Martine DerzelleTowards a Psychosomatic Conception of Hypochondria2014The Impeded Thought10.1007/978-3-319-03053-1_9
© Springer International Publishing Switzerland 2014
9. Towards a Psychosomatic Conception of Hypochondria
(1)
Institut Jean-Godinot, Reims, France
Abstract
We sum up and explain the theoretical and clinical contributions of this study of hypochondria. A new clinical case exemplifies them. Thanks to the psychosomatic conception of hypochondria we go in-depth into the complexity of this case to open new perspectives on hypochondria and other disorders.
Thinking hypochondria in this perspective, alternative hypothesis of a prospective nature, therefore produces new effects. Because when we question the status of the body on the basis of a multidimensional model, our research results in a new plural set of landmarks on a possible therapeutic level as well as on the technical and theoretical one which could constitute “the formula sought.” These contributions are the following:
(1)
In the global reflection on systems, two important findings obviously emerge:
The study of hypochondria shattered the Freudian model based on an evolutionary organization. Transverse notion of projective nature, if hypochondria is first and foremost a belief including in its cipher a relationship to another person, it does not only defeat a notion of Actuality designed as symptoms that are purely physical, it also nullifies all two-dimensional models introducing a radical break between two dimensions of the somatic, thought in relation to transference, positively as well as negatively.
The study of hypochondria shattered the Freudian model which was based on a purely psychological concept, pure denial from which the analytical game emanates, which is a double exclusion of reality in its social as well as biological form and to which any discourse on Actuality is linked, on hypochondria as well. Because, as it is an impasse in relational terms, possible equivalent of a somatization away from which projection keeps the subject, hypochondria calls forth Social and Biological for a complete overhaul of psychosis.
(2)
For an explanatory definition providing hypochondria with a theoretical status; thanks to a different conceptual system, the main insights appear to be the following:
Belief in a mysteriously affected body including in its cipher a relationship to another person, hypochondria which is a projective process, failed repression whose proximity must be noticed with paranoia, is the development of a situation of impasse that reveals that a former character functioning turned into the prevalent adaptative attitude is inoperative.
Impasse that has been overcome because it is embedded in the elaboration of the unthinkable, that is the impossible loss of the narcissistic object, on which the subject vitally depends, hypochondria needs to be situated in the context of Somatization, impassable impasse offered to thought in a typical symptomatic oscillation.
Somatic first, it then becomes psychical, as the frequent succession, pointed in our examples, of allergy and hypochondriac bouts, as if the result-failure of the first triggered the beginning of psychosis.
(3)
To the relational and/or transferential plan, hypochondria reveals two essential aspects and completes the weakening of the concept of Actual:
Medically first, the objective impasse, linked to the fact that complaint is taken into account, should be read, it seems, as the repetition of a subjective impasse in terms of relationship, projective attempt of a restoration of a relationship to another person on the model of childhood. This relationship, in fact, is the repetition of an early relational situation, background constituent of body superego where the distortion of the maternal function, that equates “you must” with “you mustn’t,” prevents the subject from leaving the iterative field that holds him captive.
Psychoanalytically, as it is an episode of failed repression between two repressions, that is a projective flash of occasional appearance, a sort of breach in a type of character functioning, hypochondria yet needs to be read as the memory of a highly iterative past. Because, if we reached Freud’s conclusion that there is no transference where only a little Imaginary emerges, we would disregard that a single functioning against a single object is thus reiterated, across a life that seems absent to itself, with no possible change and until exhaustion: character transference which tirelessly transforms the other person into body superego, generated by repression and perpetuating it.
This last development deserves some explanations.
In the first place, giving transferential value to all forms of hypochondria, we consider that it is a second functioning linked to a first one in terms of inclusion: kind of parenthesis in parentheses, reaction of survival when, in critical moments, the Imaginary bursts in, to repeat a first projection. Because what is happening is not that a pathology is being overflown by another which absorbs it. Passing to the limit, staking one’s all, hypochondria is the very last resort to avoid death and it projectively takes over from the character functioning “of before,” partly lifting the ban on projection by a projection of the prohibition to project. Everything happens as if body superego, old transformation of the maternal object into an instance filling a relational void, was re-projected to question, through its loss, the subject and his feeling of being. This means that the transference specific to hypochondria extends the one of successful repression, provided that, however, we do not ignore that transference exists in one case whereas in the other it is, in the therapeutic situation, constantly transformed into superego instance. Successful repression or hypochondria: same functioning against the same object.
