1st Edition
The Anorexic’s World in Psychoanalysis Internal Drama and External Corruption
This powerful book is a multifaceted examination of anorexia nervosa, which explores the anorexic’s internal experience, as well as the key role that specific family dynamics play in the development, experience, and treatment of anorexia.
Drawing from her experience as both a psychoanalytic practitioner and a former sufferer, the book builds on Dr. Krestow’s personal history and her clinical experience providing psychoanalytic therapy to anorexics. Presented in three parts, the book first explores the inner psychic drama experienced by people with anorexia: incessant thoughts, the inner torment and the ongoing internal battle for agency and independence from the family. Part Two examines the theme of corruption in the family, which often involves a view of the world as dangerous, and their need to keep the child close and attached. Finally, the book considers treatment implications and argues for the thoughtful and collaborative treatment stance of the therapist, including recognition of the anorexic’s poor level of mentalization, and the therapist’s respect for the anorexic’s intense need for agency that had been thwarted developmentally.
Drawing on clinical material, and the author’s own experiences, The Anorexic’s World in Psychoanalysis will be essential reading for psychoanalysts in practice and in training, to other clinicians working with anorexic patients, anorexics and their families, and the interested general public.
Introduction
Part I: Inner Drama and External Corruption
1. The Inner World of the Anorexic
2. External Corruption: The Anorexic’s Outer World
3. Agency and Empowerment
Part II: Treatment
4. Outer Submission/Inner Defiance
5. Collaboration: The Therapeutic Alliance
6. Mentalization
7. The Art of Listening
Part III: Analysis of Two Dreams
8. The Early Dream
9. The Second Dream
Afterword: Anorexics Through History and Attitudes Toward Anorexia Today
Biography
Emily Krestow is a psychotherapist, psychoanalyst and supervisor in private practice based in Florida, USA.
“Emily Krestow has written a brave book revealing not only her patients' struggles with anorexia, but her own as well. In her own words, 'The reader is ushered into the inner world of the anorexic to witness the intrapsychic drama that plays out in the mind and visibly on the body in a continual dialog of pain and silent rage.' It is a book to be read by every clinician interested not only in anorexia, but in the human struggle for both connection and self-determination.”
Linda B Sherby, Psychologist-Psychoanalyst and Past-President of the Southeast Florida Association of Psychoanalytic Psychology, USA
“This book focuses on primary anorexia - the fear of being fat; readers see the inner world of the anorexic by witnessing internal dialogues of pain and rage. On its own, that would make this book a noteworthy addition; however, Krestow also presents clinical material from a long-term/successful treatment of a young woman - as well as highlighting the therapist’s own struggles with an eating disorder - thus, helping to humanize a disorder that is often treated with shame and humiliation by the suffering patient, family, and the therapeutic community."
Robert Mendelsohn, Professor of Clinical Psychology, Adelphi University, USA
“I have been practicing psychoanalysis for 51 years, reading extensively and participating in studies on early childhood eating disorders at children’s hospitals. I find Emily Krestow’s book to show an excellent understanding of anorexia and its underlying pathology. Her depth of knowledge, clarity of expression, and ability to bring unconscious feelings to light, with both sensitivity and clinical skill, make this book both insightful and accessible and is a must-read for professionals, as well as for individuals who suffer from anorexia and their parents.”
Sonia Ioannides, Psychoanalyst, Florida, USA
“Emily Krestow's courageous book distills rich clinical experience to explore her patient Marcia's world - and her own - through Peter Fonagy's mentalization-based model. She sharply distinguishes the 'restrictive anorexic' from the culturally shaped anorexic, drawing on Hilde Bruch's seminal work. Focusing on both Marcia's inner world and her family dynamics, Krestow offers an honest, jargon-free look at a complex disorder. Presenting detailed clinical material from a long-term analysis with a successful outcome, she argues that such patients can be cured. Essential reading for psychoanalysts and all clinicians treating eating disorders.”
Susan Budnick, Licensed Psychoanalyst, Center for Psychotherapy and Psychoanalysis of New Jersey, National Association for the Advancement of Psychoanalysis, New York, USA and The Arbours Association, UK
“Dr. Emily Krestow’s recent book about anorexia recounts a fourteen* year treatment of an anorexic young woman. The book helps us to understand the inner preoccupation and emotional remoteness of the anorexic and proposes an original factor of 'corruption' present in the anorexic’s family. The recognition of this element highlights the importance of a 'patient' and 'collaborative' approach to treatment. The journey to emotional connection and ego growth described is breathtaking. Whether a beginner or an experienced therapist, this book will deepen your understanding and refine your therapy in your work with anorexics.”
Richard Steinberg, Former Faculty, Southeast Florida Institute for Psychoanalysis and Psychotherapy, USA
“Dr. Krestow is to be applauded for this courageous and important book focusing on a particular form of eating disorder that is all too common in today’s world. This scholarly analysis, drawing on the psychoanalytic tradition, vividly examines the inner life and family relations of people who struggle with a fear of being fat and so are excessively preoccupied with food and their eating habits. Her analysis is rich in insights, beautifully and movingly written with vivid case examples that illuminate the subtle details of the inner experience of both the love and disgust which surrounds the anorexics relationship with food and their body. Dr. Krestow’s book is a particularly noble effort as she bravely describes her own struggles with the form of anorexia which is the topic of her work. This fine effort, akin to Freud’s own description of his self-analysis, enables the reader to gain a profound window into the deeply personal experience of what it is like to live in the mind of someone suffering with an eating disorder. Her book provides a richly detailed, deeply moving guide to treating a condition so many people in our society suffer with silently throughout their lifetimes.”
Daniel P. Schwartz, Psychologist, Psychoanalyst and Adjunct Faculty Pacifica Graduate Institute, USA, and Adjunct Faculty and Clinical Supervision California Lutheran University, USA
