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Dear Sir,
In her stimulating article (2001), Marilyn Lawrence raises the question as to the central psychopathology operating in anorexic states. While she considers there may be differences to individual cases, with a more benign nature in some bulimic states, her primary focus is on anorexia nervosa.
Here, she considers eating disorders in terms of phantasies of control of internal parents, linked with Klein's view of the manic defence. She suggests that eating disorders may represent a special case of oedipal illusions.
She highlights, in her clinical material, the obliteration of difference, e.g. the patient's dream of her mother's hospital where the different wards and words are all symmetrical, and of a ‘white-out’ quality in attacking parental difference.
Her point reminded me of a patient, with a classical history of anorexia nervosa, whom I saw a long time ago, twice weekly, for some five years. This patient would make a great point in obliterating difference. She would dress up in grey trousers and top and go to the garage to fill up her motorbike. She would take great delight when the petrol-pump attendant was unable to decide whether she was male or female. Incidentally, this behaviour did not stop her from having a sexual relationship with her boyfriend.
In her case, I felt that the core pathology lay in a hatred of appetite. This was borne forcibly on me, when a friend of hers brought her 3-year-old daughter to tea at the patient's mother's house. The patient's mother offered the child a piece of chocolate. When the child accepted the chocolate, the patient, by then aged 20, swore at the child and stormed out of the room. On another occasion, she recounted a dream where her mouth was full of cream buns, so that when I made an interpretation there was no room to take it in and she was sick.
Typically, like most anorexics, she only had to have the thought of a bite of food to experience her body as a balloon. I therefore think that the core to the severe anore