Finding a starting point that enables to think hypochondria, as required by clinical observation, as a relational pathology, is probably the first requirement. For the situation identified as a triple objective, subjective, and theoretical impasse may only remain a prevented thought as long as we keep stubbornly reasoning with the Freudian model of the psychic apparatus designed as a perfect geometric object, tightly closed and existing in itself even before entering a relationship.

How can we analyze the terms in which we habitually express our most simple and straightforward observations, and reveal their presuppositions? The answer is clear: we cannot discover it from the inside. We need an external standard of criticism (Feyerabend 1975, p.22).

The abandonment of the purely psychological vertex, which is that of an intrapsychic pathology, may however be carried out only on condition of a double statement: first that the doctor really cannot do anything—impasse on the therapeutic level duly noted—and then that this impotence is not a dismissal finding its arguments in a failing science or the vagaries of a subjectivity impossible to inscribe in the medical system—impasse in terms of thought duly noted. On these two conditions, the issues of the impasse can be formulated sanctioning a break with the strictly medical perspective that presides over all the readings in terms of description, symptoms or operation. Indeed, all assume a completed object, an enclosed space that is the place for internal processes, whose signs ordered in the discourse of the master (Clavreul 1978, p.163), have the dreaded particularity to exclude the subjectivity of their author as well as that of the one who listens. This expresses the extreme collusion between the analytic discourse for which

hypochondria must be right, organic changes must be present in it (Freud 1914, p.83),

and where the symptom therefore refers to something formulable as a syndrome or disease, and the traditional medical discourse that dooms the patient to silence to and only hears symptoms. Moreover, in On Narcissism: an Introduction, the contiguity with the Bodily vividly appears in the order of the text. The reformulation of the situation as an observed impasse breaks this proximity: as objective examination does not stop complaint, the therapist’s impossibility of action is the first step of a thought of the relationship.

The usual and repeated use, in literature, of the medical model, whether its approach is semiotics, diagnosis or clinical pictures, prognosis or therapeutic, can only divert from this intersubjective dimension specific to hypochondria as a radical belief. This is important because as it exclusively sees a pathology of symptoms, this model shares, implicitly, the same assumption as the Freudian model: a possible patient-physician encounter as nonrelation between two closed systems. This postulation that culminates in Freud when hypochondria is seen as an involution, i.e., reactivation of a primary narcissism considered from the angle of a genetic stage, underlies medical clinical practice from side to side. This basic assumption, taken over by Jean Clavreul in The Medical Order (Clavreul 1978) down to its smallest details indeed influences the possibility of a naming of these symptoms: the doctor speaks as a representative of objectivity which he guarantees; and the patient can only be an interlocutor as long as he submits to the medical order, i.e., only accepts a normality that says a health to recover (Clavreul 1978, pp.126–127). In both cases the exclusion of their respective subjectivities is considered possible, and any series of symptoms that seem indecisive are rejected into this inferior class. But there is more: as we pointed it, actual neuroses can only be maintained and defined by Freud in his thought by a surprising negativity in an approach which is not that of analysis. For, finding the support of a semiotics fading under the action of reality, they ask a serious and important question: that of an import into psychoanalysis of a founding model that is foreign to it. The latter is, of course, the medical model, as shown in the reference to the theoretical movement wherein their objectification lies. Justification of the sexual etiology of neuroses, articulation between medicine and psychoanalysis, they support the metapsychological elaboration of the Psychoneurotic. Clearly contemporary of the idea of propping sexual drives on ego drives, they are in fact invoked again during the later “discovery” of narcissism: as if their theoretical preservation allowed a definition of auto-eroticism referred to an amount of excitement in a purely somatic actuality, as well as a definition of narcissism. Propping of the psychoanalytic approach on an etiologic, pathogenic, therapeutic medical approach: sort of melting pot of a prevalidation where the major dimension of the relationship is missing.