REP 018 0160a

The Function of Eating Addictions and the Question of the
Body Image in Psychosis

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Silvia Lippi
Dans Recherches en psychanalyse 2014/2 (n° 18), pages 160a à 166a
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ISSN 1965-0213
DOI 10.3917/rep.018.0160a
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Recherches en Psychanalyse – Research in Psychoanalysis 18│2014
18│2014 – Psychoanalysis and Interdisciplinarity – II

Psychanalyse et interdisciplinarité – II
Body and Trauma
The Function of Eating Addictions and the Question of
the Body Image in Psychosis
La fonction des addictions et la question de l’image du corps dans la psychose
[Online] Dec. 26, 2014
Silvia Lippi
Abstract:
The question of the image of the body does not have the same implications in neurosis and in psychosis.
In clinical practice, we are able to observe that eating addictions are often linked to a narcissistic
problematic. But is this valid for all clinical structures? Using clinical cases, we seek to show the
difference in the function of addictions in neurosis and psychosis. This allows us to point out a
distinction that has to be taken into account in the direction of the treatment.
Résumé :
La question de l'image du corps n'a pas les mêmes enjeux dans la névrose et dans la psychose. Nous
pouvons observer cliniquement que les addictions alimentaires sont souvent liées à une problématique
narcissique. Mais cela vaut-il pour toute structure ? Nous chercherons à montrer, à travers des cas
cliniques, la différence dans la fonction des addictions dans la névrose et dans la psychose. Cela nous
permettra de signaler une distinction dont il faudra tenir compte dans la direction de la cure.
Keywords: image, narcissism, being, punishment, fault

Mots-clefs : image, narcissisme, être, punition, faute
Plan :
The Specular Image in Neurosis and its Relationship with Castration
The Specificity of Addictions in Psychosis
Food, Weight and Fault
Conclusions: The Differential Diagnosis
The image haunts the subject. Without wanting The Specular Image in Neurosis and its
to turn it into a generality, in clinical practice we Relationship with Castration
are able to observe how eating addictions are
often linked to a specular1 and/or narcissistic In neurosis, a body that is not perfect comes to
problematic. On this subject it strikes us as signal a narcissistic wound, an encounter with
opportune to draw a distinction between castration that is unbearable for the subject,
neurosis and psychosis in their respective who starts to detest himself when he does not
relationships with the question of the image and resemble what he wants to be, when he does
the question of narcissism. not look like his ideal image: he no longer loves
170
Journal of Psychoanalytic Studies.
Hosted by the Department of Psychoanalytic Studies, Paris Diderot at Sorbonne Paris Cité University.
himself because he does not accept seeing reference points, the limits of the ego. This can
himself coming “unstuck” from the perfect even stretch to the extent of pushing the
image of the self that has been constructed in subject to the brink of madness: in anorexia, the
the mirror, and with which he identifies. complaint concerning the body, or else its
The neurotic is often in a bad way due to the fall exaltation, can sometimes take on a delusional
of his specular image: as Freud showed very aspect. (We should bear in mind that a number
clearly, the neurotic problematic revolves around of manifestations of the real are independent of
castration, “imaginary” castration,2 because it is the foreclosure of the Name of the Father.4)
the phallic image3 of the self that the subject “I do not like my image” = “I do not like myself,”
fears losing. and this is a constant complaint from bulimic
We may think of the phallic body of the hysteric, patients. One day a patient said to me: “My
which contains too much jouissance: the dietician told me that I should love myself more,
symptom makes the subject jouir at the level of that my problem is that I do not love myself
the drive, at the same time as it brings him or enough.” But in neurosis, reinforcing the
her face to face with castration. In the case of subject’s ego can turn out to be dangerous.
one young woman, each time that she manages Indeed, any therapy based on support does no
to seduce someone, she subsequently feels more than reinforce the subject’s concentration
obliged to keep eating. These eating binges on his or her own (more or less) phallic image,
allow her to withdraw her investment from the by leading him or her to dodge his or her desire:
identification with the phallus that was the clinician “enters” into the symptom and
operative during the seduction (she is haunted consolidates it.
