The Body and Psychoanalysis: The Work and Influence of

A. B. Ferrari

III. ANOREXIA AND BULIMIA: TWO ASPECTS

OF ADOLESCENCE*

Fausta Romano

Translator’s introductory note: This paper is the third in a trilogy of papers dedicated to
the thought of Armando Ferrari, of which the first was ‘The body in psychoanalysis’ by
Paulo Carignani and the second ‘A brief introduction to the thought of Armando B.
Ferrari’ by Richard Carvalho which appeared in successive issues of this Journal.
Romano’s paper will be easier to follow for those unfamiliar with Ferrari’s thought in the
light of Carvalho’s introduction in which all the unfamiliar terms and concepts to be found
in it are explained.
ABSTRACT The author describes the shocking rapidity of bodily change which overtakes
the pubescent and adolescent body while the mind may be still that of a child. She
describes the way that these changes can make the child feel trapped in a body so
alarming that she is filled with claustrophobic fears and agoraphilic longings for freedom
from it. These are translated into anorexic behaviours whose denial of her body with its
feelings and desires result in a loss of contact with it. The results instead are agoraphobic
terrors and claustrophilic longings which translate into bulimic behaviours. The author
describes the way in which she uses Ferrari’s conceptual framework in order to break
this claustrophobic–agoraphobic see-saw and to gradually accustom her patients to their
new corporeal environment together with its issues of gender identity and sexuality
using several clinical examples.
Key words: anorexia, puberty, bulimia, oedipal constellation, claustrophobic anxiety,
agoraphobic anxiety, innate masculinity and femininity

Adolescence remains, as it always has, perhaps the most perplexing and

perturbing transformational period of life. There are cultures in which adults
attempt to facilitate it with rituals in order to contain the emotional disturb-
ance which characterizes it; but on the whole our understanding of it is
scant. I suggest that it should be considered a specific period of life with its
own particular psychic and physical modalities of functioning (Ferrari, 1994;

*Originally published by FrancoAngeli in Italian as Romano, F. “Anoressia e bulimia:

due aspetti dell’adolescenza”, in Carignani, P. and Romano, F. (Eds) Prendere corpo: Il
dialogo tra corpo e mente in psicoanalisi Copyright © (2006) by FrancoAngeli srl.
Reprinted by permission of FrancoAngeli srl. Translated here by Richard Carvalho.
FAUSTA ROMANO is a psychologist and psychotherapist, and President of the Istituto
Psicoanalitico di formazione e Ricerca ‘A.B. Ferrari’ (IPFR) [AB Ferrari Institute for
Psychoanalytic Training and Research]. She was the chief psychologist in a public health
psychiatric institution in Rome, and worked with Professor Ferrari from 1985 to 2006.
She is a clinician and promotes research and training in Ferrari’s theoretical and clinical
approach as well as international conferences. She has written and lectured extensively
on the psychoanalytic treatment of adolescents, particularly in institutional settings.
Address for correspondence: c/o Richard Carvalho [rrncarvalho@btinternet.com].
© The author
British Journal of Psychotherapy © 2012 BAP and Blackwell Publishing Ltd, 9600
Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. 5
DOI: 10.1111/j.1752-0118.2012.01301.x
6 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

Romano, 2000). A particular feature is the enormous disharmony within the

system of the individual when it is overtaken by violent physical changes which
oblige body and mind to negotiate a new relationship with one another. The
terms ‘harmony’ and ‘disharmony’ (Ferrari, 1992) emphasize the dynamic
aspect of the Onefold–Twofold system whereby elements emerge from the
entropic area, both periodically and in response to the demands of life. By
entropic area, Ferrari means that nucleus of the individual as a system which
contains the maximum energy and vital potential. Their emergence is very
disturbing and requires the recruitment of the ordering and organizing capaci-
ties of the system which are implicit in the bodily1 as well as in the psychic
dimensions. This conceptual framework makes the ideas of pathology and nor-
mality redundant both theoretically and clinically, because it conceives the
individual as a dynamic system in which everything converges on an incessant
drive and the search for new equilibria in relation to the constant demands of
life and the environment; and this implies the disruption of a preceding order.
This is a challenge which starts at birth as a continuous alternation between
states of greater or lesser harmony or disharmony in the relationship between
the corporeal dimension and psychic function. The psychic functions derive
from the corporeal, their function being to register the needs of the body. The
oscillation between their conflicting demands seems quietest during latency.
More recent clinical experience suggests, however, that, while even this phase
before the onset of puberty and adolescence might seem silent and undefined,
it has its own characteristic modes of functioning psychically in line with the
particular conditions determined by the body. This is the period in which, for
instance, a sense of time as unidirectional historic time emerges in association
with the process of separation–individuation. Both are part of the preparative if
invisible bodily transformations which are a prelude to the explosive and rapid
changes of puberty (Carignani, 1998). This alternation between moments of
harmony and moments of disharmony in the complex dialogue which unfolds
from birth onwards between body and mind has no conclusion, and reaches its
greatest intensity in the early adolescence of puberty, the period when the full
impact of the body returns to claim the limelight with renewed vigour, while the
mind which has to deal with it is still anchored to a mode of functioning dictated
by the demands of a small child’s body. The speed of these bodily transforma-
tions and the accompanying ‘hormonal tempests’ give the impression of disor-
ganization and disharmony. But this assumes normative ideas of order and
harmony rather than a powerful explosion of vitality which throws the old order
into disarray until a new equilibrium is established. From the point of view of
settled norms, the picture can seem ambiguous and disturbing: girls of 11 or 12
who do not yet have their adult dentition may nonetheless be visibly sexually
maturing, so that a child’s smile might greet one out of the face of someone who
is otherwise frankly a young woman, or an unbroken voice in a boy who is
obviously a man.
According to neuroscientists, this transformation is accompanied by a
process of neuronal pruning, the reduction of the number of synapses
contemporaneously with sexual maturation. This follows a phase in which, in
FAUSTA ROMANO 7

contrast, between about 10 and 12, ‘synaptic proliferation reaches its peak in
cortical regions, with a consequent disturbance of function which is like a sort of
background noise, and which can be attributed to the presence of these newly
formed synapses which have yet to be integrated into the emerging neurological
system’. Pruning coincides with:
a sort of re-establishing of order, or better, with the recovery of neurological
function, which, once the process of adolescent growth is complete, gives the young
person back the ability to process stimuli, especially emotional ones, of which he
had previously been master with the end of infancy. (Ghigi, 2003, p. 6)

