The Umbilicus as Vagina Substitute—A Clinical Note

The umbilicus is a structure, or more accurately, the remnant or vestige of an important prenatal organ that has received little attention in the psychiatric literature. I have been unable to find any reference in the literature of this structure becoming a symbolic vagina. Ordinarily neither its conscious nor unconscious significance is explored in the course of a psychiatric evaluation or in psychotherapy. Throughout my sixteen years in psychiatry I have never heard this anatomical area discussed by instructors, supervisors, or patients. This might lead one to draw the conclusion that it has little dynamic significance, if any, for most patients or, for that matter, for most human beings.

The case to be described represents the first instance in my experience in which the umbilicus had significant meaning and import to a patient. In the course of psychotherapy, the patient unveiled an obsessional preoccupation with this structure which was manifested by monthly ritualistic practices.

The patient was a forty-eight-year-old white, single, female who was four feet ten inches tall and weighed two hundred fifty pounds. She sought treatment with the expressed purpose of losing weight. In her attempt to lose weight, she had over the years tried individual psychotherapy, group psychotherapy, hypnosis, 'weight watchers', and various medical regimes with no apparent success. She was referred for psychiatric treatment by her family practitioner because her weight was felt to be contributing to hypertension, and her eating habits to relatively frequent attacks of gout.

The youngest of three children, the patient lives with a single sister, ten years her senior. Her brother, fifty-three years old, is married to a black Jamaican woman. The patient comes from a lower middle-class Jewish family in which the father was the absolute ruler of the household and everyone was expected to assume a subservient