Anorexia-A result of disturbances in developmental stages
Anorexia as a result of disturbances in certain developmental stages
Discussion on the developmental role of the Oedipus complex, as used in the Freudian and the Kleinian theory and of the paranoid-schizoid and the depressive position
The purpose of this paper is to explore the developmental value of the Oedipus complex seen from the Freudian and the Kleinian perspective. The Kleinian concepts of paranoid-schizoid position and depressive position will also be presented in their role in the child’s development. There will be an attempt to approach the subject with a slight focus on the female mental development as it is not very clear in Freud’s theory. The illustration of the differences in the two theories in both normal and abnormal development will be approached through the psychopathological causes of anorexia nervosa.
The long term mortality in the population of patients with Anorexia Nervosa is 10% according to the DSM-III-R (2002: 246-7). Abnormal eating habits are a ‘trend’ of our times. By watching television for ten minutes and going through female or sport’s magazines we all come across advertisements on how to loose weight, ten day starvation diets, and products with cancerous substitutes for sugar and fat. According to Frosh (1991: 74) our society focuses on the image, the surface and the body. The extreme situation of abnormality in eating habits is Anorexia Nervosa.
The Freudian Oedipus complex
The Oedipus complex proper for Freud begins manifesting it self in the third year of a child’s life (1916-17: 324-5). On the other hand, as cited in Fuchsman (2004) there are four developmental stages in the Oedipus complex and the first is a pre- oedipal one that starts very early in the child’s life. The way the mother takes care of her baby and nourishes it is considered to be very important in the child’s future development (Freud 1927: 138; in Fuchsman 2004). The mother and the child establish their relationship on the feeding procedure; that is the reason why we believe that any eating disorders, including anorexia, are connected with the mother – daughter relationship through feeding and with the following Oedipus complex proper. Through feeding the mother, and more specifically the mother’s breast, becomes the first love object as it satisfies the infant’s first sexual need; i.e. sucking milk from the mother’s breast (Freud 1905: 222). And in that way the mother and the feeding process becomes the prototype for the infant’s further sexual satisfaction (Freud 1916-17: 313-4). When the baby achieves to distinguish between the self and the mother it chooses the mother as a love object. According to Fuchsman, Freud was very interested in understanding how the mother is incorporated in the child and is being treated by the child as an exclusive sexual object and that is the foundation of the Oedipus complex, which Freud considered to be universal (Fuchsman 2004: 84-5). Fuchsman notices that Freud does not clearly say if we identify with the same sex parent form the beginning or with both (Fuchsman 2004: 87-88).
In the third year of life children pass to the phallic stage that, as stated above, the Oedipus complex proper begins. This stage is called phallic for both boys and girls as the phallus can resemble both the male of the female genital organs -the penis and the clitoris (Fuchsman 2004: 91). For Lacan the phallus represents an illusionary wholeness (Lacan 1966; as cited in Birksted-Breen 1996: 649). And Freud claimed that the person’s psychic position in relation with the phallus is what determines masculine and feminine development (Freud 1925).
During this stage the boy wants to replace the father in his relationship with the mother; i.e. the father is seen as the obstacle between him and his love object. Whereas the boy continues to have the same love object the girl has to switch love object. In this phase she develops hostile feelings towards the mother and chooses as her love object the father (Freud 1923: 31). The love or aggression towards the parents is not only derived by the boy or the girl but also by the parents themselves. As Fuchsman states Freud believed that the mother falls in love with the son and the father tries to gain his daughter’s affection (Freud 1916-17; as cited in Fuchsman 2004: 91). The Oedipus phase is a phase of ambivalence as the boy who in the pre-oedipal phase admired the father now hates him and the girl that in the pre-oedipal phase had the mother as her love object and now she has a different love-object; i.e. the father, and alongside she sees the mother as a rival (Freud 1921: 105). Freud noted three types of Oedipus complex. The first is the positive Oedipus complex in which the child is hostile towards the parent of the same sex and chooses as a love object the parent of the opposite sex. In the second type; i.e. the negative Oedipus complex the child has the wish to take the place of the parent of the opposite sex and get love from the parent of the same sex. And the third type is ht complete Oedipus complex I which the child has an inner bisexuality which pushes it to identify with and to choose as a love object both the father and the mother (Freud 1925: 250, 1923: 33).