So we can say that latency, the phase of transition from childhood to adoles-
cence, is marked by palpable phenomena and radical transformations in the
bodily and mental organization of the small child in preparation for what is to
become the new form of adult organization; and that this is expressed in modes
and forms of functioning which are specific and which in no way resemble those
of any other period of life. Out of this new corporeality, new modes and forms
of psychic arrangement need to come into play so as to be able to manage this
new body and its workings with all its new potential in the environment in which
the adolescent is immersed. It was Freud who originally signalled the profound
transformation which took place during puberty. In his hypothesis, with the
sudden and radical changes imposed by the body comes the definitive structur-
ing of sexuality as a result of the modification of the drives which mature out of
the autoerotic to be directed towards the sexual object. Essentially, he indicated
for the first time some central aspects of the passage from childhood to puberty
and adolescence as the one in which the definitive choice of sexual object is
made, whereby the difference between the sexes is irrevocably defined and the
real encounter with other-than-self begins. In this view, the definitive choice of
object is rendered possible by the resolution of what Freud terms the ‘Oedipus
complex’ (whose resolution he locates with the transition from infancy into
latency); and with puberty, the adolescent approaches reality in earnest (Freud,
1905, 1924). Ferrari’s thesis is that psychic functions are strictly tied to the
vicissitudes of the bodily, and he identifies the bodily dimension as the first and
only object of the mind. He hypothesizes that a dynamic relationship is estab-
lished between the corporeal and the psychic which is never completely free
from conflict (Ferrari, 1992). During adolescence, this relationship is character-
ized by the most intense entropic activity. The child’s mind becomes the witness
to rapid and radical transformations in the body of which she is a part, while she
is at the same time without the tools with which to cope with its bombardment
of new sensations and emotions. The stark differences between the sexes
provoke a feeling in the pubescent of her own loneliness together with an
awareness of the disquieting allure of the other sex of which she is ignorant,2
and with which she does not have the capacity to deal until she has had the
experience to develop it. This ushers in, with all its dramas, the perception
of personal limitation, of vulnerability, and of finite, unidirectional time which
no illusion can turn back, nor any flight of fantasy forestall. The Oedipal
constellation3 is driven in infancy by phylogentic need, the need for survival and
8 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

for security. It has to undergo a radical transformation with adolescence, when

the security afforded by possession of objects has to be abandoned, and the
adolescent has to entrust herself to the encounter with her own specific mode of
being which is driven by ontological need (Carvalho, 2012; Ferrari & Stella,
1998).
Like Freud, Ferrari places the accent on the pressure that reality puts on the
adolescent; but, in his hypothesis, the emphasis is on the reality of the changing
body, the changes in external reality being seen in relation to the changing
corporeality of the adolescent. Modifications on the vertical dimension inter-
weave and alternate with those on the horizontal (Carvalho, 2012; Ferrari, 1992;
Ferrari & Stella, 1998). They influence and are influenced by the relationship
with the cultural environment to which the adolescent belongs and which
provides the means with which she gives voice to her own world of desires,
expectations and experience. Clinically, this particular condition calls for a
specific sort of availability on the part of the analyst. First of all, he needs to
present himself in a way which is evidently distinct and therefore different from
the other adults in the adolescent’s life: he needs to be receptive to the grief for
a past which is lost forever and to which return is impossible; and he needs to
understand the drive towards experimenting in the new conditions, to create a
space and context in which the ‘doing’ which the adolescent is constrained to
enact leads as far as possible to a ‘knowing’ himself (Ferrari, 1994).The adoles-
cent is body, is anguish, is curiosity, is the heroic revolutionary leap, both
terrified and excited; he is as yet without knowing he is, as yet without knowing
how to be. The task of the analyst is to create a space with boundaries both
sufficiently flexible but at the same time sufficiently firm for the adolescent, in
which the boy or girl can experiment with their own specific way of being, rather
than provide them with models of behaviour; to indicate possible alternatives,
and to sustain the curiosity of the adolescent, and their capacity for reflection on
what they are experiencing of themselves. Rather than a direct confrontation
with areas of distress that one might adopt with adults, it is better to find
constructive areas, areas of interest, of pleasure and calm, and to use these as a
base from which they can contemplate their insecurities and anxiety (Carignani,
2003). The idea is to avoid plunging them into a sea of new sensations and
emotions without any points of reference and therefore to the risk of feeling the
need to flee back to their old defensive postures which no longer fit the new
situation, or relying upon external adult models. Both are source of disharmony
which constrain and reduce the capacities of an expanding ego constellation
(Ferrari, 1994; Ferrari & Stella, 1998).

Anorexia and Bulimia

Their new body thus seems a total unknown to the mind of the adolescent,
whose old childhood models or attempts to imitate the grown-ups is no help
to their sense of bewilderment, mixed as it might be with the curiosity
which accompanies the first unbidden transformations from childhood into
adolescence. There is no escaping this profound disquiet generated by the
FAUSTA ROMANO 9

unknown and by the need to ‘know by doing’ whereas, in order to do, you need
to know in order to avoid the torrent of emotion which such blind ‘doing’ is
likely to unleash.
The reality is that there is no shelter, or hardly any, from the changes which bear the
child into adolescence and which are unavoidably dramatic for girls. A girl lives in
conflict: she is alone with the bodily changes happening before her eyes . . . It is only
to be expected that she will look for aesthetic reference points, in particular,
stereotypical women. (Ferrari, 1994, p. 244; 2004, p. 208)

This witness of continuous and unpredictable change in her can ‘make her feel
that her body is a stranger’, as Ferrari continues, ‘a source of anxiety which she
sometimes lives with as a persecutor’ (Ferrari, 1994, p. 24; 2004, p. 208). This
situation can generate a profound sense of claustrophobia in the adolescent; and,
in some cases, it can be precisely these anxieties which can lead to anorexia in an
attempt to drastically reduce the unfamiliar, unknown aspects of her body which
feel both too obtrusive at the same time as unmistakably defining her. Girls then
might tend to try to return their bodies to the previous conditions of pre-
adolescence when everything seemed easier;to a body which is not too defined by
maturational development, albeit at the cost of their gender identity, so as to
maintain the illusion that ‘anything is possible’, and that they can oscillate
between masculinity and femininity at will. The sense of torment is often that of
being imprisoned in a body which they have not chosen to be in, and which
imposes an unmistakable bodily definition on a mind which is as yet that of a child
and unready for it. Mind is imprisonment in a body which flaunts its differences
from the bodies of those of the opposite sex, so that the adolescent can feel
isolated, while the refuge of childhood is cut off from them. Their distress can
become so pervasive and uncontained that they may become aggressive and
cruel towards their bodies as if these were indeed both strangers and a threat.
Anything which signals the presence of the body, its every sensation, shows the
futility of escape and renews the sense of entrapment together with the attempts
to reduce it to silence and restrict it to the smallest possible space, as far from
perception as possible. This is the desperate attempt of a mind which is still a
child’s to take despotic and tyrannical control of the body’s unmistakable
demands which threaten it with revolution and change.As the anorexic condition
drastically reduces awareness of the body, so the claustrophobic anxiety is
gradually replaced by agoraphobia which is provoked by the felt lack of bounda-
ries: the mind is projected into a limitless universe in which the fear of the passage
of time and life towards death becomes once again so intense as to be unman-
ageable to capacities already weakened by magical thinking. This appearance of
agoraphobic fears can lead to bulimic behaviour in an attempt to fill the feared
space so as to limit the unlimited in the attempt to return to a restricted space
which gives the illusion of being controllable. In this frame, then, anorexia and
bulimia constitute two sides of the same coin, two extremes of the same difficulty.
Analytic findings show how they are the epiphenomena of a problem that
predates their onset, as well as reflecting the enormity of the challenge to the
child’s mind of the transformations in her body, its new intensity of emotion and
10 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

