Lost for Words—The Psychoanalysis of Anorexia and Bulimia, by Em Farrell,  The Other Press, 2000,  104 ps.

Em Farrell's slim volume offers a valuable and rich contribution to the literature on eating disorders. She takes a psychoanalytic approach toward the understanding of anorexic and bulimic symptoms. As she indicates in her introduction, more than the symptoms must change. Farrell wants to understand the meaning of the symptoms for the patient within the context of his or her internal and external worlds. Farrell has chosen to study only female eating disordered patients, presumably because they make up the majority of her practice, as well as the population at large. Early in her writing, Farrell presents a reasoned and persuasive differentiation of anorexics, anorexic bulimics, and normal weight bulimics, distinguished by weight and the presence or absence of bulimia. She then takes the reader through a small handful of succinct and interesting chapters. She begins with some of the earliest theories on eating disorders, which, interestingly, were seen to be greatly influenced by the psychology of the mother as early as the late eighteenth century. Farrell covers the subsequent theoretical developments of this century, focusing on object relations, problems with separation-individuation, and the vital necessity of entering “the arena of muddle between mother and child, where who is who is uncertain.” Farrell emphasizes that it is the nature of the complex, entwined relationship of mother and child that must be examined.

The chapter entitled “The Body and Body Parts as Transitional Objects and Phenomena” forms the heart of the book. It is a particularly thought-provoking study of the narcissistic mother's pathology, her body, her conscious and unconscious fantasies of her baby both before and after birth, and her narcissistic and pathological use of her baby in order to function. Farrell believes that this mother's own development was deeply impaired, leaving her devoid of a good internalized object and, therefore, trapped within the stage between inner and outer. Bec