by the perfection of her body and she detests “I love myself / I have myself” is the same thing
the idea of putting on weight). Of course, the when one is engaged in the search for the
image in the mirror has also fallen foul of this. phallus at the level of one’s own body: we are a
The fear of not being sufficiently phallic (which long way from the dynamic of desire, the desire
at the same time goes hand in hand with the that necessarily occurs as a result of lack, the
fear of being overly phallic) sometimes gives rise desire that is constructed on the basis of
to eating symptoms. The symptom “transfers” castration5 and the painful acceptance thereof
the narcissistic problematic onto the body: the (at the unconscious level).
badly treated body – too much or not enough
food, the “urchin” effect of the body – leaves its The Specificity of Addictions in Psychosis
“mark” on castration, but it also refers to a small
“gain” of jouissance. There is castration and The question of eating addictions in psychosis is
jouissance at the same time. The specular image altogether different, for what poses a problem
is saved by a detour – there will be fasting after in psychosis is not the specular image. When
the great binge – but it still runs the risk of eating disorders become apparent, they
losing its base as soon as there is a return of the “conceal” something else that belongs to
repressed. another order within the structure. It is not the
The anorexic symptom tries to support, in a specular being that is altered, but being full
paradoxical way, the image of unity and stop: the subject is annihilated, as though he or
perfection, which runs the risk of coming she is being invaded by an outside force that
undone from one moment to the next. The cannot be fought and that objectifies him or
search for perfection, or the fear of the loss of her. At this point, the subject becomes lost as
perfection (castration anxiety) can become the level of “being” (rather than at the level of
disproportionate for a subject, to the extent of the “image”).
making him or her lose all of his or her A young woman of twenty-five, whom we shall
coordinates, the symbolic or imaginary call Pamela, had been hospitalized several times
171
following bouts of mania that regularly preceded above. For Pamela, the problematic of weight
suicide attempts. Pamela had been stable for gain and the body – a badly treated body – does
some time (but still had to give up her studies not concern the specular image; nor is it linked
and any idea of working in an unprotected to the question of narcissism. She was to say to
environment). Notwithstanding the (momentary) me one day:
stabilization of her mood, she was still causing There is something rotten in me, it doesn’t
the service some worry due to her obesity: 140 matter if I’m fat or thin. I’ll never be able to
kilos for 1.62 meters, and her weight was going fill the void by stuffing my face, I know. The
up. The situation was starting to become only solution is death. Food is my
dangerous for her from the point of view of her punishment. I punish myself with food, I punish
myself by eating. This is the punishment I
health.
deserve. Because I’m good for nothing. My
Pamela was replacing her bouts of mania by food family is right. My mother’s always saying
and eating: so… I’ve failed everything. My studies, my
work, my relationships, everything… I’ve got
When I eat, I’m happy… it does me good. nothing, I am nothing, I’m worth nothing.
Eating calms my nerves. Otherwise, I feel
bad… I don’t know what to do with my days, This young woman eats so as not to die, or else,
I get bored… I know that I’m filling a void with she is killing herself by eating. Like drink for the
food. I don’t do anything, I’m worthless, I’m
nothing. I used to buy clothes, books, CDs,
alcoholic, food has assumed the function of the
DVDs, and so on… but today I buy all this pharmacon;6 it is both medicine and poison.
junk food that makes me fat. I used to walk Through the destruction of her image, she “kills”
all over the place, all day long , and all her body – and her being – by identifying with
through the night… I remember my nights in the “trash object.”7 She is a trash object for the
Paris… I used to walk, I would walk with an
empty head, without thinking about
Other, in this case the Maternal Other:
anything… Nowadays I do nothing but eat. I My mother is only interested in my
eat all the time. weight. We never go to the cinema
together. We only talk about my weight.