In the female development there are some differentiations from the male development during the phallic Oedipus complex. In the negative Oedipus complex the girl identifies with the mother and also has the mother as a love object (similarly with the pre-oedipal phase); whilst the father is a minor threat to her relationship with the mother. In the positive Oedipus complex on the other hand, the girl has to switch objects and acknowledge the mother as a competitor regarding the relationship with the father. The mother becomes the source of disappointment for the young girl and evokes feelings of anger either because she disciplined the young girl or because she had another baby (Freud 1933: 119,124). The girl is angry at the mother and turns away from her because she conceders her to be responsible for her lack of penis (Freud 1931: 234). To overcome her lack of penis the girl turns towards the father and wishes to give him a baby (Freud 1925: 256).
Freud also talked about the differentiation in the Oedipus complex when another child is born. In that case the triangularity of the Oedipus complex no longer exists, and we have a family complex (Freud 1916-17: 333).
Freud states that the dissolution of the Oedipus complex for the boys comes because they fail to fulfill their wish of killing the father and obtaining the mother and because this dissolution comes with psychic development (Freud 1924: 173). If and when the family complex, mentioned above, occurs: the child abandons the oedipal love object, because he/she considers it to be unfaithful and rejecting. In addition boys’ fear of castration helps in abandoning his oedipal wishes. Regarding girls Freud claims that they never completely demolish the Oedipus complex and consequently their super ego is not as severe as the men’s super ego (Freud 1933: 129).
When the dissolution of the Oedipus complex takes place the little boy has to give up the object-cathexis of his mother and, in normal development, an intensify the identification with the father that already exist from the pre-oedipal phase. The girl likewise has to abandon the father as a love object and identify or re-identify with the mother. These identifications are the most important in a person’s life as they determine the masculinity or the femininity (Freud 1923: 30-2). The resolution of the Oedipus complex with the identification and internalization of the parents leads to the formation of the super ego which is not what is left of the previous object choices but also their persecutor (Freud 1923: 34). In Freud’s own words: ‘The ego ideal (or super ego) is the heir of the Oedipus complex’ (Freud 1923: 36). The super ego contains the parental restrictions and acts as an internal father that shows the way to morality; it is the foundation of conciseness. In conclusion we could say that a failure in dissolving the Oedipus complex would lead to an incomplete formation of the super ego and the person would not have an internalized moral code against the demands of the id.
The development in the Kleinian theory
Klein places the Oedipus complex much earlier in a child’s life than Freud. She claims that the Oedipus begins in the end of the first or the beginning of the second year of life (Klein 1928: 186). When the boy abandons the oral/anal positions for the genital his aim is to penetrate which is linked with his possession of the penis; these changes in both the libido position and his aim allow him to retain his original love object. The girl on the other hand will only change the position of the libido but will still have the same aim- the receptive aim. This leads to disappointment regarding the mother and she chooses the father as a love object while there is accessibility for the penis produced in her. The Oedipal wishes evoke a fear of castration and a sense of guilt. The guilt is produced by the introjection of the oedipal love objects and the formation of the super ego (Klein 1928: 186-7). In the end of the first year of life the beginning of the Oedipus conflicts and the fear of being destroyed because of the oedipal wishes evoke anxieties. Alongside the child also wants to devour and destroy the libidinal object a fact as well evokes feelings of anxiety. The interjected libidinal object, in the form of super ego, becomes the object which the child expects punishment from (Klein 1928: 187). The child during the oedipal phase knows nothing about the sexual process and due to that it feels incompetent. This epistemophilic impulse and its connection with sadism influence in a large degree the developmental process. The child sees the mother’s body as the place on which all sexual processes and developments occur. The child wants to possess the mother’s body and its content, wishes that rise feelings of guilt. Due to that there is a very early identification with the mother (Klein 1928: 188-9). In the early anal/sadistic stage there is the urge to possess the mother’s feaces, to intrude her body and destroy all of its content. The fear of the devouring mother is so intense because it is associated with the extreme fear of castration by the father. This is connected as in the child’s phantasy the mother’s body also contains the father’s penis as well as babies. So the wish to devour mother is also a wish to destroy father’s penis that exists in the mother (Klein 1928: 189-90). The girl’s need for sexual gratification leads to hatred and envy towards the mother that possesses the father’s penis and will not allow the girl to have the father and his penis to her self. And in conjunction with that, the hatred and envy towards the mother create the desire to possess the father. In the Oedipus conflict the need for sexual gratification and the way the mother becomes an obstacle to that will lead the girl to turn to the father, in addition to what Freud stated as reasons for this object choice which are previously mentioned (Klein 1928: 192-3). In the relationship with the mother is also where Klein (1928: 194) detects the root of the female constant concern with beauty. The mother is perceived as trying to destroy the girl’s beauty and she is feared for that.
