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This book, which presents one psychoanalytic approach to the treatment of anorexia nervosa, has been written by a number of authors, all members of the Psychosomatic Study Group of the Psychoanalytic Association of New York. This group was led by the late Melitta Sperling until her death in 1973 and, since then, the moderator of the group's work has been Dr. Wilson, the principal editor of this volume. The theoretical positions and therapeutic approaches are, consequently, conclusions based on extensive clinical experience acquired over many years. Attention is given in individual chapters to such issues as predisposing factors, psychodynamics, object relations, transference technical problems, dream interpretation, occurrence in males, analytic approaches to hospital and nursing care, and the relationship between self-starvation and amenorrhea; there is a major theoretical position paper written by Dr. Sperling before her death. There is also an abundance of clinical case material illustrating the authors' points.
To appreciate the significance of the book and some of the controversial views it espouses, and to place these in the larger context, it might be useful to review briefly the history of anorexia nervosa. The term was first used over 100 years ago by Gull to describe self-starvation of severe degree and presumably nervous origin. In the years following Gull, there was a great deal of confusion concerning etiology and the application of the diagnosis. For example, all sorts of starvation were so labelled, including cases in the very young, and even cases found to have an organic basis, such as pyloric stenosis. A pituitary deficiency was presumed to be the etiology for many years, and pituitary transplantation was even advocated as the treatment of choice. Among psychoanalytic theoreticians, an oral etiology was hypothesized, leading eventually to the theory that the anorexia (or more accurately, the refusal of food, since hunger continues) was the result of