Academic journal article International Journal of Psychoanalysis

Conceptual Framework from the Paris Psychosomatic School: A Clinical Psychoanalytic Approach to Oncology1

Academic journal article International Journal of Psychoanalysis

Conceptual Framework from the Paris Psychosomatic School: A Clinical Psychoanalytic Approach to Oncology1

Article excerpt

This article presents further clinical material from the Paris Psychosomatic School (Aisenstein, 2006). The Freudian foundations of psychosomatics are detailed and post-Freudian developments focusing on the contribution of the Paris Psychosomatic School are outlined, in particular, the somatizing process as a result of regression and the somatizing process as a result of drive unbinding. The authors argue that the latter possibly gives rise to progressive and serious illness leading to death. The relationship of classical psychoanalysis to psychotherapeutic treatment from the angle of the Paris school is commented on. The authors then turn to two clinical presentations of women suffering from breast cancer. The method of evaluating the patients' capacities for undergoing psychotherapeutic treatment and their mental capacity for healing is discussed. The face-to-face psychoanalytic treatment undertaken with the second case is discussed. Finally, the authors recall Freud's insistence after 1920 on the opposition of the life drives and the death drives, which placed self-destruction at the centre of psychic functioning. They conclude that current research in biology and medicine, notably research concerning programmed cell death, will converge with psychoanalytic psychosomatics to illuminate somatizing processes and demonstrate the relevance of psychoanalytic treatment to patients who are capable of mental reorganization in the course of their illness and medical treatment.

Keywords: breast cancer, death-drive, drive, ego-ideal, essential depression, mechanical functioning, mentalization, oncology, progressive disorganization, psychosomatics, regression

Different conceptions of psychoanalytic psychosomatics

Freudian foundations of psychosomatics

Freud never concerned himself specifically with psychosomatics. Nevertheless, psychoanalysts working with ill patients suffering from somatic disease have used a certain number of works and conceptual tools that he developed in other fields of psychopathology as the basis for later developments (Smadja, 2005).

While Freud was not interested in psychosomatics in the sense in which we understand it today, he nevertheless extensively studied the different states of the body. These works concerning physical symptoms all arise out of his theoretical preoccupations with drive economy. Surveying Freud's oeuvre, one can thus describe four models of somatic symptoms: conversion hysteria symptoms; the somatic symptoms of the actual neurosis; hypochondriac symptoms; and organized organic ailments.

In Freudian theory, conversion hysteria symptoms are memory symbols converted into the body and representing an ensemble of unconscious fantasies in which the subject's bisexuality plays a role. From a clinical point of view, it must be emphasized that these corporal symptoms are not typically accompanied by anxiety. From a metapsychological point of view, a certain number of mental conditions are required if they are to converge into the formation of hysterical symptoms: the existence of a post-oedipal superego indicative of a relatively complete oedipal organization, that of a dynamic unconscious responsible for symbolizations, and a securely established and efficient repression mechanism.

Clinically, the somatic symptoms of the actual neurosis correspond to the functional disorders of classic medicine. They result from a hyper- or hypofunctioning of certain somatic functions. Unlike conversion hysteria disorders, they do not generally have any symbolic signification and are typically accompanied by anxiety. At the metapsychological level, they are the result of a disturbance of psychosexuality or mental sexuality.

This disturbance results from the insufficiency of the mechanism of repression, in place of which other more economically costly mechanisms are established as substitutes, such as suppression. The subject's libido is thus diverted from its psychic use and reverts towards organs that it cathects immoderately. …

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