Two types of psychic encapsulation in anorexia

Abstract

This paper suggests that it is theoretically necessary and clinically useful to make a distinction between two types of psychic encapsulation within the broader literature. The proposed distinction, as it relates to these psychic structural manifestations, is illustrated here as applied to anorexia. The author suggests that psychic encapsulation is commonly encountered in work with anorexics, and that each type seems to imply a somewhat different therapeutic course. The distinction is made between anorexic patients who appear to display evidence of autistic/autistoid encapsulation as opposed to those who seem to manifest non-autistoid/later traumatic encapsulation – termed secondary adjunctive encapsulation in this paper. Defensive encapsulations are associated with pathological organisations of the personality – both within and beyond these structures, they exert an organising power over central mental processes. Psychic encapsulation and pathological organisations are defensive structural developments – the result of psychic trauma. Clinical material from three cases is presented to illustrate the arguments.

Keywords:

• anorexia
• autistoid
• encapsulation
• pathological organisation
• psychotherapy
• psychic retreat

Notes

1. I am restricted to a description of the first part of Amy's treatment as the entire case study is beyond the scope of this paper but can be found elsewhere (Kadish, 2011).

2. Tustin (1986) presented two such anorexic patients – ‘Margaret’ and ‘Jean’.

3. Lawrence (2008) speaks of feeling like a ‘benign headmistress’ with her patient Ms C (p. 51).

4. Certain individuals surely suffer both infantile and later traumas, and as a result seem to manifest multiple encapsulated parts of the self. I have treated patients like this and various authors too describe such cases (Adams, 2006; Parker, 1993; Shipton, 2004).

5. Unfortunately this is not the case in extreme and prolonged trauma like torture and Holocaust where full recovery is usually not possible.

6. The GP monitored her weight – at first on a weekly and later on a monthly basis in the first year of therapy.

7. Indeed with all anorexic patients, there are oedipal difficulties that need to be worked through (Shipton, 2004; Williams et al., 2004); however, a thorough discussion of this is beyond the scope of this paper.

8. Shipton (2004) discusses an eating-disordered patient who consumed chocolates and soft drinks to accompany her grandiose fantasies in her psychic retreats.

9. This better prognosis is not always the case with all secondary-adjunctive cases – as can be seen in work with holocaust survivors (Baranger et al., 1988; Hopper, 1991). In these cases, prior psychological status quo is permanently eclipsed.