Food may symbolically stand for an insatiable desire for unobtainable love, or expression of rage and hatred; it may substitute for sexual gratification or indicate ascetic denial; it may represent the wish to be a man and possess a penis, or the wish to be pregnant, or fear of it. Food may help one achieve a sense of spurious power and self-aggrandizement, or serve as a defense against adulthood and responsibility. Preoccupation with food may appear as helpless dependent clinging to parents, or as a hostile rejection of them. 1, 4 Hamburger, on the basis of psychoanalytic investigation of obese patients, reported also that symbolically food may carry an enormous variety of different, often contradictory, connotations. 16, 17.
These often very gifted young people grasped psycho-dynamic relationships with amazing ease, and they would acquire an extensive psychoanalytic vocabulary. They had a great tendency to remain basically unaffected by analysis, or to relapse after dramatic improvement. This happened not only with my patients but also with those analyzed by others. Mayer and Weinroth expressed doubt that favorable changes in anorexia nervosa could be attributed to "insight" and felt that they might be related to other factors. 27.
In evaluating and re-evaluating what might have been overlooked in the analysis of these patients, I gradually recognized that it was not the one or other "conflict" or anything of motivational content, but something in their basic approach to themselves and life. These patients suffered from an overriding all-pervasive sense of ineffectiveness, of not being in control of their body and its functions, of mistrusting as a pretense or fraudulent any thought and feeling originating within themselves. They were equally uncertain and confused in their understanding of the behavior of others. The easily acquired "insight" had been just one more "thing" they had passively accepted from their therapists, but which they had been unable to assimilate or use effectively in their own living.
