Brief overview of the changes in the pattern of psychopathologies from the late 19th century to the present allows us to see how social processes influence symptom formation. The main part of the paper is concerned with the anorexic symptom as а production of contemporary liberal discourse. With the example of a clinical vignette the paper considers the special characteristics of influence of universal, cultural and individual aspects on the formation of anorexia as well as the particular qualities of clinical approaches and techniques.
As we know, psychoanalysis came into the world from the bosom of hysteria. And for this very reason the discourse of the hysteric is a starting point in psychoanalysis. However, hysterical conversion symptoms have changed considerably over the century of psychoanalysis’ existence, or rather gave way to the other symptoms which reflect the social changes and features of our time.
In the 21st century the anorectic symptom took the place of the conversion hysterical symptoms which wereprevalentin the 19th century. Hysteria of the 19th century comprised dissatisfaction with femininity, social prohibitions, and the relationship between sexes. The society of the late 19th century was literally fascinated by hysteria, perhaps, partly, because it seemed the embodiment of the female resistance to social prohibitions, and this foreshadowed a possible change in sexual relations and the transformation of the woman’s role in society.
In other words, it might seem that hysteria was a harbinger of possible equality and sexual enjoyment for both sexes. For this reason the phenomenon of hysteria not only demonstrated obsolete social prohibitions, but it was in demand by the society as one of the reasons for changes in the field of sexuality and social laws.
Today in Old Europe and in the New World freedoms for women that were wished for earlier, as well as sexual equality are achieved; and it is the deleting of sexual differences that seems attractive now. The call for total enjoyment leads the modern subject to the rejection of enjoyment. Modern discourse that calls the modern subject to enjoy establishes a total body dictatorship.
In modern liberal discourse we can see how desire became a law; social prohibitions, especially those related to sexuality, are leveled almost completely, authorities are delegitimized. Psychoanalysts call all these things “the decline of the Name of the Father”. In modern psychopathology as well as in modern mythology Narcissus took the place of Oedipus.
So, the anorexic symptom is brought to the forefront today. This symptom is associated not only with the rejection of oral enjoyment, but with the demand of modern society to have the ideal body, perfect, keeping its youth, and hence immortal. If hysterical patients of the 19th century showed the lack through their bodies, i.e. symptoms showed a defective body (paralyses, neuralgia etc.), then anorexic patients show the absence of lack with their pursuit of the ideal body. Hysteric women kept their desire by all means, having left it unsatisfied. Anorexic women reject desire as a sign of lack. Nowadays anorexic symptoms penetrate our culture. It is for this reason that my clinical case history will be developed via anorexia. However, I’d like to highlight the features associated with the specific cultural and historical conditions in which the subject is formed, and to look at the anorexic symptoms through the prism of these conditions.
My work with anorexic patients suggests that the anorectic symptom for the last 15 years has become the most common clinical problem, which is a marker of social changes. Anorexia is not only an unsuccessful attempt to cope with the demands of the Other, but the answer to the demands of modern culture to have an immortal, universal, ageless body. And yet, in each specific case it contains the traces of the subject’s history and the traces of the history of previous generations that have existed in specific cultural and historical conditions.
The case of the anorexic patient I’m going to present was treated 10 years ago. In this text I give the real name of the patient – Olya – since this name is a signifier and it plays a role in her symptom’s formation. Olya is the diminutive of Olga. She first developed anorexic symptoms at the age of 21. These symptoms developed within half a year after her marriage. After two years of the disease, having tried different treatments, having two hospitalizations in critical condition with forced feeding, the patient’s mother consulted me. Having come without any preliminary arrangement, she was eagerly clamoring to meet with me, and in the course of our conversation she urged me to try my methods on her first. Generalizing our two meetings, it may be said that the mother’s behavior was intruding, violating the borders. You got the impression that when she was in the room, she occupied the entire space by herself. Her comment upon first arriving, without a word of warning, was as follows: when a person makes no preparations for the meeting, you can understand better what he/she is really like. Through her high-handed and intruding behavior one could see the directivity and unfaithfulness and at the same time the despair of a mother who has lost all hope, and who was grasping to retrieve her child by any means.
