ABSTRACT
Susannah Rose is a psychotherapist working in an inpatient unit for patients with eating disorders. The unit offers a variety of treatments, as well as individual and group psychotherapy. Whatever treatment is offered, staff have to cope with the pain and anxiety of seeing young people with great potential who have turned themselves into living skeletons. Rose points out the high morbidity of anorexics, and many of the patients recover only to relapse. This has similarities to the patients in Angela Foster’s chapter (chapter five) and draws attention to how difficult these patients are to treat.
The chapter initially discusses anorexia as an addiction, with the characteristic illusion of being in control and not needing relationships. Rose describes the anorexic’s sadomasochistic relationship to a tyrannical “anorexic object”, which she links to Rosenfeld’s concept of pathological organizations. This tyrannical object is similar to the superego of the binge drinker described in Marion Bower’s chapter ( chapter three ). Although the anorexic starves herself of food and the binge drinker ingests as much as possible, the distinction is more apparent than real. What links these different addictions is the submission to a tyrannical superego, which compels the addict to 176 cross boundaries or limits in what is, in effect, an assault on the self. The anorexic girl cannot be thin enough, the gamblers described in Jessica Yakeley and Richard Taylor’s chapter ( chapter seven ) cannot be poor enough and feel they cannot stop gambling until they have lost everything.
The second part of Rose’s chapter looks at ways of getting alongside patients to talk about their omnipotence, destructiveness, and contempt without alienating them. This approach of getting alongside the addict is also described in the chapters by Vanessa Crawford (chapter one) and Angela Foster (chapter five).
Rose draws on the work of Tustin, Mitrani, and Bick. Mitrani suggests that a pathological organization can have a second skin function in the sense described by Bick. It then acts as a defence against states of disintegration. This is manifested in the addict’s wish for a firm, hard body. The therapist’s task is to provide a “digesting mind” in the sense described by Bion, to begin the process of converting somatized sensations back into thoughts and emotions that can be held in the mind.
