A young woman’s mantra is: “Not thin enough!”
Michele, at the age of twenty-eight, was hospitalized because of a suicide attempt. She was found semiconscious in her garage. The engine of the family car was running with the windows and door to the garage shut. The suicide attempt was considered to be serious and not merely a gesture for attention.
She was an anorectic woman and the anorexia was her major symptom—having lasted for the past twelve years. Her mother indicated that Michele began fretting about food at age sixteen and began also to worry about her weight—actually, first of all, more about how she looked and whether she was too fat. Then, gradually, she began pushing food away and whenever she would be looking at herself in the mirror, she would repeat to herself: “Not thin enough!”
From then on Michele seemed to be withdrawn and depressed from time to time. The anorexia, however, was her centerpiece symptom. Yet, rather than showing itself only as an occasional symptom, the anorexia was consistently present, never letting up. It was as though the anorexia symptom was a force, actually a demon that had a powerful influence over her in the form of a constant urging to look at herself in the mirror. Invariably, when seeing her image, the final facet of the symptom would reveal itself—that is, Michele disappointingly always thought: “Not thin enough!”
It was also the case that Michele had developed amenorrhea. She had not menstruated for the eight months prior to her suicide attempt.
It became evident that Michele was very dependent on her mother but was also impatient and somewhat negative with her mother. Yet, she talked everything over with her mother, including sexual intimacies. She desperately needed her mother’s approval, but she was also frequently angry at her mother. Both her love and her anger, in large measure, were caused by this same dependency on her mother. This kind of double take is called having ambivalent feelings. It really means ambivalent—two forces coming from the same place and going in opposite directions.
Michele’s relationship with her father was not good and she never respected his opinion and never sought him out for advice. It was clear that her mother was the power of the household. Both Michele and her father went along with all decisions the mother made.
Michele had one sister who was ten years younger and, for whatever reason, she had almost nothing to do with this younger sibling. She said that her life was so busy that she figured her mother would take care of all things related to this younger sister. However, she did have a best friend with whom she shared all of her secrets and everything else that was going on in her life. They had been friends since they were four years old and essentially grew up together until they were twelve. They would have sleepovers, have dinner at each other’s homes, go on trips together, and did homework together because they were in the same class. Then the bomb!
At that age of twelve, the friend made other friends and Michele became instantly despondent. She felt abandoned and said to me that she was “in shock.” They had been the best of friends, and suddenly, this friend more or less disappeared. Michele felt lost at sea and became disoriented. This friend had been so important to her that she was left without any sense of moorings. Yet, before long, the shock was absorbed and life went on. However, she never forgot the earthquake she felt inside when the shock hit.
Although she was always a finicky eater, at this point in her young life Michele had not yet become anorectic. What happened was that she became overly critical of her mother and of anything else that, according to her, warranted criticism. Ironically, it was then, however, and in spite of her critical attitude toward her mother, that her only relationship became with that of her self-same mother.
And this brings us to Michele’s present dilemma. The pivotal event that led to her suicide attempt concerned a man she had met almost a year earlier, which was about four or five months before the appearance of her amenorrhea. She had fallen in love with him. This man seemed to like her and told her she was pretty. However, he was direct with her and also told her he would be honest, saying she was “Nothing but skin and bone.”
He told Michele that he would like to have a relationship with her and that he could see she was beautiful and bright, but at the same time, he couldn’t, or wouldn’t, plan anything serious with her because of her unusual underweight appearance. She seriously considered reversing her entire pattern of eating and its effect of weight loss because she wanted to please him. Yet, whenever she looked in the mirror—which occurred several times each day—she would see “Not thin enough” and could not, in reality, change her ways.
In short order, this love of her life—this direct talking gentleman—was gone. And for good. Michele was devastated by his disappearance, but she still kept getting thinner. Even though she wanted to look the way he wanted her to look, she couldn’t do it. She could not resist the urge to be thinner. A few months later, and immediately before her suicide attempt, she learned that this man had become engaged to be married. It was then that she began verbalizing: “Maybe suicide will work for me.”
