Case Study M - Part 3

The Development of the Disorder

But back to M. (M. with the teddy bear and the starry eyes)

Let us go into the past and look at how and why these three disorders (often occurring separately or individually) could emerge and develop as a picture of the overall disturbance.

The Family

M. was born as the younger of two girls into a “normal” family. “Normal” only outwardly. Within the family, mother and father no longer loved each other at this point and formed more or less a relationship of convenience.

We must therefore take a brief look at the parents. The father loved the mother, but the mother no longer loved the father. The fact is that there were strong tensions between mother and father, which the father tried not to transfer onto the children. The mother was extroverted and impulsive, the father introverted and reserved, quiet.

The father wanted a child — who would later be M. — but a boy. The mother, on the other hand, under no circumstances wanted a child at all.

The Beginning of the Catastrophe

Here the catastrophe begins for M., though she was not yet born. What matters is the mother’s “No” toward the pregnancy. This “No” she inevitably transferred onto M. (still unborn). This is not about the verbalized “No,” but about the attitude. Added to this are the parental tensions, which were inevitably transferred to the unborn child.

M. was born in spring, one of the most beautiful seasons. Somehow her later life seemed as though she was constantly searching for it or wanted to live in spring.

The Missing Symbiosis

It can be assumed with great certainty that after the birth, the mother was relieved to be free “of that thing” she did not want. Since the mother had already given birth once (to M.’s sister), who would later play a significant role, the mother could not have that same profound experience as with the first birth.

What is certain is that M.’s mother should have entered into the symbiosis, which she did not do. She showed M. either a strongly rejecting behavior — “you are not wanted” — or a strong ambivalence. Both are one and the same for the infant.

We know that between 9-12 months, the child cannot distinguish between “you” and “I” with the mother. It still forms a unity with the mother. It is therefore understandable that as soon as the mother moves away, the child experiences mortal fear, as a life-essential part is departing.

It was precisely at this point that the foundation of the borderline disorder was laid for M., which would manifest over the next 3-4 years.

The Role of the Father

For the child, the father does not play a decisive role until the 3.5-4th year of life. Everything that a person experiences between the ages of 0-4, everything that shapes them, regardless of the domain, cannot be undone. It cannot be repaired.

What is certain is that the mother showed a strongly ambivalent behavior toward M., perhaps even complete rejection. But M. had to “watch” as her older sister was loved (by the mother, later also by the father). M. could thus not develop a higher-level coping mechanism beyond splitting.

The Genital/Oedipal Phase

Now comes the entry of the father into M.’s development, who would play a crucial role in the following years. We recall that the father wanted a boy, not a girl.

M. was in the 3rd-4th year of life (genital phase). Since M. did not receive from the mother what she should have received, M. had no choice but to transfer this need for love onto the father. Behind the child M.’s statement stands the demand: “Love me as I should have been loved.”

At this point in development, enormous conflicts arose for M.

The Conflicts

a) The transfer of needs from mother to father, combined with the simultaneous fear of losing the mother
b) On the father’s side, who had wished for a boy
c) On the side of the parents’ relationship
d) Watching her sister be loved (and the resulting feelings of envy, rage, hatred, and the contradiction of loving the sister because she is her sister)
e) The impossible identification with the mother, since she (the mother) rejects M. or is ambivalent

The Roots of the Disorders

In the first question, “Why don’t you love me?” lies the borderline disorder; in the second, “Why don’t you love me as you love my sister?” the later anorexia; and in the third, “What must I do to be loved like that?” the later hypochondria.

The father loved M. — this is beyond doubt — but not as a girl, rather as a boy. M. was the son for him. He transferred this into his behavior and his upbringing.

M. then did everything to maintain or be able to claim this love. That means she became more and more the boy the father had wished for. With the development of female physical characteristics, further strong fears of loss developed for M. The climax of these fears is typically the onset of the first menstrual period.

This is also typically when the already latently present anorexia breaks out (around age 12).

The Traumatic Event

Between the ages of 12 and 14, a traumatic event occurred for M. M.’s mother was (once again) at a health spa. As usual, she met a man and wanted to separate from the father.

The father sat helplessly in the kitchen, weeping. M. had to watch as the father — the person she loved above all else — crumbled inside and was incapable of action. The mother’s suitcase was packed, the taxi was waiting. The mother wanted to leave M. with the father and was about to say goodbye.

For M., as you can imagine, a psychological catastrophe. Her last resort was to tear the suitcase from the mother’s hand, dump it out, scream and cry, throw a tantrum. It worked. The mother stayed. But what M. did not understand was why the mother had wanted to leave M. behind.

Summary of Early Development

The borderline disorder was established and had manifested
The anorexia emerged and manifested
The anorexia serves as self-harm and self-punishment, but also the self-image “I am not worthy of love”
She takes on the responsibility as the link between the parents
She must deliver the achievements of a boy in order not to lose the father’s love
She stands in inner conflict with her sister, whom she nevertheless loves
She adopts the father’s image (imago) and cannot resolve the oedipal conflict

M. was by this point already completely disturbed and confused. You can also see that M. is not to blame for how she later reacts to certain situations. All emotional and behavioral patterns are based on M.’s disrupted development.

Part 2: The Symptoms The conspicuous behaviors and the diagnosis

Part 4: The Vicious Cycle Survival strategies and their consequences