‘Nahrungseinfuhr’ of an Anorexic Teenager (Part 3)

‘Nahrungseinfuhr’ of an Anorexic Teenager (Part 3)

Editors note: This is the second part of a clinical report of a psychoanalytic treatment. The first part is available here; second part is here


At this stage, two technical points can be addressed. The analyst detects a strong resistance from Isabelle on her “sexual choice of object” whose determination and that of the subsequent positioning, frontally challenge her “vital” need to control her psychic drive. Clearly, she refuses to choose. The difficulty, of course, does not focus on choosing between two sexual orientations. The analyst decides to move forward without trying to obtain, through interpretation, the lifting of the resistance and this, by displaying the greatest indifference to the issue of the sexual orientation.

In the session, Isabelle may continue to exercise her redeeming arbitrariness and, then, control the choice of object and that of her sexual orientation. But she is, therefore, obliged to make progress on her adult and genital sexuality. Another clinical point deserves a mention. The keen intelligence of the patient counteracts the therapeutic advances despite the strength of the transference. The analyst takes advantage of a little trick, certainly likely to be debated in practice: two or three times, the intellectual acuity of the patient is explicitly caught off guard by an interpretation that punctuates either a fading of her free associations or a stagnation of her progress. I could say for instance: “I got accustomed to a better cleverness of yours” or “I am surprised that you have not got it yet.” Guaranteed effects at the next meeting where, cut to the quick, Isabelle works twice as hard in her cure.

The cure progresses rapidly, including the disclosure of the incestuous nature of the relationship to her father: he has always refused his fatherhood by moving it to the field of brotherhood. More than once, remembers Isabelle, her father claimed to play with her “as would his little brother do.” The father was under the exclusive empire of his own mother with whom the girl is obviously in open conflict. Isabelle also admits that her father is opposed to the analytical processing. The father turns the words into acts as he regularly threatens to stop paying the sessions or not to carry his daughter “by car”. Nevertheless, some improvements are also accompanied by a clothing transformation of the patient and an impressive nail manicure, nail previously bitten and now covered with a varnish of a coarse color: the patient assimilates this device to a “hatching and to an integration of her femininity.”

A broadly commented metamorphosis, she says, by her friendly environment as well as by her family and which signs, essential in the anorexia, a recovery and a re-balance between the body and the psyche, between the bodily ego and the “ego as projection of a surface.” A sudden interruption of fifteen days, due to a fatherly “car breakdown”, was followed by a gloomy session during which the patient relives all the characteristics of a psychic and overflowing internal attack: a guilty speech with the returning to the ideational obsessions and the criticisms about the not progression of the cure despite the fact that she admitted the validity of it since several sessions. A couple of weeks before, she had even informed the analyst of a gradual recovery of her lunch meal.

The following week, the young girl amused herself with this brief relapse like a forgotten pleasure, “it has been a long time.” A state that had become, she says, the exception. Commenting on her “wellness,” she points out that this is “the opposite of what she has been feeling during the first session.


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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