The anorexic patient as a survivor: The denial of death and death themes in the literature on anorexia nervosa

Abstract

This paper examines by a selective review of the literature on secondary anorexia nervosa the under‐recognized role of death fears and anxieties in the etiology of this paradoxical condition. By drawing on the psychology of the survivor, the anorexic patient is conceptualised as a “survivor by proxy” of the parent. In developing and confronting these themes, areas of knowledge otherwise thought unrelated to anorexia are discussed. Of particular importance are the Rheingold theories on maternal destructiveness, the catastrophic death complex in women, Lifton's psychology of the survivor (particularly the survivor child), research on maternal depression, morbid obsessions, necrophilia, and murderous obsessions in mothers towards their children. The main thrust of this reconceptualization is that death fears and anxieties, and a close associative linking between eating, death, and other basic life functions, plays a central and not peripheral role in the dynamic etiology of secondary anorexia nervosa.

Themes of death: Helmut Thomä's “anorexia nervosa” (1967)—a research note

“…Thoma's Anorexia Nervosa provides yet another example from the "hidden" literature (Jackson & Davidson, 1986) on eating disorders of the possible role played by the life-death conflict, death anxiety, a preoccupation with death, and failed death transcendence in the etiology of this illness. The text also provides an illustration of the process of denial of death in the literature, as the morbid themata so clearly evident in the many dreams quoted and analyzed by Thoma do not integrate into the logic of his theory.…”

Ellen west revisited: The theme of death in eating disorders

“…Viewed from this perspective Ellen West provides an interesting and undoubtedly important example of the denial of death in the literature on eating disorders, and testifies to the powerful nature of the process of involuntary selective inattention to death themes, itself a psychopathological process so widespread in clinician and researcher alike that it is rarely recognized (Jackson and Davidson, 1986).…”

“…In all, there is a combined total of 585 references to death material. A monograph and article by Jackson andDavidson, (1985/1986) has earlier addressed the denial of death in the literature on eating disorders. It could be argued that Ellen West provides no better example of the process of involuntary selective inattention to death in the literature and lack of cognizance of what may well be a powerful, but hitherto neglected dynamic in the pathogenesis of some forms of eating disorder, particularly when accompanied by other signs and symptoms of major psychiatric illness.…”

Attitudes Toward Life and Death and Suicidality Among Inpatient Female Adolescents With Eating Disorders

“…On the other hand, only patients with EDs who have attempted suicide show maladaptive attitudes toward death, associated mainly with pathological bodily-related attitudes. The conceptualization of EDs as including a basic fear of life, with death wishes appearing only in suicidal patients, stands in sharp contrast to theories suggesting that unconscious wishes to die in the form of refusal to eat may be involved in the very development and maintenance of EDs, particularly AN (Jackson and Davidson, 1986).…”