‘No entry’, an invitation to intrude, or both? Reflections on a group of anorexic patients

Abstract

This paper describes the twice-weekly psychoanalytic psychotherapy of a young woman who had undergone major bowel surgery in her early 20s, with no clear medical indication for the surgery. Whilst the concept of 'No Entry' described by Williams (, b) aptly describes many features of more 'typical' anorexic patients, this paper describes a particular group of anorexic patients, referred by their physicians for multiple medical procedures; and proposes there is a group of anorexic patients, repeatedly referred for medical investigations, into whom particular types of entries occur. These are entries into the body 'legitimized' as medical, with a trajectory towards multiple procedures, examinations and surgical operations. Other entries (outside the medical setting) may occur in a state of altered consciousness, under the influence of alcohol or drugs, such that any wish for intrusion is disowned and denied. In both sets of events, intrusion is both invited, and consciously denied. The case example illuminates some of these features, and aspects of the countertransference are also described. Attention is drawn to relevant research focusing on surgical intrusion. Finally, there is an exploration as to how such patients may invite intrusions into the body through surgery and medical procedures.

Anorexia Nervosa and First-Person Perspective: Altruism, Family System, and Body Experience

“…However, we can clarify that, in the line of psychoanalytic interpretation, understanding of prosocial anorexic behaviour has to be interpreted as an essential psychodynamic defence mechanism [14][15][16]. Altruistic care, sometimes resulting in force feeding, can "hide" an unconscious aggressive relationship to other.…”

“…Feeding others is also controlling them in a very efficient way, and making them dependent on oneself. It is therefore interesting to keep in mind that this phenomenologically observed paradoxical altruistic behaviour (about feeding, but also generalized) can point out a more ambiguous relationship to others, made of hetero-control, anger, and even aggressiveness [14,15]. Besides, not feeding oneself (or very little) suggests another form of intersubjective but also subjective command and makes it impossible for others to feed him or her (anorexic patients often hate receiving food or eating in anybody's presence).…”