by Dómhnall Casey
Nearly 25% of the population of Ireland is reckoned to be overweight. Between 1985 and 2005 the Body Mass Index (BMI) over 30 (“obese, Class 1”) increased by 200%, over 35 (“obese, Class 2”) by 300% and over 50, which is morbidly obese, by 1,000%.
Co-morbidities include Type 2 diabetes (T2DM), stroke, cancer, knee, hip, back problems, sleep apnoea, lymphoedema, lipidemia and others.
My early impression, from the first patients I worked with in St Columcille’s Hospital, Loughlinstown, was that the caput Nili of obesity was sexual abuse but this proved not to be so, although it was often a factor. Instead, it became clear that a significant source was the Dead Mother. What is the Dead Mother?
This is André Green’s term (Green: 1996), but I have refined it somewhat to fit into my experience in the Weight Management Clinic. She is not physically dead, but is dead emotionally and to various degrees. She may be permanently so, or temporarily unable to respond adequately to her baby. But while “dead” she is unable or unwilling to give the infant the necessary care, mirroring and play. (This phenomenon is discussed in more detail below.)
The Oral stage in classic theory is the first stage of ego and libidinal development. The mouth is the main source of pleasure and is the centre of infant’s experience. It isn’t clear when this stage ends, but people who are fixated at the oral level tend to retain the mouth as the primary erotogenic zone.
The typical way that somebody with an eating disorder deals with depression or other psychological disturbances, is to eat. This comfort eating –sometimes “boredom” eating – is confirmed by the various tests and questionnaires completed by patients as well as by their own testimony and by professional observation.
There is an unconscious dependence on the breast (eating) which is a fantasy of fusion with the mother. The other polarity, depression, is an indication of a fantasy of loss of the mother. As we shall see, this may be a realistic assessment of the actual situation.
The oral phase is included in Margaret Mahler’s Autistic phase (Mahler et al: 1975) which lasts from birth until about two months. This is described as a closed monadic system, mother and baby are still one and the baby is not able to differentiate between him or her self and the all-powerful and to the child, beautiful and benevolent mother. This one-body phase leads to the Symbiotic phase (two to six months) where there is dual unity with the mother and the beginning of a sense of other. Crucially, there is a confident expectation that baby’s needs will be met.
Mahler’s description of these early days, weeks, months and years of the baby’s life conforms to Melanie Klein’s view of what is happening in the depths of the child’s psyche in the first six months or so of life. This is the stage of her awkwardly-named paranoid-schizoid position. The infant, she says, has sufficient ego awareness (it exists from birth according to her) to suffer anxiety and to erect defences against this anxiety.
And if the early ego is essentially a body ego (Freud), then the psychic defences must readily become somatic in their expression.
For Klein, the infant experiences anxiety from birth and from the beginning there is a conflict of instincts – the life and the death instincts (Freud’s Eros and Thanatos). The infant attempts to deal with the anxiety produced by the death instinct by partly projecting it onto mother, or part of her (the breast) and partly retaining it in the form of aggression which may do combat with the persecutory object which the breast has become.
The life instinct, the Libido, is also projected outwards towards the breast which becomes the good breast and which is at one with the Erotic ego’s desire to maintain life. So, the early life of the human ego is fragile and susceptible to terror and confusion, not only from the outer environment, but from within (instinctual conflict).
For people with eating disorders (obese patients), mother is always a “good object” (at least at the time of ingestion, which is often frenzied eating or bingeing) and therefore eating to excess is “good”. But this is followed by recriminations from the inevitably harsh Super-ego.
This is Freud’s third psychic structure and first appeared in the book The Ego and Id in 1923 (Freud: 1923). In Moses and Monotheism (Freud: 1939) he declared that:
“In the course of the individual development a part of the inhibiting forces in the outer world becomes internalised: a standard is created in the ego which opposes the other faculties by observation, criticism and prohibition.”
He would go on to describe the Super-ego in harsher terms, but Donald Winnicott (Winnicott:1958) accurately exposed the properties of the Super- ego when he wrote:
“There is an early history of the Super-ego in each individual. The introjects, used for control of id- impulses and id-products may later become human and father-like, but in the earlier stages it is pre- human and indeed is primitive to any degree.”