The patient continues: Being fat is what links me to my mother
I detest my image. I can’t look at myself in now. Since I found out that my father was
the mirror any more, I hate the body I see, I cheating on her, and he abandoned me, it’s
hate my body… I hate myself. the two of us against him. I do not know
which of us is the parasite on the other…
We may note that from a phenomenological
point of view this is the same complaint and the It should be noted that her father’s
same self-accusation that we meet in neurosis abandonment of her mother is experienced by
(see the case of the neurotic patient cited the patient as her own abandonment: Pamela
above). confuses her mother with herself;8 they are one
When Pamela is faring better, she pays self-same entity in the face of the father.
attention to how she looks, she dresses well, During another session, the patient tells me:
with a certain personal style. On the other hand, My family is horrified by my weight.
when she sinks into a depression, she does not Either way, I do not give a damn: I am
take care of herself: she does not bathe, she nothing but a lousy swine. I pretend to be
worried about putting on weight… I do that
does not look after her hair, she does not wear for my mother. I really do not give a damn.
any makeup, she wears whatever is lying around
… And she eats. She shows me a drawing she has made of
According to our hypothesis, this is not a case of herself. Her body on the paper has two
hysterical bulimia, where the symptom (eating) contours: she explains to me that she had drawn
would come to “regulate” the question of the two outlines in order to mark out the difference
phallus, or the question of seduction, as we saw between her way of seeing herself and the way
172
her mother saw her (this being the outermost At the same time, her repellent body, which is
contour). “Can you see? I don’t see myself as overtly and shamelessly exposed, turns out to
fat. My mother is the one who wants me to see be the only means of opposing the desire of the
myself like that.” Other.10 This form of exhibitionism, which is
The patient had refused to allow herself to be almost perverse, becomes a sort of
hospitalized in weight-loss clinics on several “compensation” for the psychotic subject
occasions, which shows once again that, for (though of course we clearly cannot speak in
Pamela, weight is not a concern at the level of terms of a “supplementary device”11): the
her image. perversion sustains the subject’s phallic image.
And it is, notably, this consistent phallic image,
which would allow her to maintain her “I”12
Food, Weight and Fault
which this young woman is lacking.
Sectioned for a certain time in the clinical The bulimic symptom in psychosis shows the
center, following a deep depression9 that absence of the paternal function and it becomes
prevented her from getting out of bed, of going a sign: a monolith that represents the failure of
to wash herself, of getting dressed, and so on, the paternal metaphor. In this sense, speaking
she had to go to a weight-loss clinic on the in terms of a bulimic “symptom” is (fairly)
advice of her psychiatrist in order to set up a imprecise: the difference that resides within the
treatment plan. But the young woman was signifying articulation S1 – S2 is cancelled out
never able to perform this visit. She had a here. The subject is not represented by a
further breakdown at the hospital and found signifier that represents another signifier, but
herself in the isolation room. She had given the rather inscribed as a monolith13 that is identified
finger to the psychiatrist, a gesture that with the extra-metaphorical sign that only
symbolized her refusal to enter the clinic: there represents itself.
was nothing in the world that could make her The three instances of image, body and being
want to go to a clinic for slimming treatment. So are confused in psychosis. It is not the image
she told me during one session once she had left that is “rotten,” it is the body (functional meat
the psychiatric hospital. for the Other) and with it the being of the
What therefore is the function of this subject that is reduced to nothingness from that
“misshapen” body for this young woman? What point forth.
is the function of her mistreated ego and her
destroyed image? This is not an “altered” Conclusions: The Differential Diagnosis
request for love, the need to be valued by the
Other for her own beautiful image – the In melancholia, the subject is guilty. This guilt is
homologue of the “beautiful soul” described by formed on the basis of the identification with
Hegel – that obsesses her (as is sometimes the the lost object – the distance from the lost
case in neurosis), but the Other’s will to object grows dim –, an object that the
jouissance, a will that insists in psychotic melancholic subject does not manage to grieve.
subjects and that imposes the fact of seeing In the case of Pamela, the lost object is the
oneself as a lousy swine, and of identifying with father.
this swine. The identification with the lost object in
The excess weight proves, and above all shows, melancholia comes about in an altogether
the young woman’s identification with the trash particular way: it is a matter of incorporation
object: she pays for her fault, the fault of being (Einverleibung) in its real dimension. This lost
a foul, ignoble and despicable being; as she object, which could also be named “the
keeps telling me, she is paying for a fault from assassinated little other” (hence the fault of the
which she will never be able to extract herself. subject), attacks – invades – the subject in the real
173
(and not his image, his phallic image, as is the In neurosis, narcissistic support shows itself to
case in the neurotic’s mourning). The subject be inefficient: the reinforcement of the specular
can no longer separate – unconsciously – from dimension winds up crushing the subject under
the object. Thus, this is a bad encounter, a the weight of his or her ideal. The more the
tuche, an incursion of the real through the subject believes him- or herself to be approaching
intermediary of the lost object that from this the ideal, the more confident he or she may
point forth cannot be replaced.14 feel: but the entire construction is a fictive one.
