MAy 2018

EXP
EXPRESS
Volume 4 - Issue 1

THE EGO IN ANOREXIA: EGO-SYNTONIA

NARCISsISM & IMAGINARY NOMINATION
Domenico Cosenza

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PrÉcis

This paper was presented on September 17th, 2017 one having the possibility of using phallic significa-
in the Lacanian Compass video seminar series as a tion to limit the power of narcissistic jouissance; the
lead up to Clinical Study Days 11: Delights of the Ego latter in need of finding other inventions to estab-
in NYC, Feb 2018. In this talk Domenico Cosenza lish an anchorage beyond the anorexic symptom to
unfolds, in a brief manner, his years of research and contain this limitless jouissance.
many publications, as well as his reflections on many
years of experience working with anorexic patients The author ends his proposal by underlining the
as a Lacanian psychoanalyst, not only as a clinician, strong refusal that these subjects have, which is
but also as a director of institutions in the field. linked to a sense of identity; the statement “I am
Cosenza focuses on the anorexic subject’s relation- anorexic,” becomes a position with which they
ship with the ego, which according to Lacan is the usually represent themselves and is taken as a way
human symptom par excellence, a place of conden- of being, a solution that denies the deathly risks at
sation between imaginary identifications and libido. stake. However, this is a solution that needs to cling
Cosenza takes this perspective to clarify a crucial to Ego-Syntonia to be able to sustain itself and it is
difference between the approach to anorexia of the not usually stable for a long time, as there is often
post Freudians and that of Lacan, who instead of a pass to Bulimia. This pass will bring anxiety into
situating it as a type of weakness of the ego, asserts play — Ego-Dystonia— and that may be an open-
that in the core of the anorexic symptom there is a ing to the Other, and therefore to treatment.
narcissistic jouissance, an Ego-Syntonia associated
with an exercise of power that the subject inflicts Alicia Arenas
over its own body — and the ones around it — in
the search for the ideal image of the thin body, sus-
tained by the object nothing.

To limit this narcissistic jouissance of renunciation Domenico Cosenza is a psychologist and psycho-
it will be necessary to find the specific tools for each analyst in Milan, Italy. He has PhD in Psychoanaly-
case, as the “image of the body” for the anorexic sis from the University of Paris VIII. He is AE,
subject also touches the junction between the real and AME of the Scuola Lacaniana de Psicoanalisi
and the symbolic. Thus to treat the relationship (SLP), and of the World Asociation of Psycho-
with the image, one needs to enter into the dialec- analysis (WAP), and President of the SLP. He is
tics of transference, that is, into the discourse of the Professor at the Freudian Institute, Professor of the
Other, in order to metaphorize the image through a Psychology Depatment, University of Pavía, Scien-
chain of signifiers, because when this does not occur, tific Director of Eating Disorders Institutions,
the image will remain frozen, outside of discourse, and Vice President of the Federazione Italiana Dis-
and the treatment will be difficult. In this sense, turbi Alimentari (FIDA) and responsible for
Cosenza makes a fundamental distinction between the Milan site.
hysterical anorexia, and anorexia nervosa, the first

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Volume 4 - Issue 1 MAY 2018
THE EGO IN ANOREXIA: EGO-SYNTONIA,
NARCISsISM AND IMAGINARY NOMINATION

