The analytic environment in times of bodily dysfunction: The effect of psychoanalytic psychosomatic theories.

Abstract

This article examines the analytic environment in which psychoanalytic work occurs when patients struggle with complex somatic experiences, such as disease or physiological dysfunction. Patients express fantasies and beliefs about the etiology of their somatic experiences; they elaborate theories about why infertility, irritable bowel disease, or some other disease, syndrome, or crisis is happening to them. I consider these to be patients' multiply determined, fantasy-saturated psychosomatic theories, and suggest that the analyst's understanding of patients' ideas about their somatic experiences is organized by the analyst's both articulated and not articulated psychosomatic theories. Using brief clinical vignettes, I highlight the potentially constricting effect of clinicians' theories on their analyses of patients' psychosomatic theories. I examine psychoanalytic theories of psychosomatics, suggesting that adherence to the theories we have, which often posit linear psychogenesis of somatic phenomena, can result in collusion with, rather than analysis of, the psychic stances reflected by patients' theories. To address the problematic adherence to our theories, and characterize a less constricting clinical and theoretical stance, I critique aspects of the theories and suggest directions for replenishing them.

The Trajectory of Adaptation: A Review of Psychoanalytic Conceptualization of the Working Through and Acceptance of Disability

“…Therefore, the mother, like the therapist, must acknowledge and validate the child's body as an integral part of who s/he is, giving the child a safe and secure psychological existence (Lussier, 1980). Bergner (2009) further suggests that a careful exploration of the relationship between the fantasies of the clinician and those of the patient should be a core component of the therapeutic process.…”

“…Furthermore, according to Bergner (2009), patients have conscious and unconscious fantasies about the aetiology of their experience of the illness, which shape the way they interpret the relationships between self and other. However, for the therapist, the encounter with the person who has the illness elicits fantasies about disability related to his or her body anxieties, sensations, personal history, and the current cultural attitudes about mind–body connection.…”

Seductive symbolism: Psychoanalysis in the context of oncology.

“…The potential space required for such exploratory work would have been flattened. Therapist and patient would now be colluding, perhaps subtly and not necessarily explicitly, in the fantasy that something real-the root, the actual presence of psychic reality and the psychological past in the present body-has been uncovered (Bergner, 2009).…”

“…While calling attention to the presence of such positions towards symbolic psyche-to-soma links in our literature as indicators of the meaningfulness and effect of our theoretical context upon clinical thinking, I am in no way suggesting that there exist no psyche-to-soma influences and links. Rather, as stated elsewhere(Bergner, 2009), I am calling into question the effect of the particular nature of the characterization of the psyche-soma relationship-as linear and symbolism-basedthat can be found in some of our literature, as well as our complex psychological relationship to this literature.…”

“…This theory can be quite pointedly specific-I got cancer because I absorbed my wife's negativity-and is sometimes the source, along with fears of death and disfigurement, of the psychic suffering that accompanies grave physical disease. Most powerfully, as will be demonstrated below via case material, a patient might experience cancer as the actualization or completion of a crucial fantasy about his or herself (Bergner, 2009).…”