Clinical Work with Adolescents by Judith Marks Mishne

Author:Judith Marks Mishne
Language: eng
Format: epub
Publisher: THE FREE PRESS
Published: 1986-07-15T00:00:00+00:00

Anorexia Nervosa: Case of Martha

Martha identified her self-starvation as beginning at age 12, when she attended a dance camp and was harshly warned about getting fat and thereby being unfit as a dancer. While her interests in dance were not long-standing, she remained fanatically obsessed with her weight and ate little, if anything. On the rare occasions when she gave in to familial urging and pressure, she would vomit up the relatively normal portion of dinner she had consumed. In college, she would both deny being thin enough and complain about her emaciated breastless appearance and her erratic or nonexistent menstrual periods. She diminished her most extraordinary attractiveness by maintaining a bony, undernourished figure.

She was immaculate, perfectionist, and demanding of herself in a myriad of ways; but she was continually dissatisfied, especially when she compared herself to her siblings. Her three brothers all excelled in the adolescent achievements of academics, athletics, and peer status. The brothers were accepted at prestigious colleges, and then at equally outstanding graduate schools in medicine, law, and architecture.

Martha’s family of origin was upper class, white, and Jewish, a Southern family of means and social status. Her father, an outstanding journalist in his community, did some university teaching. He was described as an involved parent, devoted to his children’s accomplishments and development, while simultaneously being a “free thinker” and believer in “open” marriage. The parents had long-standing marital discord and the mother repeatedly contemplated separation and divorce. She could neither tolerate her husband’s free lifestyle nor leave him and therefore suffered a protracted depression, finding her gratification in her children. She was a most attractive woman, but her self-esteem was low due, in part, to her decision not to continue managing an art gallery and her resulting lack of a profession and career when her children were grown and out of the home. She had an erratic work history and episodic attendance at graduate school once her children were older.

Martha’s mother articulated guilt and anger at her husband for “causing” Martha’s problems. She claimed that during her daughter’s first years of life she was not always emotionally available to this newest baby because of her rage and depression at discovering her husband’s first adulterous relationship. This caused what the mother believed was erratic, often harsh and angry care of Martha during the first year or two of her life and excessive sharing with her daughter of the strains and stresses in the marriage when Martha entered adolescence. The father was described as disavowing this explanation of the etiology of his daughter’s difficulties and endorsed a strictly medical explanation. He advocated weight gain to appropriate body weight to restore regular menarche and displayed little interest or attention of his relationship with his daughter or to Martha’s feelings about herself. Just as he denied the significance of these dynamic considerations, he also denied the significance of this adolescent’s retreat from romantic attachments, so in contrast to her brothers’ relationships with their steady girl friends.

Martha reported improved weight control following a course of individual therapy that combined a behaviorist and psychodynamic perspective.

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