The Paternal Thumb, “Nahrungseinfuhr” of an Anorexic Teenager

Sigmund Freud, in a letter to his friend Wilhelm Fliess, wrote about the feeding of a child as “Nahrungseinfuhr” instead of “Nahrungzufuhr”. The famous slip implies the idea of an “intromission” of food into a child’s mouth. This approach recalls the theory of primary seduction as developed by Prof. Jean Laplanche.

Article

"The grain of truth contained in this fantasy lies in the fact that the father has actually, by his innocent caresses, aroused the sexuality of the little girl during the infancy." - Sigmund Freud ¹

When she enters the waiting room with her parents, this fifteen-year-old girl – we will name her Isabelle – offers a striking contrast: on the one hand, a frail body, a pale skin despite colors brought by the summer sun; on the other hand, the intensity, if not to say the harshness of the glance. Under the vigilant attention of the girl, her mother explains: It is at the request of her daughter that the appointment has been made after the latter recognized that “all her problems got out of her control.” The mother clarifies: Isabelle has already “followed several therapies with psychologists and with a child psychiatrist,” but she promptly discontinued these therapies because “she did not notice any improvement of her state.” Isabelle looked at the analyst defiantly. Although she “tries to eat fruit, she no longer has lunch,” according to the mother. Divorced for many years, the parents accompany Isabelle to this consultation during which the mother monopolizes the father who is skeptical about the therapeutic approach – something he confirmed later on –and thus remains strangely aloof.

-I- I invite Isabelle to follow me into the office. A brilliant science student, the teenager reveals her story using beautifully composed and concise language, charming the analyst – a Sorbonne University graduate who loves Les Belles Lettres –and could easily succumb to the temptation. The symptom is firmly fixed to her consumption of food. Her “problem” is not new: several years ago, Isabelle flirted with dietary restrictions but, in recent weeks, she feels that “the phenomenon is no longer under her control” and that “the slope has become dangerous.” She skips lunch, systematically avoids meals with friends to avoid explaining her “difference” - that is, she does not order anything. During this first exchange, she explains that she spends her life questioning a scenario that repeats itself endlessly and that makes her feel guilty: she begins a relationship with a boyfriend she likes but, when it goes well, she promptly decides to re-orientate the relationship towards a friendship and then, “despite herself”, takes on the role of their confidante even though this pains her and inevitably leaves her feeling “very guilty.” This compulsive pattern becomes the governing principle of the future sessions during which the analyst, at first, does not fail to notice her impossibility to name the things related to emotions and sexuality. (This last word is even carefully obscured, either by endless convolution or embarrassed approximation which is contradictory to the linguistic capabilities of the young patient.) This initial face-to-face meeting proves the analytic rule: everything is said but appears in palimpsest. The session ends up with the recollection of a recurring dream: the patient is “sitting in the back seat of her parents’ car. Suddenly, her mother is violently thrown out of the vehicle. She herself escapes from the car”, then, “is lost at the foot of a snow-covered hill trail that leads to a chalet where she hopes to find her mother again.” Back in the waiting room, I am confronted by her mother’s interrogation. I answer that it is up to Isabelle alone to decide whether or not she wants to continue the work. An appointment is requested by Isabelle for the following week.

