Primitive Anxieties and Secondary Skin Formation in Anorexia Nervosa

I've loved Leonard Cohen for a long time. From what I understand, he's a complicated man, having lived a multifaceted and often painful life. Personally, I took an interest in Cohen's work in my early 20s, after learning that he was a practitioner of Zen Buddhism, which interested me a great deal at the time. Among his vast oeuvre, “Anthem” (1992) has always stood out, and the following lines in particular:

Earlier in life, I was drawn to the realism of Cohen's words. “Yes,” I'd think, “the world is imperfect, and our imperfections are what make us capable of growth.” More recently, in my professional life, I've been seeing many patients with eating disorders and also writing about eating disorders in males (Wooldridge & Lytle, 2012) and eating disorders and cyberspace (Wooldridge, Mok, & Chiu, 2014; Wooldridge, 2014). As I was listening to Cohen's lyrics again recently, I heard them differently, and began to hear my patients with eating disorders differently as well. Sometimes, they seemed to be saying, we become so “cracked” that no “inside” remains for light to penetrate.

In this paper, I understand anorexia nervosa as resulting from a failure in early maternal containment. These failures, in particular, involve experiences of invasion and intrusion that lead to primitive experiences of psychic collapse. Because these patients never internalize maternal comforting functions in the period of separation-individuation, they are unable to digest their experiences of infantile trauma. In addition, distortions in transitional object usage lead to pathological relationships with food and eating. Without the ability to contain intense anxieties about disintegration and falling apart,