sensation, and of all the changes in the internal world and in the world of external
relations. Analysis frequently reveals a repetitive cycle which defies any attempt
to intervene: the fear of being trapped generates anorexic behaviours which are
driven by agoraphilia: it aims to reduce the space taken up by the body, its needs
and its vulnerability, and to abolish the restraints which the body imposes on the
mind. This in turn plunges the adolescent into agoraphobic anxieties which in
their turn drive her into a claustrophilic bulimia. Claustrophobia, agoraphilia,
anorexia; agoraphobia, claustrophilia, bulimia: these are the features which go
round and round like an endless merry-go-round, and which result in a significant
increment in the anxieties which they are designed to eliminate. It is a self-
perpetuating and vicious cycle because it is an internal dynamic which leads to a
dangerous and dysfunctional split between body and mind which it inevitably
intensifies and widens.

Example 1
Anne (25 years) presented with anorexia in adolescence. It manifested in the
form of severe restrictions of her food intake and a reduction in her social
relationships. Over the course of her analysis, this alternated with bulimic crises
in which, in an attempt to neutralize her terror of an internal void, she compul-
sively and unthinkingly stuffed herself with huge quantities of food as well as
with work responsibilities which she claimed she could not avoid. At both
extremes, the objective was to get rid of bodily sensation, especially any
which might suggest pleasure; and her claustrophobic fears alternated with her
agoraphobic ones.
This oscillation gradually modified over the course of her analysis. Her eating
behaviours receded in importance and were replaced by a sequence of preg-
nancies and abortions, as if to suggest that her reproductive system had taken
the place of her digestive tract in the expression of her anxiety and in the
control of her alternate filling up and emptying out. The pregnancies seemed to
express her agoraphobic fears and the need to fill the frightening sense of a void
localized in her belly, though no longer in her gut. The abortions expressed the
powerful claustrophobic anxieties which were generated by an overwhelming
and over-close sense of her body, experienced with its physical sensation of
fullness and the associated emotions. It was as if there were too much life in the
very restricted and narrow mental space which was available to her.
I feel I’m always running faster and faster, away from a flood which is catching me
up . . . I look back and there’s only a tiny piece of dry land left. It’s getting smaller
and smaller, so that soon I’ll have nowhere to go and I’ll go under.
Nonetheless, the displacement from her digestive tract to her reproductive
apparatus as the theatre for her ‘perverse cycle’ of claustrophobia–agorophilia–
anorexia–agoraphobia–claustrophilia–bulimia allowed us to get nearer the issue
of her gender identity: she profoundly hated her femininity; and her hostility
towards masculinity was tinged with magical omnipotence. Her Oedipal situ-
ation was therefore marked by an insecurity which enormously exaggerated
its phylogenetic aspects of demandingness, possessiveness, jealousy and
FAUSTA ROMANO 11

competitiveness, particularly in relation to her maternal, feminine imago (Ferrari

& Stella, 1998).
Choosing this vertex of observation locates the problem strictly in the
passage from childhood to puberty and so to adolescence, which makes it clear
that to see this phenomenology as pathology induced by the culture which
surrounds us is not helpful (Ripa di Meana, 1995). For one thing, the first
definitions of anorexia nervosa date back to England in 1689 (Della Nina, 2003).
For another, I want to emphasize what appears in ‘mental anorexia’ as a
problem in relation to a real, historic mother concerns rather an infantile
Oedipal situation which is connected with difficulties for a girl in assuming her
femininity when this becomes unmistakable in her body.
The problem subsequently found a new medium of expression which was
focused predominantly on her sensory perception. Any perception, a potential
source of pleasure, or potentially evocative of an intensely sensuous experience,
was followed by a prolonged period in which the organ of perception which
was its vehicle was neutralized so that, for instance, the intense pleasure she
experienced in response to the smell of freshly cut grass or of bread straight
from the oven was followed by months of anosmia5 in the absence of any
demonstrable lesion. When she talked about having enjoyed some pleasure in a
relationship or some success professionally, she developed a sore mouth and
tongue. Interesting or enjoyable reading, or satisfying professional activity
resulted in her vision being obscured by yellow spots and her walking being
made difficult by vertigo. When a friend congratulated her on breastfeeding her
newborn infant, her milk dried up within a couple of days. Any access to her life
or any pleasure in or responsibility for her desire, emotion, or potential would
immediately activate a kind of blind automatism and a rise in her agoraphobic
anxiety. The very moment that her sense of need and vital potential were freed
from their claustrophobic straitjacket, the agoraphobic counter-fear would
mobilize to obliterate any trace of them.
The attack on her femininity was so intense as to affect her body, and the
intensity of her desire for life could only be expressed in disguised form as a
feeling of guilt in relation to Oedipal aggression and competitiveness: ‘I can’t
enjoy this perfume in the knowledge that my mother can’t smell anything any
more because of the damage to her olfactory nerve. It makes me guilty if I enjoy
what she can’t.’
Here, as I suggested above, it is useful to think in terms not so much of her
historic mother as the representation of her femininity which in the Oedipal
stage is expressed in terms of the maternal imago.
This particular type of psychic configuration which we call anorexia–bulimia
starts off in latency, particularly, for example, where the movement towards
differentiation–individuation appropriate to this phase is marked by preco-
ciously idealized dreams of femininity, so that first bodily adolescent changes
generate an enormous conflict between the wish to follow the longed for pro-
gramme of maturation and adulthood, and the wish to turn the clock back to a
stage when everything seemed possible, before the definition of gender. So the
stage is set for frustration, disappointment and defiance.
12 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

