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The relative slimness of this volume, comprising eleven chapters in only 149 pages, belies its strength, humanity and depth. Gianna Williams vividly describes her intensive work with patients — children, adolescents and young adults, as well as her supervisions of therapies and infant-observations. Throughout the book, various themes recur — the long, complex struggle to relinquish defences; how intolerable this relinquishment can seem, even in the presence of a constant, nurturing other; the constant pull-back towards other, more familiar defensive structures — addictions, obsessional states, states of not thinking or not knowing; and the psychic pain implicit in a move towards a different mode of being and relating. As Williams writes,
I think it becomes clear … that the relinquishment of defences against forming a dependent relationship on a human being, free to come and go … represents a shift especially in the area of eating disorders, from
Page 193valuing possessions to valuing a different aspect in ones’ quality of life. It could probably be most concisely defined as a transition from lending value to having, to finding greater fulfilment in the more painful but richer predicament of being.
Time and again, through empathic and detailed description of her work, she addresses the slow and painful move towards the depressive position.
Williams is both a clinician and a theoretician. She raises, for instance (in Chapter 5), some interesting theoretical questions in relation to self- and object-esteem, comparing Freud's technical approach towards reassurance in his case-history ‘Rat Man’ with his later formulations in ‘Mourning and Melancholia’, and linking this with subsequent approaches of, inter alia, Abraham, Klein and Meltzer. She demonstrates how Freud's earlier exoneration of his patient's moral responsibility for the violence of his unconscious might deprive the patient of insight into his contribution to the quality of his internal world, and the