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Body and Language in Eating Disorders [1]

Domenico Cosenza

Summary

In this text we will try to question the symptoms that descriptive

psychiatry classifies as eating disorders—anorexia, bulimia, and
binge-eating disorder—from the perspective of a Lacanian
psychoanalytic approach.

The key points of this discussion will be the themes of body and
language in the clinical treatment of anorexia, bulimia and
psychogenic obesity.

These symptoms, so widespread today, can teach us much about the

topic of the recent Congress of the World Association of
Psychoanalysis on “The Speaking Body. On the Unconscious in the
21st Century”.

The clinical treatment of eating disorders forces us to question the

status of the body in its narcissistic image, symbolic structure, and
functioning, as a place that condenses jouissance for the speaking
being. Indeed, a negative passion for the mirror, a holophrastic
dimension in the functioning of speech and language, and a limitless
compulsive jouissance, are key factors in this field in contemporary
clinical treatment.

1. Thanks

It’s a real pleasure to be with you here today in Dublin. I would firstly
like to thank Florencia Shanahan Coria and the ICLO-NLS for inviting
me. This meeting is a form of initiation for me on two fronts. Firstly, it’s
the first time I have given a seminar in Ireland. And secondly, it’s the
first time I have ever held a seminar in English. Wherever possible,
including in Anglophone countries, both in the United States and in
Canada, I have made use of my knowledge of French and Spanish to
express myself. Today, the moment has come to take a step forwards

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in my relationship with your language. For this reason, I would like to

Introduction
apologise straight away for the inaccuracies and errors I will
EJP
undoubtedly make as I endeavour to express myself in English.
Publications
Contributors

Editorial Board
1. 2. Introduction
& IBAN

Editorial This difficulty will be slightly alleviated for me by the fact that today I
Norms am going to talk about a question that I have now been working on for
more than 20 years, both in my institutional work, and in my private
On-paper
edition practice as a psychoanalyst. The question relates to the field of eating
disorders: anorexia, bulimia, obesity, and binge eating disorder. Over
Papers and
articles
the years, I have set out to plumb the depths of this field through
articles and books, starting with the indications provided by Lacan and
A
with Jacques-Alain Miller’s Lacanian orientation. I have also studied in
Conversation
with Axel detail the contributions presented in relation to these questions, not
Honneth only by the classic figures of psychiatry and clinical psychology in this
sphere, but also by colleagues in the Freudian field concerned with
JEP Journal
(1995-2011) these issues. Hardly any of my contributions have been translated into
English, but many of my articles and books can be found in French,
ITALIAN
SECTION
Spanish and Portuguese, as well, of course, as in Italian.
[I.S.A.P.]
In today’s seminar, I will seek to set out my presentation on eating
EJP Russian disorders from the perspective of the Lacanian orientation, in light of
edition
the topic of the next AMP Congress, which will be held in Rio de
Email us Janeiro at the end of April this year: ‘The Unconscious and the
Links Speaking Body’. For this reason, I have chosen to title this seminar
‘Body and Language in Eating Disorders’.
News &
Initiatives 1. 3. From Symptoms of the Unconscious to Symptoms of the Parlêtre
Reviews
As you all know, in his presentation of the topic of the next AMP
UNBEHAGEN. Congress, which was published in English in Issue number 12 of
A Free Hurly-Burly (Miller, 2015, pp. 119-132), Jacques-Alain Miller drew
Association for
attention to a passage that stands at the heart of 21st-century
Psychoanalysis
psychoanalysis, as anticipated in Lacan’s last lesson. This involved a
Number 3 –
shift in psychoanalysis, corresponding to a change within
2015/1 –
Feminine
contemporary social discourse, from the centrality of truth to the
Pathologies – centrality of jouissance. Miller specifies that,
Edited by F.
Castrillón & J. This displacement from truth to jouissance set the measure of what
Webster analytic practice is becoming in the era of parlêtre (ibidem, p. 132).

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WP Statistics For Miller, this shift is the result of a substitution in Lacan, and which
Honey Pot Page
marked his attempt to distance himself from Freud from the mid-‘70s
[2016-03-02
onward. This involved a substitution, which can be found in the text
18:55:41]
‘Joyce the Symptom’ and in Seminar XXIII, The Sinthome, of the
psychoanalysis of the unconscious, which was still grounded on the
Freudian notion of the unconscious and his first topic, with the
Book: In psychoanalysis of parlêtre, a notion invented and introduced by Lacan
Freud’s in precisely this late stage of his teaching. It was from this moment on,
Tracks when Lacan let go of Freud’s hand and took hold, instead, of that of
Joyce – as Miller explains in Pièces detaches (Miller, 2005a, p. 148) –
so as to be able to consider the role of the real in his analytic
experience – that the neologism ‘parlêtre’ was invented as a way of
establishing the status of the speaking being. On this matter, Miller
specifies that:

This metaphor – the substitution of the Lacanian parlêtre for the

Freudian unconscious – fixes down a scintillation. I propose that we
take it as an index of what is changing in psychoanalysis in the
twenty-first century, when it has to take into account an other symbolic
order and an other real besides those upon which it was established
(Miller 2015, p. 126).

This passage becomes clearer, from the clinical perspective, if we

Hysteria consider its implications for the notion of the symptom, and how it
changes in the movement from a clinic of the unconscious to one of
the parlêtre. It is here, again through Seminar XXIII, that Lacan
introduces a notion of the symptom that was to become the title of his
Seminar: the sinthome. The progression from a psychoanalysis based
on the centrality of the unconscious, structured as a language, to one
based on the centrality of the parlêtre implies a movement from the
notion of the symptom as metaphor, as an effect of meaning, to the
notion of the sinthome as a condensation of jouissance without
meaning. This is a condensation of jouissance that is, as such,
centred on the body, and presents itself as an “event of the body”.
Miller writes that:

As you know, the symptom as a formation of the unconscious

structured as a language is a metaphor, it is an effect of meaning,
induced by the substitution of one signifier for another. On the other
hand, the sinthome of the parlêtre is an “event of the body”, an
emergence of jouissance” (ibid).

