Silent Scream: The Cost of Crucifixion—Working With a Patient with an Eating Disorder

In working with individuals who have experienced extreme deprivation in early relationships, the pain is often depicted silently and repetitively. There can be a tension between the need for validation and an avoidance of growth. The analyst, then, can find herself caught between her empathic resonance to the silent scream and the need to keep in mind the “cost of crucifixion.” The latter has become my inner way of fixing in my own mind the type of dilemma that ensues when the individual truly feels helpless and at the mercy of outside sources and also resents and fears the other's power. Marking (and often magnifying) the distress, then, becomes a way of inviting salvation. The dramatic element lends an air of inauthenticity to what is, in fact, very real pain. If we are unable to note the air of dissonance with which we receive these distress calls, we miss a crucial healing element: that the self is paying a huge price for defining the other as a source of salvation, and that part of the distress ensues from the denial of the hostility expressed toward the object for being an insufficient savior. We find ourselves cast in the role of savior/persecutor, and must find some means for healing these splits so that we might become a deidealized support for the other's emerging attempts toward constructing a more viable self. This is a dilemma we encounter when working with individuals who communicate protosymbolically, as is the case with eating disorders.