From the anamnesis of the patient: Olya was the second child in her family. Her brother was her elder by 10 years, he was a lawyer and he lived separately.
From the first meetings with the patient and her mother I got the impression that anorexia – a condition of Olya’s body – is the main problem in the family. Neither mother nor the patient herself said anything about either the brother or the father. I got the impression that Olya’s anorexia was an axis all the relationships in the family revolved around. According to her mother, Olya always was an obedient and diligent child, she “does not cause any problems”, and was a good pupil. Olya’s mother was the Director of the Chinese school. At school there was a kindergarten where the basics of Chinese were taught as well. Though her father lived with them, according to both the mother and the patient it seems that his role and participation in domestic life was indifferent. Olya’s health concerns fell completely on her mother.
Olya graduated from the very school where her mother was a Director. Having received higher education, she became a teacher and a translator of Chinese and started working at the very school she graduated from. Thus the impossibility of separation from the mother was strengthened.
The patient’s marriage at the age of 21 was approved by her parents. The newly married couple had their own house and planned to live separately, but Olya’s mother gave sufficient arguments in order to keep the newlyweds in her house. One of the main arguments was that Olya absolutely couldn’t cook and therefore the parents had to feed Olya and her husband in order for the newlyweds to climb up the ladder. As for Olya’s career, her mother had an idea that after some time Olya would be able to become her deputy or even to take charge of the school by herself. Since Olya’s childhood, her mother had endeavored to ensure that Olya would have a perfect command of Chinese. Olya’s mother was a teacher of Ukrainian and Russian; she lacked any knowledge of Chinese and hoped that her daughter would fill this demand. Olya’s mother was appointed to the position of the Director of the Chinese school by the Education Department as a time-honoured School Director. She valued this position very much, since it was a chance to create a better future for her children.
When I asked the patient about the opportunities offered by Chinese, Olya answered that she liked Chinese. When Olya just started studying Ukrainian and Russian alphabetic letters, it seemed to her that these letters were similar to the parts of the body, for example: letters “A” and “Л” looked like a person’s legs viewed from the front, the letter “O” was closely allied to the open mouth, etc. The same was true of the Latin alphabet, i.e. the English alphabet that she started to learn in parallel with the Ukrainian and Russian ones. Chinese is quite a different matter; one should just remember the picture – a hieroglyph – that is similar to nothing. As though it made it possible for her to have a zone (territory) separate from her mother, where the mother couldn’t intrude upon since she lacked the knowledge of Chinese.
In childhood Olya was a plump child which influenced her social activity to some degree. The question of nutrition was very important in the family: they ate much and their meals were hearty – which is characteristic of the traditional Ukrainian family which went through the hardships of famine and war.
Having lived together with her husband and parents for some time, Olya started reducing her portions during meals; she had an idea of mini portions. Soon thereafter she practically stopped eating, later her menses stopped and she stopped her sexual relations with her husband, andnaturally she was not able to work. According to her mother, she was literally “dwindling, melting”. The word “melt” is an important signifier within the relationship between the daughter and the mother.
When I first met Olya, she was very pale, thin and small; nevertheless she was similar to her mother with a similar set of features and hairdress style. In this sense we can consider her to be an atypical anorexic because she had no aspiration to imitate modern advertising and media images of the models. Her speech was inhibited; first she tried not to look at me and showed depressive traits in her behavior. She had no concrete request for therapy. She explained her visit as follows: her relatives were worried over her health, and her visit to me brought them hope as well as this visit gave her a chance to avoid the unpleasant treatment of the hospital.
In the process of work it was found that she remembered her childhood very badly, she has no desires and recently she had no dreams or she didn’t remember them. When I asked her opinion regarding the refusal of food, Olya answered that she ate, but not as much as her mother wanted her to. It seemed to her that she was bursting from the inside with the food her mother forced her to eat by means of blandishment or coercion; she became plump and clumsy at once. I got an impression that Olya wasn’t able to control her own body while being in contact with her mother’s desire to feed her, and therefore she refused to appropriate her body image.
