Abstract
Background: This article considers the question of the subjective elaboration of a subject’s relationship to the family-other within a hospitalization facility. Our starting point is the therapeutic follow-up of Clementine, a melancholic adolescent, thrown into an institutional setting following a severe case of anorexia nervosa. We posit that, in the case of Clementine, the choice of the anorexic symptom may demonstrate both a necessity to detach herself from love objects and a difficulty in doing so, but also provides the start of a subjectifying solution. Case presentation: We propose a qualitative method for the analysis of the individual interviews conducted with this young patient in a patient/psychologist/researcher configuration. A psychoanalytical approach sheds light on several topics: anorexia nervosa, melancholy, twinning, puberty and subjective elaboration. We present the changes in the psychological dynamics and discourse of the young girl during psychological interviews, but also in the wider framework of hospitalization (medical follow-up, family interviews, relationships to the peer group and to the healthcare team, etc.). Conclusion: We think of the anorexic symptom more as a way of setting up the subjectivation process than as a self-destructive behavior, which enables us to address the specific features of a possible therapeutic approach. We open the debate on the question of the benefits of separation from the family and of hospitalization, as well as on the potential impact of the therapeutic framework on the symptom.
Highlights
We think of the anorexic symptom more as a way of setting up the subjectivation process than as a self-destructive behavior, which enables us to address the specific features of a possible therapeutic approach
We open the debate on the question of the benefits of separation from the family and of hospitalization, as well as on the potential impact of the therapeutic framework on the symptom
Meeting clementine and presentation of the therapeutical environment Clementine is a young girl who has just turned thirteen when she is admitted to a child psychiatry unit for “anorexia nervosa with melancholy”
Summary
Which benefit (s) from the therapeutic framework can be linked to which impact (s) on the symptom? Anorexia nervosa gives Clementine, on one hand, the possibility of postponing the revival of the oedipal conflict and, on the other hand, the opportunity to shift her dependence conflict from parental love objects to a food object [5]. The choice of the anorexic symptom made possible a physical and psychic distancing from her sister, distancing that was necessary to break a destructive and deadly twinning The evolution of this young girl, stuck in a process of differentiation at all costs, poses a challenge: how can anorexia nervosa be overcome if its end, marking the beginning of puberty, places it back in an indifferentiation fantasy, this time of two pubescent bodies? BThe “Good-enough mother”, according to Winnicott, is the behavior a mother adopts when she takes care of her baby, answering his omnipotence She has knowledge of her baby’s sensations, she responds to his needs and she repeats her care over and over. Marion HAZA: Clinical Psychologist, President of ARCAD Association, Senior Lecturer, CAPS EA4050, University of Poitiers, Member of the ICLA
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