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This paper describes a crucial aspect in the drive towards death which manifested itself in the treatment of a severely anorexic 14 year old girl, Amelia. I pay considerable attention to the early part of treatment as this enables one to trace, with hindsight, the mechanism used by my patient to avoid psychic pain of one kind. As treatment progressed her wish to die increased, hospitalisation was necessary to keep her alive and yet her investment appeared to be in the analytic process and her relationship with me. Her idealisation of me and of psychotherapy worked against her recovery and opened the way for perverse and destructive forces to take hold, resulting in an acute psychotic illness. Amelia's passionate involvement in the therapeutic encounter caused great anguish at the end of each session and she formed an allegiance and attachment to anti-life and anti-hope constructs, i.e. to a perverse object-relationship. The limits of psychotherapy resources in the NHS setting meant that Amelia could only be seen once a week, increasing to twice a week.
Attachment theory is described as a way of “conceptualizing the propensity of human beings to make strong affectional bonds to particular others and of explaining the emotional distress and personality disturbance, including anxiety, anger, depression and emotional attachment, to which unwilling separation and loss give rise” (Bowlby 1977).
Attachment behaviour seeks to create a tie which binds one person to another, it includes crying and calling, which elicit care, following, clinging and also protest when left. The intensity of attachment may be heightened or diminished by situational conditions: for example, helplessness and defencelessness bring fear for survival, and in such a state of terror attachment to a destructive part of the personality may be formed. Turning towards or becoming attached to a therapist may create this danger at the moment of separation. In the absence of a psychic stru