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1. 4. Eating Disorders as Symptoms of the Parlêtre

The primary thesis I wish to propose in this seminar is that eating

disorders are not symptoms of the unconscious in the classical,
Freudian sense, but rather symptoms of the parlêtre. This is the first
time I have formulated this thesis in these terms. I see this as an
interesting way to tie in the remarks I have developed over the years
in this field with the topic of the forthcoming AMP Congress. The
central idea behind this Seminar here in Dublin might thus be
understood as an attempt to defend this clinical thesis. To this end, I
would like to proceed step by step. I will begin with the outcry that
eating disorders provoked, and continue to provoke, as soon as they
established themselves as social symptoms.

I will then seek to define the essential framework within which this
categorisation of eating disorders was developed, within the
descriptive nosography typical of contemporary psychiatry, which has
as its essential reference point the Diagnostic and Statistical Manual
of Mental Disorders (DSM). After that, I will endeavour to highlight the
disparity that separates the descriptive framework in this field from an
orientation towards the symptom understood in analytical terms, in the
Freudian or Lacanian sense. And finally, I will return to my initial
thesis, according to which eating disorders are symptoms not of the
unconscious but of the parlêtre, endeavouring to support this on the
basis of clinical experience. Developing this thesis will help to reveal
the status that the body and language hold in the clinical treatment of
eating disorders.

1. 5. From Black Swans to Epidemic

Let us begin with some considerations about eating disorders in their

status as social symptom. I will begin from an epidemiological and
descriptive basis, before then proposing some structural
considerations. First of all, it should be noted that the formula ‘eating
disorders’ is a recent notion. Its history is closely tied to the
developments of the DSM, in particular from its third edition (1981)
onward. Here, the empirical-descriptive, self-defined “a-theoretical”
approach was introduced, which was closely connected to
epidemiology and the testing of the effects of psychotropic drugs,

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which then came to characterise it. In 2013, as you know, we arrived

at the fifth edition of the manual, which introduced some changes both
to the organisation of the classifications, and to the specific field of
eating disorders, as we shall see later on (APA 2013, pp. 329-360).

Eating disorders became a historic symptom starting from the point in

history at which they began to spread in an epidemic fashion, and
when this spread began to be recognised, voiced and questioned
within the social community, by the media, the scientific community,
and the institutions concerned with health and education, particularly
in relation to the young population. I have divided the epidemiological
development of eating disorders into four periods (Cosenza 2014, pp.
37-40).

I – The Black Swan Period. The first epidemic in the sphere of eating
disorders to attract the attention of the media and researchers was
that of anorexia nervosa among girls. However, this did not really
manifest itself until the second half of the ‘60s. Before this, cases of
anorexia were like black swans: rare cases, in relation to which a real
confusion persisted among the medical and scientific community. This
confusion surrounded both the causes at stake, and the treatment
methods. An epistemological diatribe left everything up in the air as to
whether this was a neuroendocrine, nutritional, or psychiatric
syndrome – similar, in certain aspects, to the situation that persists to
this day in relation to obesity. In ’65, the International Symposium in
Gottingen on anorexia confirmed for the psychiatric community that
anorexia nervosa was to be considered, fundamentally, as a mental
illness with significant organic repercussions on the organs,
apparatuses and functions of the body involved in the refusal of food
by the patient. The two main pioneers of the study and
psychodynamic treatment of anorexia nervosa, the American Hilde
Bruch and the Italian Mara Selvini Palazzoli, played a key role in
sanctioning this epistemological movement towards a psychogenetic
approach to anorexia. For this reason, the term ‘anorexia’ was
subsequently combined with the adjective ‘nervosa’ (mental), to
prevent it being confused with a malnutrition condition. In the clinical
study of anorexia, the psychogenetic approach was then combined
with an important examination of the influence played by the family
system and early relations with the caregiver in the formation of
anorexia (as with the strong narcissistic component inherent in

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anorexia, which is characterised, not by chance, by a major alteration

in the perception of the subject’s body image). However, these
considerations had already been in circulation for some time in
relation to child obesity, thanks in particular to Hilde Bruch (Bruch
1973).

II – The Period of Anorexia among Teenagers in Colleges and

Universities. In the mid-‘70s, it became evident both in the United
States and in other countries in an advanced stage of capitalist
development that anorexia nervosa had become an elective
syndrome for many teenagers from the wealthy societies of late
capitalism. The social symptom had become firmly entrenched, and
anorexia had become a subject of social discourse. This was no
longer simply a rare symptom studied by a few specialist doctors in
the sector. With its initial stage taking place during puberty, and as a
result of its diffusion within developed countries, it immediately
seemed to be the female equivalent of the major drug addiction
epidemic that had begun to invade the lives of young generations of
adolescents in the ‘60s. Young female students, mostly from good
families and medium- and upper-class backgrounds, were afflicted by
this syndrome, and remained imprisoned by it for many years. Many
studies in the field of ethnopsychiatry have sought to establish
anorexia nervosa as an ethnic pathology, based on the model of other
syndromes that possess a more exotic character for us. For this
reason, even the DSM IV, in its Appendix on culture-bound
syndromes, presented anorexia nervosa as a syndrome more
characteristic of advanced western societies. In my opinion, following
Lacan, what was most decisive in the spread of anorexia nervosa
was, more than the ethnical dimension, the reference to societies in
an advanced stage of capitalist development. This would explain, for
example, why, alongside countries with western languages and
cultures (Europe, the United States, Canada, and Australia), Japan
has also been affected by anorexia. In other words, in my reading, the
epidemic of anorexia, like the so-called new symptoms, occurs in
those societies whose dominant discourse involves a rise in
jouissance to a social peak, and a decline in the normative function of
the symbolic, which is reduced to the pure function of the semblant.
This interpretation was taken up by Miller starting from Lacan’s
Radiophonie, in the notion of “hypermodern discourse” (Miller 2005b,
pp. 9-27).