Acknowledgments it is, rather, a secondary product of it. This passage,

which Freud did not hesitate to call a narcissistic
I would like to thank you very much for inviting frustration, clearly puts the ego in a non-central po-
me to take part in your preparatory work for the sition. The ego is not the master of psychic life; it is
next Clinical Study Days in New York in early a function derived from it. It is an object produced
February 2018. I found the subject and the prepara- by psychic experience. The importance given to the
tory topic very stimulating indeed. I have tried to status of the ego is probably the most important
tackle it based on my clinical experience in the field difference between post-Freudian psychoanalysis,
of eating disorders. I had the opportunity to discuss in particular Ego-Psychology, and the Freudian
this topic a few years ago in the United States at a discovery of the Unconscious. This is a discovery
seminar in Miami, which I was invited to by Alicia that Lacan sought to take up again with his return
Arenas. In fact, this is a very important subject, to Freud.
particularly in the clinic of anorexia nervosa, as I
will try to show you in this brief presentation. In Conceiving of the ego as an object of passion also
short, I will take your subject of Delights of the Ego necessarily means highlighting the imaginary
as an opportunity to elaborate on a cardinal is- condenser status of all the fundamental identifying
sue for the clinic of anorexia, which I have never layers of a subject's life, as Lacan did in his classical
tackled directly before. I will talk to you about the teaching. This is the image that Lacan offers us of
role of the ego in anorexia. And I will try to de- the ego as an “onion” in Seminar I, which is dedicat-
velop this topic by paying special attention to three ed to the question of the ego.1 Once all the identi-
singular aspects that characterize its emergence: fying layers of the subject’s mirrored relationships
ego-syntonia, narcissistic prevalence, and imaginary with the Other, upon which its structure is built,
nomination. have been removed, nothing remains in the centre.
In this sense, Lacan speaks of the ego as a ‘line of
fiction,’ as the human symptom par excellence, and
The ego as an object of passion the mental illness of man.

From Freud, psychoanalysis teaches us that the ego Yet this reading of the ego as an object of passion is
is an object of passion. This is not only to say, as not entirely satisfactory if we consider it in rela-
Freud has shown, against the conscientious tradi- tion to Lacan's advanced teaching. After all, on this
tion of modern philosophy and psychology, that the point Freud had clearly picked up on a constitutive
ego is not the foundation of our being, but also that relationship between the ego and the libido, which

1. Lacan, J. Seminar I: Freud’s Papers on Technique. Ed. Jacques-Alain

Miller Trans. John Forrester (NY: Norton, 1991): p171.

Volume 4 - Issue 1 MAY 2018

makes the ego a place of condensation, not only of Anorexic ego-syntonia
imaginary identifications, but also of jouissance,
which becomes ensconced in these identifications, Well, what I would like to propose today in order
making it difficult for the subject to change during a to contribute to your debate is a reflection on the
treatment. To sum up Freud’s classical formula of the problem of the delights of the ego based on the
subject’s conundrum: ‘I am the best at seeing, but the clinic of anorexia nervosa. I would like to take the
worst at following,’ which patients express in many following thesis as a starting point: the Lacanian
ways when they arrive at this crossroads during an approach to anorexia is the reverse of the domi-
analysis. nant approach in post-Freudian psychoanalysis.
The second part of this thesis concerns the ego. For
The ego and jouissance post-Freudians, especially those who draw on the
tradition of Ego-Psychology, such as the pioneer of
In this sense, the topic of the delights of the ego the American study of anorexia, Hilde Bruch, at the
leads us to think about the ego’s relationship to en- heart of anorexia nervosa it is purported that there is
joyment, and the function of the ego as a place of a a fundamental fragility of the ego. This is a deficit of
condensation of the libido. As we know, Freud intro- the ego that their treatment sets out to strengthen by
duces the notion of narcissism precisely to enable us adapting it to the principle of reality. The thesis we
to consider the relationship between the ego and the can draw from Lacan, and from Lacanian scholars
enjoyment connected to the image the subject has concerned with anorexia, is quite the reverse.2
of itself. In this regard, Freud distinguishes between
two forms of narcissism. The first is a primary nar- Instead, we find a hypertrophy of the ego in anorexia
cissism, in which the ego is established during early nervosa. The narcissistic dimension dominates the
childhood, starting from the omnipotent ideals of ego, which finds a special anchor point in a fixation
the child’s parents, to which he or she adheres com- to the ideal of the image of the thin body. For Lacan,
pletely. Then there is secondary narcissism, which the key question of anorexia is not to be found at the
is produced by the child’s progression through the level of the imaginary. Rather it lies in the junction
Oedipal stage, which introduces a symbolic limit to between the symbolic and the real. For this reason,
the subject’s jouissance in relation to his or her own in our opinion, Lacan, who is also the theorist of
image. Lacan takes up this Freudian distinction and the mirror stage, does not situate the fundamental
re-articulates it through the distinction he proposes problem of anorexia nervosa at this narcissistic level.
between the ideal-ego (ia) and the Ego-Ideal (IA). The hypertrophy of the ego in anorexia is, rather, the
In Lacan's classical clinic, the neurotic appears as a effect, or the solution, that the subject finds when
subject who has been able to incorporate the Oe- faced with his or her own impasse, which usually oc-
dipal law and constitute an Ego-Ideal that serves curs at the time of puberty, in the juncture between
as a compass to guide his or her desire. However, the dimensions of the symbolic and the real. We will
when this progression is not structured, the subject look at this in detail shortly. For now, I would like
remains prey to primary narcissism, trapped in the to draw your attention to an essential clinical ele-
fundamental narcissistic relationships of his or her ment of anorexia nervosa, which concerns the theme
own life. of Delights of the Ego. Anorexic patients display an
extraordinary attachment to their symptom. For this