The fractured relationships with this man that she loved as well as with her preadolescent girlfriend must have created in her a deep well of anger that she ultimately directed at herself and that contributed greatly to the kind of symptom—the anorexia—that became her personality signature. And Michele recalled and talked about the earlier experience with her young friend when she heard that the man she loved was getting married. She then said, “It’s happening again. I can’t go through this.”
Thus, even though the suicide attempt was serious enough, it was not her main symptom. This is so because no matter how serious this attempt was during its process, it was still mostly under her voluntary control and she could have changed her mind about the act, as well as call for help almost whenever she wanted. No, it was the anorexia that she couldn’t control and, therefore, her actual symptom was the anorexia. True enough, the experience of feeling abandoned and rejected by this man and the memory of her preadolescent friend that it reactivated certainly contributed to her despondency and subsequent suicide attempt, but the suicide attempt itself was an acute acting out, while the anorexia ruled her life for the longest time and would continue to be the prevalent symptom of her life.
It was this symptom of anorexia that swallowed her whole and entirely took over her personality. This symptom became her personality. Anyone who described her would identify her solely with the layperson’s term as “the anorexic.” Everything in her life revolved around this symptom. As such, it would seem that the symptom of the anorexia shifted away from the arena of wishes in the psyche and into the realm of the psyche devoted to the organization of personality traits.
The anorectic symptom was really saying something specific. Of course like any symptom, it had a symbolic meaning. In this case, looking in the mirror and seeing “Not thin enough” really meant “The anger is still there.” The point is that there is no reality relation between getting thinner and thinner, on the one hand, and being less and less angry, on the other. A person cannot be rid of suppressed or repressed anger toward a who by becoming thinner. A person can feel better when going from obese to normal weight, but getting thinner to erase anger toward a who is not in any way realistically connected.
Yet, in her psyche, Michele made the symbolic connection between anger and thinness, even though, as stated, in reality, there is no such connection. Such a fantasy connection is a behind the line connection—a connection made out of a sense of withdrawal—completely in relation to her inner needs but again, not reality related. In her unconscious mind, this connection, at best, might be defined as an attempt on her part to “thin out” her anger. Why? Because the anger may be directed at her mother—the likely who. The problem is the ambivalence; that is, she loves her mother but is also angry with her. Because of her dependence on her mother, it becomes necessary to eliminate the anger—to thin it out. The extended problem is that it’s forever “Not thin enough!” And again, the reality is that there is no connection between erasing anger and the extent of one’s thinness.
This fantasy connection between anger and thinness likely occurred because it is assumed that the anger toward the possible who—in this case, presumably, her mother—forced Michele’s psyche to remove the symptom from the domain of wishes and into the realm of personality traits. This would have occurred by the psyche’s mechanisms delinking the memory of the who from the repressed anger. Thus, the memory of the who could be concealed from the person herself who suffered with the symptom.
Thus, in this case, because the anger toward this who was so dangerous, the anorexia was then transformed from a symptom into a symptom trait. And the reason the psyche had for pushing out the symptom from the domain of wishes to the realm of personality traits concerned the psyche’s sense of threat to its viability and integrity; that is to say, the danger this anger posed may have been of great magnitude covering all of the psyche, of great intensity—quite muscular, deeply penetrating into the psyche, and of long duration—the symptom existed for many years.
At rock bottom, the anorexia symptom was a gratification of the direct wish to love her mother and not be angry, and so whenever Michele didn’t eat, her tension would be relieved. Thus, her symptom—the assertion of the anorexia—always decreased her tension.
Without medication this symptom could not be resolved or cured, and the symptom code of the one, two, three, and four of symptom cure could not address it effectively. Only with the proper medication could “Not thin enough!” be approached with the symptom code, and in a way that could help resolve the emotional and psychological issues that underlie the anorexia—relinking repressed anger with the who toward whom the anger is intended, and then making it all conscious. Then, the to do activity related to the problem of the ambivalence and anger toward her mother would need to be crystallized in a way that produced some actual confrontation with the problem.