A Young Woman's Distress1

No other initial encounter with a patient has made such an impression on me as this one did. At the time of the appointment that we had made by telephone, a young woman arrived, carrying a heavy, bulky rucksack, an old-fashioned one, the kind they used to make before the war. She kept what looked for all the world like a burden on her lap, wrapping her arms around it as though it were the most precious thing she possessed. F was not dressed in rags, but her sexless clothes gave the impression that she was a complete drop-out—to such an extent, indeed, that I wondered (although just for a moment or two) if she were a drug addict who might be much better off in hospital than in a psychoanalyst's consulting room. She sat down on the chair facing me and fell silent. I could not say that her silence surprised me because it simply mirrored her despair; her overall appearance and the unchanging nature of the expression on her face evoked the image of a pathetic kind of unveiling, thanks to which I had neither hesitation nor difficulty in understanding the enigmatic message she was communicating. Then tears began to dampen her expressionless face, which was corpse-like in its thinness. The end of the interview was approaching, and all we had shared was this silent presence. I said to her that I would like to meet her again, and asked if she wanted to make a new appointment then and there. She nodded. We agreed to meet the following week, same day, same time. I make that point because I wonder if, somewhere inside myself and without my being able to be fully aware of it, I had already, in my countertransference, decided to embark on an analysis with her.

In the following session, she began talking almost at once. She told me of her severe and life-threatening anorexia nervosa, which was the reason for her being hospitalized at that time in a psychiatric institution, and of her recurrent suicide attempts. She spoke of her twin sister and of the extremely powerful and exclusive