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Abstract
I would like to share with colleagues some thoughts about the fascinating and disturbing states of mind and body that I found when working in an Eating Disorders Unit, and try both to describe and to think further about how these impact on the work of the staff and upon my task.
Body Mass Index: a mathematical calculation of the weight/height relationship. 20–25 is healthiest; many of the patients are admitted at 11 or less.
Some recurrent themes are: splitting and projection, showing up in many areas as either/or states of mind, which can affect the whole team at times; the refusal to let anything in, which seems linked to disastrous unconscious muddles between food and love, love and hate, etc; a great unconscious terror that, given the slightest acknowledgment, need will emerge as greed; horror of fatness, and body dysmorphic confusions; enactment in place of feeling/thinking; antagonism to change and growth.
Despite common themes and ways of behaving that can make these patients seem superficially very alike, it is their differences that are so striking; it seems clear that there is unlikely to be a single identifiable precursor. We have to keep reminding ourselves that the search for meanings is not always the same as seeking after causes, and that neither is the same as blame, often a difficult balance to hold where splitting is so prevalent a defence.
Notes
Body Mass Index: a mathematical calculation of the weight/height relationship. 20–25 is healthiest; many of the patients are admitted at 11 or less.
National Institute of Clinical Excellence guidelines.