Revista Symbios, n.1, e01001, 2026
Food-related suffering: listening to subjectivity and psychosocial dimensions in the
pediatric hospital context1
Sofrimento alimentar: escuta da subjetividade e das dimensões psicossociais no contexto
hospitalar pediátrico
Sufrimiento alimentario: escucha de la subjetividad y de las dimensiones psicosociales en
el contexto hospitalario pediátrico
Isabela Ramos Modesto2
Received on July 25, 2026.
Approved on September 15, 2026.
ABSTRACT
Eating disorders and manifestations of eating-related suffering are traditionally understood from the
perspective of diagnostic classifications focused on the behavioral and physiological aspects of the symptom.
In the pediatric hospital context, it is observed that the persistence of food refusal, somatic complaints, and
low adherence to treatment can go beyond what is explained solely by biomedical logic. This article aims to
discuss the contributions of psychoanalysis and hospital psychology to the understanding of these
manifestations, highlighting the attention to subjectivity and the psychosocial dimensions involved in the
symptom. It is a theoretical-conceptual discussion, based on literature, linked to contributions from
psychoanalysis and hospital psychology regarding eating manifestations in the pediatric hospital context.
Food refusal is seen as a possible expression of psychological and psychosocial suffering, considering its
connection to the body, how others see the person, experiences of social exclusion, and the role of the
hospital environment as a potential space for listening and acknowledging subjectivity. It is concluded that
combining hospital psychology, psychoanalysis, and the multidisciplinary team expands the possibilities for
understanding and clinical management, taking into account not just the person’s physical stabilization, but
also their individuality, relationships, and living conditions.
Keywords: Eating Disorders. Food Refusal. Hospital Psychology. Psychoanalysis. Psychosocial Suffering.
RESUMO
Os transtornos alimentares e as manifestações de sofrimento alimentar são tradicionalmente compreendidos
pela perspectiva de classificações diagnósticas centradas nos aspectos comportamentais e fisiológicos do
sintoma. No contexto hospitalar pediátrico, observa-se que a persistência da recusa alimentar, das queixas
2 Graduated in Psychology from Universidade Veiga de Almeida. Postgraduate student in Hospital and Health
ORCID: https://orcid.org/0009-0006-8892-7389.
1 The translation of the article is the sole responsibility of the authors. Translations of excerpts from works
written in another language, when rendered into English, are likewise the responsibility of the authors, unless
a different authorship is declared.
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somáticas e da baixa adesão ao tratamento pode ultrapassar aquilo que é explicado exclusivamente pela
lógica biomédica. Posto isso, este artigo tem como objetivo discutir as contribuições da psicanálise e da
psicologia hospitalar para a compreensão dessas manifestações, destacando a escuta da subjetividade e das
dimensões psicossociais implicadas no sintoma. Trata-se de uma discussão teórico-conceitual, de caráter
bibliográfico, articulada a contribuições da psicanálise e da psicologia hospitalar sobre manifestações
alimentares no contexto hospitalar pediátrico. A recusa alimentar é analisada como possível expressão de
sofrimento psíquico e psicossocial, considerando sua relação com o corpo, o olhar do Outro, as experiências
de exclusão social e a função do ambiente hospitalar como possível espaço de escuta e reconhecimento da
subjetividade. Conclui-se que a articulação entre psicologia hospitalar, psicanálise e equipe multiprofissional
amplia as possibilidades de compreensão e manejo clínico, ao considerar não apenas a estabilização orgânica
do sujeito, mas também sua singularidade, seus vínculos e suas condições de vida.
Palavras-chave: Transtornos Alimentares. Recusa Alimentar. Psicologia Hospitalar. Psicanálise. Sofrimento
Psicossocial.
RESUMEN
Los trastornos alimentarios y las manifestaciones de sufrimiento alimentario se comprenden tradicionalmente
desde la perspectiva de clasificaciones diagnósticas centradas en los aspectos conductuales y fisiológicos del
síntoma. En el contexto hospitalario pediátrico, se observa que la persistencia de rechazo alimentario, de las
quejas somáticas y de la baja adherencia al tratamiento puede superar lo que se explica exclusivamente por la
lógica biomédica. Este artículo tiene como objetivo discutir las contribuciones del psicoanálisis y de la
psicología hospitalaria para la comprensión de estas manifestaciones, destacando la atención a la subjetividad
y a las dimensiones psicosociales implicadas en el síntoma. Se trata de una discusión teórico-conceptual, de
carácter bibliográfico, articulada a contribuciones del psicoanálisis y de la psicología hospitalaria sobre
manifestaciones alimentarias en el contexto hospitalario pediátrico. Rechazo alimentario se analiza como una
posible expresión de sufrimiento psíquico y psicosocial, considerando su relación con el cuerpo, la mirada
del Otro, las experiencias de exclusión social y la función del entorno hospitalario como posible espacio de
escucha y reconocimiento de la subjetividad. Se concluye que la articulación entre psicología hospitalaria,
psicoanálisis y el equipo multiprofesional amplía las posibilidades de comprensión y manejo clínico, al
considerar no solo la estabilización orgánica del sujeto, sino también su singularidad, sus vínculos y sus
condiciones de vida.