If we are all born with an already-functioning and harsh phylogenic Super- ego then at the least one of the tasks of parents is to soften its cruel influence. But this job often falls to psychotherapists and it would seem that most of the super-ego-related problems dealt with by professionals are generous top-ups of primitive super-ego attacks, courtesy of poor and often wantonly harmful parenting.
The psychologist and philosopher Karlfied Graf von Durckheim wrote that everyone is born still connected with his or her Essential Being. This connection, he said, is often (or usually?) damaged or severed by our early life experiences.
This rather Platonic notion is echoed by the assumption that babies are born with the expectation that their needs will be met, that they will be helped to gradually take control of their limbs and body functions and their egos will be nurtured and developed by their families, beginning with their mothers.
This, of course, doesn’t always happen. The phenomenon of the Dead Mother pervades the lives of many people dealing with eating disorders. This mother is not physically dead, but is emotionally dead for various reasons and to various degrees. She may be temporarily unavailable emotionally to the infant because she is bereaved, suffering from post-natal depression, overwhelmed by the task of looking after another baby when she already has too many and is burdened by an abusive and useless husband (or none). She may be immature, neglectful, psychotic, incompetent or malignant.
Donald Winnicott pointed to the normality of maternal hostility to babies in his paper Hate in the Countertransference (Winnicott: 1958) where he listed 18 reasons why women hate their babies. The reasons are often prosaic:
The baby is a danger to her body in pregnancy and at birth.
The baby hurts her nipples even by suckling, which is at first a chewing activity. If she fails him at the start she knows he will pay her out for ever and so on.
But this is normal and all the vicissitudes of child-rearing are borne patiently and courageously by Winnicott’s good-enough mother. It is important to note, too, that human beings are all born prematurely, unlike our mammalian cousins. This means that psychological birth takes about three years and in that period as baby occupies his body zone by zone, crucial bonding is taking place with the mother, who is the representative of the outside world and who sets the tone for the newborn’s later encounters with life outside of the home/womb. It is also crucial to remember that in the early years for a child, time is measured in seconds and minutes, fleeting to adults, but a lifetime to an infant.
This mother maintains eye-to-eye contact with the baby, there is much coo- ing and other talk (universal across all cultures and races) from mother to baby, massaging, skin to skin contact, elaboration of what is going on between them (“mammy has our bottle ready, is baby hungry”, etc). When the baby cries and the mother searches for the source, she is not only matching the discomfort with the cause, thus helping the baby to get a sense of his own body and needs and to discriminate and identify feeling, pain and location later in life, but she is also teaching and elaborating vocabulary.
An example of this is a woman patient of mine who proudly announced that she was able to identify that a feeling she thought was hunger was actually anxiety, and so she could then work on it and deal with it for what it really was. Most patients who successfully diet, thus denying themselves “comfort”, will suffer the anxiety, depression and terror that have been waiting in the wings, repressed. Indeed, I usually prepare them for this, saying that “if you lose weight you will initially feel awful – depressed, anxious, etc”.
Touching and skin-to-skin contact between mother and baby is not just a pleasant and rewarding activity. All mammals clean their infants (usually by licking) and this stimulates nerve-endings which can’t be activated in the womb. According to Joseph Chilton Pierce (Chilton Pierce:1992):
“These nerve endings…. are involved in motor movements, spatial orientations and visual perspectives as well as touch and if they are not activated the reticular formation (in the brain) will not be fully operative, leading to impaired muscular movements, curtailed sensory intake and a variety of emotional disturbances and learning deficits.”
Nature, according to Chilton Pierce, has organised things so that:
“…throughout history, the mother has placed her newborn to her left breast… this simple position unlocks a cascade of overlapping functions designed to assure cessation of hormone production and successful adaptation to the new environment.”
Originally called ‘attachment behaviour’ by John Bowlby… the pattern of this primary genetic programme unfolds perfectly through the simple act of ‘skin-to-skin’ contact between mother and newborn at that left position. Face-to-face and skin-to-skin contact is made possible by nature by the length of the umbilical cord (18 to 20 inches). The infant’s “subtle sphere” is only about 12 inches and he shares this with the mother. Left outside of this, the heart signals “abandonment” and the infant becomes anxious and stressed, not to mention filled with terror and despair if left alone long enough. Newborns are still in their subtle world and are almost completely identified with their mother’s body.
