Doctoral thesis: Redefining normality in relationship to one’s body through psychopathology analysis: a study of the borderline case of anorexia nervosa (english version by DeepL Pro) (original) (raw)

Our research focuses on analysing the relationship between normality and pathology in light of an eating disorder: anorexia nervosa. Our aim is twofold: achieving a better understanding of anorexia nervosa, whilst also assessing how this clearer view can help us grasp what constitutes a normal healthy relationship to one’s body. Does normality differ in degree or in essence from this psychopathological condition? Can normality be extrapolated from the patient’s previous experience before the onset of anorexia? Can it be found in the social norm outside of the patient? We argue that the criterion of normality can only emerge and emanate from the heart of the pathological experience and its subsequent recovery. We were therefore compelled to focus our study on a definition of the latter two. Our research includes a conceptual definition of anorexia nervosa as an alienated by-product of subjectivity within the determined sociological context of modern individualism. We base our study on the findings of Dorothée Legrand who, starting from the phenomenological notion of “bodily self-consciousness”, reaches a vision of anorexia nervosa as a rupture of the typical relationship between the ‘‘body-as-subject’’ (the body perceived from the inside) and the ‘‘body-as-object’’ (the body perceived and targeted from the outside, as sharing its existence with other external objects). According to this definition, an anorexic patient seeks to transform, in a controlled fashion, her own object-body in order to turn it into a material expression of her subjectivity. Paradoxically, losing weight and becoming thin, even to the point of reaching a negation of the object-body, are inherent parts of the process insofar as they contribute to expressing and consolidating the patient’s subjectivity. The anorexic patient’s self-affirmation is achieved through the controlled modification of her object-body: she uses her objective dimension as a mirror of her own subjectivity. She is then able, from that exteriorised controlled manifestation, to seek self-recognition from others. The fact that the awareness of the subject-body is too weak in an anorexic patient, as opposed to an overpowering object-body, leads her into trying to control the object-body in an attempt to turn it into an external prop for expressing her inner self, and thus bearing witness to her own existence. This allows us to understand anorexia nervosa in a Hegelian perspective: the anorexic patient works on her body, so as to stamp it with the seal of her own inner self, determined by her own conscience. This enables her to escape the estrangement of her own raw material body and allows her to inhabit a body she recognises as her own; the workings on her body will also allow her to achieve self-recognition from others. However, this definition does not cover the full extent of anorexia nervosa. In our opinion, anorexia nervosa appears to be a partly addictive strategy through which the patient attempts to become a socially integrated individual, whilst avoiding a true expression of her inner subjective “self”. We think that the anorexic patient’s notion of self is opaque and ill-defined, hence hard to exteriorize within the object-body. Indeed, how could she express something she does not fully grasp (or maybe, rather, « experience »)? We suggest that anorexia nervosa stems from a fundamental anxiety: that of an undetermined subjectivity, due notably to a predominance of alexithymia in the personality. Interestingly, this lack of subjective self-awareness coexists in our modern western society with a pressure, keenly felt by perfectionist anorexics, to be “someone”, i.e., to become an accomplished individual and be granted social recognition as such. Lastly, as revealed by Hilde Bruche’s work, anorexic people intrinsically suffer from a feeling of “inefficiency”, which makes them convinced they are not really capable of leading autonomous lives and to have a positive impact on the outside world despite their efforts. Achieving thinness therefore brings three outcomes: (a) it provides a substitute identity (a kind of “fake self”) to the anorexic person unable to find out who she is, (b) it allows them, through this substituted identity, to appear like a highly performing individual, admired by others for their self-discipline and high achievement, (c) it allows an immediate relationship to their body and provides an escape from other personal achievement demands, such as work, which confront them with an external reality potentially uncontrollable and unpredictable. On the opposite, the body is perceived as ultimately self-controlled. Our analyses lead to an understanding of the key stages of recovery, which depend on the patient gaining real autonomy. This autonomy can only be achieved firstly through a capacity by the patient to identify and understand her own inner emotions and develop an immanent “self” awareness, no longer dependent on external parameters, and secondly through an ability to understand signals inherent to her own body and achieve a body shape adapted to the body itself. When the body is no longer forced to be the symbol of a subjectivity based on a weak or non-existent self-awareness (alexithymia), it can then fulfill its own individual norms. This is the criterion of a healthy and normal relationship to one’s body. Thus, a pathological state is that of a body being used as physical proof and compensation for a subjectivity experienced as non-existent and ill defined; whereas a healthy relationship to one’s body is one which follows its own needs, freed from the coercion to be the externalised marker of a subjective state of confusion.