Characteristic Clinical Interventions

The central issue in the context of the analytical relationship is to address
the anxieties which underlie the anorexic and bulimic behaviours so that the
analytic relationship is enriched and freed from the constant litany about
food, weight and death. The emphasis is on creating space for the airing and
analysis of claustrophobic and agoraphobic anxieties which, hitherto unheard,
uncontained and un-understood, have merged and escalated, and translated
into automatic behaviours. The aim is to gradually modify the relationship the
girl has with her body, her sensations, perceptions, desires and expectations,
rather than getting lost in preoccupations about weight and intake which are
spectacularly futile and empty of any meaning, so that the patient is helped to
break the inevitability of the sequence claustrophobia, agoraphilia, anorexia,
agoraphobia, claustrophobia, bulimia, however briefly to start with. The focus
with each individual then is on the form that the relationship with her chang-
ing body assumes, and on avoiding content such as weight and intake which
deadens the analytic dialogue rather than progressing it. The function of what
I have been calling the ‘automatic and perverse cycle’ seems usually to be to
wipe out any experience as it emerges over the course of the analysis, because
perception itself is so freighted with anxiety inasmuch as it necessarily implies
the perception of solitude, of being alone with a body which is registering new
and unknown sensations, even, and perhaps particularly if they are pleasur-
able. In this regard, the adolescent ‘doesn’t yet know’.
Wanting to know how and who one is can lead to ‘doing without knowing’
and to the paradox which is that in order to ‘do’ one needs to ‘know’ (Ferrari,
1994). In this, too, the adolescent is alone because no one can tell her what she
is becoming. All the richness and complexity of her perceptual and emotive
world can seem ungovernable; so that she can feel inadequate to it and try to
wrest some illusory control in ways which are violent and self-destructive. The
intolerability of the sense of isolation tends to lead the adolescent to enclose
herself in an ever more isolated world, further and further away from the rest
of the world, from her peers and from grown-ups. This world is made of
dreams, idealizations and magic which is appropriate in childhood, but which
become a trap at this stage, when the realities of a new body with its new
sensations, perceptions and emotions erupt. It is a world which revolves
around weight control, food and obsessive rituals, all in the vain cause of
omnipotent control. It is a world which is coloured by hate and desperation,
obstinacy and hyperactivity, all of which intensifies every time the hope of
emerging from this grim prison offers a prospect of something new (Tustin,
1986). The anguish which arises in relation to perception then mixes with that
which arises from the sense of isolation, from that of pleasure and sometimes
from the sense of not being up to the impact of the thirst for life, an extreme
barrier to this being a sense of guilt. It is as if to enjoy life might in some way
result in the destruction of the surrounding world: added to the challenges of
her new body, of the desire to explore its possibilities, there is now the fear of
losing in the competition with other women. This is most acute in relation
to the maternal imago of femininity which dominates her Oedipal scenario,
FAUSTA ROMANO 13

especially now that the adolescent is capable of attracting the attention of the
male component. So imagining herself as a woman and assuming her wom-
anhood implies the guilt of destroying this rival, and this might represent a
line she cannot cross in order to take hold of it. Clinically, the challenge is to
transform this feeling of guilt into one of responsibility: ‘not in despite of
someone else, but on my own behalf’.
This can help reduce the fear of the new and unknown vitality which is
emerging out of the corporeal and can be a threat to thinking. It is a fear
which can sharpen the wish to prove one’s intellectual ability and so use them
to take on exams or work, so that the misgivings about assuming one’s
responsibilities can be contained by the pre-ordained rhythms into which
these fall. But all this effort can seem rather feeble and uncreative if it is
motivated by the attempt to find some distance from the perturbation of
unknown perception and emotion which seem unmanageable as they arise out
of the entropic area. This situation is complicated by the fact that, in terms of
the Oedipal situation, intellectuality is associated with the masculine compo-
nent, so that the girl on the threshold of adolescence is confronted with a
difficult paradox which she herself has generated in the construction of an
Oedipal constellation which inevitably remains trapped in the stereotypes of
phylogeny: the maternal imago is saddled with undiluted self-sacrificing good-
ness, and diminished beside the masculine which is all intelligence but one-
dimensional. This diminished feminine/maternal imago nonetheless emerges
as a sort of Amazon whose task is to embody the masculine/paternal imago.
The girl then finds herself in an dangerous impasse: her Oedipal situation is
governed by possessiveness and competitiveness, while her innate femininity
and masculinity (Ferrari & Stella, 1998) are reduced to empty simulacra in a
pointless struggle in which there is no possible position to take: in the situa-
tion where the male component seems so much more desirable and interest-
ing, what competition is there with a femininity so deprived of ‘femininity’?
And yet there is no escaping the way that her body advertises her femininity.
What way is there out of this impasse? The girl is oppressed by a body which
is making itself felt in ways which are unfamiliar, disturbing, explosive and
ungovernable, and in Oedipally, phylogenetically driven ways. Her need for
reassurance is increased and makes it more difficult for her to adapt herself
ontogenetically to her new corporeality, to the differentiation and individua-
tion which are by now inescapable, and to the sudden insistence of the direc-
tionality of time. Whence the strenuous attempts to obliterate the least trace
of the transformations or of experience; but whether the attempts succeed or
fail, the anxiety is increased and the situation is unsustainable. For the analyst,
the task is to ‘hold’: to mark whatever discernable movement, however tiny, in
the internal world of the patient, and to not be swayed by the blackmail of
vomiting, fasting or binging, by threats to life; nor to fall into the trap of
relations based on seduction or hate. It is essential to contain the intensity of
hate which is often overwhelming, and often takes the form of sadism, which
the adolescent, imprisoned in her anorexia, usually directs against herself and
her body. Holding this position facilitates the possibility of the claustrophobic
14 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

and agoraphobic anxieties emerging and, bit by bit, the anxieties which need
to be negotiated in the relationship with the new body. Attacks and rejection
which are ostensibly directed towards the analyst are in reality the expression
of the pressure to open up to life and the imminent unknowns together with
the accompanying terror of the ‘space’ which is opening up in the ego con-
figuration; so that, between hateful attacks and terrified rejections, the patient
might interject something like: ‘You’re very elegant today’; ‘I like the way
you’re dressed this morning’; ‘Oh, you’ve got a new hair style’. Behind these
blandishments, if they are resisted, lies a tentative solidarity with the patient’s
own femininity, however masked and fettered, which are the beginnings of an
imitative impulse and of an initial gesture towards the choice of gender; and
this is sometimes followed by a change in the way the girl dresses so as to
allow her body and its femininity, hitherto shrouded in loose and baggy cloth-
ing, to be seen more clearly. These are the initial but definite moments in
which the girl starts to experiment with wanting to be a woman and how to go
about it. It is the analyst’s job to register this, full in the knowledge that they
will probably be hidden again and, for a long time, giving the impression of a
retreat. It is a question of waiting, because these traces which have apparently
been obliterated by a re-emergence of violent attacks against her corporeality
continue to work invisibly within her system – invisible to both analyst and
patient. After a time, they make another appearance which is usually slightly
more complex than before.

Example 2
Barbara, 20 years. At the beginning of her analysis, there seems to be no space
in which this young anorexic might experience or express her feelings or in
which they might be rendered thinkable or sayable. There seems not the minut-
est space for a dialogue with herself or within the analytic relationship and,
during the session, she apparently limits herself to attacking the analyst or
herself or the world in general. She cries, makes a scene and is histrionic. The
analyst feels at a complete loss. Nothing moves. Every word is blocked, every
intervention heaped with scorn and destroyed. She either saturates the space
with interminable accounts of events, more as a vomiting than as a communi-
cation; or she interrupts the session once she has finished ‘vomiting’. When the
analyst attempts to intervene, she turns to her and says: ‘Oh! Hi there, sweetie!’,
dripping with hate.
Or: B: ‘You see what happens when I don’t vomit? I get pissed off with you,
even though you have nothing to do with anything.6’ Analyst: ‘You don’t need to
vomit your hate by vomiting your food at home before you come here like a
good little girl.As far as I’m concerned it’d be better the other way round so you
could work here on the hate which seems so disturbing for you.’ B: ‘See? You’re
too sweet: I can’t possibly hate you’, and she leaves in tears. The problem for the
analyst, as I have already said, is to hold on and to not give in to the blackmail
of seeing her ever skinnier and more skeletal. This is easier if the concrete
medical problems of the patient are being taken care of by a colleague, and
another is working with the family.
FAUSTA ROMANO 15

Registering modest changes and little fragments of experience as the analysis

progresses is one way in which the analyst can withstand and contain the
destructive and self destructive impulse with which the analysand attacks her
own experience.