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III – The Period of Bulimia and Overeating. The ‘80s and ‘90s were
characterised by rise in bulimia, which was also formulated in specific
descriptive terms in ’79 by Gerald Russell, and introduced as a
separate condition in the third edition of the DSM. Over time, pure
forms of anorexia, restrictors, proved more marginal, giving way to
forms of anorexia whose development included stages of bulimia.
This is the period of anorexia-bulimia, in which the refusal of food
alternates with moments of blowout, followed by a constant,
corresponding practice of evacuating the substances ingested in the
human body. Purging methods can vary: they include, for instance,
vomiting, the use of laxatives, or frenetic exercise. What matters in
bulimia, driven by an anorexic ideal, is that the end result, between
substances ingested and substances evacuated, be at least zero.
This can be verified through the subject’s weight, on the basis of the
measurement given on the scales after any food substances ingested
have been purged. In these forms, hyper control in anorexia coexists
and alternates with bulimic excess, in a devastating oscillation.

At the same time, the effects of economic globalisation and the

development of new technologies applied to mass communication
enabled anorexia and bulimia to spread well beyond the rigid barriers
of social classes, and beyond the confines of advanced capitalist
countries. Even in developing countries, especially in large cities, the
phenomenon assumed an epidemiological consistency. In the section
on eating disorders, the DSM IV introduced the Binge Eating Disorder
as a framework within eating disorders not otherwise specified, that is,
which cannot be related to anorexia and bulimia. This is one step
away from what the fifth edition of the DSM sanctioned in 2013: Binge
Eating Disorder as an autonomous syndrome, distinct from anorexia
and bulimia. In the field of eating disorders, this syndrome displays a
clear-cut prevalence of the compulsive dimension over the narcissistic
one.

IV – The Beginning of the 21st Century: Mass Obesity and Virtual

Communities. The fourth stage that I wish to highlight in this brief
history of the epidemiology of eating disorders is the one in which we
are now fully immersed, the 21st century. This stage is characterised
by a number of dominant trend lines.

First of all, there is the progressive prevalence of overeating disorders

over undereating. As I was saying earlier, Binge Eating Disorder was

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established as a veritable psychiatric syndrome in the DSM V. It is

characterised by periodic bingeing crises, without successive purging
practices. The condition is characterised by a lack of control,
ego-dystonia and reactive depression, and often acts as a precursor
in the development of true obesity, understood as a nutritional
pathology denoted by a Body Mass Index higher than the statistic
norm. The question of the aetiology of obesity remains entirely
unresolved, and the debate in the psychiatric field on this matter is
also still up in the air. Nonetheless, when we are confronted with
forms of obesity that cannot be clearly explained through organic
factors, we believe the question of psychic causality is yet to be
articulated. This question already presents a challenge for various
kinds of medicine and therapy (from clinical nutrition, to
psychotherapies, and bariatric surgery), given that nothing seems to
render therapy quite as powerless as obesity. At the same time, the
OMS has described obesity as “the new pandemic of the 21st
century”. Far from a marginal matter, then, this is an absolutely
emblematic syndrome, paradigmatic of our times.

Secondly, given the stability of the ratio between women and men that
develop anorexia or bulimia – out of ten cases, one is male and nine
female – we are witnessing earlier onsets than in previous periods, as
well as frequent relapses in adulthood, coinciding with moments of
crisis. In this regard, the picture presented by binge eating and obesity
nonetheless differs considerably from that of anorexia and bulimia:
these are not markedly female syndromes, and, for the most part, are
not treated in puberty, but often later on in adulthood, as an already
well-installed symptom in the patient’s life.

One further, characteristic aspect of the contemporary development of

eating disorders concerns the appearance, from the beginning of the
new millennium, of virtual communities distinguished by an
identification with the symptoms of anorexia and bulimia. Unlike many
sites that are geared at the treatment of anorexia and bulimia, offering
mutual support mechanisms to help individuals overcome the
condition, most websites put forward a form of propaganda in favour
of anorexia and bulimia, which are deified as incarnations of an
alternative, fundamentalist lifestyle. In the face of this new
phenomenon, a wide debate has been initiated not only in the
scientific community, but also in the larger political community, since,

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in all intents and purposes, this is a social phenomenon with

disturbing implications, which can no longer be restricted to the
clinical field.

1. 6. Limitations of the Sociological and Psychosocial Approach

Let us turn now from the social dimension at stake in eating disorders
to the clinical one. It is important to draw a distinction between the two
levels, and not to reduce the singular manifestation of anorexia or
bulimia in a patient to the characteristics of their social context. We in
fact hold it as true, following Lacan, that the subject is constituted in
the field of the Other. But it is also true that this process of constitution
follows a particular itinerary for each individual subject, which can
never be reduced to a pure, linear determinism. Psychoanalysis, since
Freud, has highlighted this principle of over-determination of the
symptom, which releases it from all linear determinism, be it
biological-genetic or social. As such, there is no doubt that the
hypermodern social discourse favours the epidemic spread of
symptoms that are not organised Oedipally, and are not governed by
the symbolic function of the limit. In this context, in a famous book,
Richard Gordon once explained the movement from the social
symptom of hysteria to that of anorexia-bulimia, from an
ethnopsychiatrycal perspective (Gordon 1990), as an effect of the
movement from the disciplinary regime of Victorian-style classic
capitalism, to contemporary capitalism, which overturns the taboo
surrounding sexuality, and subjects this, too, to the system of goods
and the social circuit of free consumption. However, even if the
operation of social discourse can account for the spread of a social
symptom, it is never enough to explain why a certain symptom takes
hold in a subject’s life. Here, all sociological and psychosocial
approaches find their limit when faced with the results of clinical
experience. Indeed, in this field the analytical principle of the case by
case, one by one approach must apply.

