Anorexic prohibitions from a Psychoanalytic Perspective
In their formulations of the psychodynamics of anorexia, psychoanalytic
theories concentrated on the mechanisms of prohibition. From the 1930s
and into the 1950s, anorexia was viewed according to Freud’s
impulse-defense model. In this model, there is a conflict between sexual
and aggressive impulses and the prohibitions of a rigid ’super ego,’
wherein the ego activates defense mechanisms in order to mediate the
conflict. Thus, it was hypothesized that self-starvation was a defense
against fantasies of becoming pregnant through the oral aperture:
anorexia was viewed as a regressive defense against Oedipal desires
(Bachar, 2001, p.14-15). Psychoanalysts have viewed anorexia as an
illness that mainly manifests as a somatic expression of the fantasy of
oral fertilization. Therefore, the stubborn refusal to eat was
hypothesized to be a defense against cannibalistic sadistic oral
fantasies (ibid). Unlike Freud’s seduction theory, psychoanalytic and
psychological thinking about eating disorders today recognizes and
emphasizes the real connection between past sexual traumas and the
development of eating disorders (Root, 1991; Wonderlich et al., 1997).
After the transition from viewing anorexia as a product of oedipal
conflicts to the view of anorexia as a manifestation of pre-oedipal
conflicts, anorexia began to be studied within the framework of object
relations theory. According to this theory, anorexic’s patterns of
relationships are based on mechanisms of survival and control, wherein
the anorexic fantasizes controlling significant objects in her life
(Farrell, 1995, 30). According to researchers from the object relations
stream, anorexics find it difficult to separate from their mothers and
to develop an independent self.
Unlike Freud and Winnicott who specifically discussed the role of
cultural and social prohibitions in the development of mental disorders,
the object relations stream examines prohibitions, almost exclusively
through the lens of interpersonal relations, as well as the anorexic
prohibition. The Kleinian view, for example, interprets anorexia as a
reflection of pathological narcissism, wherein the mother is not only
perceived as unseparated from the child, but as having nothing to offer
the child. The object relationship is characterized by a strong sense of
envy that destroys any knowledge of the ’good breast’, since any
awareness of it implies acknowledging the existence of something good
outside of the individual, which the anorexic cannot tolerate (Boris,
1984a, 1984b). As part of her survival strategy, the anorexic perceives
herself as omnipotent. The absence of need, in her fantasy, implies the
absence of separateness, since being self-sufficient enables her not to
recognize her dependency on an other. According to this view, if the
desire does not exist, then the need for the mother does not exist as
well. Many anorexics, on an unconscious level, still associate food with
the mother. Food serves as a substitute for the desire to merge with the
mother (ibid.)
As Kohut’s theory of the self-evolved in the 1970s, the concept that
anorexia is the result of difficulty separating and forming an
independent self was further developed (Bachar, 2001, 16). The
self-theory asserts that a failure occurred during the development
stages of the anorexic’s ’self-object’. Thus, a girl who develops an
eating disorder does not believe that she can rely on humans to fulfill
her needs. During the child’s development, there is a role reversal
between the parent and the child, when the parent leans narcissistically
on the child, expecting them not to act according to their own
interests, but to listen to and fulfill the parent’s wishes. Therefore,
these children are inhibited from expressing their individual needs and
desires: they are forbidden to develop as individuals. Eating involves
both self-giving and responding to internal needs. The anorexic views
eating itself as an unwarranted act of self-indulgence which betrays the
role of being a self-object to others. Therefore, the image of the
anorexic patient is of a selfless person. Anorexics have a dualistic
view of the world. They attempt to cleanse themselves of the body’s
troubles so as to reach a higher ’spiritual’ or human level - one that
does not succumb to the body’s desires.
Accordingly, anorexia can be viewed as imposing a prohibition on
connecting the body and the soul. Bordo describes anorexic subjectivity
as constructed by a soul that is detached from the body. The split body
is viewed as out of control, a foreign factor, and an enemy that
threatens the mind. Bordo says that
“the body is the locus of all that threatens our attempts at control.
It overtakes, it overwhelms, it erupts and disrupts” (Bordo, 2004,
p.94). In anorexia the fundamental identification is with mind (or
will), ideals of spiritual perfection, and fantasies of absolute control
(ibid., p. 97-98). Cartesian dualist view perceives the body as alien to
the mind or self. As eruptive other, the body threatens to overwhelm the
self and to disrupt self-integrity (Malson,1998, p.124).
In conclusion, the anorexic’s need to control their body, whether as a
result of forbidden fantasies, physical-sexual injuries, or restrictions
on separation from the mother and developing an individual self, leads
to a conscious avoidance and recognition of physical vulnerability. In
order to avoid this recognition, the anorexic maintains a fantasy of
omnipotence and invulnerability (Mushatt, 1992, 309). Taking an extreme
Cartesian view, they believe that their soul transcends their physical
body and gives them an infinite amount of power and control over their
own behavior and that of others (Selvini Palazzoli, 1978, 223). In
severe anorexics, the strong desire to disconnect from the physical
world contributes to a common delusion, which is that extreme weight
loss does not cause death: The body will die, but not the nuclear self
(Cross, 1993).