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You're the specialist when it comes to defense mechanisms, and you seem to have a good model there, but I'll suggest, tentatively, that there's a deeper deflection, here.
I think it's a bit worse than even that, and even worse than Amadan's "incapable of genuine self-awareness, reflection, or taking responsibility for their own emotional reactions". Ortega doesn't recoil like an alcoholic, or a gambling addict, nor does she spiral around the subject like a smoker patting her pockets for cigs that she left in her coat. She knows, pretty directly, what she's doing and that she's hurting herself and others doing it. The fascination and fixation on appetite is, itself, an excuse.
The story is about her ex-friend. It's about her control of that ex-friend.
That's a running theme.
The wegovy is a symbol, just as countless other examples and offenses have been symbols. It's something someone else did Wrong, that let her draw a new ultimatum, then evaluate whether the person would follow her lead, or be cut out. The stigma being applied to a perfectly good medication is an intentional benefit, but it's just a side effect.
I mean, optimistically, she might just be a sociopathic liar who makes up non-existent friends and incidents to explain how control should be acted out for others, but I'm not that optimistic, and she's not a good enough writer to be a good liar. Charitably, she might be like the vampires of Pratchett's later works, who substitute one form of addiction for another, where she substituted one need for control for another, and her substitution of controlling people for controlling food intake is just much direr than an addiction to photography or coffee. I wouldn't bet on it, though.
I didn't want to say BPD, but let's be honest, it's probably BPD. I'm not sure if she meets the usual criteria for sociopathy (which is a far looser and more informal qualifier than ASPD, which I doubt she has), but she's clearly a massive narcissist, with a genuinely impressive capability to make everything about her. Maybe that warrants a formal diagnosis of Narcissistic Personality Disorder too, but I'm only willing and able to go so far. Her black and white mentality/splitting is evocative.
I'm starting to think the therapist might be part of the problem too... Then again, is she a reliable narrator? Fuck it, surely she can't have found someone as bad as her right? I'm siding with the therapist out of professional solidarity.
Agreed. She does get off on control, both direct and indirect forms. "Oh, sorry, you dared to take medication that I disapprove of? What exists without my knowledge exists without my consent, and you know that I'm a big fan of consent culture."
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