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Giovacchini, P.L. (1963). Somatic Symptoms and the Transference Neurosis. Int. J. Psycho-Anal., 44:143-150.

(1963). International Journal of Psycho-Analysis, 44:143-150

Somatic Symptoms and the Transference Neurosis

Peter L. Giovacchini

SUMMARY

This clinical study uses the frame of reference of the transference neurosis in order to determine what role object relations have for the satisfaction of drive needs and the total psychic integration of a patient who suffered from two somatic syndromes, migraine and hypertension.

Drive needs and object relations are conceptualized along a continuum, a hierarchy whose spectrum extends from primitive omnipotent megalomanic, primary process modes of operation to judgemental reality-tested sensory and motor phenomena that are organized in a secondary process fashion. The somatically oriented drive needs in a primitively fixated or deeply regressed ego do not have a mental representation, since the qualities of mentation and consciousness relative to such basic needs are still embryonic. At the other end of the spectrum, the drive is experienced as a conscious impulse that can potentially be gratified in an object-directed fashion.

The study of the transference neurosis of this patient revealed the following striking correlations. When she was able to relate in a nonautistic way towards the analyst, which, of course, reflected her general status of object-relatedness, she did not suffer from somatic illness. When she was unable to relate affectively to an object which was also reflected in the transference neuroses and which was indicative of a regressed primary process oriented ego state, she suffered from somatic signs.

Here the organ dysfunction is considered as an indicator of a disturbed psychic equilibrium. Any physical illness is the outcome of some disturbance of homeostasis and in turn contributes further to disequilibrium. When the ego was able to handle its needs at a reality oriented object-directed level, then the function of the lower visceral systems was not disturbed. From a phenomenological viewpoint, the correlation between the surface adjustment and somatic illness was not consistently maintained; there were times when the patient seemed well adjusted and the hypertension had reached dangerous levels, and times when she seemed to be in a state of almost complete dissolution and would be practically free of cardiovascular signs. The subtleties of the transference neurosis, however, revealed aspects of her psychic integration which did correlate consistently with the somatic states.

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