In order to understand the developmental role of the Oedipus complex in the Kleinian theory we must see the states of minds that exist previously and parallel to the Oedipus complex. According to Klein (1930) in the beginning of the child’s life there is an oral-sadistic desire to devour the mother’s breast which passes away with the introduction of the earlier anal stage (Klein 1930: 219). In this state that sadism predominates the aim is to obtain possession of the content of the mother’s body and destroy her; a state of mind that exists as an introduction to the Oedipus conflict. As stated above the baby has the phantasy that the mother’s body contains the father’s penis, babies and excrement; which are all equated with edible substances; there exists the phantasy of destroying both the parents, since by destroying the mother’s body the father’s penis which is inside it will be destroyed as well. These attacks bring to life anxieties and the infant believes it should be punished. Due to the internalization of the anxiety through the oral-sadistic introjection of objects the infant is heading towards the formation of a young super-ego; which comes much earlier that in the Freudian developmental theory that we previously explored (Klein 1930: 219). To the oral –sadism the urethral/anal sadism will be added. The phantasies during this phase involve seeing the excreta as dangerous weapons and later on as poisonous substances. The anxiety of this state leads to the formation and use of the early ego defenses. The ego has two sources of danger. The first one is coming from within and it is the ego’s own sadism firstly because it liberates anxiety and secondly because the weapons used to destroy the object are felt to be dangerous to the self as well. The ego defends its self towards this first threat by expulsion. The second source of danger to the ego is the attacked object as it is felt to be capable of attacking back. The ego will attempt to destroy the object to protect itself (Klein 1930: 220). The risen of anxiety and the libidinal interest will lead to a mechanism of identification. In the infant lays the desire to destroy the organs of the object but at the same time it is dread of their destruction so he equates the organs with other things. The constant creation of equations and the consequent interest in new objects will eventually lead to symbolization (Klein 1930: 220). According to Klein, ‘(…), not only does the symbolism come to be the foundation of all phantasy and sublimation but, (…) it is the basis of the subject’s relation to the outside world and reality in general’ (Klein 1930: 221). The sadistic phantasies mentioned above regarding the destruction of the mother’s body are considered to be the first link to reality. The development of the ego depends on the way it will tolerate these early anxieties and the ability to symbolize will define the degree of connection and correspondence with reality. Through the development of the ego a relation with reality is established gradually out of the urethral reality (Klein 1930: 121).
