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Sperling, M. (1955). Psychosis and Psychosomatic Illness. Int. J. Psycho-Anal., 36:320-327.

(1955). International Journal of Psycho-Analysis, 36:320-327

Psychosis and Psychosomatic Illness

Melitta Sperling, M.D.


I have used the case of the leg ulcers in an attempt to demonstrate that the early established psychosomatic relationship with the mother was the mainspring for this patient's illnesses, somatic and mental. As a result of this relationship a special mechanism in dealing with the destructive impulses had been adopted by the patient early in life. This mechanism was referred to in the paper as repression of destructive

impulses, yet it would seem to be more closely related to the mechanism of denial. In denial it would seem that the denied impulses are split off from and barred access to the ego. This means that they cannot undergo the modifications which the derivatives of the repressed impulses undergo in neurotic symptom formations. It would seem that only in this way can the ego of such a patient develop and maintain itself in what would appear to be a reality-adjusted manner (non-psychotic).

It was possible through the analysis of the personality underlying the various psychosomatic (ulcerative colitis, ulcers of the leg) and psychological (neurotic, perverse, psychotic) manifestations, to gain an understanding of the dynamics of these manifestations and to resolve them in the course of treatment. (Five years of psycho-analytic treatment and five years of close follow-up.) In the psycho-analytic treatment of this case it was necessary to free the libido from its fixations to the original object (mother) and from its original aims (oral-anal, infantile-sexual gratifications from the mother) and to move it forward to the genital phase, the position of the libido which is a pre-condition for mature functioning. At the same time it was necessary to help the patient gradually to accept and to tolerate her denied impulses consciously. In order to achieve this it was necessary to modify and eventually to resolve the psychosomatic relationship. In the course of this procedure a better fusion of the freed libidinal and destructive impulses could take place, a situation which is important for the sublimation of such impulses. Psycho-analysis initiates, promotes, and brings to a conclusion these complex psychodynamic processes which eventually result, as they have done in this case, in a better solution of the struggle between the destructive and the libidinal impulses, and lead to the establishment of stable, that is, less dependent and less ambivalent object relationships. I do not know of any other treatment which could achieve this.

It is hoped that a better understanding of the genesis and the interrelation of psychosis and psychosomatic illness will relieve anxiety in those who treat these cases and make available the full benefits of psycho-analytic therapy to a greater number of psychosomatic patients.

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