-II- We will now discuss how we conducted the analysis, quite typical of anorexia nervosa in adolescence where incest, coupled with questions related to sexual identity, were predominate. 2 The first session revealed, as mentioned in the introduction, that Isabelle is experiencing anguish with regard to her genital and pubertal sexuality: she changes a budding romance into an accomplice friendship in order to neutralize the possibility of a physical relationship. Does this anguish recall those of the virgins and that of their “full horror of feeling” ³ vis-à-vis the sexuality? In the early stages of the treatment, the patient is surprised to dream “sexually about one of her college professors with whom she lives as a couple”. Transference seems to be at work. This perspective, mentioned painfully in her free associations, is coupled with a sanction playing the role of a psychic dyke: “That’s impossible.” As a priori argument, her early age is gradually set aside by the patient, ⁴ which permits to widen this notion of that impossibility to other registers. One of the dreams offers a valuable insight: “she is on a beach, at a party with a group of friends of her generation, and there is an appetizing buffet. Accompanied by her boyfriend, the patient approaches the buffet in order to serve herself – the hunger torments her – when a series of unpredictable events take place and, abruptly, take her away from the big table” (the events involve a melee between persons that the patient claims not to recognize). Reinforced by the analyst’s interpretation, the patient comes to understand that the diet is aimed at reducing and containing the instinctual desires of her body by weakening it through self-inflicted, painful restrictions: these are all classic manifestations of the pubertal crisis. ⁵ The abundant victuals on the table are easily assimilated by her into the realm of sexual pleasure. She manages gradually to distinguish her fears of weight gain, caused by eating, from those associated with the deformation of the body caused by pregnancy. These are displacements in the representations and affects. ⁶ Strangely, we never talked again about food for months. This issue of her anorexic relation to food gives way to questions about her sexual identity, underscored by an obsessive thought: since her childhood, Isabelle questioned herself compulsively and anxiously about her possible sexual preference for girls. She remembers, in particular, a movie which featured a female couple and, immediately after, a discussion with her mother about it. This obsession has never abated even though she firmly claims to desire young men.

-III- At this stage, two technical points can be addressed. The analyst detects a strong resistance from Isabelle on her “sexual choice of object” whose determination and subsequent positioning frontally challenge her “vital” need to control her psychic drive. Clearly she refuses to choose. The difficulty, of course, does not focus on choosing between two sexual orientations. ⁷ The analyst decides to move forward without trying to obtain, through interpretation, the lifting of the resistance, by displaying the greatest indifference to the issue of the sexual orientation. In the session, Isabelle may continue to exercise her redeeming arbitrariness unpredictability and, then, control the choice of object, as well as that of her sexual orientation. But she is, therefore, obliged to make progress on her adult and genital sexuality. Another clinical point deserves a mention. The keen intelligence of the patient ⁸ counteracts the therapeutic advances despite the strength of the transference. The analyst takes advantage of a little trick, certainly likely to be debated in practice: two or three times, the intellectual acuity of the patient is explicitly caught off guard by an interpretation that punctuates either a fading of her free associations or a stagnation of her progress. I could say for instance: “I’ve become accustomed to you being more astute” or “I am surprised that you have not figured it out yet.” The guaranteed effect of this was that Isabelle worked twice as hard at her cure during the next meeting.

-IV- The treatment progressed rapidly, including the disclosure of the incestuous nature between Isabelle and her father: he refused his fatherhood by moving it to the domain of brotherhood. More than once Isabelle remembers her father claiming to play with her “as a little brother would.” The father was exclusively under the dominion of his own mother with whom the girl is obviously in open conflict. Isabelle also admits that her father is opposed to any analytical treatment. In fact, the father’s words are turned into action as he regularly threatens to stop paying for the sessions or, at other times, refuses to take his daughter “by car”. Nevertheless, some improvements can be seen from the transformation of the patient’s choices in fashion and an impressive nail manicure (where her nails were previously bitten, they were now covered with brightly-colored varnish: the patient ascribes this shift to a “emerging of and integration into her femininity”).A broadly commented on metamorphosis, she says, by her friends as well as by her family and which signals, essential in the anorexia, a recovery and a re-balance between the body and the psyche, between the bodily ego and the “ego as projection of a surface.” ⁹ A sudden interruption of fifteen days, due to the father’s “car breaking down,” ¹⁰ is followed by a gloomy session during which the patient relives all the characteristics of a psychic, internal attack: a guilty speech follows in which Isabelle returns to the former ideational obsessions and critiques about the lack of progress, despite the fact that she had previously admitted to the validity of the therapy in earlier sessions. ¹¹ A couple of weeks before she had even informed the analyst of a gradual recovery in terms of her lunch meal. ¹² The following week, the young girl amused herself with this brief relapse like it was a forgotten pleasure – “it has been a long time” – a state that had become the exception, according to her. Commenting on her “wellness”, she points out that this is “the opposite of what she was feeling during the first session.”