In order to fully understand the developmental importance of the early Oedipus conflicts it is sufficient to explore the process of symbol formation that starts in these early stages. Hanna Segal (1957) tried to explain how we achieve symbol formation and how disturbances in this procedure can lead to psychopathological states of mind. In her effort she introduced the term symbolic equation to distinguish between symbolizing an object in the internal world, and the case in we which we believe that the internalized object is the actual object (Segal 1957). When we must give up desire regarding an object because it is a cause of conflict we create a symbol for it in the internal world in our attempt to deal with the loss. The symbolism is the relation between the ego, the object and the symbol. The ego uses symbols when it needs to deal with anxieties derived from objects that could be either fear of bad objects or fear of the loss of good objects (Segal 1957: 392). If the ego is unable to differentiate between it self and the object, it cannot differentiate between the object and the symbol and this leads to ‘a concrete’ way of thinking; which is a psychotic trait (Segal 1957: 393). By examining the content and the way symbolic formation takes place we can determine the developmental stage of the ego. Segal used the developmental stages of Melanie Klein (1946) to explain the gradual development of symbol formation and, consequently, the development of the ego. The oral stage is deviated in two phases; the paranoid-schizoid position during which the fixation reflects to a schizophrenic group of illness, and the depressive position which reflects to manic-depressive states of mind (Segal 1957: 393). In the paranoid-schizoid position the object is split into ideally good, in which case the ego’s aim is to unify with the object; and a wholly bad, in which case the ego desires to destroy the object as well as parts of the self related with the bad object. While Freud supposed that only the good object is hallucinated, Segal states that if the bad object is not destroyed in is equally hallucinated with the good object with which the unity was not possible (Segal 1957: 393). The defense in this state is projective identification and it gradually leads to symbol formation. Large parts of the self are projected into the object and the self identifies with the object and the parts of the self that it contains. Alongside internal objects are projected in the external world and the self identifies with the parts of the world that relate with those objects (Segal 1957: 393). Because of the inadequate development of the ego the early symbols are equated with the object and are felt to be the actual object not symbols or substitutes of the object. This early form of symbolization is what Segal calls symbol equation. The boundaries between the self and the object are because of symbolic equation blur. Based on that, if we have symbolic equations of bad objects the ego tries to annihilate the symbolic equations and the original objects and consequently the person has no interest in the external world (Segal 1957: 393).
In the depressive position that follows the objects become whole and the ego manages to differentiate between it self and the objects. The wholeness of the object that can be good and bad at the same time leads to ambivalence and guilt because of the previous attempts to destroy the object. Parallel to that a fear of loss takes place in the self which leads to mourning and attempts of recreating the object. The introjection is increased in the ego’s attempt to keep the object inside in order to repair, restore and recreate it. In normal development the good object is securely established in the ego (Segal 1957: 394).
The awareness of the ambivalence, the diminished projection and the ability to differentiate between the self and the ego leads to a sense of external and internal reality. The ego is trying to protect the object from its aggression and possessiveness. Through symbolization the ego is able to displace its aggression and possessiveness from the object and direct it towards the symbol and as a result the ego experiences less guilt and not as severe fear of loss. The symbol is felt to be one of ego’s creations and it is no longer equated with the object; the ego now can control the symbol and deal with the object. The symbol is later on re-projected in the external world so that it can have a symbolic meaning (Segal 1957: 395).
In the schizoid level mentioned above the feaces are equated with the ideal breast; and if this idealization fails the feaces are felt to be a persecuting breast and they are ejected as the destroyed breast. If there is an attempt to symbolize feaces in the external world, the world is felt to be persecuting feaces as there is no sublimation (Segal 1957: 395). In the depressive level the ego is capable to recreate the devoured breast; the feaces are understood to be created by the ego; so the symbol of breast is felt to be created by the ego. The symbolic equation was used to deny the absence of the ideal object or control a persecuting one. When the proper symbols start to be formed the ego does not deny the loss but deals with it. The separation from the object the ambivalence and the guilt are experienced and tolerated (Segal 1957: 395-6).
In conclusion we could say that normal development through the developmental stages stated above leads to a healthy ego able to symbolize, communicate with the internal and external world and be in touch with reality. But what happens if there are distortions in the developmental process? In our attempt to find answers to that question we will try to apply the theories mentioned above and the supposed disturbances in the ego development to the psychopathological causes of Anorexia Nervosa.
How is Anorexia Nervosa related to distortions in the developmental stages?
