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Wilson, E., Jr. (1992). Revue Française De Psychanalyse. XLVIII, 1984: On Somatic Problems in Freud's Work and in That of Some of His Successors. Rosine Debray. Pp. 1133-1142.. Psychoanal Q., 61:141-142.
Psychoanalytic Electronic Publishing: Revue Française De Psychanalyse. XLVIII, 1984: On Somatic Problems in Freud's Work and in That of Some of His Successors. Rosine Debray. Pp. 1133-1142.
Debray reviews the development of Freud's thought on somatic illness. Freud made a distinction between hysterical conversion and the opacity of somatic illness, which was devoid of "meaning" in his sense. However, some, including Groddeck and Garma, found that somatic illness improved through psychotherapy, and so made a premature and unfounded leap to include somatic illness within the framework of mental symptoms that could be treated in the same manner as conversion hysteria. The contemporary French school has, in contrast, been influenced by Freud's theory of the actual neuroses, and by the notion of stress as it appears in the work of Franz Alexander, who recognized "specific patterns of conflict." This work was continued by Flanders Dunbar, who investigated the typical psychological profiles of individuals presenting with the same illness. Sometimes this has become falsely reductive, as in the notion of "Type A personalities." Such studies lose the psychoanalytic perspective but still afford doctors some false sense of predictability and epidemiology. The notion of stress cuts across all this research, and can include
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a purely medical model as in the work of Hans Selye, or can refer as well to object loss or mourning as in psychoanalytic theory. The latter work is illustrated by George Engel. The notion of a typical profile has shifted now to the notion of a special mental organization in the group of patients called "psychosomatic." Operative thought, the absence of fantasy activity, and essential depression constitute a triptych frequently found in the clinical picture, but the Psychosomatic Institute group questions whether this will eventually constitute a congenital nosological entity. The variability of the symptomatology tells against such a simplification. Marty's and de M'Uzan's description of operative thought has been taken up by others, in particular Peter Sifneos and John Nemiah in the United States, in the description of "alexithymic" characteristics. In contrast to Franz Alexander and Max Schur, who held that the decompensation represented by somaticization was the result of too much neurosis, Marty believes these patients do not present with sufficient frank neurosis because of a failure in the functioning of the preconscious. The question of using classical psychoanalytic treatment for psychosomatic illness is still unsettled. Can it be carried on without falling into the simplistic notions of Groddeck, or of Garma and his collaborators? Some results have been obtained by applying classical psychoanalysis to this group of somatic problems, but in general the poor therapeutic results, as well as the lack of interest these patients have in psychotherapy, have led to the description of alexithymia and the preference for "active" technique. The approach of the Psychosomatic Institute group is to achieve greater permeability between the intrapsychic structures through the transference and countertransference bond that the patient establishes with the analyst. This does not, however, remove the question of the opacity of the somatic symptom itself.
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Wilson, E., Jr. (1992). Revue Française De Psychanalyse. XLVIII, 1984. Psychoanal. Q., 61:141-142