-V- The sexual precocity in this case reveals Isabelle’s failed identification with her parents, and the place she occupied within her family. During the divorce, Isabelle defended her mother from the violence of her father, but with Oedipal ambiguity. In other words, through this intervention, Isabelle experienced the pleasure of taking the place of the mother as sole interlocutor to the father. This strategy has many disastrous consequences, however, mainly due to the “enigmatic messages permeating with unconscious sexual meaning” ¹³ of the father vis-à-vis her: this locks up Isabelle’s love in an exclusive and highly incestuous tonality, paralyzing her own psycho-sexual development. The mother is now simultaneously a safeguard and rival, and the father too personifies both love and a threat. More than once, the patient talks about this “impossible” love while remembering to have felt the “non-natural” dimension and the “unhealthy” side of her father's affects – to such an extent, in fact, that she mentions that she continually avoided his “tender impulses” towards her as a child. Two screen-memories, presented by the young patient as both “insignificant” and “the most unpleasant she had ever had to deal with,” ¹⁴ must still be overcome to address her infantile sexuality. These recollections are punctuated by a dream clearly featuring her “amorous hesitation” between a father figure and that of her “first boyfriend.”

-VI- Isabelle suddenly remembers a story that her parents often told by her about her bath-time as little girl. They said that when she was highly distressed, the only way her “father could instantly calm her, was to put his thumb in her mouth.” This “experience of gratification” was then amplified by a “seductive experience” ¹⁵ because it originally contained something sexual. This seems to be closely related to Freud’s slip in his letter to Fliess about the “intromission” ¹⁶ of the presence of the other and could also be extended to the perpetual search for identity linking the satisfactory discharge of the psychic drive to a “representation of an elective object.” ¹⁷ The patient demonstrates her false ingenuousness – “I never thought that such a simple gesture could have as many consequences” – while questioning herself about the reasons that she “had carefully preserved this anecdote” among the other forgotten ones. Every gesture, every facial expression takes a signifying function, especially in this “oral area” which acts like an “erogenous zone.” ¹⁸ Now two dreams take place, followed by Isabelle acting out. First, a replica of the dream she had during the early stages of therapy, but with a change to the final scenario. The patient meets up with her parents again in the chalet, but “something has changed”, she says, “despite the reunion. “In the second dream, she has to meet her father by crossing over a ravine on a balancing beam. In the midst of this passage, the patient falls into the void and ends up in the arms of a boy she knows. She is surprised to find that she does “not shout or experience any anxiety as she lands in the arms of the young man.” In reality, the patient “has just fallen in love” with a boy of her age. She is astonished by her laissez-faire attitude towards her own sexual desires, and is surprised to find that she is hungry for lunch. One day, on the couch, she seriously questions herself about a luncheon with her friend planned for the next day. She asks: “What am I going to wear?” She then acts out and arrives at the next session with a “short” haircut. Her father “loved her long hair so much that she had never before wanted a haircut.”

-VII- The question of maternal attachment has remains unqualified but is finally raised when treatment is suspended. Officially, it is claimed that the reason for the suspension is financial and because there has been “steady improvement”. Could the mother not, or did she not want to, pay for the sessions because she thought she was owed by Isabelle’s father? Was it a kind of “settling of scores” between divorced adults through an intermediary financial transaction? Could the acceptance of the loss of the father by Isabelle also satisfy the subsequent jealousy of the mother? The patient had a dream in which “she told her mother that the walls of the house are dirty and covered with mushrooms, but her mother did not want to see it. It would take two days and two nights to clean it in the dream, which meant they to clean it together.” The associations of the patient are dazzling: “My mother always denied it, but I always strongly felt that she wanted a boy. Moreover, the clothes she bought for me always had a masculine touch.” From my seat, I look at the shoes worn by my patient who usually dresses with a lot of care. She is in fact wearing military boots! I interpret: “Yes, you are right, like these delicate opera shoes you wear.” She gets up, looks at her shoes and bursts out laughing!

March 2016

Jean-Luc Vannier

The author is a French psychoanalyst based in Nice (French Riviera), and a full-time lecturer of psychoanalysis at Nice Sophia-Antipolis University and Edhec & Ipag Postgraduate Business School. He regularly writes articles for several analytic French journals and publishes columns, using the psychoanalytic approach to address various societal issues. This article is a clinical report of a psychoanalytic treatment. The title quotes a famous slip of Sigmund Freud in a letter to his friend Wilhelm Fliess about the feeding of a child. Freud wrote “Nahrungseinfuhr” instead of “Nahrungzufuhr”which implies the idea of an “intromission” of food into a child’s mouth. This approach recalls the theory of primary seduction as developed by Prof. Jean Laplanche. The French version of this article has been published in “Psychiatrie française” , the review of the French Psychiatrists Association.

