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The anorexic mind, by Marilyn Lawrence, London, Karnac, 2008, 143 pp., £18.99, ISBN-10: 1855753839, ISBN-13: 978-1855753839
When Freud first discovered that his patient Emmy von N. was covertly disposing of her pudding by throwing it out of the window, his insistence that she eat and drink more was met by ‘open rebellion’ (Breuer and Freud, 1895: 81). His irritation with her intransigence is transparent. Many since have commented on the strong feelings that arise in the countertransference towards anorexic patients, whose pathology is characterised, Lawrence suggests, by the refusal to accept help. Some of the intense frustration and anxiety evoked are related to the fact that the condition carries the highest mortality rate in young women (90% of sufferers are female) of any psychiatric illness. It is therefore unsurprising that a burgeoning psychoanalytic literature seeks to enlarge our understanding of the anorexic mind.
Marilyn Lawrence writes on the basis of 30 years of experience of individual psychoanalytic work with anorexic patients as well as, importantly, of consulting to the staff of specialist eating disorder units. Recognising the increasingly multidisciplinary design of treatment in inpatient settings, her book is written with a broad professional audience in mind: ‘an approach that helps practitioners to find meaning in the illnesses of their patients is likely to be helpful to mental health workers from a range of different backgrounds’ (p. 1). The book is a volume in the Tavistock Clinic Series, which sets out to make accessible the clinical and theoretical work of this institution. It is thus firmly situated in the Kleinian tradition and aims to provide a concise and approachable overview rather than a detailed or innovative account. Lawrence highlights that members of this patient group are difficult to think about, not least because they have such difficulty in thinking about themselves, and the book provides tools for thinking t