The legitimacy of this reduction implies solving a problem upstream: that of the essential link of character repression with the relational level, link constantly denied in the Freudian system which considers the Actual functioning as a “deficient functioning.” How then can we define this typical relationship that is always created, automatically, taking no account of the real qualities of the other person which very quickly appears to be allocated the systematic role of body superego? What name can we give to this unique relationship to oneself and to the other person, fixed once for all in a character functioning intended to deny Difference to produce Identity? If this singularity which suggests a great complexity is ignored, transference seems absent in a situation devoid of the imaginary dimension. That is why character transference which reproduces a strange relationship to the other person, relationship of dependence and even of obedience, as if to the ordinary functioning was substituted a special functioning, taken in charge by the other person on the projective mode, in an imaginary complementarity.
Presupposition of any analytical work and epistemological gap violation intended to go beyond the psychoneurotic scope, transference, far from being an isolated set of affects or conducts, is indeed a structured set, an internalized unconscious situation, and finally appears to be the concept sought to extend analyzability. It must not be confused with projection that yet is part of it. It allows a definition of the body, of its symptoms, in terms of transferential function made of the possible repetitions consistent with various fixation points, referring to the constitution of functions as well as to those already established. This demonstrates how thinking hypochondria seems in fact inseparable from a conception of the subject as a totality known as psychosomatic and within which points of fixation of different levels can coexist, the “actual” or “neurotic” events then always taking place in a relation to the other person. This totality, sometimes can be identified from the beginning. This is the case for example here for Mrs. V.
A hypochondriac symptom can be part of a symptomatic complex, associating a cancerous somatization in the form of a non-metastatic relapse with the specific traits of a hystero-phobic (Sami-Ali 1987, p.126) character; this surely shatters the Freudian conceptual framework. Burst and overflow of a reference framework which cannot allow to conceive the coexistence, or at least the alternation, within the same subject, of several somatizations of different levels, i.e. the levels of Real Body and Imaginary Body considered in their dialectical opposition. Therefore, we need a thought seizing in its unity a stratification of symptoms whose variability in time has to be incorporated into a totality linked to a type of functioning.
Conception of a totality which the case of Mrs. V. invites to develop since we can observe in it, assembled into a combination of symptoms at the same distance between “pure” organicity and “pure” neurosis, three different formations respectively corresponding to three different states, different in their degree but not in their nature, of a same basal process: projective activity. Thus coexist in her, for a specific period and at various levels, the three following sets, predominant in turn:
A hystero-phobic (Sami-Ali 1987, p.126) level where projection is at work, through a movement making it possible to return to the pleasure principle, typically accompanied by a spatial structuration exclusively controlled by a unique relation of reciprocal inclusions. Regression which operates on the transferential level, reviving a maternal figure on the other person, as well as on the level of fantasy with confinement phobias where the relation between “outside” and “inside” is reversed, and which allows to solve, in a very peculiar way, the Oedipus in a unique relationship where the other person, active or passive, is a narcissistic double.
A hypochondriacal level, where the outline of a projection intended to create, inside a space devoid of depth, an unthinkable distance, over determines a pain that primitively reveals that distance could not be created using projection. If, as the associated thermal changes, headaches indicate that Mrs. V. has to suffer constantly in strict obedience to a sadistic figure (dependence), their time of onset in fact equally reveals the attempt to create a distance in the form of a tension (independence). In fact, the “migraine feeling” has a single function, perfectly identifiable: whether it comes as the final stop to an experience of pleasure, as a total blockage to the utterance of a desire or as the punishment for any active position, it breaks an otherness while pointing at its attempt. Paradox of a symptom combining opposite directions: obedience and desire to live.
A “real” somatic level, where the failure of projection, indissolubly linked to the emergence of an always denied difference that suddenly, however, appears, without being this time once again reduced to identity, and is allied in our patient with a severe regression which, in her case, takes the form of a cancerization. Faced to what, for her, is completely unthinkable, i.e. inelaborable, or even unintegrable, to be and not to be different from her sister (figure of the mother, moreover), sister against whom she allowed herself one day to verbally express all her aggressiveness, Mrs. V. seemed to have no other possible remedy than a somatization affecting the Real Body, only way to “negotiate” what was conflicting and had just taken by surprise her relational system. Contradiction appears where there is an implicit logic of being which is that of identity: in the absence of an acceptance involving a change of thought structure which would allow to incorporate it (psychosis), only the biological and immunological level seems to be able to restore a relationship to another person momentarily interrupted by a projective fiasco that revealed its strangeness. In cancer here, immune evasion precisely inhibits the release of tumor antigens, with either site specific or central mechanisms. Pointing to an alternative that therefore reveals the biological value (Villemain 1989) of projective activity.Related posts:
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