Lacan is explicit on this point. In the Seminar on The image is ravaging: specular identification,
The Transference he writes: which is a blend of phallic unification and drive-
One curious thing is that the object is
based jubilation, is fatal for the subject, who will
never manage to hold fast in the attempt to stay
much harder to grasp here on account of
certainly being present, and on account of in harmony with this image. A clinical practice
triggering infinitely more catastrophic that is oriented by the question of desire can
effects, since they extend as far as the turn out to be more effective than any other
drying-up of what Freud calls the most
fundamental Trieb, the one that fastens you
full-frontal attack on the symptom (whether the
onto life. symptom is bulimic and/or anorexic). At the end
of The Four Fundamental Concepts of Psycho-
And he adds: analysis, Lacan speaks of the analyst’s desire as
“I am nothing, I am no more than a piece “a desire to obtain absolute difference,”16 a
of trash.” You will remark that the specular difference that is none other than the cut
image is never involved. The melancholic
subject does not tell you that he is not
between narcissism and desire, where the
looking well, or that he has got an ugly mug, phallic fall of the subject corresponds, of course,
or that he is twisted, but rather than he is to the abandonment of any concern for the
the last of the last, that he brings about image, but above all to the enactment, to the
15
catastrophe for all his kind, and so on. praxis, of his or her desire.
In melancholia, as is the case in mania, too In the clinic of psychosis, sustaining narcissism is
(which is the other side of the same coin), the most surely in vain: the foreclosure of the Name
subject is not haunted by the specular of the Father blocks the “interplay” between the
problematic: the question does not revolve presence and absence of the phallus (and of
around the narcissistic object, but around the castration). It is not, however, a pointless
fault, a radical existential fault that directly enterprise to seek to reconstruct narcissism from
attacks the subject’s desire. scratch. In other words, it is not pointless to seek,
When we think differently about the function of in the treatment, to install an avatar of the mirror
addictions in neurosis (the specular problematic stage that allows an egoic consistency to be given
that revolves around castration) as opposed to to the subject, a certain “imaginary mate-
the function of addictions in psychosis (an riality,”17 as Jean Clavreul has put it (even if this
attack on the desire for life from the angle of an “imaginary materiality” does not hold up in every
identification with trash, at the same time as an circumstance). This is a provisional and
attempt to refuse objectification), we are also precarious sleight of hand in the imaginary, an
pointing out a difference in the direction of the artifice that seeks the reemergence of a subject
treatment. who is in the process of eclipse.
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Lepoutre, T. (2011). Remarques sur l’autisme de la can also be the “symbolic” phallus (Φ), which represents
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4
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5
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sujeito? Que lugar para o sujeto nas drogas? Uma lectura minimum must be retained in order to define what the
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Notes: Miller, Paris: Le Seuil, p. 308.
6
Like alcohol, food can also have a “compensatory” function
1
By “specular image” we mean the unitary narcissistic for the psychotic subject, a compensation that comes to “fill
image that is constructed in the mirror. in the signifying fault line or the effects of this fault line.”
2
The symbolic, the imaginary and the real may be defined Askofaré, S. & Combres, L. (2011). “Symptoms and
as the “synthetic” qualities of the structure: according to Supplementary Devices, An Attempt at Problematization”. In
Lacan, they constitute the different dimensions (dit- Recherches en Psychanalyse [online], 13.
7
mensions) of existence. See Lacan’s 1975-1976 Seminar, Identification with the trash object concerns both
Le sinthome, which has now been published as Lacan, J. melancholia and schizophrenia, of course, depending on
(2005), Le séminaire livre XXIII: Le sinthome 1975-1976, its different modalities. “Nowadays, one willingly inscribes
edited by J. A. Miller, Paris: Le Seuil. The imaginary is the into the same register both this terribly infernal passivity
dimension that stems from the constitution of the image for therapeutic pretension, in which the psychotic only
of the body. Therefore, it is to be understood on the basis seems to exist as an object of care, by showing us that life
of the image. This is the register of both the specular and no longer sustains him with any consequence in which he
the lure. The symbolic is the dimension that is attached to would have to put something of his own into it.”
the function of language, and more especially to the Lepoutre, T. (2011). “Remarques sur l’autisme de la
function of the signifier. The symbolic bears a close schizophrénie” in Schizophrénie. L’évolution psychiatrique,
relationship with the father and, in particular in Lacan’s Vol 76 Issue 4, p. 607.