Palabras clave: Trastornos Alimentarios. Rechazo Alimentario. Psicología Hospitalaria. Psicoanálisis.
Sufrimiento Psicosocial. Sufrimiento Psicosocial.
INTRODUCTION
In the hospital setting, specifically in pediatric care, manifestations of food-related
suffering frequently mobilize multiprofessional teams due to the complexity of symptoms
that simultaneously involve organic, subjective, family, and social dimensions. Although
medical conduct legitimately and necessarily prioritizes the clinical and nutritional
stabilization of the patient, it is observed that, in many situations, the persistence of food
refusal, nausea, vomiting, somatic complaints, and low adherence to proposed
interventions may exceed what is explained exclusively by biomedical logic. In these
cases, the food-related symptom calls for a broader reading, one capable of considering not
only the functioning of the organism, but also the listening to subjectivity and psychosocial
issues that may be involved in the subject’s relationship with the body and with food.
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The diagnostic understanding of eating disorders and food-related manifestations
associated with psychic suffering plays an important role in the health field, especially
because it facilitates communication among professionals and guides clinical conduct.
However, when the reading of the symptom is restricted to its behavioral or physiological
dimension, there is a risk of reducing the subject to the condition presented, disregarding
the complexity of their history, bonds, affective experiences, and living conditions. In the
pediatric hospital context, this issue becomes even more sensitive, since children and
adolescents do not always have sufficient symbolic resources to name what they
experience, and may communicate their suffering through the body, refusal, pain, or
difficulty adhering to treatment.
In this context, hospital psychology occupies a fundamental place by enabling a
differentiated form of listening, directed toward the subject’s singularity and the meanings
involved in the way they experience the process of illness, hospitalization, and care.
Psychological practice in the hospital is not limited to promoting adherence to treatment,
although this is also an important dimension of care. Its contribution lies, above all, in the
possibility of shifting the reading of the symptom from an exclusively organic perspective
to an understanding that includes subjectivity, family bonds, the relationship with the team,
and the social crossings that may participate in the production and maintenance of
suffering.
From the perspective of psychoanalysis, anorexia, bulimia, food refusal, and other
manifestations of food-related suffering are not reduced to disorders of eating behavior or
physiological alterations. Rather, they may and need to be understood as expressions of
psychic suffering and as particular forms of relationship with the body, desire, lack, and the
Other. In this sense, contributions from the founder of psychoanalysis, Freud, and from
Jacques Lacan in his return to Freud’s work, make it possible to think of the food-related
symptom not merely as something to be eliminated, but as a formation endowed with
meaning, which may indicate impasses in the subject’s relationship with demand, care, the
body, and the experiences that affect them.
Psychoanalytic reading also makes it possible to understand that food does not
occupy only a nutritional function. From the earliest moments of life, feeding is articulated
with care, the presence of the Other, and experiences of satisfaction, frustration, demand,
and bond. Therefore, when food becomes an impasse in the subject’s life, whether as
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refusal, excess, or suffering, it may indicate something that exceeds the plane of
physiological need. Food-related suffering, in this sense, may be thought of as a
manifestation that calls for listening to that which does not find elaboration through words,
but presents itself in the body and in the relationship with the other.
However, understanding the food-related symptom in the pediatric hospital context
also requires attention to the psychosocial dimension. Experiences of exclusion, bullying,
social vulnerability, family conflicts, difficulties connected to the territory of living,
ruptures in routine, and suffering in the social bond may produce important subjective
effects, affecting body image, the relationship with food, and the way children or
adolescents communicate their suffering. Thus, the symptom is not organized only in the
biological body, but also in the relationship between the subject, their bonds, and the
concrete conditions of their existence.
