Epistemology and legitimacy in the production of aneroxia nervosa in the journal Psychosomatic Medicine 1939-1979

This study examines the role of the interplay between epistemology and legitimacy in shaping the conceptualisation of anorexia. It focuses on the process of knowledge production within a particular medical setting - the journal, Psychosomatic Medicine. The journal was founded as part of the first psychosomatic movement in the history of the US seeking to undermine the epistemological foundation of biomedicine: the mind-body division in medical theory and practice. From its inception, the movement was haunted by an ongoing identity problem, institutional uncertainty and scientific ambiguity. The study relies on four separate data sets - articles appearing on anorexia in Medline, archival sources and editorial board minutes of Psychosomatic Medicine, the journal's referees and their decisions and the articles on anorexia which appeared in Psychosomatic Medicine. The study shows how in the course of its knowledge production, the journal managed to increase the level of consistency while evaluating papers submitted. At the same rime it moved towards the dominant biomedical discourse, either through shifting the psychosomatic focus on anorexia from the mind-body interaction to the 'anorexic body' only, or alternatively through reducing the methodological model from causal to correlational. This transition in reasoning in the case of anorexia represents an intriguing trade-off between the scope and the reliability of ambiguous medical knowledge in the face of the overriding need to gain legitimacy within the existing dominant biomedical domain.