist Mara Selvini Palazzoli and had wrongly suggested that psychotherapy was useless, a message she feared would damage patients and their families.
The books that defined a field
In 1973 Bruch published Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within, drawing on decades of observation and treatment. It is still considered a definitive work on the subject. In 1974 she published Learning Psychotherapy: Rationale and Ground Rules, and in 1978 Harvard University Press published The Golden Cage: The Enigma of Anorexia Nervosa, a short distillation of her work written for patients, families and general readers. It reached a wide general readership and helped make anorexia nervosa a subject that families, teachers and doctors could talk about openly.
Bruch was firmly optimistic about treatment, at a time when many doctors were not. When a reviewer suggested that she doubted a genuine cure was possible in long-standing cases, she wrote to the review to say the opposite was true, and quoted her own book: “A higher age of onset and protracted course are not incompatible with complete recovery.” The last chapter of The Golden Cage, “Changing the Mind,” described her approach. Therapy, she wrote, was difficult, slow and at times exasperating, because patients had to build a genuine personality after years of what she called faked existence, but there was nothing more rewarding than seeing them become warm, spontaneous people with a wide range of interests.
How her work helps people today
Eating disorders are now recognised worldwide as serious, treatable illnesses with among the highest death rates of any psychiatric condition. Much of how they are understood and treated begins with Bruch. She moved anorexia nervosa out of the margins of medicine, described its psychology in terms patients and families could recognise, and insisted that the goal of treatment was not just weight gain but helping the person inside find a real sense of self. Her emphasis on the family, on early experience and on long-term psychotherapy influenced the specialist eating disorder services that now exist in hospitals and clinics in many countries. Her earlier work on childhood obesity likewise helped doctors see weight problems in children as medical and emotional issues rather than moral failings.
Exile and family
Bruch’s Jewish background shaped her whole life. Antisemitism closed her academic career in Germany and drove her into exile. In the years that followed she helped rescue her mother and several of her siblings from Nazi Germany, but many members of her family were murdered in the Holocaust. In 1946 she adopted her orphaned nephew, Herbert Bruch, who had survived the war in England. She returned to Germany several times but felt extremely uncomfortable there.
Colleagues remembered an outspoken individualist who relished her independence and rebelled against any form of authoritarianism.
Last years and legacy
Bruch retired in 1978 but remained in Houston as an emeritus professor. Although she suffered from Parkinson’s disease, she continued to see patients and to play an active part in the faculty until her eightieth birthday. She received many honours, among them the William A. Schonfeld Award of the American Society for Adolescent Psychiatry and a golden doctoral diploma from the University of Freiburg in 1978, the Mount Airy Gold Medal for distinction in psychiatry in 1979, the Nolan D. C. Lewis Award in 1980, the American Psychiatric Association’s Founders Award and Agnes Purcell McGavin Award in 1981 and the American Medical Association’s Joseph B. Goldberger Award in Clinical Nutrition in 1981. She died in Houston on December 15, 1984, at the age of eighty, half a century after arriving in America as a refugee. A final book, Conversations with Anorexics, edited by her colleagues from her tapes, was published in 1988.
Her papers are kept at the Texas Medical Center Library in Houston. For the many people who recover from eating disorders today, the belief that recovery is possible, even after years of illness, owes much to the German Jewish refugee who first insisted on it.
Sources & further reading
Hilde Bruch, Jewish Women’s Archive Encyclopedia · Hilde Bruch, Wikipedia · Hilde Bruch publishes The Importance of Overweight, Jewish Women’s Archive, This Week in History · Hilde Bruch, ‘Anorexia’, letter to The New York Review of Books, April 19, 1979 · Hilde Bruch, MD Papers: author biographical information, Texas Medical Center Library · Researched from the sources above and checked against them. Spotted an error? Tell us.
A life of tikkun olam. This is part of tikkun olam, the Jewish idea of repairing the world, and every one of us can add to it.