In addition, the hospital environment may appear as an ambiguous function. At the
same time that it is marked by illness, pain, disruption of routine, and clinical urgency, it
may also become a space for listening, welcoming, and recognition. The presence of the
multiprofessional team, when articulated in a way that is sensitive to the subjective and
social dimensions of illness, may favor the construction of care strategies that are not
limited to the remission of physical symptoms, but also consider continuity of follow-up,
family guidance, and articulation with other points in the care network after hospital
discharge.
Given this, this article aims to discuss the contributions of hospital psychology and
psychoanalysis to the understanding of food-related manifestations in the pediatric hospital
context, highlighting the importance of listening to subjectivity and the psychosocial
dimensions involved in the symptom. To this end, a theoretical-conceptual discussion of a
bibliographic nature is developed, articulated with contributions from psychoanalysis and
hospital psychology regarding food-related symptoms, food refusal, and the impasses of
health care. Food refusal is taken as a starting point to think about subjective and
psychosocial dimensions that exceed organic stabilization and call for listening directed
toward the subject’s singularity, their history, their bonds, and the living conditions that
traverse suffering in the pediatric hospital context.
THE SYMPTOM: BETWEEN MEDICINE AND PSYCHOANALYSIS
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Contemporary psychiatry, through manuals such as the DSM-5-TR (2023), defines
feeding and eating disorders as persistent disturbances in eating behavior that result in
altered consumption or absorption of food and significantly impair physical health or
psychosocial functioning. This approach, although essential for diagnosis and clinical
management, is based on a descriptive and statistical logic centered on the observation of
phenomena.
Psychoanalysis, in view of this, points to a parallel path in the understanding and
management of eating disorders. This theory works with the subject’s subjectivity,
distancing itself from the descriptive, statistical, and phenomenological logic of manuals.
Even with this difference, according to Vianna (2016), entering this path does not
presuppose adopting a merely biological or generalized view of food-related suffering, but
rather requires dialogue with different professionals in order to establish interlocution and,
in this way, construct a multidisciplinary view of the theme.
Following this logic, according to Malzyner (2016), work with patients who present
eating-related issues requires a constant dialogue that demands finding a common language
with the Other professionals who participate in a multidisciplinary team. This makes it
possible to rethink daily practice and review the form of work. For effective
communication, it is necessary to know and to be able to dialogue with the way
psychopathological phenomena are understood.
Freud (1926/2014) elaborates that the symptom is the true substitute and derivative
of a repressed impulse that continuously renews its demands for satisfaction, causing the
ego to produce a signal of unpleasure and to place itself in a defensive position. Regarding
this, Malzyner (2016) explains that cure in psychoanalysis is a quite complex concept and
distances itself from medicine insofar as it does not seek the elimination of the symptom.
From the medical perspective, a person suffering from eating-related issues must quickly
abandon their symptomatology, and it is in this way that physicians measure the degree of
success of treatment.
Keeping in mind what Freud mentioned about symptom formation and bringing in
Malzyner’s (2016) ideas, in psychoanalysis the symptom is taken as something that
expresses a movement of the ego seeking to free itself from unbearable suffering. Thus,
according to the psychoanalyst, differently from the medical perspective, the analyst makes
use of the symptom as an indirect pathway in order to work through and dissipate
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unconscious pain. Therefore, it may be stated that cure is not the goal of an analysis, but a
consequence.
Also according to the same author, it is necessary for the analyst to be capable of
dialoguing with the multidisciplinary team, which, at various moments, has as the central
axis of treatment the elimination of the symptom. However, the practitioner of
psychoanalysis cannot simply follow the team in this pursuit. If they do so, they run the
risk of hindering the treatment and attempting to adapt the subject to the desire of the
Other, repeating a dynamic that is quite common in the families of these patients.
Moreover, McDougall (1997 apud Malzyner, 2016) contributes by bringing the idea that
the analyst’s sole objective is to understand the patient’s psychic experience and
communicate it, with the hope that the subject assumes full responsibility for their choices
and acts.
FOOD REFUSAL, PSYCHOSOCIAL SUFFERING, AND HOSPITAL LISTENING
Before proceeding, it is important to emphasize that this article does not aim to
discuss anorexia and bulimia in their diagnostic entirety, nor to reduce hospital food refusal
to these conditions. Psychoanalytic formulations on anorexia and bulimia are revisited
because they allow the food-related symptom to be considered beyond its organic and
behavioral dimensions, offering theoretical elements for understanding food refusal as a
manifestation that may involve the body, desire, the Other, and psychosocial suffering.
