Infantile Anorexia, Co-Excitation and Co-Mastery in the Parent/baby Cathexis: The Contribution of Sigmund and Anna Freud

By Cascales, Thomas | International Journal of Psychoanalysis, April 1, 2017 | Go to article overview

Infantile Anorexia, Co-Excitation and Co-Mastery in the Parent/baby Cathexis: The Contribution of Sigmund and Anna Freud


Cascales, Thomas, International Journal of Psychoanalysis


Introduction

Eating, self-feeding, and ingesting are all terms that define the act of nourishing 'oneself' or the act of 'being' nourished. This a priori ordinary physiological act is underpinned by a vital need that corresponds to the metabolic and cellular needs of the organism. The different modes of expression of these needs may be grouped together under a more general function which we will call the feeding function. This function has a special place in the developmental landscape of the baby. However, while in principle it is solidly anchored in biology, it proves to be more fragile than it seems. Indeed, recent epidemiological research shows that 25% to 35% of the babies in ordinary paediatric clinics suffer from difficulties of restrictive feeding. For certain babies and toddlers, these difficulties can become more accentuated and turn into anorexia (2%) (Chatoor, 2009).

Infantile anorexia, as a symptomological entity, is complex and heterogeneous. There are many protagonists (parents, grandparents, nanny, baby, siblings, and so on), multiple causalities (infant/parent interactions, nanny/ baby interactions and so on), and important somatopsychic indications (sensory vulnerability: gustative, olfactive etc.). Indeed, many care practitioners from different orientations and disciplines are involved in this treatment: paediatricians, nurses, speech therapists, educators, paediatric nurses, and therapists. Hospital teams are often multidisciplinary and private sector treatment is provided by a network of practitioners. In spite of the constant increase in the number of anorexic babies, the modes of treatment proposed are increasingly dominated by the organic/functional dimension and less and less by the psychic dimension. Without denying the importance of the contributions, for instance, of Gianna Williams (1997), therapists specialized in the treatment of anorexic babies (contributing to the current international scientific literature) are almost all of a cognitivist and behaviourist orientation (Cascales, 2015). In view of this fact, it would seem useful to recall the clinical pertinence and scientific interest of psychoanalytic propositions. My clinical experience in a children's hospital suggests that psychoanalysis has a role to play alongside that of somatic carers. This article will help to further a better understanding of the interest of the psychoanalytic perspective in the clinical care of infantile anorexia.

To begin with, I am going to present a case study from my clinical activity in a hospital setting. In the second, theoretical part, I will focus on Sigmund Freud's research on orality (stressing parent/baby libidinal co-excitation) and also on Anna Freud's contributions, particularly on orality in relation to feeding (emphasizing the place of mastery in the parent/ baby relationship). In the third part, I will compare the metapsychological factors proposed by Sigmund and Anna Freud with the case study presented in the first part. The fourth part will be devoted to a number of clinical recommendations arising from hospital psychoanalytic practice with anorexic babies. In my conclusion, I will attempt to synthesize and open up the field of perinatal psychoanalytic practice with anorexic babies.

Case Study

The psychoanalytic treatment lasted one year at a rhythm of one session per week for the first three months, then once fortnightly for the next 3 months, and finally once a month for the final 6 months. A therapeutic consultation was conducted initially. Consultations specialized in eating disorders have existed for about 10 years now at the Toulouse children's hospital. The psychoanalyst who conducts this consultation may be assisted by a paediatrician, speech therapist and dietitian, if indicated by the treatment requirements. A video is proposed at the outset. If the video is accepted by the parents, it is used as a therapeutic support at the beginning of the treatment; working on the intersubjective elements initially serves as a springboard for gaining access to the intrapsychic elements. …

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