In the patient’s childhood there were some key episodes which influenced the formation of her phantasm. She remembered a frightening dream that she had dreamt several times as a child. With different variations she dreamt that she was looking in a big mirror, and there was nobody there (there was no reflection). She awoke with a start. Her associations led me to the fact that she first had this dream not long after the death of her grandmother who had lived with them. She remembered one detail from this event: all the mirrors in the house were covered with black cloth. At the time, the adults explained to her that this was done in order to not see the deceased when looking in the mirror. Since there is a superstitious belief: if you make eye contact with the deceased in the mirror, it will spell disaster, or the deceased can take the person into “the next world”. Since then she has been afraid of mirrors. When she needed to cross the room while going to the kitchen or to the lavatory and there was nobody at hand, she tried to run very quickly without looking in a big mirror that was there. Perhaps it was a cover memory for even earlier unhappy contact with a mirror.
The other associations related to the mirror led to the memories of the child fairy-tale film The Kingdom of Curved Mirrors. The main character of this movie, Olya, has the sweet tooth and she is a naughty, whimsical girl. She gets into a magic mirror and meets there her own reflection – a girl Yalo (reverse of Olya). Yalo carries Olya with her into the World behind the looking-glass. It is the country where the names of all its inhabitants are pronounced just the other way round, vice versa. The country is ruled by the foolish KingYagupop (reverse of Popugay, meaning parrot), and the mirror-makers are his slaves. In this film Yalo helps Olya to commit the right acts. In the course of their adventures the girls manage to release the World behind the looking-glass from the power of the silly King and to free the slave Gurd (reverse of Drug, meaning friend) from imprisonment.
Having seen this fairy-tale, the patient liked the idea that the double-reflection could suggest how to deal with something; and one could consult this reflection. And sometimes Olya began to talk with her own reflection in the mirror. Thus, her own name became a kind of marker of failure in going through the mirror stage, the inability to connect a mirror image to her own body. And this designated the difficulty to recognize a mirror image as her own and to accept the reality of her own body. Within a mirror reflection it was possible to see either the deceased – a person from “the next world”, or someone who is opposite to you – a girl from the World behind the looking-glass. Phantasy – a game with her own reflection through to puberty – was Olya’s attempt to try on or to make friends with her own reflection.
At thirteen, when her menses began, Olya tried to get a view of her genitals in the mirror. Her mother found her doing that and scolded her very much, having threatened her with severe punishment if it happened again. This episode left a vivid sense of shame and fault; and for a long time a look in the mirror revived these feelings.
In the course of our therapy the look played a significant role. As I have already mentioned above, at the initial stage Olya tried not to look at me as though she was afraid to meet something terrible in the reflection of my eyes. After a while the patient began to look at me with greedy and riveted eyes as though she tried to establish control over all my actions. I got the impression that she devoured me with her eyes. During this period one more signifier emerged in Olya’s associations – the Snow Maiden.
The Snow Maiden is a very important character in the mythology of childhood for Soviet and post-Soviet children. It is our history that has made the Snow Maiden one of the central characters of childhood that distinguishes us both from the Slavic countries and from the other countries of Europe and America where Santa Claus is a must-have figure during Christmas celebrations.
Unfortunately, the English name Snow Maiden doesn’t convey the connotations contained in the Slavic name Snegurochka: a gentle, diminutive-hypocoristic name for a snow girl. The Snow Maiden is a pagan repercussion of the Slavs’ beliefs described in 1869 by Alexander Afanasyev in his book The Poetic Outlook of the Slavs on Nature. In 1873 a famous playwright Aleksandr Ostrovsky wrote a well-known spring fairy tale The Snow Maiden based on these descriptions. In 1881 Nikolai Rimsky-Korsakov wrote the eponymous opera due to which the Snow Maiden became a world-famous figure, and, I hope, it is familiar to my audience. As we can see, the Snow Maiden as a character from the fairy tale and opera appears during a time of great interest in hysteria, and it may be said that it represents conversion hysteria. Being the child of Frost and Spring, the Snow Maiden can’t find her own place in human society. Her body is cold, insensitive to erotic enjoyment. She is tempting, but she can’t love.