2. I developed this point in Il muro dell’anoressia (Roma: Astrolabio 2008):

pp. 41-63, and more recently in Le refus dans l’anorexie (Universitaires de
Rennes 2014): pp. 47-59.

Volume 4 - Issue 1 MAY 2018

reason, they are severely opposed to any attempt is linked to an exercise of power, exercised over the
to cure their condition, to counteract their extreme subject’s own body and the people who are emotion-
thinness, and to encourage them to nourish them- ally connected to them. It is not just a question of
selves. More radically, they do not recognize their losing weight: for the anorexic subject, controlling
condition as pathological, and therefore see no need their body also means devitalizing their impulsive
for treatment. investment in objects and not depending on them
in the exercise of satisfaction. As a result, the libido,
Rather, they love their condition, and are attached to removed from the objects of the world, and disen-
their extreme thinness, which they in fact strive to gaged from the Other, retreats into the ego. In this
accentuate more and more. This factor places them sense, anorexic jouissance is essentially a narcissis-
at risk of death, yet they do not experience it as a tic jouissance. An enjoyment that at the same time
problem. Generally, we gather these clinical observa- keeps the Other under tension, anguished by the
tions together using the term “ego-syntonia.” With perverse maneuver that Lacan calls the threat of
this term, we underline the fact that for the anorexic disappearance.
subject, his or her symptom is neither a disorder, nor
a factor of division. Rather, it is a happy solution,
a positive solution, as is the case with drug addicts, The hypertrophic ideal of the
at least for a while. It is a happy marriage. In other thin body and its paradox
words, anorexic subjects enjoy their own symptom,
in an extreme, unlimited manner. Because of this, The anorexic treatment of the body and the narcis-
it is not uncommon for them to reach the point of sistic jouissance that the subject derives from it have
death itself, or often the borders of death. This con- an essential point of support: the hypertrophic ideal
dition is quite different from the partial, ambivalent, of the thin body. This serves as a compass, a point
ego-dystonic jouissance experienced by the subject of reference around which the practices of body
due to neurotic symptoms. This is very apparent in treatment in the anorexic patient’s daily life are
the most extreme clinical situations. When the body organized. The problem that often arises in such
is in a state of severe malnutrition and there is a risk cases, however, is that for most of these patients
of death, the anorexic subject continues to deny the there is no threshold below which they will not go.
evidence and refuses to be admitted to a hospital, The narcissistic jouissance of renunciation linked
often compelling the physicians and family members to the image of the thin body is limitless. Herein
to take forced action. lies the paradox of anorexia linked to a narcissism
of the thin body image and its mastery. The more
the patient exerts their dominion over their body by
Bodily discipline and narcissistic refusing to follow the drive, the more they become
jouissance a slave to the enjoyment of renunciation. For the
subject, this jouissance of rejection is impossible
In fact, anorexia can also be defined as a treatment to control and can lead them to kill themselves. In
of the body, radical bodily discipline. A treatment anorexia nervosa, in fact, the subject lacks a phallic
designed to exercise extreme control over the body. anchorage of the body capable of placing a limit on
The anorexic subject seeks to be the absolute master the enjoyment that organizes it, and of attaching it
of his or her body, and the euphoria they experience firmly to the field of the Other. For this reason, we
is largely connected to precisely this domain. This must distinguish very carefully between hysterical
domain encompasses control of the family Other, anorexia, in which the body is symbolically orga-
tormented by the threat of death incarnated by its nized around phallic law, and serves, in its thinness,
own symptom. At this level, anorexic ego-syntonia as a cause of desire, and anorexia nervosa, in which

