The Pathogenic and Therapeutic Potential of the Gaze of the Other in the Clinic of “Eating Disorders”

Abstract

Building on the optical-coenaesthetic disproportion model of so-called eating disorders, this paper provides a framework for the psychotherapy of people affected by these conditions. This model characterizes “eating disorders” as disorders of embodiment and identity, where a sense of unfamiliarity with one’s own flesh, experienced as shifting and incomprehensible, leads to an impairment in the constitution of the Self and thus of one’s own identity. Since there is a deficit of the coenaesthetic experience of the embodied Self, greater importance is assumed by body perception conveyed from without. To these persons, their corporeality is principally given as a body-object “to be seen” from a third-person perspective, rather than as a body-subject “to be felt” from a first-person perspective. The Other’s look serves as an optical prosthesis to cope with dis-coenaesthesia and as a device through which these persons can define themselves. They are unable to accept the hiatus between “being a body” and “having a body,” constitutively present in every human being, forcibly trying to recouple it, and finally ending up objectifying themselves to succeed. The external foundation of the Self thus takes the form of a constriction one can never be completely free of. Psychotherapy should thus accompany persons affected by eating disorders in their encounter with the miscarried dialectic between feeling oneself from within and seeing oneself from without through the gaze of the Other, so keenly feared by people desperately in search of self-control. Tactfully, the clinician accompanies the patient in taking a stance towards her symptom as the outcome of this miscarried dialectics, which is one premise for overcoming it. The clinician’s gaze becomes the herald of recognition, allowing the patient to feel accepted in terms of her individuality. Feeling themselves touched by a gaze that waives its alienating potential in order to signify acceptance reactivates the identity-forming dialectics. Their body is thus revealed as the receiver of gazes, but also rediscovers its own possibility for self-determination starting out from these gazes. This intersubjective resonance between the clinician’s gaze and the patient reactivates the identity-making dialectics between body-subject and body-object, creating the relational premises for overcoming the symptom.

The role of embodiment in the treatment of patients with anorexia and bulimia nervosa: a 2-year follow-up study proposing an integration between enhanced cognitive behavioural therapy and a phenomenological model of eating disorders

“…However, the improvement of CBT-E with phenomenological concepts, namely with the optical-coenaesthesic disproportion hypothesis, may contribute to overcoming some of its limitations, making it more effective. Indeed, the integration with phenomenologic modules focused on the exploration of domains of selfhood and identity (top-down strategies), that go beyond the conceptualisation of ED symptoms as consequences of the overvaluation of body shape and weight, may contribute to help patients to reconstruct their personal identity [40], overcoming the identification of their Self with the status of "anorexic person" [4,6]. Moreover, the implementation of modules specifically aimed at addressing the interoceptive deficits of these patients [34] might be a precious resource in the complicated process of recovering a healthier contact with one's bodily sensations and thus with emotions [41], consequently breaking the pathological interconnection between impaired coenaesthesia, imprisonment in an allocentric perspective on one's own body [6,36] and overreliance on the gaze of the others as the only way through which defining one's own identity.…”

The disappearing body: anorexia as a conflict of embodiment

“…The result of this struggle is a radical dualism of self and body: on the one hand, the anorexic patient exercises a quasi-military regime over her body; she closes it off from exchange with the environment and suppresses its libidinal needs. She constructs her body as a self-contained, closed system whose boundaries "may then be crossed only on her 6 Esposito and Stanghellini [18] interpret these findings as evidence that the disturbances of bodily self-experience are a primary deficit of anorexics ("hypo-and dis-coenaesthesia"), which results in their excessive orientation to the gaze of others as conveying a substitute sense of identity. However, this assumption of a primary disturbance of coenaesthetic experience does not seem to be proven by the merely cross-sectional findings.…”

Lived body and the Other’s gaze: a phenomenological perspective on feeding and eating disorders

“…The image of my body, as it appears to the gaze of the other, is no longer one of the elements that form the mosaic of my person, but the main piece of the picture, perhaps even the only one, which defines what I am. In consequence, the frenzy and the fury in trying to make that body-I-have, the visible body, all the more mirror of the body-I-am, of the body-I-feel, are not surprising [12]. The body image therefore becomes a blackboard of self-expression, but always expresses a reified body, an adhesion to the body object that the gaze of the other offers me [9-11, 14, 26].…”

“…The psychotherapeutic relationship, mediating the experience of recognizing the other despite its fragilities and weaknesses, offers the subject a different Other than the one with the reifying gaze that he has always known [12,31,51]. The psychotherapist reveals to the subject that there is the possibility of renouncing the alienating effect of the gaze of the other, in favor of an experience of intimacy [14,26].…”

“…Understanding how persons affected by FEDs experience their body opens the possibility of intervening therapeutically not only on behaviours, but also on those experiences that give rise to behaviours themselves [12].…”