1. 7. From disorder to Symptom

Turning now from the psychosocial field to the clinical one, the issue
of the mode of classification proposed by the descriptive psychiatry of
the DSM needs to be addressed. Beyond any variations, however
important, introduced in the passage from one version of the Manual

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to the next over the past 35 years, it is important to highlight the points
that prevent the reduction of such a classification to an analytically-
oriented clinical approach (Loose 2014, pp. 113-121). I will now
summarise these in three points:

I – deficit/solution. First of all, while the DSM presents the very notion
of a disorder in terms of a behavioural deviation compared to a
statistically calculated norm, for example a deviation in the subject’s
eating habits, the analytical approach conceives of the institution of
anorexia or bulimia in terms of the creation of a solution for the
subject, however precarious or pathological this might prove. This is a
solution to a more radical problem that the subject cannot tackle in
any other way.

II – universal/singular. The notion of the disorder, like that of illness,

refers to a universal idea of the subject’s condition, based on the
model of biomedical sciences. The psychoanalytical approach, by
contrast, suggests that anorexia, bulimia and binge eating disorder
represent symptomatic solutions whose keystone is to be found in the
singularity of the subject in question. The key question we need to
pose when confronted with this symptom is, on each occasion: what
function does this symptom have for the subject? What purpose does
it serve for them within the structure of jouissance? What problems
does this symptom respond to for the subject, in their relationship with
the Other? The classificatory descriptive approach of the DSM does
not offer a programmatic response to these questions, putting the
subjective dimension involved in the disorder to one side. However, in
clinical work with these patients, it is difficult to achieve lasting effects
of change without dealing with the level of subjective implication
involved in the symptom. It is essential to address this level, because
individual subjects do not develop eating disorders via the same paths
or for the same reasons, even if they can seem identical from the
perspective of descriptive nosography.

III – transference factor. The descriptive diagnosis of the DSM takes

place outside of transference, excluding from its diagnosis that which
is in fact the central factor in psychoanalytical diagnosis: transference.
Indeed, it is not so much on the basis of the regular repetition of an
organised series of behaviours deviating from a standard norm that
we conduct diagnoses. This is typical of a descriptive diagnosis, in
line with the DSM, as well as psychotherapeutic approaches that are

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more consistent with this approach, such as cognitive-behavioural

therapies. By contrast, psychoanalytic diagnoses are based on how
the patient engages with the transference relationship, and the extent
to which this reiterates his or her unconscious mode of relating to the
Other and the circuit of jouissance. For this reason, it seems more
fruitful to propose the Freudian approach of the symptom in the field
of anorexia, bulimia and binge eating too, than the neo-Kraepelinian
disorder-based approach.

1. 8. From Symptom to refusal of the Other

However, in the clinical treatment of so-called eating disorders, we

cannot help but note a difference that is encountered repeatedly in the
patients concerned when compared to the analytical symptom
revealed by Freud. To return to what we were saying before, Freudian
symptoms, in line with neurotic ones, are symptoms of the
unconscious. These symptoms transmit a message, a meaning that
emerges from between the lines of what is said, beyond the conscious
intention of the speaker. These symptoms have a meaning for the
speaker; they convey some unconscious, enigmatic signification. The
neurotic subject who undergoes analytical treatment wants to know
this enigmatic signification; they cannot live without seeking to identify
it.

The so-called contemporary symptoms, among which we can

certainly count eating disorders, as well as drug addictions, present
themselves as symptoms disconnected from the unconscious. To use
the expression employed by Lacan in relation to Joyce, we are
dealing with subjects who, for the most part, are “unsubscribed from
the unconscious”. These symptoms do not convey any meaning for
the subject affected by them. They do not carry any unconscious
message. They do not function on the basis of a principle grounded
on metaphor, on the reference to an elsewhere, but rather establish
themselves in the life of the subject as condensations of jouissance
anchored on the exercise of a number of regularly reiterated
practices. The subject does not resist such practices. Instead, in an
ego-syntonic relationship with the symptom, they do not experience it
as an illness but rather as a style of living; not as a problem, but as a

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solution.

Even in those symptoms in which no truly ego-dystonic relationship

can be detected, such as bulimia and binge eating disorder, the
subject’s experience is still dominated by a suffering that is not
transformed into an enigma. This is in fact what occurs with classic
neurotic symptoms, such as in hysteria or obsessive neurosis.
Understanding the meaning of their symptom, which is consistently
repeated, preventing the subject’s desire from being satisfied, stands
at the very core of the need of the neurotic patient in analysis. The
new symptoms, by contrast, are divested of the value of an enigma.
These are symptoms lacking in any enigma, disconnected from the
unconscious, and thus without meaning. For this reason, they are also
immune to transference, associated with weak demand, and hostile to
medical or psychotherapeutic treatment, analytical treatment even
more so. To take up the formula coined by Miller in ’97, in his Seminar
L’autre qui n’existe pas et ses comités d’éthyque, such symptoms
incarnate a substantial refusal of the Other (Miller e Laurent, 2005, pp.
373-379).

