CONDREA Victoria, PhD student in psychology

            The purpose of our theoretical study is to address the phenomenon of obesity from a psychological and psychotherapeutic point of view. This pathology needs to be studied due to the ever-increasing global and national incidence of people suffering from this pathology. The study focuses on the cause and the problem of relapses in weight loss from the perspective of psychoanalytic theory and how gender differences affect weight and self-esteem.

Keywords: obesity, food, weight, subconscious conflict, symbol.

            Introduction

            Currently, about 56% of the population of the Republic of Moldova is overweight and about 23% are obese people, according to the STEPS study. [5] Obese people are at a great disadvantage in our society. They are stigmatized at work, in social environment and even within their own families. They are more easily denigrated than most other groups. In a society whose deep roots make us believe that anything is achievable if someone makes the effort, obesity is perceived as a moral failure. More importantly, obese people often see themselves as failures and feel out of control of their own lives. They are ostracized from early childhood and are subtly isolated from society. However, statistics show that the ability to lose weight and maintain this loss is considerably low.

            This article will focus on the psychological meanings of food, appetite and weight, as well as the basic motivations that are involved in eating disorders. We will address the issue of recurrence during the weight loss process from the perspective of the psychoanalytic theory. As problems with disturbed eating behavior occur predominantly in women, gender differences will also be explored. The aims and methods of the contemporary Freudian model will be discussed. Clearly, genetic, physiological, nutritional and social considerations are essential to understanding obesity, but for this article we will isolate the psychological issues.

            Gender differences in obesity. The historical background of the gender difference

            At least from the story of Adam and Eve, women were seen as subordinate to men and as morally inferior. Due to birth and upbringing of children, a woman's body is seen as her defining goal. Mind / body dualism, which is the cornerstone of many Western philosophies, attributes the mind to the male personality and the body to the woman. As Spelman [4] points out, the attitude towards the "body" has profound implications for the attitude towards women. The ascension to divinity is done through the mind and soul and the body is the one that pins us on earthly and humble activities; this is the idea of the burden of this historical reality that predisposes women to despise their own bodies and create fertile ground for the fetish of the diet and the struggle for control of the body.

            Social pressure and gender differences - obesity stereotyping

            Westerners are besieged by advertisements in the media that encourage them to buy products to improve their appearance, whether it's the latest weight loss diet, anti-aging creams or anti-cellulite devices. Virtually all of these advertisements are addressed to women, the main target of marketing, to whom pressing subliminal messages are sent to improve their alleged imperfections. The total number of these messages, which attack us daily, creates an overwhelming pressure to conform, if not to a certain body type, then at least to purchasing products marketed to encourage body image insecurities. The individual defines himself through visual appreciations reflected in society in general. Women are vulnerable to the stigma of obesity and self-concepts revolve around the actual or potential contempt they perceive or predict.

            Psychological aspects of obesity

            While physiology focuses on the biological functioning of the body and the harmful effects of obesity on health, the psychological approach focuses on the role that the mind plays in obesity as a symptom of mental needs or conflicts. Moreover, the therapist understands the difficulty of the patient's weight as being developed as an attempt to solve a problem that may not be conscious. Thus, what is maladaptive in terms of health could be adaptive in terms of psychological functioning. There are many psychodynamic formulations that address the use of food as an urgent adaptive response to certain conditions; lack of mother-child synchronization during early care, especially with regard to feeding; the use of food as a transitional object (a self-reassuring object that is imbued with the child's belief that he has total control over his environment) or competitive efforts with the mother. The role of the psychologist is to help the patient understand that this condition, despite all the sanctions against obesity, can be useful in maintaining mental balance. From this dynamic point of view, although weight loss is the main goal of the treatment, the mechanism by which it occurs is achieved by understanding the symptoms and reconsidering them from a more positive perspective. Improper use of food, overeating and obesity itself are seen as symbols of subconscious conflicts or deficits. Bringing these conflicts into the conscious mind and understanding the automatic responses to stressful situations is the core of psychodynamic work. From an intrapsychic point of view, resistance to change does not refer to the sanogenic point to which it tends, but to the abandonment of a method of adaptation or defense to an emotionally charged situation in the early stages of development. [1]

            Theoretical and therapeutic approaches

            The treatment of this problem is based on numerous theoretical conceptualizations. Although there are many therapeutic approaches, they all focus on etiology and treatment. Whether it is an internal conflict based on sexual and aggressive impulses, a relationship problem or compensation for a deficit, food, eating and weight can become symbols of subconscious problems. The theory we consider in this article is the contemporary intrapsychic Freudian model.

            The contemporary Freudian model (intrapsychic)

            Freud's theories were called "a biology of the mind," as he regarded mental life and its development as intrapsychic (arising from internal constitutional factors). Thus, the mental life is seen as autonomous, resistant to external influences, self-sustaining, sheltering unconscious fantasies. Social demands require the repression of the unacceptable expression of sexual and aggressive impulses that originate in the early stages of our lives, while allowing their discharge through indirect or symbolic means. During adulthood, these compromised adaptations may be expressed as socially acceptable sublimations or in a range of neurotic symptoms, for example, the use of food to avoid unpleasant effects.

            When a patient asks for psychological treatment, she may see her obesity as shameful and painful evidence of her failure as a woman. In social context, she self-stigmatized and self-blamed herseld for being obese. Her goal is to find a way to lose weight. She is frustrated and angry because she is unable to eat efficiently, although she wants nothing more than to be "fit". She repeats the same behaviors of losing and gaining weight. Sometimes she is aware of anxiety and discomfort even when she has lost weight.

