Frontiers of Infant Psychiatry - Vol. 2

By Justin D. Call; Eleanor Galenson et al. | Go to book overview

49
Pediatric to Psychosomatic Economy:
Fundamentals for a Psychosomatic
Pathology of Infants

Léon Kreisler, M.D.

Clinical psychosomatics is a vast field where so many disciplines intermingle that it is important to define one's position. My position is essentially clinical, outside of neuro- and psychophysiology, although I take into account basic research that can help interpret clinical data as in sleep endocrinological and immunological disturbances (one finds, for example, correlations between mourning and a lowering of immunological resistance). Developmental biology brings much to the understanding of childhood psychosomatics.

The object of study is the sick infant, both from a psychiatric and pediatric point of view and practice. The method is based on the study of clinical case material without reference to statistical analysis (with one exception: a qualitative and quantitative study of the evolution of newborns that had spent time in an intensive care unit [Kreisler et al., 1978]). The theoretical background is based on concepts developed at the Paris Institute of Psychosomatics, where psychoanalysis is considered a necessary tool for the understanding of psychosomatic phenomena. Here are some of the essential concepts we use.


Basic Postulates

We assume that there are defenses at any age that protect the infant or child against psychosomatic disorganization. These defenses are supported by a full affective life and balanced psychic functioning. However, these two processes do not function in cases of psychosomatic disorganization, particularly when certain forms of depression are part of the clinical picture. French authors who have specifically studied psychosomatics (Fain, David, de M'Uzan, Marty) have described factors that predispose the individual to somatization: such patients are unable to cope with psychic trauma on a psychological level because they suffer from disturbances in symbolic functioning. Unconscious drive derivatives cannot be represented psychologically (or expressed psychologically); instead they find expression through somatic channels.

Historically these authors first described conditions known as pensée opératoire (Marty and de M'Uzan, 1962) as characterized by certain clinical modalities of expression: character

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