A mother may or may not be aware of this “subtle world” – she has other tasks to attend to – but for the infant it is the ONLY world. And when things go wrong here, they can go disastrously wrong.
According to Chilton Pierce this position also opens:
“Corresponding intelligences in the mother as
well. A major block of dormant intelligences is activated in the mother, causing precise shifts of brain function and permanent behaviour changes. Ancient mammalian nurturing intelligences and latent intuitions are awakened in her; the mother then knows exactly what to do and can communicate with her infant on an intuitive level.
The mother’s own defensive birth postures can relax to higher cortical structures… birth intelligences awakened in the mother are not learned, nor can they be taught. They are archetypal and primal knowing, a complete wisdom that opens spontaneously if the mother is given the proper structural-coupling with her infant.”
This relationship is most certainly a crucial prototype for all future relationships and when successful not only begins the process of bonding for the baby, but is the birth of the bonded mother too.
The “bonded” mother has a new sense of personal power, physical strength and an intuitive knowledge of her infant’s needs. She has access to the vast intelligence through which our species has survived.
But the Dead Mother does not bond like this; she feeds roughly, scantily, too late, inappropriately. Such a mother may smack a child, even an infant, in response to a normal (infantile) act of rage or exuberance. She may be rough or violent when cleaning the baby. There are consequences then, for his later self-expression (as well as perhaps confusion with sexual abuse by others).
The Dead Mother fails to mirror. If she fixes her gaze on the infant it is with hostile and cold eyes. There is therefore a catastrophic failure of mirroring and feeding, resulting in the child’s cravings for “hits”, oral or otherwise, from other sources. Christopher Bollas (Bollas:1989), echoing von Durckheim, writes that the:
“…baby expects Transformation through mirroring by the mother. When this doesn’t happen, things go devastatingly wrong for the baby and he grows up looking for it, the hit, through magical phenomena.”
This may include moving statues, Tarot cards, gambling, alcohol and, of course, eating to excess. I would add there may also be a childish reversion to (mother) nature and a belief in the dubious wisdom of ancient and long- gone civilisations and religious practises.
This craving for a transformational hit – now we can call it an addiction – can be to food, alcohol, drugs, gambling, compulsive promiscuity, catastrophic relationships and a pervading, stubborn and unconscious coping fantasy of miraculous salvation which is unrealistic, and apparently unshakeable. The expected Transformational Mother has been replaced by transitional substances and activities unequal to the sacred task. The expected Transformational Mother has been replaced by the Dead Mother and this has disastrous consequences. The ego fails to thrive and adult children of Dead Mothers typically have no will and so find it difficult or impossible to follow a diet or an exercise regime, though their lives literally depend on it.
Infantile depression takes place in the presence of an object (mother) who is absorbed and self-preoccupied by her own problems.
There is a brutal change in the infant’s maternal imago which is accompanied by loss of love AND MEANING. If this loss coincides with the infant’s discovery of the father, premature and unstable triangulation takes place. The infant is now caught between a Dead Mother and an (apparently) inaccessible father.
The arrival of a sibling can also be traumatic. Sibling rivalry, or as I am beginning to call it in this context, sibling trauma, is arguably already underestimated. But for the child of a Dead Mother (who may also be actively hostile) it can be almost unbearable. It is worth remembering that the Biblical story of Cain and Abel is about sibling murder, among other things. And the other sibling story, that of Jacob and Esau, is not only about sibling rivalry of a particularly duplicitous kind, but also has a strong Oedipal flavour to it. Rebekah, the mother, conspires with her favourite son Jacob, to cheat Esau out of his inheritance.
Sibling rivalry can be fomented by parents, in this case, the mother. And it should be borne in mind that in the myth of Oedipus, Queen Jocasta’s crime was not to commit incest (“nor need this mother-marrying frighten you; many a man has dreamed as much”) but to willingly participate in the attempt to kill her son and not to face up to the truth, whatever it might be. The Oedipus complex is a two-way street, as the Bible and Sophocles’ play tell us.
