Psychosomatic and hypochondria
The link between body and mind, in the psychosomatic, insists in putting psychoanalysis in a difficult position after funding it with hysteria. I'll submit here some new theories - after those of Alexander, Kreisler, Marty and Guir to only quote the most important - of which the operative value has sometimes appeared efficient with some patients. Marcel Proust will impose himself as the most logical illustration for this chapter...
We will first recall a few traits of hysteria, to clearly distinguish the problem. It is an unconscious language used by the body as a sign. This is exactly its specificity, an overly detailed translation of the self in the register of the other, the language. This exaggerated presence of the other in the hysterical person's psyche and body is what allowed the discovery of the unconscious thanks to the spectacular nature of its apparitions within that context.
If in hysteria the body's occurrences are decipherable by unconscious mechanisms written within the speech's register, it is however frequent to notice that on the opposite hand hypochondria is usually reluctant to the effects of interpretation. It is that in fact, it necessitates more rebuilding than analysis...
Hypochondria is a non-translatable physical suffering reducible neither in the language (by interpretation) nor by the body (by the effects of medicine).
In other words, psychotherapy and medicine are usually thwarted. It is in fact the same process of translation from one informative system to another (between conscious and unconscious, symptom and medicine) that poses a problem, that is faulty and on which the therapist can't therefore lean on.
In this work I'll take the decision to put hypochondria and hysteria in the same chapter: they are probably variations on a same theme. Their common points are sufficient for a conjoined function structure to be studied. Indeed, the similarities between one another are numerous in both ways and it is striking to note the common investments of those structures:
- in both cases we observe an over-investment of objects related to the illness, real or not
- those disorders affect deeply the other connections of the patient who bears them, far more than other illnesses more independent from the psyche in their genesis. Particularly they constantly affect romantic and sexual relationships (transfer).
The body is affected, objectively in a case and subjectively in the other. The difference between one and the other only depends, in my opinion, on the differences of genetic equipment between subjects. In both cases exist a painful affect of the body, objective or subjective, partly linked to a breach of the relationship with the other. The way by which this action happens is more often through the immune system for the psychosomatic even if other systems, especially neuro-vegetative, can be involved. The current progresses of biology highlight ta growing complexity of the connections between neurotransmitters, the immune system's molecules and the inflammation's mechanisms. Already this system seems complicated enough to allow the development of certain ways of functioning linking those phenomenon together in a way that a clinical specialist of relationships could start finding his way through. This is what we'll attempt here.
Of course it is only useful to talk about this problem if we offer a new theory about its singular difficulty. This theory will have to both demonstrate a certain amount of partial success in its application and show why failure is frequent when it is ignored. This will implicate to detail the question of transfer and pleasure in psychosomatic which will take us far away from the benevolent neutrality technique.
The psychosomatic structure
The psychosomatic illness brings us to notice an attack from one to oneself. Most serious psychosomatic illnesses are in fact caused by auto-immune mechanisms. They correspond to a perturbation of the immune system, process usually directed toward outsider bodies.
The very complex and still mostly unknown structure of the immune system lends itself to numerous metaphors concerning the psychological field. In particular the definition between the self and the non-self usually taken as a fixed element is in fact dynamic, as much on the biological plane than on the psychological one. Just like the body is constantly trapped between internal and external exchanges with constant renewal of its internal components by effects of diet and breathing, the psychological self is always being reworked by the mandatory exchanges in which it is taken and constantly redefine its limits and links.
Immunological accidents, as psychological accidents would then be linked to a too important identity rigidity. Indeed, when an auto-immune illness declares itself it is, in the actual state of our knowledge, probably linked to a crossed relation, meaning the external attack of a bacteria, a virus or an antigen triggering the production of antibodies that will then behave as enemies to a part of the body that has structural similarities to the virus, the antigen or the bacteria in question.
Instead of accepting that idea that the assailant would now be part of itself which would imply a lack of antibodies production, then leaving to other part of the biology and immunology the care to defend themselves despite everything instead of finding an identity compromise with this external input (as in the desensitization in immunology, the mithridatization in toxicology or the accommodation in psychology...), the body antagonizes the antigen in a radical spotting of strangeness, paying the price of sacrificing a part of itself. It is indeed identity rigidity. The body is looking to continue to exist in an old way, independent from the new encounter it just made.