Example 3
Carla who is 21 had vomited systematically after every meal for the last two
years and had damaged the lining of her throat. She remembered witnessing
the changes in her body around the age of 12 or 13, and the unspeakable
horror that she had no control over its expansion. She began to eat nothing
but carrots for a long stretch of the summer holidays. Terrified now at the
condition of her throat which she was worried she had damaged beyond
recall, she sought out an analyst so as to put a stop to her self-destructive
behaviour. The model of the little girl who in adolescence loses control of the
expansion of her body was unchanged: she was dismayed by the idea of a kilo
over her current weight which was dangerously close to the minimum which
can sustain life. She worked hard in the first months of her analysis and
agreed with her analyst to increase her sessions to four times a week. As she
confronted issues related to her gender identity, her primal scene emerged
with great clarity: she did not want her body to develop because she did not
want to lose her father’s attention. She said that wherever she might be in the
world or in whatever danger, he could rescue her; and he still, whenever she
met him, lifted her in his arms and put her on his knee. Beside this prince
charming of a father, there was a wicked step-mother of a mother whom she
saw as incapable of affection and taken up exclusively with her own loveli-
ness, about which the patient had a dream in which she was ‘spitting pellets of
food’ at it. This infantile myth or even fairytale to which she clung so stub-
bornly was maintained at the price of obliterating any contradictory sensory
perception: she ignored the cold, wearing light clothes in the depths of winter
when she slept with the window open because of her fear of suffocating.
Perhaps this was to relieve her sense of loneliness as if an open window rep-
resented communication with others, but also to lower the explosive heat of a
body she was unable to filter out, and whose vitality she could not stifle, her
mind being taken up with constructing fairytales with which to cling to the
past and to keep at bay the terrors on the unknown present. Over the course
of the analysis, she began to register smells, cold and heat, as well as – God
forbid – hunger. First of all, she dreamed of being hungry, and woke with the
impulse to empty the fridge. She got up and bit into a bread stick before she
had properly woken, at which point she realized what she had done which
made her anxious, so she made herself go back to sleep. Following this,
a temporary amenorrhoea put her in contact with a profound wish for
‘maternity’: ‘If only I were pregnant, I could eat what I liked because I’d be
doing it for another life within me.’
Such fantasy-desires are common in girls over the course of an analysis,
feeling within them the stirrings of a desire for life, the sense of a life which they
want to live but which immediately confronts them with the question of their
16 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

femininity. They seem like children who faced with their womanhood can only
open themselves to the urgency of pleasure and life via the medium of another
life which is conceived within them.
When Carla became ‘embodied’, she was so immediately overtaken by the
most extreme claustrophobic anxieties that she felt constrained to interrupt her
analysis. She left town and drifted from friend to friend in other places. She told
her analyst that she was much better and did not feel the need to continue her
analysis, which as far as she was concerned had achieved the desired result in
the six months it had lasted. Now she just wanted get on with her life, and the
sessions were in the way: ‘My life is just analysis and study and I’m suffocating.
I need something else. I want to live.’ The analyst tried various ways of getting
round this, including a reduction in frequency, before agreeing to interrupt the
analysis for a month, but to review the situation then. When the patient came
back for the prearranged session, she asked to come back; but she wanted to
change the frame, to pay for the sessions herself and come just once a week. She
alternated between episodes of bulimia where she would compulsively empty
the fridge or cram her time so as to leave no space free. This left her so anxious
that she would have to vomit everything out again. After a bit she admitted
dejectedly that she had started to vomit again, and that the old trouble with her
throat had come back. She felt she had failed.
Analyst: ‘You act: you live and gather experiences, and then you have to
remove any traces of experience.’ C: ‘That’s exactly how it is. I have to wipe it all
out and start again. I’m doing it all day now, eating and vomiting; beginning and
wiping out. I know I can’t start from scratch, but. . . .’ Analyst:‘Your thinking self
knows that, and I rather agree; but you have a sort of underground stream
below that with which it has interrupted all communication; and that thinks it
can obliterate everything.’ C:‘I hadn’t thought about it like that; but that’s right.’
Analyst: ‘So your knowing that you have had experiences, that you have had
those smells and tastes and can feel hungry, that you can take your body and
enjoy looking at yourself in the mirror – all of that fails to communicate to the
river of hate and fear which is running underneath. I wonder what it might be:
fear of time? Hatred of women whom you fear are prettier or cleverer than
you?’
What I am trying to do here is to is to reach something at a tangible level we
have not yet managed before, so that in this sense, the re-emergence of the
anorexic behaviour plays a constructive role, given that the patient otherwise
wants to bypass sensation and emotion with her intellect. Returning to the
month’s interruption and the analyst’s acquiescence, it is worth underlining that
part of the work with adolescents is to respect their need to experiment7 outside
the context of analysis: to experiment in the sense of experience, that is of
learning from experience (Bion, 1962b). Often, adolescents who are taken up
with ‘discovering by doing’ their own potential, which is as yet unknown, find
the presence of an adult, and therefore of the analyst as well, a useless or even
dangerous obstacle and inhibition. For Carla, who was no longer adolescent
strictly speaking, but stuck in a childishness which stopped her accessing the
ontological processes of adolescence, this modality of ‘discovering by doing’ was
FAUSTA ROMANO 17

particularly necessary, especially given the agoraphobia and claustrophobia

attendant on her ‘becoming embodied’.

Gender Identity, Parents’ Imagos and Relationships with the Family

Relationships with the family and, in particular, with the mother are often
invoked to explain what are called anorexia and bulimia. I want to clarify in
the first place that what seems to be about the adolescent girl’s relationship
with her actual mother is an epiphenomenon of something much more com-
plicated, and this has to do with the way in which she represents herself in
relation to the parental imagos, the maternal imago in particular. The imago
does not coincide simply with the historic mother, as I have already indicated,
but concerns rather the way in which the patient represents to herself aspects
of her innate femininity in sharp contrast to her innate masculinity in the
Oedipal drama. In addition, the violence and conflict with which her gender
identity confronts her find representation at the same juncture as her gender
itself is becoming unavoidably apparent in the relationship with this maternal
figure which is simultaneously so full of conflict, so idealized, so primitively
fought against and so desired. It is not, however, that the relationship with the
family can be neglected when working with adolescents given their emotional
and financial dependence on it, in our culture at least. Especially where self-
destructiveness is an issue, as it is in anorexia and bulimia, the creation of a
therapeutic context for the parents facilitates the analytic relationship with
the adolescent. It is often a question of providing a context in which emo-
tional problems connected with the parents’ own difficulties in facing their
respective changing identities. They are frequently people of particular sensi-
tivity, who themselves have managed to bypass the emotions, the fears and
anxieties which are part of growing up, and which, now, the processes of
development in their child no longer allows them to avoid; so that providing
an environment where they can be heard and worked through can contribute
to a family situation which is more suitable to the working through and
growth their child is seeking in analysis, and which will be firmer in the face
of worry and turbulence, blackmail and seduction. Some clinicians of course
think that family therapy is the treatment of choice (Selvini Palazzoli, 1998),
but, in my view, the most helpful approach is to offer the patient an analytic
experience in which she can revise and re-constellate the relationship with
her body.

