Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,
Department of Psychological, Health and Territorial Sciences, G. d'Annunzio University, Chieti, Italy.
Psychopathology. 2020;53(5-6):291-297. doi: 10.1159/000509625. Epub 2020 Sep 3.
Building on the optical-coenaesthetic disproportion model of so-called eating disorders, this paper provides a framework for the psychotherapy of people affected by these conditions. This model characterizes "eating disorders" as disorders of embodiment and identity, where a sense of unfamiliarity with one's own flesh, experienced as shifting and incomprehensible, leads to an impairment in the constitution of the Self and thus of one's own identity. Since there is a deficit of the coenaesthetic experience of the embodied Self, greater importance is assumed by body perception conveyed from without. To these persons, their corporeality is principally given as a body-object "to be seen" from a third-person perspective, rather than as a body-subject "to be felt" from a first-person perspective. The Other's look serves as an optical prosthesis to cope with dis-coenaesthesia and as a device through which these persons can define themselves. They are unable to accept the hiatus between "being a body" and "having a body," constitutively present in every human being, forcibly trying to recouple it, and finally ending up objectifying themselves to succeed. The external foundation of the Self thus takes the form of a constriction one can never be completely free of. Psychotherapy should thus accompany persons affected by eating disorders in their encounter with the miscarried dialectic between feeling oneself from within and seeing oneself from without through the gaze of the Other, so keenly feared by people desperately in search of self-control. Tactfully, the clinician accompanies the patient in taking a stance towards her symptom as the outcome of this miscarried dialectics, which is one premise for overcoming it. The clinician's gaze becomes the herald of recognition, allowing the patient to feel accepted in terms of her individuality. Feeling themselves touched by a gaze that waives its alienating potential in order to signify acceptance reactivates the identity-forming dialectics. Their body is thus revealed as the receiver of gazes, but also rediscovers its own possibility for self-determination starting out from these gazes. This intersubjective resonance between the clinician's gaze and the patient reactivates the identity-making dialectics between body-subject and body-object, creating the relational premises for overcoming the symptom.
基于所谓的饮食失调的光学共美感失调模型，本文为受这些病症影响的人群的心理治疗提供了一个框架。该模型将“饮食失调”描述为身体认同障碍，其中对自身肉体的陌生感表现为不断变化且难以理解，导致自我和身份认同的构建受损。由于缺乏对自身肉体的共美感体验，身体知觉从外部传达的作用就更为重要。对于这些人来说，他们的肉体主要被视为一个需要从第三人称视角“被看到”的身体客体，而不是一个需要从第一人称视角“被感受到”的身体主体。他人的目光成为应对去共感的光学假体，也是这些人用来定义自己的手段。他们无法接受每个人都存在的“作为身体存在”和“拥有身体”之间的差距，因此会强行试图弥合这种差距，最终导致自我客体化以获得成功。自我的外在基础因此形成了一种束缚，人们永远无法完全摆脱。因此，心理治疗应该陪伴受饮食失调影响的人，帮助他们应对内心感受自我和外部通过他人的目光观察自我之间失败的辩证关系，这是人们拼命寻求自我控制时所恐惧的。治疗师应该巧妙地陪伴患者，将其症状视为这种失败的辩证关系的结果，这是克服这种辩证关系的前提之一。治疗师的目光成为识别的先兆，使患者能够在其个性方面感到被接受。被一种放弃其异化潜力以表示接受的目光所触动，重新激活了形成身份认同的辩证关系。他们的身体因此被揭示为目光的接受者，但也从这些目光中重新发现了自身自我决定的可能性。治疗师的目光和患者之间的这种主体间共鸣重新激活了身体主体和身体客体之间的身份形成辩证关系，为克服症状创造了关系前提。