To follow on the biological reality of those illnesses, it is necessary to note the probable function of this immunological shifting process devoted to the constant encounter of the news field with the identity field, of the stable and the unstable. It is in reality a system linked to adaptation and evolution which treats encounters in terms of integration, redefined privacy with the goal to engage a negotiation during said encounter which will have different types of conclusion: acceptance, neutrality and finally a reaction of reject followed perhaps by recognition following the insistence of the antigen's presence (desensitizing).
An allergy is therefore a lack of recognition, of acceptance of the new, however located at the surface of the body, external surface (the skin) or internal (the digestive track). As seen by Didier Anzieu, the consciousness is sometimes linked in analysis to this surface of the body. More often, this allergy works on outside elements despite being recognizable, conscious, sometimes avoidable. The spotting is clearer, being limited to the surface of the body, to the visible of the external surface so to the conscious. The allergy is the physical manifestation of the phobia on the psychological level: the disturbing element can be avoided.
An auto-immune disease is the absence of acceptance of a compromise with an only partially damaging element, which makes it harder to identify: it functions on an internal ambiguity, the inside and the outside are confusingly mixed up.
On the psychological plane, in accordance with the idea of a self made of narcissistic overlaps, just like a Russian doll, we are here in a specific pattern where all or part of a level will make the next level partially stranger to itself... It then puts a partial or total stop to the narcissistic chain's coherence, which we'll see leave part of the body and psyche suffering. The psychological breach and the physical suffering are at this level totally indistinguishable for reasons that we will understand a bit later. It is possible, if we extrapolate from psycho-therapeutic elements to immunology, that one of the essential driving forces of the psychosomatic response process goes to evaluating the well-being and displeasure felt as a global mechanism, like some sort of confused addition of every details of pleasure and suffering encountered. The body, and not the mind, sorts out a negative or positive conclusion of said encounter. It is indeed an encounter that we can qualify of internal to the body, of massive. Those are elements that concerns what psychoanalysis qualifies as introjection. The conflict will happen in some way inside of the body, inside of the psyche and not at the surface which makes it so that the subject will neither be able to escape it nor be conscious of it.
Antibodies actually work as symbols inside of the body, they allow to nearly nominally target objects moving outside and inside of the subject, integrating them in a structured systemic biological reaction that triggers the immune response through the aim of what could be beneficial or dangerous for the organism. These aren't explicit signs, meaning that they don't consciously arise, they're not integrated to the language but they are implicit, linked to the body and they allow it despite everything to symbolize reality through some sort of ideogram. Each antibody corresponds indeed to a specific antigenic object which strangely looks like the Chinese language and its endless complexity. It is an internal defense system overcoming the impossibility of a conscious, external defense. The fight is internal, with every risk it comprises... Notice that in allergies the response is of a same nature, only on a more accessible body part linked to the surface of the body so to the consciousness. The chances of mobility, of change are then higher as noted by the clinic even if the necessity of a new significant symbolization (non-corporeal) exists there too.
My theory is that the great organizer of those immunological reactions which will orient them in a direction or another will be, outside of the genetic equipment, the feeling of pleasure at the encounter. Pleasure more or less partial or complete including or not contradictory parts.
Therefore, in the processes of psychosomatic illnesses, we can suppose an encounter going badly but perfectly internalized that is part of the subject's identity that goes beyond the level that we have seen on the chapter about autistic structure. The outside came inside by a global pleasure, enough for the door to open, for the recognition of others structures itself as part of the subject's identity.
But inside of this identity entered some kind of Trojan horse of which the negative effects will sometimes take over the hope of pleasure this encounter offered. It is therefore the beginning of a fight between the self and the self or more between self-conservative forces and narcissism, between the being and the subject. There was a trap, the symbolic structure introduced within the consciousness and the pre-consciousness elements hostile to a part of the self, some kind of internal sabotage that will disrupt the smooth walk of the narcissistic Russian dolls, accommodating from the new to the self. The subject will take for themselves a part of them that isn't linked to pleasure.