Example 4
Dorothea (16 years) is saying: ‘I can’t stand seeing my body so deformed. I hate
it; I can’t bear to look at myself; I must hide it. At the sea-side I swam in a tee
shirt. I never show myself ever. If I ever think of having a relationship with a boy
I fancy, I imagine undressing in front of him, and him looking at me, wondering
what on earth’s wrong with my skin. I can’t bear to think of it.’ For this 16
year-old bulimic girl, the problem seemed to be a dense network of red stretch-
marks all over her skin which were the result of cortisone which she had been
prescribed for chronic asthma as a child. The reality was that her skin had
18 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

become the concrete and visible representation of all the bodily changes asso-
ciated with maturation which she so much feared. D: ‘My mother and sister are
tiny. I’m huge in comparison. I hate going out in the street with them: everyone
looks at me.’ Analyst: ‘Maybe it’s really your mind which can’t accept or manage
your body insisting on becoming a woman and seeming to grow too much,
rather than it being your skin that looks to you as if it’s breaking down and
laddering around it.’ D: ‘I eat lots – I can’t help it – so as not to think about what
it all means; but then I get anxious . . . and then, as I eat, I wonder what I have
to do so as not to absorb what I’m putting in my mouth. Otherwise my body is
going to get even bigger. So I think, for example, that bread takes a certain time
to be absorbed compared with meat or pasta and it’ll be ok if I can vomit it
before I’ve absorbed it; but I have to get to the bathroom in time to drink lots
of water until I can bring it all up, and so while I’m sitting at table with everyone
else, I stress that I won’t get to vomit before I’ve absorbed everything.’ Analyst:
‘What a terrible race against time! You’re fighting to keep your body within the
limitations of space and time which you have decided to impose on it. I wonder
what you can do about your fear. Maybe your body might seem less dangerous
to you if you knew a bit more about it: what it needs, what is good for it; what
is bad for it and so on.’
A few months later D came out of the isolation in which she had barricaded
herself against her peers out of fear and shame and even spent some time with
boys. But the way in which she did so was still dictated by the fear of coming into
contact with what she felt and perceived. D: ‘I’m going out in the evening to the
usual places with my friends and drink till I’m totally pissed: then I can let a boy
near me. But I’m not there and I have no idea what I’m doing . . . my friends tell
me in the morning . . . they think I’m the group tart . . . but I don’t know how
else to manage. If a boy ’phones me I can talk to him and tell him about me,
disclose a bit because I know he can’t see me. But if we meet, and if he tries to
hold my hand, I sort of feel disgusted and have to run away.’ Analyst: ‘So there’s
a part of you that doesn’t want to know what your body is doing, and that this
body has needs and desires which this something in you doesn’t want to know
about either. I wonder what it is: fear of your liveliness and beauty? Fear of not
coping? However frightened you are, can you at least see how much energy and
richness you’re wasting? Perhaps there’s a way of getting hold of it, a bit like a
horse that is spooked by its liveliness, and of calming it down a bit so it has an
idea of discovering how it is. Otherwise all that will be left of D will be her
stretch-marks because, as far as you’re concerned, at least they are concrete and
visible for you.
In certain cases, the fear of emerging sensation and emotions is so intense as
to provoke a break with the perception and knowledge of feeling. On the one
hand, these girls seem overwhelmed by a chaos of feelings, all of which seem
indistinguishable, so that, on the other hand, they seem totally unable to use
the simplest feeling in the service of experience and therefore of thought. In the
cases I have been describing, I use a technique which is more usually used in the
treatment of children in severely disharmonic states (Romano et al., 1993). I
create the conditions in which the analysand can enter in direct contact with her
FAUSTA ROMANO 19

feelings in order to mobilize her contact net, significant links, between sensa-
tions, emotions, feelings and thoughts. In this spirit, I have sometimes found it
useful to help girls to taste food during the session. The objective is not to
‘get them to eat’, to ‘feed them up’, but to help them have an experience of
sensation, of the functioning of her organs of sense as physical organizers
(Ferrari, 1992) with less anxiety.

Example 5
An example of this is that of Elena (20 years) who told me that, every morning
she came to a session, she would stop on the threshold of the bar opposite my
consulting room and feel tempted to eat certain ‘little biscuits’ she saw in the
window. I suggested she buy some and bring them next session, so she did: she
bought a bag of the biscuits containing four different flavours. I set them out on
pieces of papers on my desk and invited her to taste one, to which she agreed so
long as I did too. I did so, asking her to describe the different qualities of the
little biscuits and the criteria on which she had chosen these particular four
types. After a bit, while we were tasting this food, E started to tell me about her
anxiety of never living in the time in which she is: whatever she is doing, she is
always in the next moment with the things she has to do next. So I said: ‘That
way, you’re never doing what you’re doing while you’re doing it, and you can’t
know what you’re doing means. How terrible for you. A frantic rush to what?
Instead of thinking perhaps that you might sleep when you’re sleepy, drink
when you’re thirsty or eat when you’re hungry . . . because I guess that the way
you operate, you can’t ever know if you’re sleepy, thirsty or hungry.What do you
think?’
What this sequence shows is that, in allowing herself to perceive sensations of
taste, and so to experience different flavours, her discriminative capacities are
also activated at the level of symbol and thought, whence she is able to distin-
guish and recognize her anxieties and her mental function. Here, the analyst is
merely the means, using the medium of the food, of achieving a bypass whereby
E can get round the obstacles she has erected in the communicative channel of
her vertical area.
Some time later, E brought me something she had written at a moment of
terrible anxiety in which she was gripped by an explosive turmoil of desires,
fear, guilt, despair and hope, all mixed together.
Here is what she wrote:
A girl had found herself looking at a box of chocolates, alone in the house. She
looked at it longingly, wanting to take its ribbon of while at the same time bodily
repelled by a sense of violent disgust.
What she did was, without using her hands, to knock the box off onto the floor and
start a sort of sensual dance in which she crept and contorted herself, arching her
back until her buttocks were against the window before managing to get the ribbon
off the box and flick one of the chocolates out onto the floor with her tongue so as
to smell it. While she was immersed in this dance, however, the door suddenly
opened to reveal two boys who had been observing this scene without her knowing
and were now looking at her askance.
20 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

This is a vivid expression of B’s condition: she is unable to relate to her desire
with all its intensity and sensuality, so that everything in her life towards which
it might direct her, including the assumption of her femininity she sees closed to
her in a stupendous box of which she dare not take hold of knowingly, though
she is also unable to pretend she is not interested. So she uses all these exhaust-
ing subterfuges which do not, however, protect her from the irruption of what is
different, unknown or new to her, things she has insisted on looking at askance
ever since she was a little girl, and which appear to her unattainable and yet
threatening violations of her secret desire. All of this conspires to transform a
normal sense of shyness and modesty which accompanies the adolescent’s
attempts to realize themselves into a feeling of profound shame.