1. 9. A Symptom that Covers the Structure

One particularly striking aspect in the clinical treatment of

contemporary symptoms, and certainly that of eating disorders, is
diagnostic opacity. I am clearly not referring to the descriptive
diagnosis of anorexia, bulimia or binge eating, which does not present
great difficulties of formulation. I am referring, rather, to structural
diagnosis: the diagnosis that enables us to also gain an adequate
understanding of the patient’s unusual relationship with food
substances. It has been repeatedly stressed that when we encounter
such patients, for example during the initial sessions, it is generally
speaking rare to be able to identify any elements that would enable us
to clearly lean in the direction of an open psychosis, for instance.
There are of course some cases in which anorexia develops in an
openly paranoiac subject, for example in the classic delusion of being
poisoned, or more recently, as stressed by Dewambrechies La Sagna,
of contamination (Dewamrechies La Sagna 2006, pp. 57-60). Such
patients refuse to eat because they are tormented by the certainty that
their food has been poisoned or contaminated. The refusal of food is,
in this case, clearly a persecutory defence characterised by an
invasive, threatening jouissance coming from the Other. Another

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classic version of this case is anorexia predicated on a religious

delusion. In this case, food is identified with an object of demonic
temptation from which subjects must distance themselves as far as
possible in order to draw closer to the purity of God. The historic
phenomenon of the ascetic fasting of medieval female saints cannot,
of course, be reduced to a simple chapter in the history of
psychopathology. As has been suggested by some Italian colleagues
that have studied the phenomenon in depth, especially in relation to
the work of Saint Teresa of Avila – Erminia Macola (1987) and
Giuliana Kantzà (2015), in particular – the position of the mystic, in
which the renunciation of bodily values is played out in a dialectic
relationship with a transcendence towards God, must not be confused
with the lay and nihilist cult of the thin body characteristic of
contemporary anorexia. It is nonetheless true that in some cases the
line between anorexia and the ecstatic experience and religious
delusion is a thin one.

Most patients suffering from eating disorders present none of the

fundamental phenomena (hallucinations, delusions) that can be
clearly associated with psychosis in its classic forms.

On the other hand, the same could be said for neurosis. It is rare for
such subjects’ speech to display clear elements that testify to a
subjective division, a questioning of their own symptom as something
enigmatic. For the most part, their relationship with their symptom,
when not openly loved as in the early stages of anorexia or drug
addiction, is instead governed by the model of illness understood in a
medical sense: something which has afflicted them from a certain
point in time, which is repeated irresistibly, but in connection with
which they have neither any involvement, nor any subjective
responsibility.

We should not deduce, however, that there is no neurotic use of these

symptoms. Hysteric anorexia clearly does exist, as stressed by Lacan
in his Seminars from the latter half of the ‘50s – Seminars IV (1994,
p. 199) and V – and in his text from ’58, ‘The Direction of the
Treatment’ (1966, pp. 598-602, 608). Equally, there is such a thing as
neurotic bulimia, and, more generally, a neurotic functioning of the
subject’s uncontrolled, excessive relationship with food. It is essential
to identify and distinguish these from the more typical forms of
anorexia nervosa, bulimia and obesity, by identifying certain features

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that can be detected in the former but not in the latter:

a) A clear metaphorical function as a message being

transmitted through the eating symptom and directed at a receiver
who is able to recognise it in its metaphorical significance as an
appeal, responding to the call for love (father, mother, parents,
teacher, boyfriend, instructor…);

b) A phallic inscription of the body of the subject which, however

precarious, enables them to function in the dialectic of the sexes
through their own body as a cause of desire, phallicising thinness
itself;

c) A sensitivity towards the enigma on the part of the subject and a

desire to know, which is an essential passion for the hysterical female
subject, and which we find intact, on the condition that it is roused
from the state of symptomatic torpor, in the neurotic forms of eating
disorders.

As has been stressed by Dewambrechies La Sagna, the territory in

which anorexia nervosa is to be found with the greatest specificity can
be identified via a method of exclusion, by distinguishing it from cases
of open psychosis with anorexic symptoms, and from hysterical-
neurotic forms. I propose taking the same approach to forms of
bulimia and binge eating, which involve an excessive consumption of
food. In my opinion, however, this does not imply that we must see
anorexia nervosa as a structure apart, as Dewambrechies La Sagna
would appear to uphold. Rather, I believe that within the vast territory
of eating disorders, as distinct from open psychoses and forms of
neurosis, one must begin to recognise the hidden signs of ordinary
psychosis, as expressed by the title of the next NLS Congress here in
Dublin. This is an idea that I developed in my doctoral thesis at Paris
VIII, which was published last year in France with the title Le refus
dans l’anorexie (Cosenza 2014, pp. 163-167).

My contribution today is thus intended as a reflection on the role of the

body and language in eating disorders, in the lead up both to the AMP
Congress in Rio on The Unconscious and the Speaking Body, and the
NLS Congress in Dublin on hidden signs in ordinary psychosis.

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1. 1. Two Off-Topic Areas: Food and the Mirror

I will seek to structure my remarks on the body and language in eating

disorders around three thematic coordinates: the subject’s relationship
with the drive, image, and speech. These three coordinates reflect the
three registers of subjective experience proposed by Lacan: the Real,
the Imaginary, and the Symbolic. I am placing them in this order for a
didactic purpose, because this structure reflects, sufficiently faithfully,
the order in which the symptomatic aspects presented in the clinical
treatment of eating disorders appear. In reality, though, at the
structural level, these axes should be considered together in their
synchronic, logical connection, testing the tightness and form of the
link between them on a case by case basis.

I – Eating Disorders as Pathologies of Orality: the Refusal and the

Object ‘Nothing’

Let us begin by considering eating disorders from the perspective of

the drive. First of all, they could be defined in terms of pathologies of
orality. This is the most obvious way of framing them, which justifies to
a certain extent the classification between the eating disorders of
anorexia, bulimia, and binge eating disorder. The eating function and
the subject’s relationship with food prove highly disturbed. This aspect
strikes one immediately in these patients, who might appear on the
surface not to be particularly problematic. When they enter into the
sphere of their relationship with food, as with the mirror and their body
image, such patients find themselves confronted with two black holes.
They are absorbed by out-of-the-ordinary practices and thoughts. In
relation to anorexia nervosa, Dewambrechies describes these two
dimensions of experience as two outside discourse areas.