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Volume 4 - Issue 1 MAY 2018
the body is de-phallicized, without the anchor of subject’s problem with their own body image.4 The
the phallus, in the grip of an unlimited jouissance gaze of the Other introduces an essential sense of
and a source of horror. mortification in relation to the subject’s body image,
which is Soria’s definition of anorexia as a body in
anamorphosis.
Beyond the phenomenon:
anorexia, and the pathology In general, I would say that these readings try to fill
of the ‘image body ’ Lacan’s silence in relation to the narcissistic dimen-
sion at stake in anorexia nervosa through a clinical
As I said at the beginning, Lacan gave us the theory application of the mirror stage theory. As I argued
of the mirror stage, with which he could easily have last year during some conferences, in Rome and in
tried to say something about the peculiar clinical Dublin, I think that Lacan's silence in this regard
phenomenon of ‘body dysmorphic disorder’ –a dis- was significant. This significance consisted in his
torted perception of one’s body, which is so typical shifting the focus of the issue of anorexia away
of anorexia nervosa. According to this phenomenon, from the primacy of the narcissistic dimension, and
as you know, the anorexic patient sees the image of instead bringing it to the very heart of anorexia, to
his or her body as increasingly fat, compared to how an invisible nucleus that bears the visible plot of its
it is perceived by others, and always discordantly symptomatic manifestation. In this sense, I thought
in excess of the scientific weight measuring instru- it would be interesting to take a cue from Miquel
ments, (the scales) and Body Mass Index (BMI). Bassols, who, based on the literary work of Lizama
For this anorexic subject this perception takes the Lima, provided a useful idea at the WAP Congress
form of a certainty, presenting itself in the form in Rio on the topic of the speaking body. In this
of an indisputable fact. Several Lacanian scholars regard, Bassols emphasizes the ‘image body for-
have tried to re-read the clinical question specific to mula,’ which refers to the structure of the image as
anorexia in light of the mirror stage. More precisely, governed by the laws of language.5
they have attempted to interpret it as a peculiar
failure in the subject’s passage through this struc- It is the signifying structure of the image that is
tural crossroads. Some have traced its origin back to at stake in this definition. This structure can func-
the maternal Other’s judging attitude in the mirror tion as such, provided that the traumatic action of
with respect to the body of the anorexic subject. lalangue on the body of the speaking being (parlêtre)
This is the position taken by Recalcati, for example, has produced an effect of inscription and of a loss of
when he speaks about a grimace of the Other of jouissance. If this effect of loss does not occur, the
the anorexic subject in the mirror, as a sign of the image does not function as a signifier for the sub-
devaluation of its body.3 Other authors have high- ject, but rather remains fixed, frozen, holophrastic,
lighted the persecutory dimension at play in the disconnected from a dialectics with the Other. The
anorexic subject’s encounter with the mirror. This is hypothesis that I want to advance, then, is that in
the case for Nieves Soria, for instance, who has spo- anorexia nervosa, the dysmorphophobia in regard to
ken about the return of the real of the gaze of the the body image is not a problem that can be read at
Other in the mirror, as the source of the anorexic the level of the image of the body, that is, whether
or not the body image fits with reality. Rather, it is

3. Recalcati, M. L’ultima cena. Anoressia e bulimia (Milano: Bruno Mon- 4. Soria, N. Psicoanalisis de la anorexia y la bulimia (Buenos Aires: Tres
dadori 1997): p 122. Haches 2000): p. 96.