Example 6
Francesca, 18 years. Another patient told me that she did not know why she
needed to eat and that she had lost her taste. I offered her an orange to eat there
during the session so as to give her the opportunity of seeing what this taste might
mean to her. She started to peel it with exasperating slowness, and took a segment
between her lips. Then, very slowly, and as if struggling violently with herself,
started to chew it using only her four incisors.The drama reached its apogee at the
point she might have swallowed it: the segment would not go down.Far from taste
being the problem in this sequence, the problem was in taking something inside.
For the first time, she was able to have an experience which showed her that the
problem was not so much one of eating as of swallowing, of acceptance, of making
space within herself, of containing something.
My choosing to do this is because I saw that, in this case, rationality had
completely usurped perception and experience to the point that any attempts
they made to communicate were swallowed up by her rationality to be appar-
ently shared as such, but only as abstractions which could be kept at bay so as
not to allow the emotional experience anywhere near.
After a time, Francesca came back to continue the experiment with a bag of
nibbles of which she left half. This time, the problem with swallowing had
diminished, and she was eating happily, tasting what she was eating. The next
session, she said with some surprise: ‘I finished the bag when I got home and,
apart from tasting of itself, I also noticed it had the same smell as this room.’
Analyst: ‘You’re surprised by how many smells, tastes, sounds and sensations
there are around you. All this might lead you to think that that the more you
allow yourself to differentiate, distinguish and compare what you sense and
perceive, the less anxious you feel.
I should emphasize that, in both these cases, choosing to offer this concrete
experience of tasting food during a session comes out of a particular intrapsy-
chic context at a particular juncture in an analysis. I am not suggesting for a
moment that this is a generalizable or repeatable technique, but illustrating the
way that the possibility of tasting food was something which arose specifically
and spontaneously with these two particular patients at these particular junc-
tures in their analysis, as a function of the particular analytic relationships in
which we were involved.
FAUSTA ROMANO 21

Concluding Comments
Our observations have led us to the conclusion that anorexia and bulimia are
two extreme and complementary manifestations of a profound disharmony
between the capacity to articulate (mind) and the bodily sphere. This bodily
sphere (Onefold) is not able to generate meaning and so create the links which
lead to mind (Twofold) (Ferrari & Stella, 1998), which in turn does not have
sufficient space in order to focus the sensorial and emotional hubbub. The two
modalities are always co-present, even though, at any one moment, one might
be dominant. In the course of an analysis, however, as the internal world is
stirred, whichever of the two which has been left in the background makes its
appearance as the source of the prevailing anxiety, in relation to which the
complementary activity was put in place in order to protect the mind from the
emergence of disorganizing chaotic emotion. Schematically speaking, we might
say that, in both anorexia and in bulimia, the assault is on the bodily; but, in a
predominantly claustrophobic/anorexic state, the body becomes a prison for the
mind while, in agoraphobia/bulimia, it is the mind which confines the body.
What is set up, therefore, is a dangerously dichotomy of conflict between the
bodily dimension and psychic function which it is possible to reduce in analysis
and thereby re-establish a dynamic and functional unit. With Dorothea, when
the urgency of her corporeal vitality prevailed, the response was to switch
her mind off by resorting to alcohol so as to leave her body to it. But a body
deprived of mind cannot begin corporeality in the sense of the matrix of
experience from which it is possible to learn. In the other cases I have described,
the enterprise has been rather to preserve mind at the risk of killing body and
of putting the whole system at risk. Both methods are obviously pseudo-
solutions, but I find it useful to identify and recognize the presentation of these
different states in the course of treatment of these young women. It helps them
recognize what is going on inside them and to identify other ways and other
language registers with the aim of allowing them to communicate within them-
selves. This in turn helps them tolerate the fearful but fascinating descent into
the unknown which is the ontogenic event which is the assumption of their body
(rather than a phylogenetic given), and which is the abandonment of their
phylogentically protected place within the parental couple for the uncertainties
of life where nothing is assured them. Analysis is usually a question of treading
an unknown road with the patient, and silencing all theory and preconceived
concepts so as to be able to listen as closely as possible to what is evoked in
me during the course of the analytic relationship. A sense of impotence, for
instance, can then transform into the possibility of waiting and accepting my not
knowing with humility; or the powerful temptation to gather in and embrace the
baby/woman who seems imprisoned in a cage without an exit can be trans-
formed into the possibility of my holding the oscillation between her waning
infant and the rising adolescent striving to assume all the power of her vitality
within the analytic relationship. I will finish with a brief extract from a session
with a young anorexic who is trying to use her relationships with others as a
screen with which to shield herself from the unease of her relationship with
herself and the changes within.
22 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

Example 7
Giovanna, 16 years: ‘I can’t stay in the house on my own. If I find myself alone
for some reason, even if I’m doing something like reading or watching a film,
I feel terrified by the little noises around me. I can’t be on my own; it’s too
frightening. I don’t know if it’s mice or what.’ Analyst: ‘Well, . . . in the silence
when you’re alone, you feel you’re hearing the little noises of your body chang-
ing around you, your bones growing, your shape changing, and that all that
change in your body feels intolerable.’ G: ‘I feel I live in a spider’s web with my
parents, my friends, my brothers and sisters . . . I need first of all to look after the
web. It’s a load of threads which are the relationships with my family which are
suffocating me. If I don’t do something about them I’ll never be able to get on
with anything else.’
Analyst: ‘But don’t you think that this web is exactly what you are using to
keep you and your ‘little noises’ at bay because you hate what your body feels
as if it were ‘defective’? I’m not interested in that web, but in the body you’re
wearing away at, starting with your throat. That’s where G is perhaps; and
maybe G can look after her own web: she still needs it.’ G’s throat bled because
of her vomiting, which is what she did whenever she ate, despite herself, because
she was hungry and wanted to eat and put on the odd kilo so that she began to
look more like a woman.
If we think of infancy and pre-adolescence as an enthusiastic ascent towards
the peaks that pierce the bluest heaven, then we might understand the amaze-
ment and enthusiastic euphoria mixed with disconcerting fear in the adolescent,
who, having reached the peak, is faced with the view of an unending valley
beyond, rich in promise, but daunting in its uncertainty, in the fear of not coping,
or even in the terrible sense of impotence at not feeling able to match the
omnipotent fantasy of having achieved everything already, before realizing that
not a step has been taken into that alluring if disturbing prospect. It seems to me
that this is the sense in which anorexia and bulimia or rather claustrophobic and
agoraphobic anxieties accompany the passage from childhood into adolescence
in ways which are more or less evident. The new body feels claustrophobic; but
then so does the childhood world which is being left behind; while the immen-
sity of the beckoning vistas seems agoraphobic: all that potential experience,
everything to be lived, but in a certain way already present in a way which is as
yet unthought and unthinkable in that body full of little noises which is making
itself felt and transforming radically under one’s astonished gaze. This is the
body, which as we have already said, is at the peak of its neuronal connectivity
which the neurologists have described as ‘an expansion of volumetric transmis-
sion, that is the complex brew of neurotransmitters, of neuromodulators and of
neurohormones in which the central nervous system is immersed’ correspond-
ing to a simplification of neural pathways. ‘The surviving pathways represent a
reduction and are overburdened with metabolic demand; the neuronal reserve
is reduced . . .’ (Bandecchi, 2003, p. 25). If this is the physiological substrate of
the transformative processes that are realized in the passage from childhood to
puberty, it is hardly surprising that the adolescent has necessarily to concentrate
all her energies on this condition of exaggerated entropy, and that to expect
FAUSTA ROMANO 23

