History

The term “pica” was first coined by the French physician. Ambroise Pare in the sixteenth century, although references to the syndrome predated him by centuries. Aristotle and Socrates both wrote about “earth eating,” and during the classical periods of Greece and Rome, red clay lozenges from Lemnos were believed by physicians such as Galen to be antidotes for poison and cures for illnesses. They were also believed to facilitate childbirth. The lozenges were called terra sigillata (sealed earth) and stamped with the seals of the goddesses Artemis and Diana. As Christianity spread, these seals were replaced with Christian symbols and the lozenges, blessed by monks, were traded throughout western Europe and the Mediterranean region with the approval of the Roman Catholic Church (Hunter and De Kleine 1984).

The word “pica,” and its older variant, cissa, come from the Latin word for “magpie,” a bird thought to have a not very discriminatory appetite where edible and nonedible substances were concerned. Nineteenth-century medical texts describe both the eating behavior of magpies and that of humans with pica as consisting of an appetite for unusual edible and nonedible items (see, for example, Hooper 1811). The misconception that the magpie consumed earth and clay was likely based on observations of magpies collecting clay to build nests.

Pica was classified in Greek and Roman medical texts as a form of morbid or depraved appetite. In 1638, M. H. Boezo distinguished pica, the consumption of nonfoods, from “malacia,” a voracious appetite for “normal” foods. He attributed malacia in pregnant women to mental changes thought to occur in pregnancy. (As early as the sixth century A. D., pica was thought to result from the cessation of menstruation during pregnancy [Cooper 1957]). Today, malacia, or the craving and binge eating of specific foods, is considered a form of pica (Castiglia 1993). (For the early literature on pica, see Cooper 1957 and Halsted 1968.)

In mid-sixteenth-century England, pica was associated with coal eating among pregnant women and children. But within western Europe and the United States from the sixteenth century through the late nineteenth century, pica was commonly understood as the consumption by young women of substances such as lime, coal, vinegar, and chalk so as to achieve a pale complexion and otherwise improve on appearance (Parry-Jones and Parry-Jones 1994: 290). Historically, this condition was said to be accompanied by “chlorosis” or “green sickness” in prepubescent girls and young women. Chlorosis, a disease recognized from the sixteenth century through the late nineteenth century, was characterized by a loss of menses or irregular menstruation and was accompanied by symptoms such as listlessness, pallid skin, loss of appetite, and weight loss.

It is interesting to note that the debate in early medical literature about the causes of chlorosis prefigures the current debate about pica and iron deficiency in terms of cause and effect. For example, the consumption of nonfoods by young women in order to achieve a pale complexion could easily have resulted in iron-deficiency anemia or chlorosis. However, iron-deficiency anemia can cause cravings for nonfoods, and chlorotic females ingested large amounts of unusual foods such as pepper, nutmeg, and raw corn, as well as nonfoods such as plaster. In addition, psychological reasons such as sexual frustration and nervous conditions were considered possible causes of both chlorosis and pica (Loudon 1980). In the twentieth century, pica among young women has been manifested by excessive consumption of real foods such as fruit and vegetables and nonfood substances like ice (Parry-Jones and Parry-Jones 1992). (For an extensive historical account of pica within Western industrialized cultural contexts, see Parry-Jones and Parry-Jones 1994).

In various regions of the world, especially in tropical zones, pica most often takes the form of geophagy. Harry D. Eastwell has noted that geophagy is associated with the “world’s poor or more tribally oriented people” (1979: 264). Other investigators have characterized such groups as constituting “subsistence” societies (Hunter 1973), although in this chapter, the term “nonindustrialized” societies is used. In these societies, geophagy has been observed for many centuries and variously attributed to religious, cultural, and physiological causes (Hunter 1973; Hunter and De Kleine 1984; Parry-Jones and Parry-Jones 1992). Geophagy, or “dirt eating,” was also thought to be a peculiar affliction of enslaved Africans and, later, lower-income. African-Americans and whites in the southern United States, who were characterized as “dirt eaters” (Forsyth and Benoit 1989).