From the Lacanian rereading, anorexia may be understood not as a simple “not
eating,” but as “eating nothing.” Lacan (1956-1957/1994) approaches this as follows: it is
not a nicht essen (“not eating”), but rather a nichts essen (“eating nothing”). This Lacanian
formulation indicates that the symptom is not reduced to food refusal, but has a symbolic
dimension related to the subject’s position before the Other. This results in a symbolic
plane of eating nothing, which may suggest that something beyond the physical act of
eating is being displayed. The “nothing,” in this context, assumes a psychic value,
functioning as an attempt at a subjective response to the demands of the Other. In this way,
anorexia exceeds the merely physiological dimension and appears articulated with
unconscious conflicts, the articulation of desire, and the subject’s particular forms of
relationship with the body and the social bond.
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In this context, anorexia may be understood as an attempt to establish a lack in the
Other, especially in the relationship with the maternal figure. When the demand of the
Other is experienced as invasive or suffocating, the subject resorts to “nothing” as a
strategy of separation. Thus, for Pena (2014), the symptom does not express only
deprivation, but a subjective operation that seeks to delimit a space for desire. In this sense,
the body comes to occupy a place of manifestation of this psychic suffering. What does not
find the possibility of symbolization or elaboration through words may emerge through the
food-related symptom, showing that the body is not only a biological organism, but also a
space of the subject’s subjective and affective experiences.
This dynamic may be articulated with the operations of alienation and separation.
Lacan (1964/1998) elaborates that, in alienation, the subject is constituted from the desire
of the Other, initially occupying the position of object. In separation, in turn, the
psychoanalyst explains that there is the possibility of emerging as a desiring subject
through the introduction of lack. In this sense, difficulty in carrying out this separation may
lead the subject to remain excessively captured by the demands of the Other, finding in the
food-related symptom an attempt at subjective delimitation. Thus, food refusal may appear
as a paradoxical form of affirmation of desire, even at the expense of the body itself.
Furthermore, food refusal may be related to the oral drive, since, according to Freud
(1915/2013), the drive does not have a fixed object of satisfaction, being marked by a
constant search. From this perspective, “eating nothing” may be understood as a way of
circling the lost object, showing that no food is capable of fully satisfying the drive. In this
sense, food exceeds its biological function and comes to occupy a symbolic place in the
subject’s psychic economy. Food ceases to represent only bodily nutrition and becomes
articulated with affective experiences, early relations of care, and forms of inscription of
desire. Thus, food refusal may appear as an expression of subjective conflicts related to
dependence, separation, and the relationship with the Other.
In the case of bulimia, a distinct movement is observed, marked by binge eating
followed by purgative behaviors. This cycle may be related to the Freudian concept of
repetition compulsion. Freud (1920/2020) explains that this compulsion that repeats causes
unpleasure for the subject, but because it is also at the service of the pleasure principle,
there is satisfaction. This repetition is a return of the same, of experiences; that is, the
subject finds themself trapped in a circuit that simultaneously produces pleasure and
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unpleasure. Differently from anorexia, in which “nothing” appears as a central operator, in
bulimia there is often a movement marked by excess, impulsivity, and difficulty
symbolizing psychic tensions. The binge-purge cycle may be understood as an attempt to
fill a subjective lack that, however, is never fully satisfied, repeatedly producing feelings of
guilt, anguish, and emptiness.
The excessive ingestion of food may be understood as an attempt to appease
psychic tensions, while the act of vomiting appears as a form of rejection of the object and,
at the same time, of separation in relation to the Other. This movement may also be related
to the fort-da game described by Freud (1920/2020) in Beyond the Pleasure Principle, in
which the alternation between presence and absence symbolizes an attempt to elaborate
loss.
Fagundes Netto et al. (2013) elaborate that, both in anorexia and in bulimia, the
symptom may be understood as a strategy for establishing desire by producing a lack in the
Other. Thus, these disorders should not be reduced to eating disturbances, but understood
as complex expressions of the subject’s relationship with desire, the body, and the Other. In
addition, it is worth emphasizing that food-related symptoms are also traversed by the
individual’s social and cultural experiences. Issues related to exclusion, symbolic violence,
body ideals, and experiences of suffering in the social bond may participate in the
constitution and maintenance of these conditions, especially in contemporaneity.
Psychoanalytic contributions to the understanding of food-related symptoms can be
observed since the earliest Freudian writings, in which articulations between food, psychic
suffering, childhood experiences, and family relations already appeared. From this
perspective, the food-related symptom may be understood as a form of subjective
language. When certain experiences do not find the possibility of symbolic elaboration, the
body and food come to occupy a privileged place for the expression of suffering.
