Beyond the image

Abstract

By imposing itself as the dominant model of modern medicine, the biomedical model leaves little or no place for the psychical/subjective dimension of illnesses. The author presents a clinical case illustrating the essential contribution psychoanalysis can make to understanding the causes of a serious neurological disorder of indeterminate origin, its psychic determinism and its unconscious dimension. This original contribution argues in favour of the idea that understanding the development of neurological disorders associated with an unexplained lesion cannot be reduced exclusively to the organic level, and must not overlook the notion of unconscious. More generally, it emphasizes that body and mind form an integrated inseparable unit, thus breaking with the traditional dualistic conception of the human being.

Key words:

• amnesia
• brain imaging
• hippocampus
• neurology
• repression process
• soma
• trauma
• unconscious

1. Translated by Andrew Weller.

1. Translated by Andrew Weller.

Acknowledgements

I greatly acknowledge Prof. P. Giannakopoulos, Prof. F. Ansermet, Dr. A. Michon, Dr. V. Thomazic, Dr. R. Seidl and Dr. G. Charbonnier for support and helpful discussions.

Notes

1. Translated by Andrew Weller.

2. There is an extensive psychoanalytic literature, going back to S. Bettelheim and H. Hartmann (1925) on the psychodynamic determinism of the phenomenology of brain disease.

3. The amnesic symptom is envisaged here from the angle of repression as exposed by Freud in his Studies on Hysteria (1893–95) and in his article on Repression (1915). The concept of repression must be taken here in the broad sense; that is, is the amnesia the consequence of a psychical force which is opposed to the conscious recollection of ideational content? Does the amnesia have a symbolic meaning? It should be noted that this theoretical choice in no way excludes other psychoanalytical theoretical corpuses, as I discuss further on (p. 17).

4. There is a condensation here between mari = husband and arrière passé = distant past.

5. After Freud and Breuer, different movements have taken interest in the study of the psychical processes involved in somatic illnesses. Among those, the contributions of the Paris Psychosomatic school (P. Marty, M. Fain, M. De M’Uzan, Ch. David) aim principally to integrate the somatic pathology with all the other means that the subject has at his disposal for regulating his homeostasis. Failure of mentalization, repression of affects, essential depression and operational thinking are all concepts that this school has contributed to somatic phenomena. According to the psychosomatists no symbolic meaning should be attributed to psychosomatic symptoms, which presumes an aetiology more archaic than that of hysteria. These symptoms are to be approximated with the actual neuroses described by Freud. In my present contribution, I have chosen to treat the amnesic symptom from the angle of repression as it is presented by Freud notably in his first elaborations concerning his studies on hysteria where, for the first time, he describes a psychical apparatus anchored in the biological realm. Although the main intention of this paper is not to propose a model of psychosomatics in neurology, this clinical situation could be of interest and be discussed in the light of this theoretical corpus.