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In a previous publication (Dare, 1988) a schematic account of a family therapy with a young anorexic patient was presented in order to depict a psychoanalytic psychiatrist's approach to family therapy. This present paper continues an exploration of the families and the family therapy of anorexia nervosa integrating a psychoanalytic viewpoint with that of family systems theory. It is not an account of a distinctive, that is to say a ‘pure’, psychoanalytic family therapy of the eating disturbance. Rather, by making an extended account of a case in treatment, further details of the integrated model can be described.
There is an extensive literature on family organisation and structure in anorexia nervosa (e.g. Dare, 1985; Minuchin et al., , 1978; Selvini Palazzoli, 1974; Stern et al., 1981; White, 1983; Yager, 1982). Writings within the psychodynamic framework have portrayed other aspects of family psychological make-up. The work of Sours (1980) is especially relevant for the detailed evocation of the experience of such patients and the poetic title of his book on the subject (Starving to Death in a Sea of Objects) is a source for the title of this paper. The psychodynamic psychiatrist, Hilde Bruch (e.g. 1978), has also given vivid accounts of the internal world and its evolution in anorexic patients, accounts that have to be absorbed by the therapist wishing to engage with whole families in which there is an anorexic patient. All of these writings explore the development of the inner life of the patient by examining the anorexic patient's expression of their experience of relationships with parents.
In addition to using both family systems and psychoanalytic frameworks for understanding processes within and around the anorexic patient, there is another pertinent field: developing awareness of the psychological effects of starvation upon the individual (the effects of a starving child upon other family members must also be considered). This awareness is deriv