With this in mind, the case of Emmy von N. may be cited. Entering the description
of the case, Freud (1893-1895/2016) treated this patient through visits to a sanatorium,
describing her as hysterical. In one of the visits, Freud reports that the patient complained
of severe stomach pains. In view of this, he asked her to try to identify the origin of these
pains, asking whether she remembered any occasion on which she had forced herself to eat
after experiencing intense emotions. From this, Freud was later able to determine that, after
the death of her husband, the patient had completely lost her appetite and began eating only
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out of obligation. According to the author, the stomach pains began during this same
period.
Freud (1893-1895/2016) continues by reporting that, after a few weeks, Emmy
remained under his observation and appeared to be in good health. However, at the end of
her stay, a situation occurred that, according to him, shed light on the patient’s character
and on the way in which her states had been produced. During a visit at lunchtime, Freud
was surprised to find a dried-out dessert that had remained there for days, which led him to
examine the Other plates of food she had left. When he questioned her about why she ate
so little, the patient replied that she was not accustomed to eating more than that and that,
if she did so, it would harm her, since this characteristic had the same origin as her father,
who also ate very little. Later, Freud advised her to drink more water and increase the
amount of food she consumed. Faced with this suggestion, the patient, agitated, responded:
“I will do this because you demand it, but I warn you that it will end badly, for it goes
against my nature and my father was also like this” (Freud, 1893-1895/2016, p. 67).
The next day, the patient told Freud that she had severe stomach pains, attributing
them to the increased food intake and water consumption. Addressing the physician, she
stated: “[...] I have ruined my stomach, and I must starve again for five to eight days until I
can tolerate anything” (Freud, 1893-1895/2016, p. 67).
Still in the case description, Freud reports that, during another visit, he hypnotized
the patient, a method that would later be abandoned, and again asked her why she could no
longer eat more. Immediately, her response was (Freud, 1893-1895/2016, p. 68):
[...] when I was a child, it often happened at the table that I, out of bad manners,
did not want to eat my meat. My mother was always very strict on those
occasions and, under threat of severe punishment, forced me to eat it two hours
later, on the same plate on which I had left it. The meat was completely cold and
the fat so stiff (disgust), and I still see the fork before me. When I sit at the table
now, I always see before me the plate with cold meat and the fat.
The patient reports that she had meals with her siblings, one of whom had
tuberculosis and another who, also ill, spat on the plate during meals. Months later, Freud
received a letter from Emmy informing him that she was eating well and gaining weight. In
view of this, Freud (1893-1895/2016), when discussing the case, states that the patient’s
anorexia offered an example of abulia, in this case related to food and water. For the
author, the fact that she ate little, or stopped eating under the justification that the foods did
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not please her, was related to the association between the act of eating and repugnant
childhood memories whose affective charge had not diminished. The reduction of disgust
linked to meals did not occur because the patient was repeatedly forced to repress it,
instead of expressing it or elaborating it through a reaction. In childhood, out of fear of
maternal punishment, she was forced to eat with disgust; later, out of consideration for her
siblings, she prevented herself from expressing the unpleasant feelings she experienced
during shared meals.
According to Gomes et al. (2020), when analyzing this case, Emmy associated the
act of eating with childhood memories marked by repulsion. This association was justified
by experiences in which the mother, described as severe, forced her to eat all the food,
even when cold and hours after it had been prepared, as well as by the coexistence with ill
siblings during meals. For the authors, although Freudian psychoanalysis did not
emphatically dedicate itself to the study of anorexia as a disorder, there are indications that
the construction of psychoanalysis did not disregard the importance of phenomena of
deprivation and food restriction, as observed in Emmy’s case.
Still within the Freudian contributions to the understanding of anorexia and food
refusal, it becomes important to mention the concept of drive and how it may be articulated
with this theme, without disregarding the later contributions of Jacques Lacan. Therefore,
Freud (1915/2013), in the text Drives and Their Vicissitudes, conceptualizes the drive as
something situated between the psychic and the somatic, highlighting that it does not act as
a momentary force, but as a constant force. For the creator of psychoanalysis, the aim of
the drive is always satisfaction, while its object is that through which this satisfaction may
be achieved.
However, this object is not fixed, nor necessarily material; it may vary and may
even correspond to a part of the human body itself. Precisely because of this variability,
there is no specific object capable of guaranteeing full and definitive satisfaction, which
causes the circuit of the drive to remain in constant movement.
