On psychosomatics: The search for meaning

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Notes

1. In her Introduction to the 1995 edition of Le Moi‐Peau, Evelyne Séchaud reminds us of Didier Anzieu’s three planes of description of the relationship between the ego and the body (specifically the skin): (1) a metaphorical dimension: the skin‐ego (more the ego‐skin) as the ego as a metaphor of the skin; (2) a metonymic dimension: ego and skin mutually containing themselves as the whole and the part; and (3) as an ellipsis (like a figure with a double focus: mother and child). I think this is an interesting way of thinking about this subject. This triple‐level of understanding acknowledges the relationship to the object, includes both a metaphorical dimension and takes into account the continuity between the physical and the mental dimension , between the ‘real’ body (which we can also refer to as the ‘soma’, the site of ‘instincts’) and the phantasized body: the recipient of projections, the imaginary one. It brings together the separateness of mind and body as well as its unity. It is in this latter locus where I think the ‘drive’ comes into place and, with it, the concept of phantasy, of internalized objects and of identifications. The metonymic dimension brings in the continuity between ego and soma, mediated by the body. The ellipsis alludes to the container, to the object relation between mother and child (Séchaud, in Anzieu, 1995; Bronstein, 2007).

2. The notion that both representation, that is ideation, and emotion always come together and that thought takes part in the constitution of emotion has been discussed by a number of authors who hold different theoretical perspectives (Cavell, 1993; Green, 1977, 1999).

3. I believe that some physical ‘somatic’ predisposition must also play a part but once the symptom is brought to the analytic session we can only address it from and within a psychoanalytical perspective.

4. According to Klein (1946) normal splitting is necessary in order to protect the ‘good’ aspects of both self and object from being overwhelmed and destroyed by the ‘bad’ aspects of the self (linked to the death drive and to anxiety of annihilation). The inability to achieve this normal splitting can cause an early state of confusion between persecutory and depressive anxieties. Rosenfeld proposed that, as a result of this failure in differentiation and in order to deal with the confusion, patients resort to further splitting and projective identification.