Then, a nearly-physical reason (internalized displeasure) ends in an internal fight that a truly immune, biological support with its genetic part will represent for the subject. The development of the identity's narcissistic process is stuck on this unresolved suffering that, calling to be relieved, blocks the subject in this moment of identity, making it rigid.
Of course, a generally positive interjection which doesn't contain ambivalent, non-coherent elements that are partially toxic for the self doesn't exist: the parental imago is never ideal. It is necessary to polish the difference between neurotic, psychotic processes and those psychosomatic processes knowing that throughout this book they are an integral part of the human soul's development on different levels and don't designate individual patients.
The identity process doesn't only happen between the self and the world but between the self, the other and the world. The link between the self and the other is called the me. The auto-immune and hypochondriac problematic is therefore a disease of the me, it is a disease of the difference between the me and the self, between the subject and the other. This identity process includes elements that are strangers to oneself, or too strange, more or less toxic. Here too it is only a question of acceptance and psychosomatic diseases are therefore completely inevitable as everything is only a question of level and threshold. Anybody in a specific relationship can feel uncomfortable as long as this relationship is essential for them and comports toxic elements. This experience is shared by everybody in a more or less fundamental way, more or less generalized. The usual experience of stomachaches in a very stressful situation is obviously a complete psychosomatic experience. We find it all there, at first a time of alliances with people that we like in a context we desire, with goals we hold close to our heart. In a second time there is the turnaround against oneself of this ensemble, of this system of function that will lead to live a hostile situation in the development of a dynamic in which we still find ourselves. The third time is the time of realization of the internalized disturbing element. Most of the time it will be missed in the psychosomatic structure itself causing a freeze-frame of this second time. The fourth time, after the realization, is usually the release, the treatment, the side-lining of the disturbing element. When this side-lining isn't possible despite the realization of the origin of the problem the defenses put in place will be neurotic and not psychosomatic.
An important element is the non-identification of the disturbing element in this second time we were talking about, internalized without being symbolized. It is located, felt by the body as we saw but through language. There is the psychological breach. As all that concerns the pre-conscious symbolization comes from the neurotic field we're not in it.
What prevents the symbolization, conscious or pre-conscious, is obviously a strong psychological factor: the intense dependency. This means that consciousness refuses to establish itself, to settle down outside of the disturbing link probably due to a feeling of incapability, of an idea of impossible, the fear of a catastrophe, of an experience of reality without protection. This intense dependency is a way of explaining what I called earlier identity rigidity.
Therefore every psychosomatic process is followed by a structural immaturity of the me and the self, probably both, that will then also lock the subject in the psychosomatic process. As they can't escape, they go back to this place that defines them while partially intoxicating them at the same time.
The relationship is intense only by the lack of an autonomous feeling of the capacity to exist. In psychosomatic illnesses the intense feeling is only partial, only touching certain functions of the identity. This partial breach of the me's individual functioning is precisely linked to the romantic function, to what we call the object's relation: a toxic dependency element will continue in the subject's functioning as long as they imagine not being able to live without that other that they love and that unconsciously partially intoxicates them. Of course to understand this case we need to get past the lacanian view saying that love would only be a narcissistic illusion that is necessary to bypass to gain the status of subject responsible for themselves, as if they were safe from love. On the contrary love is the major catalyst element of the psychological structure! And then of transfer, romantic, therapeutic or work related. But we will let Proust describe for us what precedes in A l'ombre des jeunes filles en fleurs:
