Bulimia: The Construction of a Symptom

The purpose of this paper is to explore a psychiatric symptom: bulimia. A natural departure point is to consider the usual meaning of a symptom in medicine. Symptoms belong to the realm of semiology; they are signs that suggest a mystery. Symptoms have a painful manifest reality. They may also contain a latent reality that explains the patient's discomfort. The symptom is necessarily ambiguous. Chest pain may tell a story of coronary occlusion, or it may not. Headache may reveal the tension of overwork, or it may disclose a brain tumor. This latency of meaning has the quality of a clue, a signpost along our way of inquiry. Signs have several common characteristics, including polysemy (the generation of multiple strands of meaning) and ambiguity. Even as they represent an aspect of reality, they do so without total equivalence, inevitably adding something here, transforming something else there. Signs generate meaning beyond representation, by virtue of their nonequivalence and ambiguity. Contained within the additions and subtactions of the sign are traces of other significant meanings.

We can welcome symptoms as clues to an underlying process. Naturally we are first impressed by the pain of the symptom itself, yet we are also confronted by uncertainty, mystery, and the possibility of many meanings. This is particularly the case for psychiatric symptoms, if we regard them as pathways to the unconscious. Freud (1926/1959) describes the synthetic quality of symptoms “which once stood for a restriction of the ego (and) come to represent satisfactions as well.” He also notes the “extremely restricted ego” that is the consequence of symptom formation. The psychiatric symptom is at once a source of distress to the patient, a complex assortment of unconscious meaning, a form of communication, and a cause for our own discomfort as we seek to unravel its interweavings.

Bulimia is a ritually repetitive sequence of acts, which begin