Biomedical subjects
Publications and source records attributed to J R Bemporad.
The process of psychotherapy with individuals with Attention Deficit Disorder who may require this form of intervention (in addition to medication and psychoeducation) is described. Salient features of therapy specific to these patients, such as the subjective effects of medication, characteristic defensive operations, and reconciliation with the past, are emphasized.
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A review of cultural and historical accounts of anorexia nervosa indicates that this disorder is found primarily in Westernized societies during periods of relative affluence and greater social opportunities for women. Some hypotheses regarding the vulnerability to eating disorders are proposed to the basis of these data.
UNLABELLED: Recent publications have indicated that voluntary self-starvation is not a recently developed syndrome and that it has been reported throughout history. These prior forms of inedia are summarized and related to their historical and cultural contexts. On the basis of these data, some hypotheses are proposed regarding social influences on the vulnerability to eating disorders. OBJECTIVE: To document and describe forms of eating disorders occurring prior to the formal medical description of anorexia nervosa in the late 19th century. METHOD: Review of historical references to self-starvation, of recent publications on the history of eating disorders, and of articles describing cases of eating disorders occurring in the past. RESULTS: Forms of eating disorders have existed since ancient times varying in frequency, manifestations, and possible motivation. DISCUSSION: Certain sociocultural factors appear to foster or inhibit the frequency and type of eating disorders.
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Much has been written in both the professional literature and lay press regarding the sociocultural basis for the current increase in eating disorders. The typical victims of these afflictions appear to be intelligent adolescent girls from middle and upper class families (Garfinkel and Garner, 1982). Although the general pressure for thinness, mastery, and achievement among women in our culture undoubtedly help shape the course of illness, these social mores do not appear to be its root causes. The data presented here suggest strongly that the truly eating-disordered individual has a history of disturbances in early relationships, leading to a lack of security and pronounced difficulties in trusting others, and in simply being an authentic individual in the presence of others. As such these individuals share many characteristics of others with severe personality disorders such as inner emptiness, problems with identity, fear of abandonment, and peer relationships (Clarkin et al., in press), but differ in the expression of these basic defects or in solutions found to compensate pathologically for these core deficiencies. Therefore, although contemporary cultural ideals and values may supply the shape of the disorder, these individuals would have fared badly in any social climate although their presentation of illness may have differed (Bemporad et al., 1988). It is this profound underlying personality pathology that necessitates prolonged treatment for any hope of amelioration. Later reports will address this indication with a description of the results of therapy.
The theory of neoteny assumes that adult animals that are higher on the phylogenetic scale retain juvenile characteristics for greater periods of their lifetime. This hypothesis would account for the continuation of curiosity, learning and playfulness in humans and other higher primates in contrast to less evolved mammals. The failure of the neoteny process could result in humans that have lost these juvenile characteristics and lack motivation, curiosity and the capacity to learn freely. These features are indicative of the negative symptoms of dementia praecox, a chronic mental illness that strikes individuals as they become adults. It is postulated that a possible mechanism in the etiology of dementia praecox is the failure of regulator genes to program structural genes to produce enzymes necessary for neoteny. Positive symptoms of the disorder may be conceptualized as the organisms aberrant response to this activation failure. The role of regulator genes in chronic illness may prove a significant avenue for further investigation.
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The systems of Janet and Freud are briefly presented, compared, and interpreted as different variations of the application of the theory of evolution to psychopathology. Although both men accepted a hierarchical view of the psyche, Freud held that there existed an ubiquitous and inherent conflict between phylogenetic strata of the mind, while Janet maintained that with the exception of disease states, the psyche was a unified organizational structure.
Anorexia and hysteria seem to be expressions of age-specific conflicts intensified by constrictive cultural ideas and certain kinds of familial constellations. The disorder that ensues appears to represent the individual's desperate attempt to escape the conflicts of adult life according to models offered by the prevailing cultural values.
Depression may be conceptualized as the response to the loss of meaning or satisfaction sufficient to affect the individual's optimal view of the self. At each stage of the life cycle, the failure to achieve developmental tasks threatens the concept of the self, producing a phase-specific vulnerability to depression. Adolescence presents particular stresses by forcing the youngster to relinquish the relative familiarity and security of a childhood psychosocial role and create a sense of self independent of family, without childhood denial mechanisms, and of value to a new peer culture. Most individuals experience a sense of loss, confusion, apprehension, and dysphoria during this difficult period of transition. Many who seek psychotherapy require only a secure holding environment that will support their self-esteem as they create new avenues of worth and satisfaction. A few, however, are so hampered by psychosocial limitations that they cannot master this developmental passage without more extensive therapeutic assistance.
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The intensive psychotherapy of six recovered anorexic females revealed consistent information regarding premorbid parental and familial interaction as well as particular difficulties surrounding the onset of the anorexic illness. Persistent personality problems, difficulties in relationships, and characteristic transference reactions in these adult individuals are described.
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