In Beyond the Pleasure Principle, Freud (1920/2020) advances his elaboration of
the drive. He writes that the drive is like a pressure inherent to the living organism,
directed toward the restoration of an earlier state that was abandoned under the influence of
external forces. In this sense, the drive also comes to be understood as an expression of a
conservative tendency in organic life.
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When developing this formulation, Freud continues to sustain that life contains a
tendency to return to an initial state, prior to the disturbances imposed by existence itself. It
is along this path that he formulates the notion of the death drive, affirming that the aim of
all life would ultimately be death. This elaboration allows the thought that drive
satisfaction will not always be oriented toward the preservation of the organism, and may
also, therefore, be articulated with forms of repetition of jouissance that place the subject
before important impasses.
Lacan (1964/1998), in Seminar XI, states that the drive obtains satisfaction only by
circling the object a, which is the representative of a structurally lacking object. Thus, its
aim is not confused with the direct apprehension of an object, but with the return to the
drive’s own circuit. For the French psychoanalyst, there is always something of the drive to
be satisfied, which allows one to understand its constant force. From this reflection, Pena
(2014) emphasizes that the symptom, as in the case of anorexia and food refusal, precisely
evidences the radicality of the lack of a specific and natural object for the subject. The
anorexic person, through “eating nothing” in the form of refusal, shows that it is not food
itself that satisfies the oral drive, but the circling around the void left by the object that has
always already been lost. In this sense, Lacan (1964/1998) states that no food will ever
fully satisfy the oral drive except by circling this eternally lacking object.
Miller (1998), when commenting on the Lacanian formulation of the drive,
contributes to this discussion by stating that eating is not merely a satisfaction of the oral
drive. Food may appear as the object or aim of the drive, but the objective of the drive is
jouissance, which may be achieved even without the ingestion of food. Taking anorexia as
an example, the author indicates that the anorexic subject, by eating nothing, may extract
from this a form of oral jouissance elevated to a potentially lethal point, approaching the
dimension of the death drive. This reading makes it possible to articulate food refusal not
only with lack of appetite or with the refusal of food itself, but with a drive dynamic in
which the body, emptiness, and jouissance are intertwined. Thus, anorexia may be
understood as a symptom that calls for a listening beyond the merely organic dimension,
questioning the subjective function that food refusal assumes for each subject.
In contemporaneity, when this discussion is shifted to the pediatric hospital context,
it is observed that certain food-related manifestations may exceed what is explained
exclusively by the organic dimension. In situations of hospitalization, the persistence of
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somatic complaints, nausea, frequent episodes of vomiting, low adherence to proposed
interventions, and persistent food refusal may call upon the care team to consider not only
the patient’s clinical stabilization, but also the subjective and psychosocial meanings
involved in the symptom. In these cases, even when medical intervention does not reveal
alterations proportional to the intensity of the complaints, suffering may continue to
express itself through the body and through the relationship with food.
In this scenario, the psychology professional may be called upon as a possibility for
broadening the understanding of the clinical picture, offering a form of listening that will
not be restricted solely to food or medication adherence. The construction of the bond, the
use of playful resources in pediatric care, and listening to the family members present may
favor the emergence of elements that initially do not appear in verbal language, but are
presented through the body, refusal, and somatic complaints. In this way, psychological
intervention is not oriented only toward the attempt to eliminate the symptom, but toward
the possibility of understanding the place it occupies in the subject’s psychic economy.
From this perspective, food refusal may be thought of as a manifestation that
condenses not only psychic suffering, but also the effects of the psychosocial conditions in
which the ill subject is inserted. Experiences of exclusion, bullying, social vulnerability,
family conflicts, ruptures in routine, and difficulties in the bond with the Other may also
affect body image, self-esteem, and the relationship with food. Thus, the food-related
symptom is not organized in the biological body alone, but also in the relationship between
the subject, their bonds, and the concrete conditions of their existence.
This reading makes it possible to bring Freud’s formulations on the case of Emmy
von N. closer to situations that may emerge in the contemporary pediatric hospital. In the
Freudian account, eating difficulties appear associated with childhood memories marked
by repulsion, imposition, and suffering in family relations. Similarly, in current hospital
contexts, persistent food-related manifestations may indicate that the act of eating is
traversed by affective, family, and social experiences that exceed the physiological need
for nutrition. The comparison does not seek to equate distinct clinical contexts, but to show
that, since Freud, eating can be understood as a field traversed by subjectivity.
