307.51 Bulimia: The essential features are episodic binge eating accompanied by an awareness that the eating pattern is abnormal, fear of not being able to stop eating voluntarily, and depressed mood and self-deprecating thoughts following the eating binges.
(DSM p69)
This is how bulimia is classified in the most commonly used diagnostic manual of our times –the DSM (Diagnostic and Statistical Manual of Mental Disorder). While in some cases it might be helpful to outline some general characteristics of this condition, when working with people in counselling and psychotherapy such descriptions are often of little or any help at all. Describing eating disorders in such general terms leaves very little space for any individual implications. More than describing a general set of symptoms, it is important to say that the person is not a helpless victim but someone who is trying to say something through these symptoms. That these symptoms speak. When we begin thinking about symptoms in this way we can understand how problematic it is to simply remove them from a person’s life as if it were an unwanted burden. And indeed if we do try to get rid of the symptoms, they often return.
What’s missing in all this is subjectivity. For a psychoanalyst a symptom often tells us a unique story or holds some truth, which the person may not even be aware of. The idea that symptoms speak is not new. The discovery was made by Sigmund Freud who replaced the previous therapeutic method, hypnoses, with listening. One of his early patients, Anna O., described it as the ‘talking cure’ and from this all the talking therapies that we know today are derived. Psychoanalysis however differs in that it does not provide general answers but instead tries to capture what is unique in the story of each individual.
For example, a young woman, Beatrice (pseudonym), suffering from bulimia went to a psychoanalyst. She had a very successful life professionally and was married to a loving husband. If it wasn’t for her bulimia her life would have been almost happy. Beatrice felt that her bulimia was something which she inflicted upon herself as a punishment but had no idea why she felt this way. Her symptoms were only experienced during dinner time and only with a particular kind of food. After a bout of excessive eating, she suddenly felt it was ‘too much’ and threw up. In the course of the therapy it turned out that Beatrice’s bulimia started around the time of her father’s death. On the day of his death, her work demands were greater than usual. Her farther had been ill for a long time and she didn’t realise that her father’s situation had badly deteriorated. After work she went straight home and knowing that she would spend most of the night with her father, had a quick bite to eat before attending to him. By the time she was finished her father had died. When asked what she had eaten that night, to her own surprise it was the same food she now repeatedly ate and threw up. During the treatment Beatrice discovered that she was unconsciously blaming herself for not being present at her father’s deathbed and was now able to link her feelings of punishment to their original cause. The result of this was that her bulimia disappeared.
Beatrice’s story is one example among many. Unlike the classifications in the DSM, Psychoanalysis does not provide any single answer but focuses on listening to what is unique in each person’s story and the patient’s willingness to explore their unconscious desires. The process is often emotionally painful and involves exploring issues many people would prefer not to talk about. Yet, from this pain something new is born.