The real neurotic’s family romance is developed in the fairy tale The Snow Maiden. The Snow Maiden lives in the family of Bobyl and Bobylikha for whom she is a subject for a possible beneficial exchange in case of her marriage. But still she has her real more powerful parents – Spring Beauty and Father Frost – who might represent desire and prohibition as well. The Snow Maiden has a desire to love, but its realization results in her death; she melts in the sunlight. Instead of acting as the object of exchange she turns out to be a femme fatale, because Mizgir, who loves her intensely, drowns himself in the lake.
As I have already mentioned, for all children of the Soviet and the post-Soviet space the Snow Maiden is a very important mythological character of their childhood. This is due to the peculiarities of historical development. After the revolution in 1917 all religious holidays including New Year and Christmas were cancelled in the Soviet Union. There were new Soviet holidays with ideological meaning. In 1935 the New Year celebrations were introduced again, but the traditional European Santa Claus was replaced by Grandfather Frost. In fact it was the return of a pagan deity. In 1937 the Snow Maiden under the character of Grandfather Frost’s granddaughter appeared officially during the New Year celebrations. She is represented as a little girl or a young woman. Perhaps, the appearance of the Snow Maiden as an equal character at Father Frost’s side marked those social transformations that were brought by the Soviet system: the equality between men and women, the reforming of marital and sexual relationships.
Thus, the New Year holiday turned out to be quite special among Soviet ideological holidays, possessing pagan and Christian remnants, magic and miracle expectations. It’s no exaggeration to say that nowadays this holiday is still the same for all children united by a shared Soviet past bothhistorically and geographically (even in the republics where the population practices Islam or other religions).
Let’s return to Olya’s case. As I have already noted, in childhood she was plump, therefore she had never played the part of the Snow Maiden during New Year festivities. She suffered from this fact and wanted to be a sylph, but the mother and the grandmother fed her insistently. Sometimes meals lasted for hours when Olya didn’t want to eat up the entire portion. Nutrition was strictly controlled, and sometimes turned into an act of adult violence towards her. The image of the Snow Maiden – slim, attractive, pretty, and at the same time cold, forbidding – became one of her main identifications. In Olya’s fantasies this image allowed her to get free of the mother’s oppressive control. The New Year’s Snow Maiden needn’t eat since there is no one to force her; she has no parents, but only a grandfather Frost who is an asexual character. Later on the image of the Snow Maiden was embodied for Olya in numerous on-screen images. And in her fantasies this image allowed her to move away from the suffocating atmosphere of the family, since the New Year’s Snow Maiden appears only once a year – during New Year festivities, and nobody knew where she lives the rest of the time.
When Olya started refusing food, she constantly looked in the mirror, trying to check whether she managed to come close to the desired image, and the result was always unsatisfactory.
The facts I present in this brief clinic vignette have been drawn out of the work of many months, very slowly out of little mosaic details (one can say out of ice fragments) to become the overall picture. From the very beginning of therapy the patient spoke slowly, with large gaps in her speech. First it seemed that she would never be able to associate freely. Speech patterns often hindered the understanding of her story. But in her speech a search for the answer to a question “What sort of person am I?” was obvious. Through this question and in her quest to not recover her health one could see the attempt to not be similar to her mother, to not allow any identification. The anorexic patient could not construct her body as a body that was able to create a desire. Father figure never really became significant, and it couldn’t establish the Law and the borders in relationship with the mother. The maternal law was total; the mother seemed phallic, persecuting and insatiable. Olya’s marriage as an attempt to address a man as a subject and to offer herself as the object of desire as well as to create a border between herself and the mother failed. And she had no choice but to establish her own rules and to regulate her mother’s intervention by means of food.
