Table Of ContentThe Body in Adolescence
The Body in Adolescence: Psychic Isolation and Physical Symptoms examines the
affective experience of psychic isolation as an important and painful element of
adolescent development. Mary Brady begins by discussing how psychic isolation,
combined with the intensity of adolescent processes, can leave adolescents unable
to articulate their experience. She then shows how the therapist can understand
and help adolescents whose difficulty with articulation and symbolization can
leave them vulnerable to breakdown into physical bodily symptoms.
This book introduces fresh ideas about adolescent development in the first
chapter. Subsequent chapters include clinical essays involving adolescent patients
presenting with bodily expressions such as anorexia, bulimia, cutting, substance
abuse, and suicide attempts. Attention is also paid to adolescents’ use of social
media in relation to these bodily symptoms—such as their use of online “pro-ana”
or cutting sites. Clinicians can feel challenged or even stymied when presented
with their adolescent patient’s fresh cut or recent episode of binge drinking. Brady
uses Bion’s conceptualization of containment and the balance of psychotic versus
integrative parts of the personality to examine the emergence of concrete bodily
symptoms in adolescence.
Throughout, Mary Brady offers ways of understanding and empathically
engaging with adolescents. This book is essential reading for psychoanalysts and
psychotherapists who treat adolescents and other patients with physical symp-
toms, as well as other readers with an interest in a psychoanalytic understanding
of these issues.
Mary T. Brady is a psychoanalyst and clinical psychologist. She is in the private
practice of psychoanalysis, psychotherapy, and consultation in San Francisco. She
is on the Faculty of the San Francisco Center for Psychoanalysis. She is a member
of the International Psychoanalytic Association and the American Psychoanalytic
Association. She has published widely on adolescence and bodily symptoms. In
2010 she won the American Psychoanalytic Association Ralph Roughton Award
for her paper, “‘Sometimes We are Prejudiced against Ourselves’: Internalized
and External Homophobia in the Treatment of an Adolescent Boy.”
Praise for The Body in Adolescence
“This book by Mary Brady is a matter of absolute necessity in the literature of
Psychoanalysis. Presenting her own clinical experience with young people ‘of
our times’ – in which the body is taken as the seat of conflict – we can see an
experienced and dedicated analyst working sessions with adolescents who suffer
from the most frequent presentations of their age: eating disorders, cutting and
substance abuse.
With masterful tact, she shows us how clinical work with these developing
individuals enlightens us as to the singularity of young people, the dynamics of
family groups, as well as the characteristics of a culture which, inundating the
senses, aids and abets psychic isolation.”
—Virginia Ungar, M.D., Training and Supervising Analyst,
Buenos Aires Psychoanalytic Association and President Elect
of the International Psychoanalytic Association.
“This is a very fine book. It enormously extends the range of our understanding of
disturbed adolescents. The author has great expertise and wisdom, and her beauti-
ful clinical stories are also informed by serious scholarship. Her identification of
the sense of psychic isolation felt at times by even the most ordinary – and ordi-
narily sociable – adolescents as a major issue in adolescent psychopathology, is
clearly a breakthrough. She draws our attention to their attention to their bodies,
and her descriptions of her tact and sensitivity with these very touchy wounded
young people are a joy to read.”
—Anne Alvarez is a Consultant Child and Adolescent Psychotherapist,
and retired Co-Convener of the Autism Service, Child and
Family Department, of the Tavistock Clinic, London.
“In this book Mary Brady puts her finger on two crucial areas of adolescent anxi-
ety, each of which makes the other one worse. She finds that loneliness is almost
universal; adolescents’ frenetic socialising is often a defence against this. The
other is their preoccupations with their bodies whose rapid changes fill them
with terror. Their bodies are the seat of projections of disturbing feelings and
unconscious beliefs. Her clinical and literary illustrations bring this beautifully
to life. As Bion would have it she has identified the selected facts in the crisis of
adolescence.”
