You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
It is not easy to review this book on anorexia nervosa by Kestemberg et al. The problems presented to this reviewer fall into three distinct categories, each deserving separate treatment: (1) the ambiguous nature of the disease; (2) the treatment method chosen by the authors—at variance with the classical analytic situation; and (3) the authors' basic theoretical orientation, which pressures them into a certain format of interpretation.
The authors' stated goal is not to construct a new metapsychological formulation of this illness or to arrive at a specific psychoanalytic constellation of its dynamics. Rather, their initial concern is clinical: how can it happen that, starting with the child proclaiming he is going to stop eating to punish his mother (indicating an incomplete differentiation between him and her), certain people go as far as starving to death? The authors came to conclude, to their great surprise, that on the road to death, the children "died of pleasure." This discovery led to the deepening of certain clinical and metapsychological concepts—perversion and primary masochism.
The first chapter, a historical survey, will serve as a backdrop for the discussion of the first set of problems dealing with the basic nature of this disease entity. In general, the development in the understanding of this illness from an analytic point of view has followed that of analytic theory, with each successive advance being applied to it in the hope of clarifying the picture (object-relations theory, adolescent asceticism, separation trauma, drug addiction, theories of development of self, etc.). The diagnostic difficulty resides in separating a specific disease entity from all the so-called nervous anorexias secondary to either hysterical or psychotic disorders. Is it possible to make an entity neither too narrow, nor too