them to match up to adult expectations of coherence, intellect and thought in no

way helps the process.
Nor is it surprising that, in some cases, faced with all the bewilderment and
difficulty which all of this arouses in the individual, they should try, among all the
other possible ways of coping with them, to wipe out every trace of their existence
and ontogeny. This results in obvious damage, suffering and pain, and gets in the
way of the only resource available: learning from the experience in hand.The task
of the analytic relationship is to register the presence of these traces of experi-
ence as they arise and before they are buried, just like a river in lime-stone under
an apparently impenetrable barrier of rock, in the expectation that they appear
again a little further down the valley, a bit more articulate and complex, and more
congenial to the experience of living. In these ways, it seems that we are at the
beginning of our clinical research into adolescence,on the crest of the hill we have
just climbed, and ahead of us is all the potential to be explored and known.

Notes
1. [Translator’s note: ‘Bodily’ etc. here translates the Italian corporeo, which I have
largely refrained from translating into ‘corporeal’ etc. because it seems clumsy; but as I
explain in the accompanying introduction (Carvalho, this issue), Ferrari makes an impor-
tant distinction between the ‘physicality’ [fisicità] of the medical body as objective fact,
and the subjective body experienced as sensation and emotion [corporeità]. ‘Body’,
‘bodily’ etc. appear in the latter guise in this translation unless it is otherwise obvious.]
2. [Translator’s note: The Italian does not specify gender here; and it seems simpler, less
cumbersome to say ‘she’ unless gender is specified, given that all the clinical material is
about young women or girls. But the generality applies across the sexes.]
3. In Ferrari’s hypothesis of the Concrete Original Object (Ferrari, 1992), the Oedipal
constellation originates at birth, and with the succession of events which arise from the
continuous interplay between the components of innate masculinity and femininity
(innate in the ego configuration as preconceptions) in the context of the genetically
determined bodily aspects of gender identity: it resolves only with death. It is a constel-
lation made up initially of the parental imagos, but enriched in the course of a lifetime by
numerous other imagos, both masculine and feminine, all of which are registered and
take part on the individual’s particular stage, on which he himself moves in relation
to them, enhancing and articulating the relationship he has with his gender identity
(Ferrari & Stella, 1998).
4. [Translator’s note: These two passages from Ferrari’s works are in my translation.
I have given the pagination of the available English translation, From the Eclipse of the
Body to the Dawn of Thought (Ferrari, 2004).]
5. Anosmia = the incapacity to smell.
6. [Translator’s note: What is lost in translation in these passages is the interplay
between the contemptuous informality of the patient’s mode of address to the analyst in
which she uses the familiar ‘tu’ form, while the analyst retains the respectfully formal ‘lei’
form when responding.]
7. [Translator’s note: The Italian sperimentare means both to experiment and to
experience.]
References
Bandecchi, A. (2003) Basi neurobiologiche dell’adolescenza [The neurobiological basis
of adolescence]. Atti del convegno ‘Adolescenza, dal corpo alla mente’ [Conference
Proceedings, ‘Adolescence: From Body to Mind’], Rotary Club Arezzo, Arezzo, Italy,
2003.
24 BRITISH JOURNAL OF PSYCHOTHERAPY (2013) 29(1)

Bion, W.R. (1962) Apprendere dall’esperienza. Roma: Armando, 1983.

Carignani, P. (1998) La finta calma della latenza [The supposed calm of latency].
Parolechiave 16: 77–99.
Carignani, P. (2003) Corpo ed emozioni come regolatori della glicemia in un ragazzo
diabetico [Body and emotion as regulators of glycaemia in an adolescent boy].
Atti del convegno ‘Adolescenza, dal corpo alla mente’ [Conference Proceedings, ‘Ado-
lescence: From Body to Mind’], Rotary Club Arezzo, Arezzo, Italy, 2003.
Carvalho, R. (2012) A brief introduction to the thought of Armando B. Ferrari. British
Journal of Psychotherapy 28(4), forthcoming.
Della Nina, M. (2003) Anorexia nervosa e a psicanalise: tendencias e uma leitura
[Anorexia nervosa: Trends and a reading]. Revista Brasileira de Psicanàlise 37: 687–
710.
Ferrari, A.B. (1992) L’eclissi del corpo [The Eclipse of the Body]. Roma: Borla.
Ferrari, A.B. (1994) Adolescenza: La seconda sfida [Adolescence: The Second Challenge].
Roma: Borla.
Ferrari, A.B. (2004) From the Eclipse of the Body to the Dawn of Thought. London: Free
Association Books.
Ferrari, A.B. & Stella, A. (1998) L’alba del pensiero [The Dawn of Thought]. Roma:
Borla.
Freud, S. (1905) Three Essays on Sexuality. SE 7, pp. 125–245.
Freud, S. (1924) The dissolution of the Oedipus complex. SE 19, pp. 19–173.
Ghigi, I. (2003) Crescita ed adattamento all’inizio dell’adolescenza [Growth and
adaptation in adolescence]. Atti del convegno ‘Adolescenza, dal corpo alla mente’
[Conference Proceedings, ‘Adolescence: From Body to Mind’], Rotary Club Arezzo,
Arezzo, Italy, 2003.
Ripa di Meana, G. (1995) Figure della leggerezza. Anoressia. Bulimia. Psicoanalisi
[Figures of Lightness: Anorexia, Bulimia, Psychoanalysis]. Roma: Astrolabio.
Romano, F. (2000) Memoria e tempo storico nell’analisi con adolescenti [Memory and
historical time in the analysis of adolescence]. Psiche 2: 85–94.
Romano, F., Bucci, P. & Innocenti, P. (1993) L’alleanza terapeutica [The therapeutic
alliance]. In: Proposte per la salute mentale [Proposals for Mental Health]. Roma:
Kappa.
Selvini Palazzoli, M. (1998) L’anoressia mentale. Dalla terapia individuale alla terapia
familiare [From Individual to Family Therapy]. Roma: Feltrinelli.
Tustin, F. (1986) Autistic Barriers in Neurotic Patients. London: Karnac.
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