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Modell (1994), mentioned, in the light of a premorbid temperament. The anorexic person has difficulty in differentiating positive and negative feedback due to exaggerated activation of the caudate, a region in the brain involved in linking action to outcome. It has been hypothesized by Kaye and others “that individuals with anorexia nervosa have an imbalance in information processing, with an impaired ability to identify the emotional significance of a stimulus” (Wagner et al., 2007, p.1842). This reveals further information related to the question of aliveness and deadness. Interventions informed and approached from the “bottom up” can address the body, taking into account the biological/genetic make up of the client and her vulnerability predisposing her to Anorexia Nervosa. This may also relate to their inability to respond to reward and to what neuropsychotherapy calls the approach-avoidant evaluation so necessary for motivational work and therapy (Grawe, 2007). For some clients this sounds like the unbudgeable rigidity Freud thought was rooted in psychic life and in the very nature of matter (Eigen, 1995a). Freud (1937) believed it was part of the inherited equipment; that depletion of plasticity and psychic inertia and entropy, which he thought as a force, could not be mapped. Freud’s sensitivity to rhythmn had him think that death work probably sees “some alterations of development in psychical life not yet appreciated” (p. 242). Grawe (2007) notes that in neuropsychotherapy, mental pleasures include the joy of one’s own competencies and that psychic entropy is the opposite of Csikszentmihalyi’s (1990) flow concept and therefore “exerts a negative influence on mental health” (p. 245). “Entropy implies 39
increasing disorder….a psyche working in reverse” (Eigen, 1995a, p. 289). On this lack of plasticity and “movement between states between selves and between worlds” (Eigen, 1995a, p. 297), it would seem that the science and phenomenology of psychoanalysis and neuroscience have continued to agree. I began this chapter outlining the literature and interest in deadness as experienced in the therapeutic setting. Sekoff (1999) notes death is a subject that does not sit well with “attachment, sex or the self” and says Ogden (1995) and Green (1989) have drawn much criticism for using “too grim a vocabulary when other less exaggerated descriptions would do” (p. 120). Sekoff wonders if this has to do with the reduction in death’s presence due to public health measures now available to the fortunate. It seems, in reviewing the literature, that Anorexia Nervosa remains outside this modern solution (still rating the highest death rate of any psychiatric illness), and that much of the lack of exploration around the aetiology of death in Anorexia Nervosa is due to the confrontation of it’s presence, not only in the clients embodiment of it, but also in her attraction and dissociation to death. In the following chapter I will thread this theme into the ‘moment to moment’ encounter with the anorexic client and how the psychodynamic use of countertransference can inform and guide approaches to assist both therapist and client. 40
Page 1 and 2: This dissertation is submitted to A
Page 3 and 4: ACKNOWLEDGEMENTS I would like to th
Page 5 and 6: ATTESTATION OF AUTHORSHIP ACKNOWLED
Page 7 and 8: Chapter One: INTRODUCTION Anorexia
Page 9 and 10: In chapter five, I will bring toget
Page 11 and 12: they acknowledged a “lack of prog
Page 13 and 14: lack of controlled research. This l
Page 15 and 16: elates to my clinical question: How
Page 17 and 18: important part of the information g
Page 19 and 20: 4. Quality of appraisal of included
Page 21 and 22: Table 1 shows an outline of keyword
Page 23 and 24: “clinical and empirical evidence
Page 25 and 26: decision was made to use the system
Page 27 and 28: Axis of Experience: Deadening to En
Page 29 and 30: to be occurring, and the analyst ma
Page 31 and 32: in commenting on the notion of the
Page 33 and 34: study on anorexia, murder and suici
Page 35 and 36: elationship of life. The ever chang
Page 37 and 38: Protection through Preserving Empti
Page 39 and 40: acknowledges the importance of “c
Page 41: an object through identification. G
Page 45 and 46: issue of Anorexia Nervosa. It is th
Page 47 and 48: intersubjectivists such as Mitchell
Page 49 and 50: and client. Safran & Muran’s (200
Page 51 and 52: identification, eating disorder cli
Page 53 and 54: (p.325). She helped clients to reco
Page 55 and 56: negative emotions, particularly ang
Page 57 and 58: negative transference, the undevelo
Page 59 and 60: opportunities to test out what the
Page 61 and 62: analytic pair” (Ogden, 1994, p.94
Page 63 and 64: can arise as a conflict with the an
Page 65 and 66: dopiaminergic, sub-cortical ascendi
Page 67 and 68: Chapter Five: CONCLUSION In this fi
Page 69 and 70: The views expressed by Kristeva and
Page 71 and 72: elationship was, for Winnicott, lin
Page 73 and 74: The Body’s Central Role for Defen
Page 75 and 76: Use of Countertransference as an In
Page 77 and 78: It seems many psychoanalysts would
Page 79 and 80: client is provocative and harsh, th
Page 81 and 82: to measure the effect of treatment
Page 83 and 84: concept of ‘sense of self’ is a
Page 85 and 86: REFERENCES Agras, W. S., Brandt, H.
Page 87 and 88: from a psychoanalytic perspective:
Page 89 and 90: Freud, S. (1957). The future prospe
Page 91 and 92: Transmission, 111, 827-840. Herzog,
Page 93 and 94:
ulimia (pp. 109-127). New York: Gui
Page 95 and 96:
Alliance of Psychoanalytic Organisa
Page 97 and 98:
Stolorow, R. D., Brandschaft, B., &
Page 99 and 100:
Zerbe, K. J. (2007). Psychodynamic
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