It is appropriate to refer to Lacan who speaks of two stages of narcissism:
“First of all, there is, in fact, a narcissism connected with the corporeal image… It makes up the unity of the subject, and we see it projecting itself in a thousand different ways, up to and including what we can call the imaginary source of symbolism, which is what links symbolism to felling, to theSelbstgefuhl, which the human being, the Mensch, has of his own body”.(Lacan 1988, p.125)
According to Lacan, the second stage of narcissism is associated with the reflected attitude towards the other, when the specular image appears as “the channel taken by the transfusion of the body’s libido toward the object”. (Lacan 1977, p.696) Because of the failure in the perception of her body, it became impossible for Olya “to transfuse a libido toward the object”.
At the beginning of therapy it seemed impossible to determine transference since there was no definite request. There was a feeling that the Other (psychoanalyst) couldn’t emerge within the relationships.
In the process of therapy, when the patient started devouring me with her eyes, her ideas of my role in the course of therapy became associated with the fact that I would treat her like everyone else had, trying “to feed”. Thus, she expected that my attitude would be interfering and persecuting towards her very body. As noted above, this fact made her keep a close watch on me. In this case the analyst couldn’t take a position of subject supposed to know. I played the part of the imaginary object, similar to the persecuting mother. In the course of time my neutral position seemed to defuse the breathless expectation of attack. And the patient gradually came to a more active search for her image; within transference I could hear more and more persistently: “Tell me, who I am!”
As a rule, anorexic patients complain of nothing; they don’t notice the gap between their real and imaginary bodies; they can’t define a request, that’s why it comes from other people. Here are the roots of the difficulties of working with transference while dealing with anorexia and the hindrances when constructing the symbolical order.
In the case of my patient, until her puberty she had a hope that her specular reflection – Yalo – would tell Olya how to behave in different situations. Her meeting with corporeal changes during puberty and her fear of punishment related to this fact, as well as sexual relations that were loaded with archaic ideas of invasion and violence resulted in her rejection of sex, femininity, which coupled with narcissistic regression where her entire existence was focused on the mirror image, in the field of imaginary, resulted in no place for the Other.
Being so deadly absorbed with the imaginary image, one isn’t able to recognize the real and symbolic dimension, and thus to separate oneself from the ideal image and to be able to see the Other.
This inability of the patient to see me in countertransference caused strong emotions. My wish to stir up the patient, to do something in order to thaw her “frozen” speech, to breathe life and desire into this “Snow Maiden” melting in my sight was broughtto the forefront. However I understood that my activity could only do harm. For a long time I had the impression that I had experienced a total therapeutic failure. Having analyzed these feelings, I started listening to the speech of the patient more attentively as well as I tried to avoid inquiring her about state of her health since all her relatives and medical personnel had a preoccupation with this very issue. At some point she managed to understand that I could hear her, and this fact became her resource to hear herself speak. In the mirror without reflection a contour gradually began to emerge – it was a birth of the subject who had its own outlines and so was able to separate from the mother.
In the context of this brief clinic vignette we can see how historical and cultural development has changed the character that is so familiarto everyone. In the course of time, Ostrovsky’s Snow Maiden which personified the hysterical woman of the 19th century, turned into the anorexic woman of the 20th century: the change from oedipal issues to narcissistic ones is obvious.
This transformation has also happened to the doll, a traditional toy for girls all over the world. While playing with a doll that doesn’t possess any secondary sex characteristics, girls nurture the features of maternal identification as the bases of future motherhood, developing oedipal aspects of the psyche. By the end of the 20th century the doll has changed from a child to a young woman – Barbie – endowed with a perfect sexual body. Such a doll can’t be a child for a girl playing, but it can be an ideal body image of the very one the girl should be aiming to be, one that she should see herself when looking in the mirror in the future. Herein we encounter the narcissistic dimension.
Thus, the modern liberal discourse ensnares the contemporary girl via total dictatorship of body images meant for seduction. Femininity in modern discourse turns into a denial of femininity, sexual differences and death.
