The author has found great interest in the book by Rudolph M. Bell, Holy Anorexia (Univ. of Chicago Press, 1985), according to which anorexic behavioral patterns are
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a social as well as intrapsychic phenomenon, in the sense that they are a response to the patriarchal social structure in which women are forced to live: it is the type of culture which decides whether anorexia should be considered a holy or a nervous phenomenon. Under the influence of Bell's book and of a seventeen-year-old anorexic patient, Bruno was intrigued by the monastic world and was stimulated to read the “Legenda Major,” the main source for the life of St. Catherine of Siena. This reading opened his eyes to a meaning of anorexia he had not yet considered: by refusing food the patient is searching for a special, secret relationship with her father, her ideal self. The very physical sensation of an empty stomach is capable of restoring her perception of what she was afraid of losing, i.e., her bond with an ideal figure. The precarious nature of an equilibrium based on this ideal relationship is experienced as intense anxiety about an inner void, countered by a strong physical sensation similar to that which causes pain. Strong physical sensations have a reorganizing effect on certain basic body sensations which, thus stimulated, lead, as they develop, to psychic self awareness.
According to the author, it is important to be able to identify the patient's intentions by distinguishing punitive fasting (the wish to punish the other who has not come up to expectations, or oneself for not loving with enough intensity) from fasting whose function is to recall the lost object and re-establish an idealized link with it. Furthermore, these two must be distinguished from fasting whose function is to stimulate the perception of one's own body image and the ability to influence one's own feelings, by an omnipotent flight from dependency. The paper points out how some anorexic behavior patterns, though they take on a guise of rejection and self-punishment, express more deeply the need for union and self-individuation. In the final part, the author considers countertransference and interpretation problems roused by anorexic patients.
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Meregnani, A. and Ferro, A. (1995). Rivista di Psicoanalisi. XXXIX, 1993.. Psychoanal. Q., 64:630-631