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Psychoanalytic papers on eating disorders focusing ‘on the object relations of the patient and their manifestation in the transference are few and far between’ writes the author. As a rare food, this paper is both palatable and digestible.
Marilyn Lawrence brings together a number of concepts to explain the internal dynamics of the psyche underlying disordered eating behaviour. She links the Oedipal situation with the Kleinian theory of manic defences against depressive pain, explaining a need to murderously control both the internal parents and their relationship with each other.
Case material from three female patients is used to illustrate both the general theme of control of internal objects and to differentiate between anorexia and bulimia. Anorexia is regarded as the more serious condition, with its unrelenting murderous ferocity. Some sufferers describe visual images of a ‘white out’, interpreted by the author as the phantasy of an objectless world. The patient may experience this as clean and good but, in eating terms, there is no doubt that it marshals the starving internal parents to their seats at opposite ends of a dining table adorned with a pure white table cloth but no food. Bulimia, on the other hand, suggests an in between stage of ambivalence and conflict in which the parents may be starved and then intermittently hit by binge eating, like violent terrorist attacks. The author emphasizes the repetitive, serial nature of these attacks in which the associated vomiting represents a phantasy killing of internal objects.
The paper provides a dynamic theoretical framework for the understanding of eating disorders. The case material and discussion make this framework assessable in clinical terms. Aspects of treatment are introduced, such as the need to determine the patient's suitability for analysis by considering the degree of murderous intent towards the internal parents and their relationship. This can be viewed as a reflection of the degree of murderous