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).