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This book is one of the latest in the Psychismes series, edited by Didier Anzieu. Its author, Professor Bernard Brusset, is a psychiatrist and psychoanalyst with many years' experience of treating and writing about patients with eating disorders. It is a sad fact, related I think to the curious divide
between French and British psychoanalysis, that I had never come across Professor Brusset's work before being invited to review this important book.
Comprehensive psychoanalytic accounts of anorexia are rare. Rarer still are accounts that allow themselves to be informed by and to integrate medical and non-psychoanalytic knowledge and research on these puzzling conditions that lie on the boundary between psyche and soma. In his foreword, the author refers to the institutional separation between neurology and psychiatry that took place in France in 1969 and the struggle that ensued between competing explanations for mental illness. The neuro-endocrine dysfunction present in anorexia led to a serious confusion within psychiatry as to its origins and in Brusset's assessment, to treatment that was at best paternalistic and at worst sadistic. He therefore puts himself firmly on the side of attempting to understand anorexia psychoanalytically. However, he acknowledges the huge contribution made to this field of enquiry by non-analytic authors such as the pioneering American psychiatrist, Hilde Bruch, and his own researches finally bring him full circle to considerations of the role of starvation in the production of endorphins.
The book is in three parts; the first is a clinical description of anorexia nervosa and a theoretical account of its origins and development. This latter includes a most interesting account of cultural factors and in particular the significance of the fast. The second part presents his psychoanalytic understanding of anorexia, with the use of rich clinical material, largely derived from two detailed cases. The third part covers the addictive dimension