The inversion of the fall: on identity construction in anorexia nervosa.

Anorexia nervosa can be comprehended as an illness in the broader context of Western culture. The myth of the Fall, narrating a forbidden act of eating, provides a symbolic background of a philosophical-anthropological comprehension of the identity of man, which frames a clinically relevant point of view of anorexia nervosa. The formation of identity in its broader anthropological sense and particularly with people suffering from anorexia nervosa is subjected to a philosophical and psychological analysis consulting the relevant philosophical, sociological and psychodynamic literature. The order of eating in terms of interdiction and disobedience anthropologically constitutes the identity of men: by ignoring the divine taboo, men can reach consciousness and culture. Philosophy and psychoanalytical theory have focused on this process regarding an emerging capacity to symbolize and on its relation to emancipation and the pursuit of autonomy. Under postmodern conditions with a decline of stable cultural value systems and traditional structures the process of an emancipatory identity construction becomes critical. Surrogates replace missing values; thus, injunctions such as to enjoy substitute interdictions. This paper sheds light on the impact of these cultural conditions and their postmodern changes on the identity construction of anorexia nervosa. Moreover, implications for psychotherapeutic treatment are outlined. Besides the medico-scientific models, a multifaceted understanding of anorexia nervosa has to consider cultural contexts and symbolic processes that matter in the disorder in order to provide a broader background for the treatment approach of the anorectic patient.