Regarding Freud the Oedipus complex that we explored in the first chapter of this paper is a developmental hurdle and the child must experience it and overcome it in order to reach maturity. Klein also treats the Oedipus complex in the same way; i.e. as something that the child must accept and overcome. The important difference between the two theories is the time that the Oedipus complex begins, for Freud (1916-17: 324-5) in the third year of life and for Klein (1928: 186) in the end of the first year or the beginning of the second. There are also differences in the way they approach the Oedipus complex and the language they use. Freud (1916-7: 313-4) speaks in terms of sexuality in the oedipal object choice while Klein (1937) speaks of internalization, reparation and re-creation of the object out of guilt for the aggression towards the object and fear of loss of the good object. Regarding the dissolution of the Oedipus complex, Freud attributes it to the failure of fulfilling the oedipal wishes and to the fact that as a part of developmental process the Oedipus complex must be dissolved (Freud 1933: 129). The problem in Freud’s theory in our perspective is that he is not clear about the similarities or differences between the sexes and that he claims that normally girls fail to adequately dissolve their Oedipus complex (Freud 1933: 129).
We find that the Kleinian theory of development is more holistic and clear in the developmental stages and what takes place in those stages. With the use of symbolization Klein explains how the person can mentally mature and gain the ability to communicate with both internal and external world (Klein: 1930: 221). In both theorists, we see the Oedipus situation as the basis for the formation of the super ego through the internalization of the parental figures (Freud 1923: 34; Klein 1928: 186-7).
The way we will explore the differences between the two theories stated above is by trying to apply them to anorexics and see the different causations of anorexia from each perspective.
In both theories the nourishment of the baby by the mother is crucial in the child’s development. For Freud the primal mother – child relationship in the oral stage becomes the prototype for the child’s future sexual relationships (Freud 1905: 222). If there is a disturbed relationship with the mother during oral stage the child might experience pain (from hunger) instead of pleasure and develop a bad relationship with food in general as the prototype is bad. The oedipal state is more important in our view to explore distortions in development that lead to anorexia. If a girl fails to identify with the mother during the dissolution of the Oedipus complex and instead she identifies with the father she has the father as her model. That distortion might explain why girls try to have a non feminine figure by refusing to eat of by purging the food. This non feminine figure could also be desirable as it might represent an erected phallus so that the girl will be able to deal with her lack of penis. The phantasy of being a phallus gives the girl the power that the boy has because of his penis (Lawrence 2002: 841). The girl finds this way to enter a positive Oedipus complex (Freud: 1931). By relying on the Freudian theory we were only able to make some vain assumptions about the distortions in the development that might lead to anorexia. As we are also more interested in the girl child’s development it was even harder to apply the theory on the particular psychopathology. Fuchsman sates that: ‘(…) neither in relationship to all males nor all females is Freud able to show that the Oedipus complex is resolved or dissolved, nor that the positive Oedipus complex is a universal phenomenon’ (Fuchsman 2004: 108). Since we are having trouble to follow the normal development, according to Freud, towards maturity; it is even harder to point out what distortions during development lead to abnormal and pathological states of mind.
With the Kleinian theory on the other hand about the Oedipus conflicts, the paranoid-schizoid position, the depressive position along with the symbol formation it is easier and more valid, in our view to point out disturbances in the developmental stages that might lead to anorexia.
In anorexics the main fear is that of intrusion. If the child (we are more specifically talking about girls), is not able to over come the paranoid-schizoid position and enter the depressive position during which the mother is seen as a whole object and distinguished from the self; the child is unable to tolerate the anxieties of intrusion which leads to refusal of food (Segal 1957: 394; Lawrence 2002: 838). In the paranoid-schizoid position the symbol formation starts but the early symbols are symbolic equations as previously mentioned. Because of the fear of loosing a good object or being attacked by a bad object the child creates symbols internally for these objects. When the symbols are treated as if they are the original object we have concrete states of mind. The good breast of the mother is the one that provides food and the child is afraid of loosing it so it creates a symbolic equation of it; the same happens to the bad breast in order to control it and protect the self from the objects attacks. If food is equated with the mother and the person does not achieve the real symbolization anorexia might occur. If the food is in phantasy the actual good mother the child might not take in food in order not to destroy the object by biting and devouring it. If on the other hand the food is a symbolic equation for the bad breast the child refuses to take it in as it can attack or poison the self- it is the intruding object (Segal 1957; Klein 1930: 220). In this case we could also have a purge type of anorexia when the child projects the bad object into the external world. As the bad object is not symbolized but equated with food the projection is vomiting. In this state of thinking the connection to reality both internal and external is disturbed. In normal development though the symbolic equations become real symbols during the depressive position and there is a gradual establishment of reality (Klein 1930).
