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Thomas Ettl, a German psychoanalyst with over twenty years' experience of treating and supervising bulimic cases, presents in this book a very thorough and extensive study of bulimia. Taking his inspiration probably from the fact that bulimia is a ‘secret eating disorder’ that only unfolds completely in a space that is without witnesses but that nevertheless arouses very immediate representations of orgiastic greed, murderous power, nausea and despair, the author gives the book a framework that is structured like the imagery of a criminal case. He refers to a case from Theodor Reik's book Der Unbekannte Mörder [The unknown murderer] (1925) which Reik uses to explain an analytic procedure that prevents deception by appearances and any temptation to draw premature conclusions: a farm girl's naked corpse is found in a river. An investigation committee moves from an initial apparent acceptance that she has ‘drowned while swimming’ to the suspicion of suicide following an autopsy that reveals a pregnancy; it is not until a long and laborious trek along the river, the ‘continual precise inspection’ of further clues such as, for example, weals on the girl's body and the mother's information about the daughter's lover that they are finally led to the conclusion that the girl was murdered by her lover.
Ettl uses this imagery in his discussion of the course of bulimic symptoms and, as this is not, in fact, a detective novel and there is no suspense to be spoiled, I can also anticipate his conclusion. Ettl suggests that a view orientated purely towards the external image that appears would ‘hand over the water-corpse bulimia to the gravedigger in the “certain assumption” that the case was one of a disturbance of eating habits’ (p. 13). This simple solution is shattered by the inward view that Ettl directs at the maltreated body, both in its internal structures and representatives and in terms of the patient's (relationship) history. His patients' statements about their inner em