5. Bassols, M. “The image body and the speaking body” www.wapol.org,

Xth Congress of WAP, The Theme, Orientation Texts. Further on this
point, D. Cosenza, “Body and Language in Eating Disorders”, confer-
ence given in Dublin the 6th of February 2016 for the Irish Group of
the New Lacanian School (www.iclo-nls.org).

Volume 4 - Issue 1 MAY 2018

the effect of an ‘impasse,’ which is invisible at the There is, however, a third operation distinguishing
level of the ‘image body’ and which does not allow anorexia that needs to be explained because it relates
the image to assume a metaphorical value for the to a clinical aspect specific to this position. This con-
subject in the signifying chain of speech. The image cerns the issue of identity naming, and the special
of the body remains, for this anorexic subject, outside importance that identifying the subject’s condition
of discourse. As is the case with their relationship to assumes in anorexia. In anorexia, the subject names
food, outside of discourse (hors discours), at least, fac- his or her being through an identification with the
tually (de fait), as Carole Dewambrechies La Sagna anorexia itself: "I am anorexic." This is an integral
says, if not structurally (de structure).6 action of attaching the individual’s ego to that condi-
tion, which is not experienced primarily as a pathol-
ogy, but rather as a lifestyle. Through this opera-
Lacan and the anorexic question: tion, which we can define, as Soria proposes, as an
three nodal points imaginary nomination, the subject’s being is defined
through its identification with a generic, universal
To pick up the threads of our discussion again, we identity.9 This definition offers the ego a certain sta-
could say that Lacan bases his reading of anorexia bility, through its rigid identification with the condi-
on two explicit pillars in his teaching. We propose tion and an anorexic ideal. It is an imaginary stabili-
adding a third, based on his most advanced teaching, zation that can even be sustained for a long period of
which could allow us to clarify an essential clinical their life, but rarely until the end of the life.
aspect of anorexia that concerns the issue of the ego.
The two pillars of Lacan's reading consist of: the
‘nothing’ (rien) object and the refusal. Rien is the ob- Psychoanalysis and the anorexic
ject at the heart of anorexic jouissance, and presents solution
itself as an object that is not partial, rather, in its own
way, absolute, unaffected by the action of the signifi- What usually happens, though, except for some
er. It is an object ensconced in the body, not extract- rare exceptions, is that the anorexic solution can no
ed, and that therefore cannot act, like other objects, longer be sustained on its own. It is at this point
as a cause of desire. Rather, it functions as a cause of that the subject moves towards bulimia, surrenders
inertia and non-desire, to take a recent definition by to the drive, towards the object, and loses its alleged
Jacques-Alain Miller.7 Anorexic enjoyment therefore purity of origin. At this stage, a step is taken that is
presents itself as a jouissance of nothing. Such enjoy- favorable for beginning treatment. A crack is intro-
ment is exerted through the action of refusal, which duced that gives way to an experience of the loss of
is the basis of the anorexic decision to ‘eat noth- control, to an ego-dystonic sensation in the life of
ing.’ The refusal is not simply a refusal of food. As the anorexic subject. Patients will often make every
Augustin Ménard has pointed out, what the anorexic effort to restore their initial anorexic condition, but
subject refuses is primarily to eat the signifier.8 Their they are mostly unsuccessful. It is at this point that
fundamental refusal, to take up Miller’s formula, is a the path is cleared for the initiation of a treatment
refusal of the Other. Eating nothing and refusing the geared at enabling the subject to find and to assume
Other are two sides of the same operation. a different name for their subject position. ‘One’
name, which is no longer imaginary and generic, but
rather symbolic and singular. This is the point at
which psychoanalysis can implement the full poten-
tiality of its discourse in the treatment of anorexia.
6. Dewambrechies La Sagna, C. “L’anorexie vraie de la jeune fille” La
Cause freudienne 63 (juin 2006): p 57-60.

7. Miller, J-A. (sous la direction de), Situations subjectives de déprise sociale

(Paris: Navarin 2009): pp. 169-170.

8. Ménard, A. “Structure signifiante de l’anorexie mentale” Actes ECF

(mai 1989): pp. 16-20. 9. Soria, N. Op. Cit. p 74.

Volume 4 - Issue 1 MAY 2018

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