Correspondence

In the Winter 2005 issue of the Journal (33,671-689), there was a most interesting article by Jeffrey H. Boyd, “Screening for the Metabolic Syndrome.” The article was followed by commentaries, first by Douglas H. Ingram and then a rebuttal by David V. Forrest. In spite of my many areas of agreement with both commentaries, there was one point of controversy where I support the positions of Boyd and Forrest.

I am so inclined because as psychoanalytically oriented psychiatrists we are indeed physicians. I do not believe an interest in the health of the patient's body interferes with or contradicts our work as psychoanalysts. I believe the person is his body and mind, and that the two are inseparable, physically and mentally.

I studied with Alexander Lowen for a decade in the 1980s and came to appreciate the Reichian understanding of the mind-body unity. Much of the analyst-patient interaction has to do with the analyst's awareness of how the patient is communicating with his body, which includes nonverbal communication, such as facial expression and tone of voice, variations in breathing and eye contact, changes in bodily position and physical mannerisms. Certainly the body also communicates something in terms of girth and weight, and the metabolic syndrome (abdominal obesity, insulin-resistance, hypertension, hyperlipidemia) signals self-destructive, self-defeating, unconsciously determined ill health, which downgrades quality of life and shortens the life span. Analyst and patient can choose (unconsciously) to deny the meaning of self-destructive living and bad health practices (overeating, no exercise), but at the peril of not going deeply enough into its developmental and psychological causes.

My recent clinical work has shown me that preverbal (infantile) developmental deficits, which can generally be simplified into inconsistent and poor mothering, greatly influence the psychology of appetite and the tendency to overeat. Very often there are periods in