The psychoanalytic situation had been, in certain aspects, a factual reliving and re-experiencing of the transactional patterns that had pervaded their whole lives. Particular manifestations of transference had been duly recognized and properly analyzed "but had remained as ineffective as other interpretive clarification in this undoing atmosphere of basic self-mistrust.
In trying to unravel this paradox, my approach to these patients became simpler, one of fact finding rather than interpretive. The direction of my questions changed from trying to understand the why, the unconscious symbolic motivation of the disturbed eating patterns, to how it had been possible for a body function as essential and basic as food intake to be transformed in such a way that it could be misused so extensively in the service of non-nutritional needs. Pursuit of this inquiry led to the to me startling discovery that hunger, the recognition of nutritional needs, was not an innate capacity of the organism, but something that contained important elements of learning. It became apparent that something had gone wrong in the experiential and interpersonal processes surrounding the satisfaction of nutritional and other bodily needs, and that there had been incorrect and confusing early learning which resulted in an inability to recognize hunger and to differentiate "hunger" with the urge to eat from signals of bodily discomfort that had nothing to do with food deprivation, and from emotional tension aroused by a very great variety of conflicts and problems. Obese patients are even more inaccurate in recognizing satiety, the feeling of having had enough. 4 It became gradually clear that the old charge of obese people having "no will power" described an important deficit in their functioning related to their not being clearly aware of bodily sensations; one cannot exercise control over a function or need which is not even recognized.