Save the Clinic!

22Nov07

/1/ – Diagnosing the diagnosis

Anorexia- the term itself makes an attempt at misunderstanding. Literally, in the Greek, it means the loss of appetite when, in reality, one with anorexia nervosa never looses their appetite but simply recodifies it – appetite becomes an enemy combatant who, at times, shifts to a flood gate of shattering pleasure – jouissance.

The rare hearing of the noun-form anorertic, suggests further disregard of the deeper psychological issues of anorexia, a dismissal evidenced by many of the sad attempts at rehabilitation within programs. Suggestive of the wide spread contemporary belief that information itself is a form of cure, one step of many programs involves the lessons of a nutritionist. The nutritionist makes sure that the patients in their stead understand the concept of a correct portion. Is the naive, or simply stupid, assumption being that ‘if they knew how much they should eat, they would then eat it?’

Furthermore, while medical authorities admit that the primary form of recognizing an eating disorder is psychological, physical rubrics are placed that often disregard the experiences of subjects. The DSM-IV-TR lays down a set of physical metrics, such as body mass index, in order to qualify those who are ‘truly’ anorexic. One of the other more ridiculous requirements is that women subjects be experiencing amenorrhoea, the interruption of the menstrual cycle. The very language of the manual borders on insulting – in the discussion of the body mass index notes that the subject should be diagnosed if they have ‘a refusal’ to maintain a certain BMI.

The ridiculous physical requirements have resulted in a basket category – eating disorder not otherwise specified or EDNOS. The effect of such an arbitrary demarcation should be clear – those with eating disorders are pushed out of the official designation of anorexic and believe that they are not skinny enough to be designated as too skinny.

/2/ – The hunger of the drive

Massimo Recalcati’s “The Anorexic Passion for the Mirror” engages the anorexic subject in terms of the Lacanian mirror stage. In the well-known account, the subject, viewing itself in the mirror, constructs an ideal image, the view of itself that it will always be. But, at the same time, that ideal self is exteriorized from the subject, always alienated and at a distance. While the subject, over time, loses the spectral fascination with the mirror, such a fascination returns during the onset of puberty.

Recalcati goes on to argue that, in viewing the specular image, the anorexic subject wishes to erase the drive of the body, the objet petit a, the thing that is literally ‘in you more than you.’ The drive object of the body is that which propels the body forward, not towards particular objects, as in the case of desire, but propels it forward just for the sake of movement. It seems worth noting that one of Lacan’s more well-known metaphors for the functioning of desire versus drive is that of the stuffed mouth. In the case of desire, the mouths obtains pleasure from the particular item whereas, in the case of the drive, pleasure is obtained simply from the feeling of a full mouth.

It is imperative that one understands drive in its radically anti-biological status, as that which runs against the grain of life, that, if fully embraced, one would have, as Slavoj Zizek has put it, the ontological status of the undead. Or, as Adrian Johnston puts it in Time Driven, drives are not only dangerous to the symbolic order but, if they were truly realized, one would be completely disgusted by the results (p. xx).

Recalcati implicitly reiterates the violence of the drive when he states that the anorexic passion is not a result of a cognitive impediment (as the nutritionists would have one believe). The issue must be viewed as a psychological knot, as a behavior stemming from the effects of a sort of ‘primal scene,’ an event which reconfigures the subject’s attitude towards the consumption of food.

/3/ – The feminine and the clinic

Recalcati points out that Lacan’s essay on the the mirror stage does not take sexuation into account, an error he will correct many years later. A form of anorexia that appears around puberty can, as one of Recalcati’s case studies suggests, function as a kind of defense against the desire of the Other, the invasion of the Other’s jouissance on the subject’s body.

This configuration of the desire of the Other as constructed in the form a threat, suggests that the subject of anorexia is always feminine. While there certainly are men with eating disorders, the numbers do remain overwhelmingly dominated by women. This threat of the sexual other could, in many circumstances, be at least partially deflected by the maternal or paternal authority but because of the declining power of symbolic authority (of an easily defined other) the strength of the subject, upon entering sexuated discourse, is more prone to destabilization.

To continue with the sexual, puberty, viewed within the confines of the mirror, brings new challenges to the ideal narcissistic ‘I’ of the anorexic subject. This image, while promising immortality, simultaneously promises death, or, more importantly, the inability to escape from the drive of the body, the objet petit a, the eventual ravishment and death of one’s physicality. The failure to integrate these two parts, is what, according to Recalcati, happens in puberty to cause a dismorphic disorder (p. 79-80). The aforementioned destabilization due to the loss of identifiable others, occurs primarily because of a lack of knowledge concerning cultural rites of passage, the steps of development and so forth, which would have been embodied in a close maternal or paternal other.

