Is somatic complaint related to dream as perversion is related to infantile sexual theories? Somatic complaint has an analogon of intelligibility that can seemingly be found, in the analytical theory, half-way between hypochondria as an illness of discourse and melancholia as a modality of grief work and an unearthing of one’s own cadaver. Could it be related to dream, understood as the par excellence somatic theory in the way Freud explains that its truth comes from its power to provide information in advance on the condition of our organs (Feud 1915[1917]a, p.223), in the same manner as perversion, and particularly fetishism, is to the infantile sexual theories whose “fragment of pure truth” resides in the part of genitality present in infantile sexuality which endow it with an intuition about adult sexuality? This abrupt question represents the polemic direction of development and central hypothesis of this work. It also suggests its deliberate style and method: trying to avoid the etiological perspective, it focuses on “ways of speaking” and conjures up the registers of model and analogy which enable to come close to an order and an economy where an apparent chaos is first seen; they also allow to find an access for the analysis of the relationship that the somatic complaining patient has with discourse, to reveal meaning in nonmeaning and contradiction, to confront to clinical experience a theoretical elaboration rooted in it and nourished with it, if it is true that

proposing models is describing by comparison, it is not giving linear causality explanations (Abraham and Torok 1978, p.373).

Ambitious attempt to build a general theory of the body whose problematic absence, so rightly pointed out by J.P. Valabrega (Valabrega 1980, p.15) has undoubtedly affected each phase of this work? Effort to reduce the immeasurable distance between, in the Freudian corpus and even in its last elaborations, the scope of actual neuroses and that of transference neuroses, by means of an analogical line of reasoning which, using imagination to establish a resemblance between what is analyzable and what is not, might reveal the transformation law which turns the anatomical and sexed body into a sexual and metaphorical one, the flesh body as bodily activity and matter into a desiring one as representative activity, the somatic complaint as scientific Unthinkable into an element of dream and thought? Based on positive observation data and nourished on its questionings with a concrete clinical material—the “negative records”—our research resulted in the need for numerous focus shiftings. From this elaboration, a set of rhapsodic notations remains, finally emerged in the “graphic thing”—“coporeal thing” probably too, as something from the body moves into the word and at the same time gives substance. Between knowledge and fantasy, between child and adult, between life and death, on the borderline of analyzability but at the exact painful center of speech, it tries to sketch out a possible intelligibility model of somatic complaint, where the body, far from being held up as a fetish through an excessive positivization, should be related, as well as sex, to the limit which flaw or lack refer to. Looking for an opening in a category of patients known as unrewarding like hypochondriacs and whose discourse seems to include, in the secret of its cypher, a therapist doomed to fail, sort of lock on the door of the cell where they pay the price of their security.

As a positive and abstract definition of negative reports would conceal the constant need to consider the interlocutor, doctor, or psychiatrist, to whom the question of naming the illness is asked, it is better to first explain the rule to which they are an exception (differential definition) and tell the communicational twists and turns that lead to them (definition through the relation to the medical community).

We cannot help evoking the circumstances responsible for this interest and this work as an “encounter of the fourth kind.” From our often ambiguous position of psychologist-psychotherapist in an Internal Medicine Service, a small hospital department with two units of 30 beds with a certain number of psychiatric patients who could avoid the Psychiatry Unit by being there because their behavior disorders were not too serious, we gradually became conscious of the existence of a fourth kind of somatic symptomatology.

Classically, somatic symptom classification is based, for psychoanalysts as for doctors, psychiatrists, and somaticians, on an opposition that has remained virtually unchanged since the time of Freud, globally setting the existence of three territories. At the two extremes, the etiopathogenic categories are simple: There is either a somatic disease due to a pathogenic factor, affecting the body, or a psychogenic illness, i.e., in which the organs of the body, although possibly algic or inhibited as to the functions, are not affected. The intermediate category, known as psychosomatic, demonstrates the artificiality of this opposition as it combines both organic lesion and psychogenic factor. However, a new idea became obvious: the specular confrontation—due to a request from the medical profession and almost never from the subjects themselves—of these irreducible deviants, unclassifiable and incurable, who are the “sick-who-have-nothing,” designated by the Institution under the eloquent name of “negative reports,” with this other deviant—“whose fantasy support remains body interdiction” (Fedida 1977a, p.75)—who clearly is the clinical psychologist in a hospital, is undoubtedly part of and contributes to, whenever it takes place, the constitution of a true fourth field of somatic symptoms: that of a speaking-spoken body which, withdrawn from what can be seen and palpated, from what can be shown and demonstrated, demands that be heard, through its complaint and in it, a somatic truth yet denied by the visible representation of the integrity of the said-to-be algic body; that of a body engaged in a language—which names itself with a corporeal synecdoche (Valabrega 1980, p.31)—in which it is represented, as staged, by an organ-centered speech successively worded as topo-logy, patho-logy, and symptomato-logy. But cannot an algy be, precisely, and perhaps above all, a “-logy,” and the aches of the soul itself only be expressed in a language that is necessarily the one of the body?

Of course, we do not ignore how arbitrary this dividing line is, even if it is a methodological necessity. First of all, it should be noted that something physiological is usually blended with the most psychogenic and something psychical with the most physiopathological elements,

analyst and physician both face the gaping lacks of their interpretive system of somatic symptom,

as noted by M.C. Célérier (Célérier 1978). But, above all, what is obvious is the usual coextensivity of the last field with the other three, as somatic complaint is to the patient asking for the doctor’s help what the call is to the child asking for the mother’s help, in that both address their interlocutor with a speech in which their call can be interpreted.

In the most common cases, diagnosis, that is the intellectual exercise of comparing medical knowledge and somatic complaint, leads, through the possible determination of their intersection locus, to the naming of the disease. Promise of a possible therapeutic as well as implicit conjecture on healing probability and duration, it is the “par excellence” act of, at least verbal, control, amending the patient’s relation to his illness in that it shows for him and instead of him what he suffers from in the system of signifiers that constitutes medical discourse,

act which contributes to relieving patient anxiety about what he experienced which was not traceable to what could be interpreted from his knowledge on himself, this flow of distressing, painful, stressful, often guilt laden subjective feelings, is included in the medical discourse which assures that a sense can be found in what was previously totally meaningless (Clavreul 1978, p.84).

Diagnosis is usually followed by a reduction in the expression of complaint. In the post-diagnosis period when the patient is given an indubitable existence by the medical profession as the suffering that he expresses and brings is articulable in the signifying components of a syndrome having a place in nosology, it remains on the lowest possible level under the essential form of the expression of a subjectively experienced suffering, undetectable and non-decodable in medical terms. It then matches the “disease of the patient,” according to the word of Leriche (Clavreul 1978, p.25), which undoubtedly refers to the only endurable speech on suffering as a state of internal tension bound to end in resolution: background noise of a waiting suffering body.