ABSTRACT
The author describes a sub-group of anorexic patients who present themselves clinically as ‘invisible’ and ‘insubstantial’. The concept of ‘invisibility’ is understood in terms of primitive object relations. The underpinning of this dynamic is a lack of separation and differentiation from mother and a consequent effort to live inside her skin. The author relies on Rosenfeld’s description (‘On the psychopathology of narcissism: a clinical approach’, in Psychotic States: A Psychoanalytic Approach, New York: International Universities Press, Inc., 1964) of narcissistic object relations and related defences against recognition of separateness between self and object. Differentiation and the development of a sense of a visible self require a growing capacity to bear pain and conflict. The author offers an extended case example in order to elucidate the factors that contributed to an adolescent girl’s experience of herself as invisible, and only really of any substance when merged with another. Paradoxically, the anorexia can also serve to make a patient’s problems truly visible for the first time. The anorexia both reflects the sense of insubstantiality and may represent an emerging opportunity for experiences that are one’s own to be considered.
