This is my little bit of early morning on-line, out-loud study/therapy, this time with Phillip Bromberg's article on eating disorders (see reference below).
Bromberg proposes that the symptomatology of 'problem' patients is an outcome of prolonged control of dysregulation of affect in infancy, possibly as an outcome of trauma. Where no trust has been established in the reparability of relationship, an experience of desire towards another becomes a threat of self-annihilation, every interaction signals a potential betrayal.
Taking a second view on Freud's psychoanalysis of Frau Emmy von N, Bromberg re-casts her hysterical symptoms as dissociative, where, as 'a trauma survivor, she protected herself against the future by treating the present as if it were nothing but a replica of the past'. This foreclosure of the moment is a 'basic adaptational function', a dissociation that protects the person from the impossibility of being self-reflective and in a state of fear while experiencing the security of a known object, all at the same time.
An incredibly vigilant mind is posed as the ground from which the anorexic 're-packages' his or her self-agency into a dynamic of dramatically purposeful activity, combined with significantly inhibited awareness of bodily signals. Bromberg lists Janet's research as identifying the amnesia that accompanies the anorectic's eating - specifying that via this model of dissociation we come to understand it as an 'organised system of self-experience', dominated by it's own affective states and it's own view of social phenomena (as a sufferer I'll attest to this anecdotally - I believe it's the biochemical changes in the brain that call forth a distinct set of personality traits, potentially entirely unrelated and non communicative with and to the personality as it would otherwise operate). The threat to self-continuity in a moment of trauma is completely survival oriented. Eating disorders patients live in a protracted relationship with that moment - survival becomes the orienting force around which the personality is structured.
Bromberg advocates the timely use of laughter in therapy to shift and incorporate more of the dissociated parts of the self into the presenting persona. This, he proposes, can help to overcome 'the absolute hegemony of the mind and the negation and abandonment of the body in anorexia'. Successful interpersonal transactions become the currency by which the anorectic can restore their own damaged capacity for affect regulation - in the language of attachment theory, this becomes the 'secure human relatedness' that, once reparability is established, allows affect regulation to function in a nonverbal and unconscious way.
While there are possible infancy dynamics involved, there is also the adult implication of needing to make choices in an affectively regulated schema. The need to make a choice can make possible a refusal to undertake it, or the possibility of making one but experiencing profound dread of loss of the choice forgone. Compensation and consolation are experienced in normal pathology - but for these patients, there is a recognition of insufficiency that is unbearable here. Desire, and desiring, are the cause of immense distress, and at their core, eating disorders can signal a loss of faith in the reliability of human relatedness.
In bulimia, the dissociation into the 'not-me' state is proposed to function as setting a 'marker at the edge of the self so that they can experience a limit and not become fragmented in a diffuse unnameable scatter'. These individuals 'starve themselves socially, erotically and nutritionally.
Enactments are proposed as necessary therapy where the processing of unprocessible experience can slowly be absorbed over time, by coming to understand a trusted relationship, that between therapist and client. It has to get ugly, in other words, before the internal reparation can take place and the reliance on the dissociation can be surrendered.
It's like walking backwards and forwards through a looking glass.
Bromberg, P.M. (2001). Treating patients with symptoms - and symptoms with patience. Reflections on Psychoanalytic Dialogues, 11, 891-912.
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