Having said this, experiences of ridicule, rejection, or social exclusion may allow
one to think of the body as a place upon which the gaze of the Other is inscribed. In
childhood and adolescence, such experiences may produce important effects on the
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constitution of body image and on the subject’s relationship with their own body. Thus, the
food-related complaint should not be analyzed only as a behavioral alteration or resistance
to treatment, but as a possible response to experiences in which the subject feels exposed,
devalued, or without sufficient symbolic resources to elaborate what affects them.
Although the hospital environment is frequently associated with pain, illness, and
disruption of routine, it may also occupy an ambiguous function. At the same time that it
marks the presence of illness, it may offer a temporary suspension of external experiences
felt as threatening, in addition to making possible an encounter with a team capable of
listening to suffering beyond the organic complaint. In this sense, hospitalization should
not be understood only as a consequence of a clinical condition, but also as a scene in
which the subject may find, through the mediation of the team, possibilities for listening,
recognition, and elaboration.
The psychosocial dimension of food-related manifestations also indicates that
hospital discharge should not be thought of only from the perspective of organic
improvement. When the symptom is articulated with social conditions of suffering, it
becomes fundamental to construct continuity of care involving outpatient psychological
follow-up, family guidance, and, when possible, articulation with the health network,
social assistance, and the school environment. In this way, the work of the team is not
limited to the remission of physical symptoms, but seeks to favor conditions of care that
consider the subject’s bonds, history, and territory.
In this process, listening to the family assumes fundamental importance, not with
the aim of locating blame, but of understanding how the symptom is perceived, interpreted,
and managed in the family environment. In situations of food refusal, the anguish of
caregivers may lead to insistent attempts to control eating, which, although understandable,
may intensify the tension around eating. The psychologist’s intervention, therefore, may
favor mediation among subject, family, and team, enabling other ways of reading the
symptom and reducing the tendency to understand it only as opposition, resistance, or
disobedience.
From this, the articulation among psychology, medical team, nutrition, social work,
and other areas involved in care becomes fundamental. Food-related manifestations
associated with psychic suffering in childhood demand a multidisciplinary approach
capable of integrating biological, subjective, family, and social aspects. In this context,
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psychoanalysis contributes by sustaining listening to singularity, considering the symptom
as a formation endowed with meaning and not merely as a behavior to be eliminated.
One of the central concepts for thinking about this listening is transference. In On
the dynamics of transference, Freud (1912/2017) writes that each subject has a particular
way of conducting their love life, constituting a cliché that tends to repeat itself throughout
life, both in external conditions and in the choice of love objects. In this movement of
repetition, the figure of the analyst may be included and articulated with parental images or
other significant figures. Freud (1912/2017) warns, however, that transference is not
restricted to the paternal model, and may also be organized from the maternal imago, the
fraternal imago, or other important figures for the subject. Moreover, in transference, not
only conscious elements are present, but also retained or unconscious contents.
For Freud (1925/2011), an analysis without transference is impossible. The author
emphasizes that transference is not created by analysis, nor does it occur exclusively within
it; analysis merely unveils and isolates it. Thus, transference may be understood as a
general human phenomenon, present in relationships and decisive for the success of
different forms of influence in the field of care. Freud (1925/2011) also develops that the
analyst makes the subject conscious of the transference, showing that transference conduct
updates emotional bonds originating in childhood. Thus, transference passes from one of
the strongest weapons of resistance to the best instrument of analysis, and its management
is one of the most difficult and important parts of psychoanalytic technique.
Alonso (2016, p. 43) contributes to this discussion by addressing transference in the
treatment of eating-related impasses, especially when this treatment occurs in articulation
with a multidisciplinary team, even before reaching the psychology professional:
[...] The team will be responsible for informing the indispensable need for the
process and clarifying some doubts of both the patient and their family members,
thereby providing the necessary support for the search for therapy. Often it is
only through this firm sustaining of the extreme necessity of the
psychotherapeutic process, encounter after encounter, with the rhythm of
comings and goings, that the analytic relationship can be established,
strengthened, and reach, in transference, the full potential of the work. The result
is the construction of a symbolic therapeutic setting capable of offering such a
space of intimacy so that the patient - within their authorial path of constructing
their own narrative - may come.
