Primary Anorexia Nervosa
In his essays on Spain, Kazantzakis reports his encounter with a young Spaniard (12).
"That's Manola," my Spanish friend laughed as he told me. "All day long he lies there stretched out in the sun. He doesn't want to work, even if it means he has to die of hunger."
I went up to him.
"Ah, Manola," I called to him. "They tell me you're hungry. Why don't you get up and work? Aren't you ashamed of yourself?"
Manola stirred sluggishly, then raised his hand with kinglike grandeur: "En la hambre mando yo," he answered me. "In hunger I am King!"
As though hunger were some boundless kingdom, and so long as Manola remained hungry, he kept the scepter of his kingdom in his own hands.
This line, "In hunger I am King," expresses the essence of the inner problem in genuine anorexia nervosa. Like Manola, the anorexics struggle against feeling enslaved, exploited, and not being permitted to lead a life of their own. They would rather starve than continue a life of accommodation. In this blind search for a sense of identity and selfhood they will not accept anything that their parents, or the world around them, has to offer. Just as Manola's hunger failed to solve the social and economic problems of his country, so will the anorexic fail to achieve his goal of becoming a respected member of his group, capable of mature interdependent relationships, through his angry isolation and food refusal.
This view of anorexia nervosa as a desperate struggle for a self-respecting identity developed gradually from contact with many patients. It was formulated through the effort to identify the psychological issues and adaptive patterns at the crucial period in an anorexic's life when the refusal to eat began. While reevaluating the traditional theoretical concepts and psychodynamic explanations I compared details of my own observations with reports in the psychoanalytic and psychosomatic literature and could confirm every interpretation, though they were often contradictory, that had been considered as of specific psychodynamic significance by various writers. Gradually I recognized that the multiple psycho