To the Editors:

In her review article “The Crack-Up” [NYR, October 4, 2001], Rosemary Dinnage takes note of the insight of Andrew Solomon and Jeffery Smith, as well as of John Bowlby and James Robertson, that a predisposition to depression takes root in infancy and early childhood. At that time, she says, no awareness, no sense of a coherent self yet exists. When subject to bereavement or parental deprivation, an instinctive fear of perishing floods a human being. That fear, if unassuaged, lies ever active in the soul. One manifestation is the eating disorder of bulimia.

Two psychic events converge in bulimia: a viscerally experienced fear of perishing, which took root in earliest childhood, and the contemporary cultural imperative of staying slim in order to be loved. Bulimia is bound up with abandonment, absence of love, and survival. Eating compulsively distends the esophagus and the stomach, which press against other organs. The pressure reassures us, at a primitive level, that we exist. Such a reassurance is not unlike what happens in an elevator where we only perceive we are moving when the elevator comes to a stop. Internal, visceral pressures provide a similar sense of grounding. They momentarily convince us, deep down, that “we” are alive and placed once again in the world. Excessive, immediate nourishment produces a desperately needed existential conviction: now, at least for a moment, we are not “lost” nor hopelessly “dispersed” as we once were when—so very young—the initial “fracturing of a ‘me’ by bereavement or separation” had occurred. Stuffing the body resembles other desperate and “rescuing” infantile behaviors like head banging, which imposes a physical limit. That limit also lends a momentary experience of coherence to a “dispersed” and terrified human being. In the case of bulimia, as food settles and “space” opens up, the contemporary horror of disfigurement—and hence rejection—rushes in. The familiar pattern of bingeing and purging now has been established.

Rosemary Dinnage suggests that perhaps depression should be treated less by medication “than by something very simple that used massage, rocking, warm blankets, soft wrappings, gentle sounds.” Bulimia, a form of depression, would benefit greatly from her idea. From having observed the suffering of a bulimic, I am certain that, in their respective accounts, Rosemary Dinnage, Andrew Solomon, and Jeffery Smith have seized upon a profound truth about the “illness of ingrained sorrow.” I am grateful for their insights, which may lead to a more enlightened therapy for depression and bulimia.

Harriet Turner
Lincoln, Nebraska

Rosemary Dinnage:

Though I only raised the possibility that a predisposition to depression could begin in infancy, I find Harriet Turner’s extrapolation to bulimia and anorexia quite plausible. Could the question of pregnancy also be involved, most bulimics being female? A wish to be, literally, fulfilled and solid, counteracted by fear? Far-fetched speculations, perhaps, but more serious than the usual explanation that girls are simply aping slim fashion models. When an eating disorder can mean dicing with death, it must have deeper roots.

This Issue

April 11, 2002