"The doctor who was taking care of me - the one who had forbidden me all travel - advised my parents against letting me go to the theater; I would come back ill, for a long time maybe, and I would eventually have more suffering than joy. This fear could have stopped me if what I was expecting from such a performance had only been a joy that in short could be, by compensation, erased by a later suffering. But - similarly to the trip to Balbec, the trip to Venice that I had so much desired - what I was asking from this morning was something completely different from joy: truths belonging to a world more real than the one I was living in and of which the acquisition once done couldn't be taken away from me by insignificant accidents of my idle existence, would they be painful to my body. At most, the joy I would feel during the show would appear to me as the maybe necessary way to perceive those truth; and it was enough for me to wish for the predicted dizzy spells to only begin at the end of the performance for it not to be compromised and wronged by them. I begged my parents whom, since the doctor's visit, did not want to take me to Phèdre. I ceaselessly repeated to myself the soliloquy: "it seems like a prompt departure takes you away from us...", looking for all the intonations one could put in it as to best find the unexpected of the one the Berma would find. Hidden like the Saint of the Saints under the curtain that shirked it away from me and behind which I lent it a new appearance at every moment, following those words from Bergotte - in the pamphlet found by Gilbert - that was coming back to my mind: "Plastic nobility, Christian hair shirt, Jansenist paleness, princess of Trézène and Clèves, Mycenaean drama, Delphic symbol, solar myth", the divine Beauty that must reveal to me Berma's acting presided day and night at the back of my mind on a constantly lit altar, of my mind of which my strict and light parents would decide if they would lock up or not and for ever the Goddess' perfections unveiled at the same spot where her invisible shape stood up. And eyes fixed on the inconceivable picture I fought from dawn to dusk against the obstacles my family put in front of me. But when they had fallen, when my mother had told me - despite this morning taking place precisely the day my father had to bring back Mr. de Norpois for diner after the Commission's session -: "Well, we can not sadden you, if you think you'll have such joy you need to go", when this theater day until now forbidden only relied on me then, for the first time, I asked myself if it was advisable, if reasons other than my parent's prohibition should not have made me renounce to it now that I did not have to worry about it being impossible. First, after hating their cruelty, their consent made them so dear to me that the idea of hurting them hurt me too and life didn't appear to me to have truth as its goal anymore but tenderness and of which goodness or badness depended oh my parents' sadness or happiness. "I would better like not to go if it must hurt you" I told my mother whom, on the opposite side, tried hard to remove from me this idea that she would be sad which she said would spoil the joy I would experience at Phèdre and considering that her and my father had backed up on their prescription. But then this kind of obligation to have joy seemed quite heavy to me. And if I came home sick would I be healed in time to go to the Champs-Elysee once the holidays over, as soon as Gilberte would come back there? To all those reasons I confronted the idea of Berma's perfection behind her invisible veil to decide which one would win. I put in one of the balance's trays "seeing mother sad, risk to not be able to go to the Champs-Elysee" an in the other "Jansenist paleness, solar myth"; but those words started clouding themselves in my mind, didn't mean anything to me anymore, lost all weight; little by little my hesitations became so painful that if I had chosen the theater it would only have been to make them stop and be freed from them once and for all. It would have been to end my suffering and not anymore in the hope of intellectual profit and in yielding to the appeal of perfection I would have let myself be led not to the Wise Goddess but towards the implacable faceless and nameless Divine for which she had been surreptitiously replaced under her veil. But suddenly everything was changed, my desire to hear Berma received a boost hat allowed me to wait with joy and excitement for this "morning": having been doing my usual stylite stance, so cruel recently, in front of the theater's columns I saw the still damp Phèdre's detailed flier that had been glued for the first time (and where, to say so, the rest of the casting didn't bring me any new appeal that could have helped my decision). But it gave a more concrete shape to one of the goals my indecision oscillated and - as the flier was dated not of the day I was reading it but of the day of the representation and of the exact hour of the curtain raiser - so much that, nearly imminent, already on the way of happening, I was jumping for joy at the idea that at this exact hour I'll be in my seat ready to listen to Berma; and fearing that my parents wouldn't be able to find two good ones for my grand-mother I ran back to my house, made crazy by those words that had replaced in my mind "Jansenist paleness" and "solar myth": "women with hats wouldn't be received in the orchestra, doors close at 2pm". Alas! This first morning was a great disappointment."
Proust, or the painful search for pleasure... We read in this excerpt the profound, consciously unsurpassable dilemma between the acquisition of "essential truths", family tenderness and Gilberte's attraction with a sickness background bringing him closer to his parents. He replaces the caesura, impossible, radical separation with the other that is never symbolized in Proust by an endless psychological analysis of the characters, hiding non-surpassability that characterizes it.