In the drama of the “Dead Mother” the child attempts to “repair” her but this effort must fail, leading to a sense of impotence and activities to ward off anxiety and depression and other psychic disturbances. The infant suppresses its own personality and becomes the Dead Mother, resurrecting her in a way and restoring contact. A split personality arises with the internalised dead mother dominating and almost suppressing the real self.
Incidentally, it may be that many practitioners of our profession are in fact grown-up children of Dead Mothers and they try desperately to re-animate their clients, having failed with their own mothers. Without insight, though, this is bound to fail, leaving the client substantially unchanged and the psychotherapist burned out.
The child blames himself (a negative megalomania). This makes no sense, but it is said so many times – “I was a problem baby”!!! Freudian theory deals with punishment for forbidden wishes but here the sin is EXISTENCE ITSELF! And there is no outlet except self-attack and suicide. Of course, self attack includes self-abuse by eating.
It is not surprising then that the typical patient has no will and is not short of rationalisations for a near-suicidal appetite. They had a wedding, a funeral, holidays, baptism, Christmas, etc.
Having given in to the temptation, the stage is set for an attack by a cruel and harsh super-ego. The ego, impoverished from the start, is squeezed between the insatiable demands of a greedy infant (greedy, in part, because the natural phase of greediness wasn’t satisfied) and a cruel, unrelenting super-ego.
Most patients react with astonishment, relief and recognition when I draw this drama in cartoon form. They typically say ‘that’s EXACTLY what it’s like for me’. The rough drawing shows a small ego, clearly terrified. The glutinous id threatens to engulf it while a ravenous superego towers over the cowering ego, fangs dripping.
The lack of ego development – perhaps character would be more descriptive – leads to the lack of will. This is, however, a fertile area for intervention and growth. The theories of Roberto Assagioli (Psychosynthesis) and his exercises for developing “will” are useful here (Assagioli: 1965). Work with dieticians, physiotherapists, medical staff and indeed the totality of the clinic ambience, including the secretarial and cleaning staff, is vital in this regard. Small, but encouraging, improvements in weight and diet compliance build ego strength and soften the effects of the malign superego.
For some, even the prospect of surgery (which according to one bariatric surgeon, will be seen as barbaric in years to come), which always entails some risk, is preferable to the so-called conservative approach. Surgery may encourage the continuation of a passive attitude, the desire to be done to and so it may be that nothing changes and many revert to obesity after a few years – or become alcoholic or otherwise disturbed.
The “Dead Mother” is by no means the only cause of obesity and food addiction but there is evidence that it is a significant factor. A preliminary statistical analysis, which I carried out about a year ago, indicated that over 40% of the cases examined fell into the category of “children of Dead Mothers”. A more comprehensive study is planned and may already be underway by the time this paper is published. And there is a difference, as yet undefined, to my knowledge, between the male and female reaction to the Dead Mother.
The multi-disciplinary approach – so-called conservative treatment by dieticians, physiotherapists, psychologists/psychotherapists and medical staff has been shown to be effective. Surgery is, at the moment at least, an indispensable option for many patients who for various reasons cannot make full use of the “conservative” programme. While psychodynamic and in particular psycho-analytic insights give a clear picture of the nature of the problem, orthodox psychotherapeutic sessions are not always possible or desirable. Group processes of various kinds are used, often with great effect. Art work, meditation and other approaches may all prove effective. More recently, patients have been setting up their own self-help groups, facilitated by the Weight Management Clinic.
It may be that Government and society will have to rethink the length of maternity leave, the provision of crèches in the work place and to pay more attention to the education of mothers and fathers to be. The maternal instinct is a very powerful force, but the birth of a baby, which also includes psychological birth, takes about three years. Parents to be must take this into consideration, that is, that one of them (probably the mother) should be preoccupied with baby for that length of time. Financial and other practical and personal considerations have to be taken into account by the State and by the individual.
Dómhnall Casey is a practising psychoanalyst and psychologist and member of IPAA and PSI. He can be contacted at firstname.lastname@example.org
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Mahler, M. and Pine, F. and Bergmann, A. (1975). The Psychological Birth of the Human Infant: Symbiosis And Individuation. London: Karnac Books. Winnicott, D. W. (1958). ‘Hate in the Countertransference’ – in D. W. Winnicott Through Paediatrics to Psycho-Analysis: Collected Papers. London: Tavistock Publications.