In the depressive position during which the sense of guilt rises when the child understands that the bad and the good object are actually one; and that the previous attacks towards the bad object were also directed towards the good object. The child must deal with the early object relations. If the guilt is unbearable and the symbolic equations are not transformed into proper symbols the mother is still equated by food. The guilt of attacking the good object in previous states may lead to refusal of food so that the object will not be harmed by the self any more (Segal 1957).
Conclusions
Klein in her paper ‘The early stages of the Oedipus conflict’ stated: ‘I wish first to point out that they’, (her conclusions), ‘do not, in my opinion contradict the statements of Professor Freud’ (Klein 1928: 197). We will agree with that statement. Of course as previously discussed there are differences between the two theories. Here we choose to see both theories as adding to each other, after all the psychoanalytic theories did derive from the Freudian theory and developed more or less independently. The Kleinian theory is easier to understand and in contrast with Freud’s theory it presents a good structure in the presentation of the concept of the Oedipus complex and its developmental value. The way Freud states that girls never completely dissolve the oedipal situation evokes negative feelings to the female reader as it presumes that women have an incomplete formation of the super ego. We will not focus on the differences regarding the beginning of the Oedipus complex in the two theories as Freud did mention an earlier pre-oedipal state that is crucially linked with the Oedipus complex (Freud 1927: 138). Both theorists value the importance of the Oedipus complex regarding development and maturity. We cannot choose one over the other in the explanation of all psychopathologies and abnormalities in development; but in the case of anorexia we found the Kleinian theory easier to apply in order to make some suppositions about the causes of this psychopathology.
References
Birksted-Breen, D. (1996) ‘Phallus, Penis and Mental Space’, International Journal of Psycho-Analysis 77:649-657
DSM- IV (2002) Training Guide, Reid, W.H.; Wise, M.G., (eds), New York: Brunner/Mazel Publishers
Freud, S. (1905) ‘Three Essays on the Theory of Sexuality’, in SE 7
Freud, S. (1915-17) ‘Introductory Lectures on Psycho-Analysis’, SE 15-16
Freud, S. (1916) ‘Some Character-Types Met with in Psycho-Analytic Work’, SE 14
Freud, S (1921) ‘Group Psychology and the Analysis of the Ego’, SE 18
Freud, S (1923) ‘The Ego and the Id’, SE 19
Freud, S (1924) ‘The Dissolution of the Oedipus Complex’, SE 19
Freud, S (1925) ‘Some Psychical Consequences of the Anatomical Distinction Between the Sexes, SE 19
Freud, S. (1927) ‘The Future of an Illusion’, SE 21
Freud, S (1931) ‘Female Sexuality’, SE 21
Freud, S (1933) ‘New Introductory Lectures on Psychoanalysis’, SE 22
Frosh, S. (1991) Identity Crisis: Modernity, Psychoanalysis and the Self, London: Macmillan Education LTD
Fuchsman, K. (2004) ‘What Does Freud Mean by the Oedipus Complex?’, Free Associations 9, no 49: 82-118
Klein, M (1928) ‘Early Stages of the Oedipus Conflict’, The WritingsOf Melanie Klein Volume I: Love, Quilt and Reparation London: Hogarth Press
Klein, M. (1930) ‘The Importance of Symbol Formation’, The WritingsOf Melanie Klein Volume I: Love, Quilt and Reparation London: Hogarth Press
Klein, M. (1937) ‘Love, Guilt and Reparation’, The WritingsOf Melanie Klein Volume I: Love, Quilt and Reparation London: Hogarth Press
Lawrence, M. (2002) ‘Body, Mother, Mind: Anorexia, Femininity and the Intrusive Object, International Journal of Psycho-Analysis 83:837-850
Segal, H. (1957) ‘Notes on Symbol Formation’, International Journal of Psycho-Analysis 38: 391-7