Psychosomatics: A current overview

Abstract

The term ‘psychosomatic’ has typically defined a series of illnesses in which somatic injury breaks out from psychic conflict not recognized as such. Currently, health is considered the only psychosomatic state of integration of mind and soma: an ideal state of integration. Somatic pathology is an effect of mind/body splitting. In the heterogeneous ‘field of psychosomatics’ interaction between psyche and soma ranges from classical psychosomatic illness to sporadic episodes in which the body has responded to an inability to process mental conflict. The author briefly reviews the development of psychoanalytic thought on psychosomatics in Argentina. He suggests the need to find appropriate conceptual tools to approach the mental structure underlying this pathology. He presents his ideas about the mental functioning of patients with somatization disorders. He introduces the concept of somatic event as a restitution phenomenon through which the subject attempts to re‐establish self‐integration and links with reality. He also offers some reflections on temporality and on changes in psychoanalytic technique with these patients. A clinical case illustrates his ideas.

Key words:

• Education Section, Psychosomatics

Notes

1. Local continuers of the theoretical line inaugurated by A. Garma are F. Cesio (1967 [1970a], 1968 [1970b], 1978) and L. Chiozza (1984, 1997).

2. The first committee was formed by Marta Bekei, Rodolfo D’Alvia, Mauricio Chevnik and Alfredo Maladesky, authors of numerous papers and books in which they continued to develop their ideas.

3. These authors include: Renata Gaddini, Peter Kutter, Pierre Marty, Joyce McDougall, Gisela Pankov, George Pollock and Sami Ali.

4. R. D’Alvia published El dolor: un enfoque interdisciplinario [Pain: An Interdisciplinary Approach] (2001); Psicoanálisis y Psicosomática: Ida y Vuelta [Psychoanalysis and Psychosomatics: Back and Forth] (2002) and Calidad de Vida: la Relación Bio‐psico‐social del Sujeto [Quality of Life: The Subject’s Bio‐Psycho‐Social Relations] (2005).

5. For this author somatosis refers to non‐neurotic functioning, an expression of the unrepressed unconscious. It sets in action primitive sensory traces, prior to words, potentially traumatic and untransformed which, when cathected by an excess of endosomatic excitation, cannot be translated into drives (Aisemberg, 2007).

6. His book, Psicosomática. Aportes teórico–clínicos en el siglo XXI [Psychosomatics: Theoretical–Clinical Contributions in the 21st Century] (Maladesky et al., 2005), compiles his own contributions and those of many other local psychoanalysts.

7. R. Zukerfeld (Zukerfeld and Zukerfeld, 2005) considers that these traces constitute the ideal ego. In the neuro‐scientific theory of memory, these traces correspond to implicit memories, both procedural and emotional.

8. ECRO: conceptual referential and operative schemata. It refers to a group of concepts that serve as a theoretical framework for the psychoanalyst’s therapeutic action.

9. Freud tells us (1905, p. 16, footnote 2): “Another physician once sent his sister to me for psychotherapeutic treatment, telling me that she had for years been treated without success for hysteria (pains and defective gait). The short account which he gave me seemed quite consistent with the diagnosis. In my first hour with the patient I got her to tell me her history herself. When the story came out perfectly clearly and connectedly in spite of the remarkable events it dealt with, I told myself that the case could not be one of hysteria, and immediately instituted a careful physical examination. This led to the diagnosis of a not very advanced stage of tabes, which was later on treated with Hg injections & with markedly beneficial results.”

10. Meltzer says: “If the mind is unable to rid itself of an accumulation of stimuli, transforming them into dreams or thoughts, into object relations, hallucinations or into a mentality of basic assumptions, then this excessive accumulation of stimuli will bombard the body to the point that one part of it will go mad. The insane part of the body will generate what we call ’psychosomatic illnesses’” (Meltzer, 1993, p. 334). Further on he adds that somatic expression of emotional conflict precedes meaning and symbolization: “In analysis new emotional experiences are often manifested as physical disorders before reaching the level of the dream [...] where symbolization is present, but has not yet reached the level of thought or dream” (ibid., p. 335).