‘Nahrungseinfuhr’ of an Anorexic Teenager (Part 1)

‘Nahrungseinfuhr’ of an Anorexic Teenager (Part 1)

Editors note: Below is a clinical report of a psychoanalytic treatment. The title quotes a famous slip of Sigmund Freud in a letter to his friend Wilhelm Fliess about the feeding of the child. Freud wrote “nahrungseinfuhr” instead of “nahrungzufuhr” which implies the idea of an “intromission” of the food into the child’s mouth. This approach recalls the theory of the “primary seduction” as developed by Pr Jean Laplanche. The French version of this article has been published in “Psychiatrie Française”, the journal of the French Psychiatrists Association. You can read the second part here. 


When she enters the waiting room with her parents, this fifteen year old girl – we will call her Isabelle – offers a striking contrast: on the one hand, a frail body, a pale skin despite colours brought by the summer sun. On the other hand, the intensity, if not to say the harshness of the glance. Under the vigilant attention of the girl, her mother explains: “This is at the request of her daughter that the appointment has been made after the latter recognised that ‘all her problems got out of her control.’” The mother clarifies: Isabelle has already “followed several therapies with psychologists and with a child psychiatrist,” but she promptly discontinued these therapies because she “did not notice any improvement of her state.” Isabelle looked at the analyst defiantly. Although she “tries to eat fruits, she has no longer takes lunch,” according to the mother. Divorced for many years, the parents accompany Isabelle to this consultation during which the mother monopolises a word, whose father, that we feel sceptical about the therapeutic approach – something he confirmed later on – remains strangely aloof.

I invite Isabelle to follow me in the office. Brilliant student in the scientific course, the teenager exposes her story with a concision of the language and a consistency of the syntax to the charms of which the analyst – a Sorbonne University graduate who loves Les Belles Lettres – could easily succumb. The symptom is firmly lashed to the absorption of food. Her “problem” is not new: several years ago, Isabelle flirted with dietary restrictions, but in the recent weeks, she feels that “the phenomenon is no longer under her control” and that “the slope becomes dangerous.” She skips lunch, avoids systematically meals with friends in order not to explain her “difference”, that of, as she tells to the analyst, not to order anything at the restaurant. During this first exchange, she explains that she spends her life with raising incessant questions about a scenario that repeats itself endlessly and that makes her feel guilty: she begins a relationship with a boyfriend she likes but, as it goes well, she promptly decides to orient this relation towards friendship, taking on “despite herself” the role of confidante for a partner who, besides his incomprehension, conceives a sharp pain about this situation. As for Isabelle, she feels “very guilty”. This compulsive pattern becomes the governing principle of the future sessions during which, at first, the analyst does not fail to notice her impossibility to name everything related to the emotions and to the sexuality: this last word is even carefully hidden, either by some endless convolutions or by some embarrassed approximations that contrast with the speech capabilities of the young patient. This initial face-to-face proves the analytic rule: everything is said but appears in a palimpsest.

The session ends up with the evocation of a recurring dream: the patient is “sitting in the back seat of her parents’ car.” “Suddenly, her mother is violently thrown out of the vehicle.” “She escapes herself from the car”, then, “she is lost at the foot of a snow-covered hill trail that leads to a chalet and where she hopes to find her again.” Back to the living room, I have to deal with the interrogation of the mother. I answer that it is up to Isabelle and to her alone, to decide whether or not, she wants to continue the work. An appointment is requested by the latter for the following week.


Jean-Luc Vannier is a French psychoanalyst based in Nice (French Riviera), and is full-time lecturer of psychoanalysis at Nice Sophia-Antipolis University, EDHEC Business School, Ipag Business School. He regularly writes for several French magazines and has his own columns. At the University of Côte d’Azur, he is the official Referent for the PPP (Personal and Professional Project) aimed at helping the students to work on their own identity and to define their job choices. Jean-Luc is an editorial board member of the Psychreg Journal of Psychology. You can follow him on Twitter @jlv06


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