Recalcati attributes the feminine attachment to the mirror in terms of masquerade, arguing that women, because feminine jouissance is not completely coded in the phallic (in terms of presence) an attachment to the veil is necessary (p, 81,83). This is not to suggest an inherent shallowness in regards to the feminine but that the feminine strategy for dealing with the fundamental void of being is masquerade which, in its very nature, is conscious of the visual deception whereas the masculine symbolic game requires that one really believe that one is what they say they are. As Zizek states in The Sublime Object of Ideology, men are women who are stupid enough to think that they actually exist.

/4/ – The fertilizing of abstract blame

Researchers of anorexia and the dozens of feminists and others who concern themselves with body image are always quick to set up ‘the media’ as an abstract entity which can be targeted for all critique. While corpulence was once the sign of class privilege, thinness is no doubt the type of body most socially desired. However, as Recalcati points out, the anorexic subject is not attempting to meet social norms but is disconnected or even opposed to them; anorexic subjects are not interested in trying to please the desire of the other (p. 85, 86).

This attitude is easy to recognize in the varied assortment of pro-ana websites. While some of the sites bill themselves as merely providing a place for discussion, others openly argue against the medical treatment of anorexics and state that anorexia is simply a lifestyle choice. “Thinspiration” communities are also popular, sites where people provide images of emaciated celebrities or anyone who appears to be exceptionally thin.

Thinspiration also comes in musical form. The best known probably being Fionna Apple’s song Paper Bag. The last verse of the song is particularly devastating:

” Hunger hurts but I want him so bad, oh, it kills
Because I know that I’m a mess that he don’t wanna clean up
I got to fold because these hands are just too shaky to hold
Hunger hurts but starvin’, it works when it costs
Too much to love”

While so many medical professionals and groups are quick to attack pro-ana participants, they seem completely unwilling to tackle the problem on the psychological level. Most genetic and neurological studies of the disorder have come up with less than conclusive results. Several studies have noted the use of psychotherapy and yet the push to medicalize the condition, to solve it with pharmaceuticals is still prominent.

/5/ – Identifying with the symptom

The treatment of anorexics simultaneously treats subjects as incapable and unwilling to consume food normatively, working through a scattergun approach which waxes scientific. In addition, the psychotherapy often suggested in such cases, such as the popularity of family therapy, seems to overlook the fact that anorexia is drastically severed from the social despite the wish to connect it to the thinness of the celebrity, the model, the heiress.

Recalcati’s statements that anorexia is fundamentally about the drive is what concerns us the most here. The end of analysis occurs, according to Lacan, when one ‘traverses the fantasy’ and ‘learns the truth of one’s desire.’ To set about unpacking these phrases, one must first understand the notion of fantasy here. Lacan argues that our very reality is structured by fantasy, that, in order to avoid psychosis or what could otherwise be called symbolic instability, the subject constructs a fantasy in order to keep their life coherent in some way. This fantasy is structured around a sinthome, essentially a wound which both gives the subject their consistency and also constantly undermines it.

Analysis then aims to discover what the symptom is by listening to the analysand’s speech and discovering what the axis of their complaints are. Through free association and the brutal acts of the analyst, the analysand is eventually forced to confront the truth of their desire, to realize the irrational kernel at the center of their errant behavior. Once this takes place, the analyst is no longer the sujet suppose savoir (the subject supposed to know, the vague ‘wise guy’) and becomes the cause of the analysand’s new desire. What is important here is not that the kernel of the subject’s desire, the objet petit a, is obliterated (it cannot be) but that a new fantasy and form of desire is constructed in relation to it that is not self destructive.

Contra Freud (depending on one’s interpretation) the end of analysis is not about achieving some fabled psychical normalcy, as such a thing does not exist, it is about removing the barriers to enjoy and exist without neurosis or other self inflicted hindrances. The mistake would be to try and force the analysand to plug back into the other’s desire; this is separate from the issue of the drive which is central to anorexia nervosa.

Ultimately the goal of analysis should be to divert the subject’s gaze from the specular image of the self to the unspecularized internal drive, to see the behavior of eating as the image of the drive. The point here is not to completely naturalize the incessant drive object of one’s being but to denaturalize the specular image, the subject in the mirror as subject. The end result should be to foster a hungry consumption of the mirror.

Filed under: Lacan, psychoanalysis   |  2 Comments