We already find this conception of anorexia as a pathology of orality in

Freud, for whom the problem assumes two forms. The first moves in
the direction of hysteria, and is hinted at in Three Essays on the
Theory of Sexuality, where Freud draws a connection between
anorexia and the hysterical disgust at the base of the refusal of food.
In this context of neurosis, the subject’s relationship with food is
ambivalent; they essentially refuse the object of their desire. The
situation is the same with food as it is with sexuality: refusing it, as
Lacan teaches us in his commentary on the dream of Freud’s
beautiful woman butcher, becomes a hysterical means of keeping the
desire for it alive. The second solution proposed by Freud moves in

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the direction of melancholia, as suggested in Draft G of Mourning and

Melancholia. Here, at the base of the refusal of food stands a lack of
any libidinal investment towards the external object, and the entire
libido is condensed in the body of the subject. In this context, the
refusal of food corresponds more to a mode of jouissance that is
entirely condensed in the body, which is without loss, and absolute. It
is for this reason that, for Freud, the mourning process is impossible
in melancholia; the object has never been lost. These two alternative
directions enable us, as early as Freud, to articulate the bases of a
differential clinic of anorexia and eating disorders.

Karl Abraham contributed more than any other direct pupil of Freud to
the elaboration of a discussion on the role of the drive in eating
disorders. In his text from 1916 on the earliest stage of the libido,
anorexia nervosa and nervous hunger are situated, in line with drug
addictions and alcoholism, at the level of the earliest fixation of the
drive at the oral or cannibalistic stage (Abraham 1977). Subjects that
develop these pathologies have not experienced the loss of the first
object of satisfaction, have not been able to incorporate the Oedipal
law, and reproduce the relationship with the primary object through
their object-substance of jouissance. They tend to experience failure
in the sphere of sexuality and desire, and find much more satisfaction
in their symptome than in the jouissance available in life with a sexual
partner. For his part, as early as his 1938 text Family Complexes in
the Formation of the Individual, Lacan conceives of anorexia as an
experience of weaning, locating a refusal to wean (refus du sévrage)
at the root of anorexia nervosa (but also of drug addictions and gastric
neuroses). Here, Lacan makes use for the first time of one of the
keywords that he will subsequently continue to employ in his
interpretation of anorexia nervosa: ‘refusal’ (2001, pp. 31-32).

Lacan introduces the second keyword twenty years later, again in his
analysis of anorexia nervosa. This word is ‘nothing’. Particularly in
anorexia, this responds to the enigma that surrounds the question of
which object constitutes the cause in anorexia nervosa.
Phenomenology already informs us that this is not an object in the
world, one which is visible or representable. Rather, it is clearly an
invisible, unrepresentable object, as indeed all objects at the root of
desire are, which Lacan calls ‘objects little-a’. Anorexia highlights the
importance of not confusing the object of desire, which is in front of

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us, a phenomenal object of the world, with the object that causes
desire, which is, so to speak, behind us, at our shoulders, as
explained in his Seminar X on anxiety. This confusion is more likely to
occur with food in bulimia or binge eating, drugs in cases of drug
addiction, and alcoholism with alcoholics, but is less likely in anorexia.

Lacan introduces ‘nothing’ as an object cause of anorexia nervosa,

debunking a common belief and clear phenomenal fact: that the
anorexic patient does not eat. Lacan writes, instead, that: the anorexic
subject eats the object ‘nothing’ (1966, p. 199). At first, for Lacan, this
‘nothing’ had an eminently symbolic value and was closely connected
with hysteria: it represented that elsewhere that could not be reduced
to an object, and which was never fully attainable in experience,
because it had been lost from the start, and stands at the very base of
the life of desire. However, the further Lacan advances in his
elaboration, introducing the centrality of the real in the analytical
experience, the more he reformulates the notion of ‘nothing’,
transforming it from a pure signifier into an object cause, and
introducing it into the series of object little-a’s. Lacan thus describes
anorexia more clearly as an affirmative action, as a practice that
produces an affirmative jouissance through the refusal of food
(Cosenza 2008, pp. 29-31). This thesis is consistent with clinical
experience, which reveals a euphoria and tone of humour in anorexic
patients which is strengthened narcissistically the more capable they
are of keeping the oral drive under control. The traits of ego-syntony
and hyperactivity are both present in anorexia nervosa, all the more
so when the patient succeeds in adhering to their own superego ideal
of rigid control of the oral drive through a refusal of food. This thesis
has been borne out by certain studies in the field of neuroscience: the
repeated refusal of food generates an increase in endorphins in the
organism, the effects of which include euphoria and a heightened note
of humour in the patient. The protracted refusal of food thus produces
an effect of jouissance in the body. This is a very particular effect of
jouissance, which differs from the plus-de-jouir effect that
characterises the loss of discursive jouissance typical of the neurotic
subject. In anorexia, the jouissance of ‘nothing’ constitutes an
unlimited, infinite jouissance, which dispossesses the subject, casting
them astray. For this reason, subjects suffering from acute anorexia
move towards death without realising it, pulled along by this mode of
absolute jouissance. As such, the anorexic jouissance of the ‘nothing’

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differs from that driven by partial objects of the drive, which are lost
objects that return at certain junctures of the subject’s experience.
The ‘nothing’ object of anorexia, as proposed by our Argentine
colleague Nieves Soria, is not removed from the body (Soria 2000, p.
120). Rather, it remains encysted in the body. The anorexic subject
does not yield her object to the Other. As Augustin Ménard writes, the
anorexic subject refuses above all to eat the signifier (Ménard 1992,
pp. 3-7), that is, to accept the loss of jouissance brought about by the
symbolic inscription of her body into the field of the Other. This, too,
renders the object difficult to locate, and the distinction drawn by
Lacan between the object ‘nothing’ and the oral object illustrates, at
least, that these are two distinct objects that cannot be reduced to one
another.