—Robin Anderson, Training and Supervising Analyst in Adult and
Child Analysis at the Institute of Psychoanalysis, London;
he was also Consultant Child Psychiatrist at the Tavistock Clinic
where he was Head of the Adolescent Department.
The Body in Adolescence
Psychic Isolation and Physical Symptoms
Mary T. Brady
First published 2016
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
And by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an Informa business
© 2016 Mary T. Brady
The right of Mary T. Brady to be identified as author of this work has been asserted by her in
accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form
or by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval system, without permis-
sion in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Brady, Mary, 1959-
The body in adolescence: psychic isolation and physical symptoms / Mary Brady.
pages cm
1. Adolescence. 2. Adolescent psychology. 3. Social isolation. I. Title.
BF724.B693 2015
616.89'140835—dc23 2015020715
ISBN: 978-1-138-79775-8 (hbk)
ISBN: 978-1-138-79776-5 (pbk)
ISBN: 978-1-315-75690-5 (ebk)
Typeset in Times New Roman and Gill Sans
by codeMantra
For Carey
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Contents
Foreword ix
Acknowledgments xiii
Permissions xv
Introduction 1
1 “Unjoined persons”: Psychic isolation in adolescence and
its relation to bodily symptoms 8
2 Invisibility and insubstantiality in an anorexic adolescent:
Phenomenology and dynamics 24
3 Cutting the silence: Initial, impulsive self-cutting in adolescence 39
4 Substance abuse in an adolescent boy: Waking the object 57
5 “High up on bar stools”: Manic defenses and an oblivious
object in a late adolescent 74
6 Sexuality unreceived and adolescent suicide 92
7 Pro-anorexia websites through an adolescent development lens 105
Index 115
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Foreword
In writing this book, Mary Brady has made a wonderful contribution to the psy-
choanalytic literature of treating adolescents. It is an honor for me to comment on
some of the notable highlights of her book. Her focus on bodily based symptoms
is timely. As she notes early on, adolescents now come into treatment much more
frequently with problems that manifest in what they are doing to their bodies.
We often first meet them when they are starving themselves, cutting themselves,
intoxicating themselves, recklessly driving their parents’ cars, or covering their
skin with tattoos and piercings.
In these situations, parents can seem forlorn, lost, incapacitated, and disinter-
ested in what lies behind these physically extreme statements about disturbing
states of mind. Brady’s understanding of how these parental attitudes affect and
shape an adolescent’s feelings of containment—or lack thereof—is repeatedly
brought to our attention in each case. In this book, the combination of her keen
intellect, deep empathy, and years of experience in treating adolescents helpfully
guides the reader into understanding her patients’ anguish. We also learn about the
healing that can come when these adolescents have access to such a dedicated and
compassionate psychoanalyst, who sees them, listens to them, and is willing to
venture where a psyche finds itself lost and stranded.
She comes to her professional life with exceptional credentials. Brady is both
an adult and child psychoanalyst. Her interest in psychology, and particularly psy-
choanalytic psychology, is long-standing. She graduated from Holy Cross College
in Worcester, Massachusetts with a major in psychology. Brady later attended The
Wright Institute in Berkeley, California to complete her doctorate. Finally, she
graduated from first the adult and then the child programs at the San Francisco
Center for Psychoanalysis.
She has extensive clinical experience in the treatment of eating disorders, a
challenging field that is not for the faint of heart. She continues to teach and lec-
ture in a variety of psychoanalytic settings, locally, nationally, and internation-
ally. To have her now write this significant book is a fitting accomplishment that
documents what many of us already know: she is a sensitive, wise, and talented
clinician.
Description:The Body in Adolescence: Psychic Isolation and Physical Symptoms examines the affective experience of psychic isolation as an important and painful element of adolescent development. Mary Brady begins by discussing how psychic isolation, combined with the intensity of adolescent processes, can leave
