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Castelnuovo-Tedesco, P. (1973). Organ Transplant, Body Image, Psychosis. Psychoanal Q., 42:349-363.

(1973). Psychoanalytic Quarterly, 42:349-363

Organ Transplant, Body Image, Psychosis

Pietro Castelnuovo-Tedesco, M.D.

SUMMARY

Recent experiences with organ transplantation contribute to our understanding of body image phenomena and, in particular, to our concepts of how the inside of the body is arranged. Until recently our knowledge of body image disturbances derived mainly from changes in the body's external anatomy when a body part is lost (as in the case of amputations or congenital aplasias). Now transplants enable us to consider what happens when a foreign part is introduced into the body, i.e., when something new is added.

Psychological material from a case of heart transplant and a case of kidney transplant are presented and related to other experiences from the literature concerning the frequency with which psychosis and other major emotional disturbances have been observed after transplantation. Although a variety of factors underlie the occurrence of postoperative emotional disturbance, the patient's need to cope with an altered body image appears to play a significant role. The patient commonly finds it difficult to regard the transplanted organ as a part of his own body; he may tend to view it, instead, as something which does not belong to him and to which he has no rightful claim. During regressed mental states, guilt about having 'stolen' the organ may occur together with the feeling that his essential characteristics have been altered as a result of possessing, inside, a part from another human being. Thus, some patients are euphoric and feel they have gained special strength as a result of this acquisition, while others, in a more regressed state, feel persecuted by the transplanted organ which they regard as a malignant foreign body.

The task of integrating the representation of the transplanted organ into the body ego is a difficult one, not infrequently fraught with major psychological complications. It is postulated that 'life-saving' and 'life-extending' operations differ significantly. The former are exemplified by the traditional surgical interventions which remove diseased organs and body parts; the patient experiences a loss and must adapt by restricting his body image. The latter are represented by the new transplant operations which add a foreign body part; the patient must cope with this predicament by enlarging his body image and permitting the foreign part to be integrated into it. There is always the possibility, fueled by the enormous life-and-death anxieties inherent in the whole transplant situation, that a major regression may occur which will not permit the new transplant to be assimilated and integrated. In fact, under such circumstances the transplant may become recharged with primitive and destructive meanings, giving rise to a clinical picture of psychosis.

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