II – Pathologies of the Image

What has been said in relation to the object ‘nothing’ also has
repercussions for the subject’s relationship with their own body image.
As is well-known, particularly in anorexia nervosa, one of the more
disturbed dimensions of the patient’s experience is their altered
relationship with their own body image. This is not to be understood
simply as an alienating relationship with this image. Experiencing an
alienating relationship with one’s own body image is not, after all,
such a strange occurrence. This forms part of the experience of the
neurotic subject. As Lacan teaches us in his mirror stage, the price
that the child pays in order to obtain a unitary Gestalt of his own body
in the mirror is a loss of jouissance. Something essential of his being
does not appear in the mirror, and is not returned by the reflected
image. This is the real, which cannot be reduced to
self-representation. For this reason, every time the neurotic subject
experiences a crisis, one variant of this crisis is a calling into question
of his own image, an identity crisis. Often, this is reflected in a
modification of the image at the phenomenal level: moving home,
changing the colour of one’s walls, getting a new hair-cut, etc. …

In anorexia nervosa, as well as in bulimia, we witness something

more radical. The relationship with the mirror presents a dual
movement that cannot be reduced to the dialectic of alienation and
separation. Psychiatry has long noted the presence, particularly in
anorexia, of a dysmorphic perception of the body image on the part of
the patient. In such patients’ daily lives, this altered perception of the

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body image translates into a failure to perceive the extreme thinness

of their body. Instead, they consistently perceive something in excess,
excess fat to be eliminated. For those around her, the anorexic
subject’s experience in front of the mirror thus reveals itself as a
perceptive experience that has lost contact with reality. For the
patient, however, this experience is repeated on each occasion as a
painful encounter with their own image. This is an unhealthy
experience in which the Other, with the mirror as its narcissistic
metaphor, says no, without fail. At the same time, the anorexic patient
cannot help but punctually show up for this appointment with the
mirror. It is stronger than she is. But what does the anorexic subject
encounter each time she punctually places herself in front of the
mirror? What she encounters goes beyond the image. She
encounters the judging gaze of the Other: in the judging gaze in the
mirror, she comes face to face with the refusal of the Other. This
refusal cannot be reduced to the judgement inherent in the judging
gaze of an omnipotent mother, undivided by castration. This is the
refusal of the Other as an encounter between the anorexic subject
and her own gaze, which is not separated, as such, from that of the
primordial Other. Thus, following the reference axis of the image as a
symptomatic question of anorexia, we can grasp, beyond the
narcissistic covering, the libidinal nucleus that sustains it, connected
to the gaze as an object not lost by the subject, but which returns to
the real each time the anorexic subject is in front of the mirror. The
fact that this is an object that is not lost in anorexia nervosa is
illustrated by the fact that the gaze presents itself in the experience of
the patient as a judgement without appeal, as a pure incarnation of
the Superego, which tends towards infinitisation. Every time, there is
something in excess to be eliminated in the body. In essence, what
this movement in anorexia aims at is to extinguish desire from the
body, to destroy the disruptive, Unheimlich element from the body
image, to kill it at its root.

III – From Body Image to the Body of the Image

Those Lacanian authors who have dealt most extensively with eating
disorders, in particular anorexia and bulimia, have interpreted the
issue of the anorexic subject’s body image by reducing it to a
problematic stage in the subject at the crossroads with the mirror

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stage. It is indeed no coincidence that the symptom erupts above all

during puberty, when the body is transformed and when the drives,
being strong, return to animating the body, directing desire at a sexual
partner. The act of transitioning from the partner of childhood, which
coincides with the primary maternal object, to a sexual partner outside
of the family, proves an impracticable passage for many of these
patients. The eating disorder most often takes hold at this critical
juncture, when, as Stevens has posited, adolescence fails in its task
of becoming a symptom of puberty for the subject.

It is striking that, despite having accorded considerable attention to

anorexia nervosa in particular, Lacan did not tackle the problem it
raised in light of his theory of the mirror stage, as numerous Lacanian
analysts working in this field did in fact proceed to do. I would
propose, though, that one might identify an element of rigour in this
omission on Lacan’s part. While many researchers of anorexia from
the ‘60s sought the key to anorexia in the narcissistic disorder and in
an altered relationship with body image, Lacan focused on the
invisible core of anorexia: what he calls the object ‘nothing’, as the
driving force behind anorexic refusal. We might propose, picking up
on a recent intuition by Miquel Bassols (2015), drawn from the poet
Lizama Lima that, from the Lacanian perspective, what matters most
in the issue of the image in anorexia is not body image and the altered
perception that takes place compared with the reality principle.
Rather, the problem is to be found at the level of the body of the
image. What fails in anorexia is the signifying treatment of the body,
which gives rise to a functioning of the imaginary register and a body
image which does not follow the logic of the signifier, the laws of
metaphor and of metonymy: the laws of the unconscious, which are
essential for the ‘fallicisation’ of the body and for it to function in the
dialectic of desire. In anorexia, the image does not function as a
signifier, but rather as a rigid, frozen, a-dialectic sign. For this reason,
too, anorexia does not present itself as a symptom of the
unconscious, but rather as a symptom of the parlêtre. It is a writing of
the body not constructed on the logic of the signifier, but rather on the
letter of jouissance.

