Eating Disorders: A Lacanian Approach

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When they poured across the border
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LRO 181
9th October 2019

Eating Disorders: A Lacanian Approach
Domenico Cosenza – Andrés Borderías
 

AB: You have worked for many years in institutions linked to the treatment of eating disorders. What does the Lacanian psychoanalytic approach contribute, in respect of psychotherapies and current psychiatry in this field?
DC: The Lacanian psychoanalytic contribution within the framework of the clinic of eating disorders is very original and fruitful. It has guided and guides many institutional experiences in this field in various parts of the world, having found a significant place, in particular in Italy, in the last 25 years. On this contribution I have written several books, from The Wall of Anorexia (Gredos 2013) to the new revised and expanded version of Food and the Unconscious (NED 2019).
The cut that Lacan introduces in this field is radical. This cut is not limited to highlighting the poverty of the treatments that are trapped in the dimension of behavior, cognition and their disorders, and that try to normalize them – as occurs in cognitive-behavioral treatments that dominate the field of psychotherapies recommended for eating disorders, according to internationally recognized protocols by international psychiatric institutions. Nor is it limited to redirecting these disorders to the status of symptoms of an internal communicational imbalance within the family system, as in the systemic-relational approach, which has a long tradition since the early 1970s in this field, especially in the treatment of children and teenagers. Cognitive-behavioral approaches remain caught up in the dimension of the manifest phenomenon, and they don't want to know anything about the structural causality that sustains the development of eating disorders. The systemic-relational approaches sacrifice to the logic of the system the particular dimension that pushes the patient to choose this symptom as a solution. But Lacan's cut is also a cut regarding the attempts of the post-Freudians in this field. In particular regarding those who redirect these disturbances to the context of a narcissistic disorder produced by the difficult primitive relationship with the mother as 'caregiver' – all the heirs of the Ego-Psychology tradition, from Hilde Bruch to Jeammet, and especially with regards to anorexia. The whole staging of the issue is essentially reduced to the ravaged relationship between the mother and the daughter (or the son), leaving the father out of the problem. What seems to me most essential in the Lacanian perspective is not so much the highlighting of the role of the father as a third party with respect to the mother / child dyad, nor that the analyst is placed as a substitute for a weak father – as sometimes the Lacanian perspective on this issue has been misread. Lacan refers us to the structural value, particularly in the clinic of mental anorexia, of the object nothing. This is the clinical invention that Lacan brings about in this field, like a meteorite, clarifying it.
More precisely, the pair that Lacan summons at the center of this clinic, thinking about mental anorexia, is that of the refusal and the nothing. Refusal as a fundamental operation, understood as the 'rejection of the Other' in its double aspect: the Other that rejects the subject, and the subject that rejects the Other; and the nothing as an object that causes such rejection. This is a very peculiar drive object in the list of Lacanian objects, which the clinic of anorexia helps us to locate in its proper place. It is the object that in the neurosis is negativized as lost, and takes the relay, for example, in hysterical anorexia, of the signifier of the impossible object of desire. But in the forms that do not belong to the neuroses, it takes on the value of an object that has not been lost: full, embedded in the body, a cause of no-desire and of inertia (as Jacques-Alain Miller says in 2009). Thus, it is necessary to clarify, within this clinical field, the dominant status of the object nothing in each patient, to orient the treatment in a good way. Lacan invites us to enter into this clinic by opening this door, to clarify the phenomena that constitute the specificity of this field. It is a paradoxical door, which looks more like a wall, where there is a massive jouissance that gets in the way and hinders, preventing (or sometimes causing) the encounter between the subject and the Other.
Lacan allows us to enter the clinic of eating disorders from this operational dimension that localizes a singular jouissance in its field. This is what we have tried to develop in our research and in our clinical practice, whether in institutions, or in private practice. In the books we have written we have provided many details of this operation. Particularly in Food and the Unconscious, we try to develop this perspective beyond the clinic of anorexia and bulimia, with an extensive research on obesity and the so-called binge-eating disorder. We thus advance a critique of the paradigm of the new forms of the symptom, in the attempt to open up another perspective.
AB: You have been leading the EuroFederation of Psychoanalysis for some time now, what can you tell us about the presence of psychoanalysis in institutions in Europe?
DC: My first two years in my the role as president of the EuroFederation of Psychoanalysis have effectively allowed me to realize more precisely the variety and richness of the institutional experiences developed in Europe by analysts from our four Schools. The travels that this role entails towards several places of our continent, have allowed me to appreciate more closely, talking with colleagues from various countries, the contributions and institutional inventions that the Schools (in the case of CPCTs in France and Belgium, now gathered in the FIPA – Federation of Institutions for Applied Psychoanalysis), the Institutes of the Freudian Field (as it is the case with the Clinical Centers in Rome and Milan in Italy, but also within the framework of the NUCEP Network-CPA in Madrid), or the multiple initiatives of colleagues who have founded therapeutic institutions based on our orientation. The recent recognition of the ELP (School of Lacanian Psychoanalysis in Spain) as an institution of public utility received from the Spanish State, together with the existence of the Foundation (FCPOL), is also a factor that must be taken into account, and which may play an important role in the future of psychoanalysis in Spain as well.
Such richness and variety are not exempt from the complexity of our contemporary Europe, where the push towards standardization, and especially towards the administrative / bureaucratic logic of evaluation based on the parameters of evidence based medicine, puts us in difficult situations, and pushes us every time towards the search for new solutions that allow us not to give ground relative to the desire that guides us as psychoanalysts regarding the encounter with the singularity of each person that we meet in the institutions where we work. In the last Congress of the EFP, PIPOL 9 (The Unconscious and the Brain: Nothing in Common) we were able to verify the variety of possible responses and inventions of which we can make use, in order to reach this goal, according to the specific field where we operate.
 
 
 
 

Interview with Domenico Cosenza conducted by Andrés Borderías
for the Clinical Study-Day of the Madrid Psychoanalytic Network,
with the participation of the CPA Madrid and CP-Ado.
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