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From Fetish Object to Transitional Object: The Analysis of a Chronically SelfMutilating Bulimic Patient
Phyllis L. Sloate
Abstract: This paper challenges the view that food, or the patients own body, functions as a transitional object for bulimics during the bingepurge cycle or symptomatic equivalents of selfharm. The author proposes that the bulimic patients actions in and on her body more closely approximate the use of a fetish, which temporarily enhances a deficient and unstable body image and assuages separation anxiety, but does not promote progressive development. To illustrate these distinctions, the author presents an analysis of a selfmutilating bulimic patient who used her body as a fetish until a more integrated me evolved within the shared skin of her treatment. At that point, a transitional object and an idealizing selfobject fantasy were created, and the patient was able to engage the question of not me, relinquish her selfmutilation, and resume the process of separation and growth.
Bulimia is a common problem, and in some ways familiar to clinicians. The phenomenology of the illness has been carefully delineated. The concreteness of bulimic patients and the dynamics of symptomatic equivalents and symptom substitutionsuch as cutting for vomitingare well known (Farber, 1997; Wilson, Hogan, & Mintz, 1983). Analytic authors have published crosscase research studies and reflections on individual cases (Kreuger, 2001; McDougall, 1989; Schwartz, 1988; Wilson, Hogan, & Mintz, 1983). But there is as yet no agreement across the psychoanalytic community regarding the etiology of bulimia, and no single model prevails. This theoretical uncertainty raises interesting technical questions for clinical psychoanalysts. The bulimic patients concreteness and inability to assume an as if attitude toward the transference, for example, has been understood variously as
Phyllis L. Sloate, Ph.D. is Training and Supervising Analyst and Faculty at the New York Freudian Society and Faculty and Supervising Analyst at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis and at The Westchester Center for the Study of Psychoanalysis and Psychotherapy. She is in private practice in New Rochelle, NY.
Journal of The American Academy of Psychoanalysis and Dynamic Psychiatry, 36(1) 69-88, 2008 2008 The American Academy of Psychoanalysis and Dynamic Psychiatry
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an ego deficit (that is, a structural lack), an ego defect (that is, impaired functioning), and...