8
oeuvre, with the Name of the Father, the dead father of “One would witness a confusion of limits in the
Totem and Taboo who founds the law and desire. The real transgenerational tie,” from Estellon, V. (2012). “Le temps
175
immobilisé” in La pensée magique, Cliniques méditerra- (S1 and S2) . Cf. Lacan, J. (1977). The Seminar Book XI, The
néennes, Issue 85, p. 135. Four Fundamental Concepts of Psychoanalysis 1964
9
The patient had had a breakdown during her return to [1973], edited by J. A. Miller, translated by A. Sheridan.
work (in a protected environment). London: Hogarth Press; reprinted by Penguin Books
10
Teixeira Ribeiro, C. (2009). “Que lugar para as drogas no (Harmondsworth, 1993) with an introduction by D.
sujeito? Que lugar para o sujeto nas drogas? Uma lectura Macey, p. 238. According to Colette Soler, the holophrase
psicanalitica do fenomeno do uso de drogas na can be implicated in all structures: “The holophrase
contempraneidade” in Agora, Vol. XII issue 2, p. 335. precedes the sentence,” writes Soler; “[...] the first
11
Here we reproduce the definition of the supplementary spoken words can function as an enjoyed holophrase
device offered by Patrick Martin Mattera: “A supplementary distinct from any message.” Soler, C., The Unconscious
device consists in attempting to replace the Name of the Reinvented, translated by E. Faye & S. Schwartz, London:
Father by a singular signifier that is often the result of a Karnac Books, 2014, p. 34.
14
delusion or conditioned by one, and which belongs to the Lippi, S. (2008). “Espace de la passion dans la
subject alone and thus, by virtue of this fact, only manages to mélancolie : quelle place pour la séparation ?” in
preserve a social bond with great difficulty.” In Martin Séparations, Cahiers de Psychologie Clinique, issue 31,
Mattera, P. (2011). “Sublimation ou sinthomation ? Apports p. 165-177.
15
et réflexions cliniques sur la création dans la psychose” in Lacan, J. (1991/2001). Le séminaire livre VIII: Le transfert
Ecriture, L’évolution psychiatrique, Vol 76 issue 3, p. 425. 1960-1961, edited by J. A. Miller, Paris: Le Seuil, p. 463.
12 16
Lippi, S. (2013). “Une femme, objet d’amour ou fétiche ?” Lacan, J. (1977). The Seminar Book XI, The Four
in Violences conjugales, Cliniques méditerranéennes, 88. Fundamental Concepts of Psychoanalysis, Op. cit., p. 276.
13 17
See also the concept of “holophrase.” For Lacan, the Clavreul, J. (1987). “La folie de Louis II de Bavière” in Le
holophrase is the “mass seizure” of the signifying couple Désir et la Loi, Paris: Editions Denoël, p. 110.
The author: Electronic reference:
Silvia Lippi, PhD Silvia Lippi, “The Function of Eating Addictions

Psychoanalyst, Philosopher, Clinical Psychologist and the Question of the Body Image in
(EPS Barthélémy Durand, Etampes) Psychosis”, Research of Psychoanalysis [Online],
Doctor in Psychology (PhD) associate lecturer at 18|2014 published Dec. 26, 2014.
the University Sorbonne Paris Cité, Paris Diderot
This article is a translation of La fonction des
Université Paris VII Diderot addictions et la question de l’image du corps
Campus Paris Rive Gauche dans la psychose.
Bâtiment Olympe de Gouges
11, rue Jean Antoine de Baïf Full text
75013 Paris
France Copyright
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18│2014 – Psychoanalysis and Interdisciplinarity – II

Keywords: image, narcissism, being, punishment, fault

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