            The psychologist sees eating disorder as a symptom of a conflict of which she may not be fully aware. The problem is not the diet, but the patient's mind. The therapist is like an interested archaeologist, even a detective, analyzing the narrative of the patient's life and trying to locate the source of the conflict. In this approach, the mechanism by which it works is the transfer (a phenomenon in therapy in which the patient projects experiences of important early relationships on the therapist). The therapeutic meeting is a safe environment for moving these feelings and associations on the therapist, which helps the patient to analyze and interpret their meanings.

            Neutrality (an analytical position in which the therapist does not impose the approval or disapproval of the patient's thoughts, feelings, or actions and does not take part in their conflicts) is an important tool for the therapist. It encourages an environment in which the patient feels safe to express his forbidden desires. According to this theory, the patient defends himself against the discovery of unacceptable desires that are the source of the conflict and the symptoms begin to be understood through resistance (unconscious sabotage of both memory and insight). The symptom is a compromise between these unacceptable desires and the demands of reality.

            In the Freudian approach, interpretation is considered curative. It encourages to focus on memories that bring unconscious desires and fears into the consciousness and thus frees the patient to re-examine from an adult's point of view, rather than a child's, his or her maladaptive behaviors. [3]

            Examples of the Freudian approach. Neutrality as a therapeutic position

            Glucksman describes a case of a patient who has been in treatment for 14 years. She adds and loses weight during treatment, but at the time of recording the data, she weighs about the same as when she started. The therapist remains neutral in terms of weight gain and loss throughout the treatment. The patient is angry with the therapist because he does not support her weight loss and does not help her in her efforts. His goal is for her to accept herself at any weight and he refrains from his involvement in her weight loss projects. He sees that she has divided herself into the unacceptable and hateful "fat self" and the "fantasy, thin self" she wants to become. This thin self will allow her to realize his forbidden sexual fantasies. However, whenever she approaches the "ideal weight", anxiety and fear stifle her attempts to stay "in control" of food. A reduction in self-loathing, a pragmatic view of her body image, and an integration of her self-perception are ultimately more important than praise for small successes in weight loss. [2]

            Overweight as a symptom of a subconscious conflict. Case study (Emily)

            Emily came to treatment for depression. She was angry and restrained, extremely shy in social situations. She was full of self-hatred, but she could barely express it. Although she was quite overweight, she never considered that her food and weight were related to her internal conflicts and confusions. During the treatment, she complained bitterly about the situation and her inability to do anything about it. She was mad at her for not losing weight. However, she was a successful banker and extremely competent in her work. It was a mass of contradictions, able to manage accounts of millions of dollars, but unable to navigate simple social situations. She chose not to face anyone and she refrained from any closer relationship, so she defended herself from the humiliation of wanting something she could not get.

            Emily was the third of five children, raised in a well-organized and well-run home. This quality of her mother, who took care of the management of the household without participating in the emotional life of her children, left Emily feeling empty inside and alone. He remembers sneaking into the pantry to eat biscuits and swallow them like being in trance. Her mother never seemed to notice the missing food. Due to her father's work requirements, the family moved frequently, compromising the possibility of forming close friends. Interestingly, despite this environment, the sisters did not rely on each other. Emily felt like the only child. She never relied on her brothers for comfort and understanding. She was a model child who fit perfectly into her organized household, never opposing, always compliant. Beneath this shell were feelings of anger. The food became for her a symbolic expression of that inward anger. It is interesting to note that the foods that pleased her the most were "crunchy things in which she can dip her teeth." On another level, food was the pain reliever, the possibility of a friend, and the psychic equivalent of a maternal touch.

            As the treatment progressed, Emily began to explore her position as an "exemplary girl" in the family and how it helped her avoid the aggressive and competitive expressions of her personality. This served to remove the dangerous possibility of alienating her mother, whose tolerance for failure in her well-run home was minimal. She understood how the food saved her from her anxiety about being abandoned and began to assert herself in many situations that had previously led her to retire. Her empathy for herself as a frightened and confused child grew and she became more accepting of her body. She started going to a gym and seeing a nutritionist. At the end of treatment, she lost 23 kg of weight in three years. This was not the purpose of the treatment, but a consequence of it. Her self-acceptance and appreciation of her "adaptive" reaction to a difficult education set her free to make this change. More importantly, this patient was able to make new and meaningful decisions and to respect her own efforts and needs. [2]

            Conclusion

            In conclusion, we can say that obesity is a symptom of a deeper, intrapsychic problem, and the solution to the problem of being overweight by simply losing weight has proven to be ineffective. From a psychodynamic point of view, weight is just a signal coming to the surface, a starting point, of a psychological analysis. The goal of weight loss sustained from this perspective is, at best, secondary to the goal of self-understanding and acceptance. However, we believe that self-acceptance has many benefits: a greater sense of self-control and a decrease in social anxiety and pressure to comply.

            Bibliography

1. Akabas S. R., Lederman S. A., Moore B. J. Textbook of Obesity: Biological, Psychological and Cultural Influences. Chichester: John Wiley & Sons, 2012. 84-86 p.
2. Gluckman P, Nishtar S, Armstrong T. Ending childhood obesity: a multidimensional challenge. Lancet. 2015 Mar 21;385(9973):1048-50
3. Shill, M. A. (2007). Intrapsychic intersubjective conflict and defense in modern Freudian theory: A response to Stolorow (2005). Psychoanalytic Psychology, 24(3), 525–538 p.
4. Spelman, E V. Woman as Body: Ancient and Contemporary Views. Feminist Studies, vol. 8, no. 1, 1982, 109–131 p.
5. http://www.old2.ms.gov.md/sites/default/files/prevalenta_factorilor_de_risc_bolile_netransmisibile_in_republica_moldova_studiul_steps_2013.pdf