Academic journal article International Journal of Psychoanalysis

Beyond the Image

Academic journal article International Journal of Psychoanalysis

Beyond the Image

Article excerpt

By imposing itself as the dominant model of modern medicine, the biomedical model leaves little or no place for the psychical/ subjective dimension of illnesses. The author presents a clinical case illustrating the essential contribution psychoanalysis can make to understanding the causes of a serious neurological disorder of indeterminate origin, its psychic determinism and its unconscious dimension. This original contribution argues in favour of the idea that understanding the development of neurological disorders associated with an unexplained lesion cannot be reduced exclusively to the organic level, and must not overlook the notion of unconscious. More generally, it emphasizes that body and mind form an integrated inseparable unit, thus breaking with the traditional dualistic conception of the human being.

Keywords: amnesia, brain imaging, hippocampus, neurology, repression process, soma, trauma, unconscious

I would rather know the person who has the disease than know the disease the person has.

(Hippocrates)

Never relating anything other than the visible ... anatomy cannot say that which is connexion, process and legible text in the order of time. A clinic of symptoms seeks the living body of the disease; anatomy provides it only with the corpse.

(Michel Foucault, 2003, p. 134)

The body ego is the projective screen of the unconscious drama.

(Mario Cifali, 2008, p. 65)

From antiquity, with Hippocrates (450-356 BC) and Galen (131-201 AC), up until the introduction of the mechanistic conception of the body, which began with the upheavals of the Galilean era in the 17th century, medical science was based on the theory of 'humours' (Furst, 2007). According to this theory, health (both mental and physical) depends on a balanced relationship between the four humours of the body, which, in analogical correspondence with the four elements of the Universe, and depending on their relative predominance, determine four fundamental temperaments. The lack of balance resulting when one of these humours gets the upper hand is the cause not only of physical illnesses, but also of psychical disorders. Founded on a holistic perspective, this theory considered the human being as a unity in which body and mind are interdependent, and placed him at the heart of a socio-cultural and environmental ecology. The emphasis was placed on the individual. A deep and intimate knowledge of the patient guaranteed the choice of the best remedy and optimized the chances of recovery. This body-mind interdependence remained the basis of Western medicine up until the beginning of the 19th century, when the discoveries of pathological anatomy initiated by Marie-FranÅois-Xavier Bichat (Foucault, 2003), and the invention of instruments allowing for spectacular progress to be made in the knowledge of how the human body functions (Furst, 2007), gradually revolutionized the practice of medicine and constituted the historical condition of positive medicine. The body and its functions became measurable and objective entities. Henceforth, medicine referred more to normality than to health (Foucault, 2003, p. 35); the individual fact disappeared in favour of a nominalist reduction of the individual to his disease; the medicine of symptoms became a localizing medecine of organs: lesions and visible alterations explained symptoms. As ocular medicine was supposed to include the whole field of knowledge, "the local space of illness was at the same time, and immediately, a causal space" (Foucault, 2003, p. 189). An immediate corollary of these changes was that the emphasis placed on the body put the mind to one side, and the body-mind dissociation became operative in medicine. Mental disorders, which did not escape this rule, gradually became diseases of the brain; and neurology, which had just established its pedigree, supplanted psychiatry and thought that it could resolve the enigma of madness by providing an organic explanation for it (Furst, 2007). …

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