Still with Alonso’s (2016) contributions, the constant and active presence of the
team symbolically promotes an experience of contour, like a border that indicates limit,
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risk, and direction to follow. The author illustrates this function through a patient’s
statement: “it will not be easy, but, on the other hand, I see you as my reverse parachute,
who, when I cannot do it alone, will not let me crash” (Alonso, 2016, p. 44). For the
psychoanalyst, this statement shows that the team may function as the one that activates
warning signs for patients and family members, especially when they, immersed in certain
forms of bond, are unable to recognize aspects of exclusion, control, and fusionality
present in relationships.
Alonso (2016) continues by stating that the analytic relationship has as its material
for work resistances, acting outs, and other modes of psychic functioning. However, when
family dynamics also participate in the treatment, the analytic relationship becomes
traversed by contact with the psychiatrist, nutritionist, and other professionals, through
whom the analytic relationship will also be worked on. In this sense, the position of the
analyst must safeguard the subject’s relationship with their psychic body, which, still
without contours and sufficient limits to sustain it, may reveal a kind of psychic nutritional
deficiency, whether through the experience of emptiness or through that which overflows.
In this process, invasions and overflowings may also arise on the part of family
members, which requires careful attention in the management of the case. For Alonso
(2016), the analyst’s position should be neither excessive nor lacking, but should be
situated in a just measure. This implies the need for an active position, one that tolerates
not knowing and is careful not to run over the patients’ own construction of knowledge,
especially when dealing with subjects who present a symbolic emptiness and, often, scarce
free association.
Although separated by distinct historical and institutional contexts, the case of
Emmy von N. and the food-related manifestations observed in the contemporary hospital
context make it possible to sustain the same direction of reading: food-related symptoms
should not be understood exclusively from the organic dimension. In the Freudian account,
eating difficulties were related to childhood memories charged with unpleasure,
imposition, and repulsion. In the contemporary pediatric hospital, persistent eating
complaints may be articulated with experiences of social exclusion, psychosocial suffering,
family conflicts, and difficulties lived in the bond with the Other.
Although the clinical manifestations are distinct, both the Freudian reading and
contemporary hospital listening show that eating may function as a field of subjective
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expression. The body, in this sense, does not appear only as an organism to be stabilized,
but as a place traversed by affective, family, and social marks. Thus, clinical listening
makes it possible to shift the focus from immediate symptomatic remission to the
understanding of the function that the symptom may assume for each subject.
In this way, hospital psychology, articulated with psychoanalysis and the
multiprofessional team, contributes to thinking food refusal and other food-related
manifestations beyond the logic of adherence or resistance. It is a matter of sustaining a
form of listening that recognizes the complexity of human suffering, considering the
subject’s singularity, history, bonds, and living conditions. This direction does not oppose
medical care, but broadens its possibilities by including the subjective and psychosocial
dimensions in clinical management.
FINAL CONSIDERATIONS
Eating disorders and food-related manifestations associated with psychic suffering
constitute complex phenomena traversed by organic, subjective, family, and social
dimensions. In this sense, their understanding requires an approach that goes beyond an
exclusively biomedical logic, without disregarding the importance of clinical and
nutritional stabilization. In the pediatric hospital context, which is the focus of this work,
psychology, articulated with psychoanalysis, contributes by sustaining a form of listening
directed toward the subject’s singularity and the meanings involved in the symptom.
The discussion developed here makes it possible to understand that the persistence
of food refusal, somatic complaints, and low adherence to proposed interventions may, in
certain hospital situations, express forms of suffering that are not explained only by the
physiological dimension. Elements such as social exclusion, experiences of bullying,
family vulnerabilities, and difficulties in the bond with the Other may affect the subject’s
relationship with the body and with food, indicating that the food-related symptom may
also be articulated with psychosocial experiences marked by helplessness, exposure, and
suffering before the gaze of the Other.
In this way, the practice of hospital psychology proves important not only for
favoring adherence to treatment, but mainly for shifting the reading of the symptom from
an exclusively organic perspective to a broader understanding that includes the subject’s
history, bonds, living conditions, and subjective position in the face of illness. The
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construction of transference, listening to the family, and, in the case of pediatric care, the
use of playful resources as mediators of speech may favor the emergence of contents
initially communicated through the body, opening space for subjective elaboration.
Finally, the importance of multidisciplinary work is emphasized in the construction
of care strategies that integrate clinical stabilization, subjective listening, family
welcoming, psychosocial attention, and continuity of follow-up after hospital discharge.
Thus, it is understood that listening to subjectivity does not oppose medical care, but
broadens the possibilities of understanding and intervention in the face of human suffering
in the pediatric hospital context.
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