The hysterical body of the previous century is the body meant for “theatrical” demonstration. Our time tends towards the frozen body, the body in a state of petrification, hallucinatory stupor, in the imaginary mirror screen from oversaturation with surrounding visual and virtual images, spaces where body fragments and parts are installed. The screen becomes a surface of anesthesia for the modern body deprived of the right to feel. While dealing with the hysteria of the 19th century, the denial of sexuality was the attempt to keep desire (unsatisfied). The modern anorexic subject, surrounded by screens (computers, TV, telephones, etc.), rejects sexuality since nowadays it has no desire, i.e. lack.
All these facts make psychoanalysts reconsider their clinical approaches. The difficulties associated with the inability to draw the line between the virtual (imaginary) and the real, the impossibility to identify and to recognize the Other tasks us with defining our symbolic place in the course of therapy, where the analyst will be able to appear as a symbolic figure. Nowadays analysts – especially in the case of anorexic psychopathology – should find the opportunity to specify their presence and to confirm that they hear and see their patient, which in turn may allow patients to ally themselves with their own images and to construct their own subjectivity having connected real, imaginary and symbolic.
- - (1977) The Subversion of the Subject and the Dialectic of Desire in the Freudian Unconscious, in Écrits (New York: W. W. Norton & Co)
- (1988) The Seminar of Jacques Lacan, Book I: Freud’s Papers on Technique (New York: Norton & Co)
The plot of the opera: The fifteen-year-old Snow Maiden wants to live with the people in the nearby village, and her parents, Spring Beauty and Grandfather Frost, agree to let her be adopted by Bobyl and his wife. Snow Maiden is enchanted by Lel’s songs, but is saddened when he goes off with a group of other girls. Kupava enters and announces her own wedding to Mizgir. The ceremony takes place, but then Mizgir notices Snow Maiden, becomes smitten with her, and begs her to love him. Kupava brings this effrontery before the villagers, and they advise her to go to the Tsar for redress. Kupava complains of Mizgir to Tsar Berendey, who decides to banish Mizgir to the forest. But these deliberations are disrupted by the appearance of the beautiful Snow Maiden. The Tsar asks her whom she loves, and she says, “no one”. The Tsar declares that whoever successfully woos Snow Maiden will win both her and a royal reward. Although the maidens present Lel as the likely candidate, Mizgir swears that he will win Snow Maiden’s heart. The Tsar agrees to the contest as the people sing his praises. The people amuse themselves with song and dance. The Tsar invites Lel to choose a maiden. Despite Snow Maiden’s pleas, he kisses Kupava and goes off with her. Snow Maiden, left alone and disconsolate, wonders why Lel has rejected her. Suddenly Mizgir appears and tries once more to win her love. Frightened by his words, she runs off; but the Wood-Sprite tricks Mizgir to follow an apparition of Snow Maiden instead. Lel and Kupava enter, declaring their mutual love. Snow Maiden finds them and, seeing their happiness, at last truly wishes to have the capacity to love. Snow Maiden calls on her mother, Spring-Beauty, who appears from a lake surrounded by flowers. Spring gives her daughter a garland and warns her to stay out of the light of the sun. Spring and her retinue sink into the lake. Before Snow Maiden can enter the protection of the forest, Mizgir appears. No longer able to resist, she professes her love for him. The Berendeyans, in ritual bride-and-groom pairs, arrive to celebrate Yarilo’s Day. Mizgir introduces Snow Maiden as his bride. As she declares her love for Mizgir, a bright ray of sunlight appears, and Snow Maiden bids farewell: the power to love is the source of her demise. To the astonishment of the people, she melts. The inconsolable Mizgir drowns himself in the lake. The Tsar calms the horrified Berendeyans with the fact that this event has ended the fifteen-year-long winter that has befallen them. In response the people strike up a stirring hymn to Yarilo.
 The word bobyl means a lonely, unmarried person.
 Bobylikha is a wife of Bobyl.