Notes

¹ Minutes de la Société psychanalytique de Vienne, T. IV, 1912-1918, séance du 24 janvier 1912, Gallimard, 1983, p.43.

² Cf. Philippe Jeammet « L’anorexique et son corps », in Claudine Geissmann & Didier Houzel (edited by), L’enfant, ses parents et le psychanalyste, Bayard, Coll. « Compact », 2000, pp. 697-711.

³ Sigmund Freud, Lettres à Wilhelm Fliess, 1887-1904, PUF, 2007, pp. 70 et 104.

⁴ The analyst understood at this moment the infantile and sexual significance of the concept of “earliness” which is discussed later on.

⁵ Cf. Jean-Luc Vannier, « L’injonction à la jouissance ou la rue Monnot revisitée », in Subjectivités et appartenances, Dynamiques inconscientes des cultures, Le Coq Héron, n° 175, Erès, 2003, pp. 89-94.

⁶ “The surest clue of a primary process”, according to Jean Laplanche & Jean-Bernard Pontalis, Vocabulaire de la psychanalyse, PUF, Coll. « Quadrige », 4èmeédition, 2014, p. 119.

⁷ The patient herself confirmed - indirectly - the hypothesis of a representative “displacement”, while explaining that she does not understand the obsessive fear of being lesbian as she clearly feels a physical attraction for boys.

⁸ The anorexia mobilizes psychological and physical energy of any patient: hence, the most often, hyperactive and / or particularly smart anorexic cases.

⁹ Sigmund Freud, « Le moi et le ça », in Essais de psychanalyse, Petite Bibliothèque Payot, 2001, p. 264.

¹⁰ The patient called me on the phone to apologize, firstly, for what she thought would only be a delay and, then, more tormented a few minutes later, to confirm the cancellation of the session. She was obviously looking forward to receiving some kind of narcissistic reassurance from the analyst, while simultaneously reminding herself of her “commitment to the regularity of the sessions.”

¹¹ One of the points of this return of the repressed coincides with a brief episode of amenorrhea on which the patient, feeling herself “ashamed with regard to the analyst,” kept silent. It should be probably seen as a result, negative this time, of the clinical practice mentioned above.

¹² On this point, the analyst did not want to intervene in the reality to express one support to or one locking of this benefit. The analyst did not intend to return to a highlighting of the initial symptom and did not want to risk a premature termination of the treatment reduced to this specific improvement, whose outlook was raised several times by the parents. One could discuss this clinical option. This “reality” was then taken into account by a dietician requested by the mother, thus completing the therapeutic device even if, obviously, the maternal intervention remained to be elaborated.

¹³ Cf. J. Laplanche, Nouveaux fondements pour la psychanalyse, PUF, Coll. « Quadrige », 2008, p. 125.

¹⁴ The simultaneity of these two characteristics of the “screen-memory” can be found in the Vocabulaire de la psychanalyse, op. cit., p. 450.

¹⁵ Cf. Jean Laplanche, Sexual, La sexualité élargie au sens freudien 2000-2006, PUF, Coll. « Quadrige », 2007, p. 73.

¹⁶ Sigmund Freud, Lettres à Wilhelm Fliess, 1887-1904, op. cit., p. 626.

PUF, 2007, p.626. The slip from “Nahrungszufuhr” to “Nahrungseinfuhr” has been noticed and explained by Jean Laplanche, « Ponctuation », Le primat de l’autre, Champs Flammarion, 1997, p. xxvii.

¹⁷ J. Laplanche et J.-B. Pontalis, Vocabulaire de la psychanalyse, op. cit., p. 194.

¹⁸ “With no need to give some sort of specialphysiologicalerectility to it” according to J. Laplanche, « La pulsion et son objet-source », Le primat de l’autre en psychanalyse, Champs Flammarion, 1997, p. 238.

¹⁹ Autisme et psychoses infantiles, Psychiatrie française, Vol. XXXXV, 4/14, septembre 2015.

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