1. 2. Speech That Does Not Resonate

Having discussed the anorexic subject’s relationship with the oral

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drive and the image, let us now turn to the relationship between the
anorexia subject and speech. Compared with the first two aspects,
this point has undoubtedly received the least attention in discussions
within the scientific community concerned with eating disorders. Yet it
is a central point, and psychoanalysis, particularly Lacanian
psychoanalysis, is to be thanked for having highlighted it as such. I
would propose, based on clinical experience, that this trait does not
concern solely anorexia, but bulimia and binge eating disorder too;
that is, the entire spectrum of eating disorders. We touched upon this
earlier, when I suggested that the anorexic subject – but also in
bulimia and binge eating – poses a problem in relation to the
metaphoric function of language. This problem affects the function of
speech, conditioning its use. This can be seen from the earliest
sessions with such patients. Their speech appears to be deprived of
metaphoric significance. It is an empty, often stereotyped, impersonal
speech. It is rare to find that disparity, which is present in the speech
of the neurotic subject, between the dimension of the enunciated and
that of the enunciation itself. Nor can we detect, or at least only very
rarely, the delusional construction or hallucinatory formulation typical
of open psychoses.

In some areas of research in the medical-psychiatric field, this aspect

has been examined in light of the paradigm of alexithymia. According
to this paradigm, there are pathologies that directly afflict the body,
including anorexia and obesity, in which the patient experiences a
sense of impermeability, a sort of desensitisation caused by the
symptom, which prevents them from either recognising or expressing
their own emotions. This is a sort of sensorial freezing, which also
affects the subject’s relationship with their own speech. Another, more
recent approach, associated with the latest developments in the
theory of attachment, places the emphasis, instead, on a deprivation
at the level of such patients’ meta-cognitive capacities, that is, in the
difficulty they experience in thinking their own thoughts. This is very
evident in the hyper-concretism of thought that is so apparent in
psychogenic obesity, where the metaphoric significance of language
and its inscription in a determined discursive context are lost in the
subject’s speech. This is the resonance effect within the structure of
speech, connected to the metaphorical functioning of language, which
is lacking in these subjects. For this reason, we have long posited
that, in the clinical treatment of eating disorders, such patients present

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a closure of the unconscious. It is in fact precisely the opening up of

the subject to their unconscious dimension that allows for the effect of
resonance typical of the speech structure. In the daily lives of
speaking beings, the evocative, metaphorical dimension of speech –
upon which the art of poetry constructs itself, through writing – like the
formations of the unconscious (dreams, lapsi, Freudian slips,
symptoms, etc.), is guided by a reference to an elsewhere, to another
place, the supposed repository of their meaning.

1. 3. From Metaphor to Holophrases

Within our field, it has thus been common practice for some time now
to approach the clinical treatment of eating disorders from the
perspective of holophrasis rather than of the metaphor. The concept
of holophrasis is a notion that Lacan gleaned from linguistics, and
which he distinguishes from the use of metaphor. Holophrasis is
introduced, in particular, in Seminar XI, to offer a linguistic grounding
for the structural position of three clinical frames that cannot be
reduced to the logic of the metaphor: psychosis, mental debility, and
the psychosomatic phenomenon. First of all, this means that these
frames cannot be explained in Oedipal terms or through a clinical
approach based on the paternal metaphor and the Name of the
Father, which underpins the field of neurosis. In the clinical approach
founded on the metaphor, the subject is constituted in the interval
between two signifiers (S1 – S2), which return to us the minimal
signifying battery in the chain in operation. It is precisely this
dimension of the interval between signifiers, the site of lack and
constitution of the subject, which is omitted in the clinical approach of
holophrasis. The holophrastic structure in fact constitutes a monolithic
condensation of signifiers that do not form a chain among themselves,
but which agglutinate, repeating themselves unvaryingly, off-topic, in
the form of S1s not attached to any S2s. Going beyond those cases in
which we can detect a clear hysterical-neurotic structure, it has for
some time been more common within our field to consider eating
disorders from the point of view of the clinical approach of holophrasis
rather than that of the phallus and the paternal metaphor. This does
not necessarily mean that we are dealing with cases of psychosis,
that is, with unmodifiable structural holophrases. Rather, in a
significant number of cases we are confronted, to use a formula by

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Carlo Viganò, with positional holophrases (2011), connected to the

pervasiveness of the symptom, which can be altered with treatment.

In fact, one need only consider what happens in moments of crisis in

bulimia or binge eating to clearly perceive the implications, for the
subject, of this inability to exist in the interval between signifiers.
Often, bulimic crises and binge eating episodes occur when the
subject is faced with empty time, a period of waiting, or an unforeseen
event that changes their plans for the day. The impossibility of
experiencing this temporal interval (Cosenza 2015, pp. 93-100), of
coping with the deferral of a meeting or someone’s absence, drives
the subject to binge and to lose control. Oral jouissance imposes itself
upon the defenseless subject while the reference to the symbolic
Other disappears. But it is the subject himself or herself that
disappears in the midst of this experience of jouissance, which
presents clear analogies with the experience of the drug addict in a
moment of crisis. In this sense, we might also understand eating
pathologies as temporal interval pathologies. In these pathologies, the
logical experience of the time for comprehending, like the symbolic
space in the process of working through mourning, proves
impracticable for the subject. In this sense, eating disorders serve to
compensate for the failure in the subject’s symbolic constitution,
providing him or her with a solution that offers a treatment for this
failure.

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[1] Seminar given in Dublin the 6th February 2016 for the Irish Circle
of the Lacanian Orientation (ICLO) of the New Lacanian School
(NLS).

10 July 2016

Body of the Image , Eating Disorders , Holophrases , language ,

Psychoanalysis

Published by I.S.A.P. - ISSN 2284-1059

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