ABSTRACT
This chapter examines the psychoanalytic idea of the death drive, with the aim of testing its applicability to clinical situations concerning patients with eating disorders. It is concerned with finding ideas that are clinically useful and enable the clinician to think more effectively under the enormous pressure that the patient’s behaviour imposes. Bion (1956), writing about the development of schizophrenic thought, talks of a “conflict that is never decided between life and death instincts”. The chapter suggests that this conflict is also in evidence in work with anorexic and bulimic patients. Hyatt Williams (1998), working as a forensic psychiatrist as well as a psychoanalyst, describes what he calls a “death constellation”, a constellation of fears, fantasies, and preoccupations with death which he first found prevalent in the minds of individuals who have committed murder. In fact, the therapist was a psychoanalyst of some standing within the profession, but the patient had somehow kept herself from knowing this.
