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Meltzer, D. (1964). The Differentiation of Somatic Delusions from Hypochondria. Int. J. Psycho-Anal., 45:246-250.

(1964). International Journal of Psycho-Analysis, 45:246-250

The Differentiation of Somatic Delusions from Hypochondria

Donald Meltzer


I have presented material from the analyses of two patients, one severely schizoid and the other moderately cyclothymic, to illustrate the thesis of this paper—that a metapsychological differentiation can be made between hypochondriacal symptoms and what I have called 'somatic delusions'.

The first case shows how a split-off part of the patient's self, characterized by a ruthlessly destructive oral envy, had become located in his anus, producing the somatic delusion of incontinence of flatus as the conscious basis of social withdrawal. The process of reintegration of this part, through its metamorphoses from machine to cat to human form, has been traced.

The second case involves a delusion of having black and frightening eyes. It served primarily to illustrate how the analysis of a somatic delusion, being essentially a process of reintegration of a severely and widely split-off part of the self, is necessarily a late development in the analytic process. It cannot be accomplished until the reorganization of infantile relations to the primal good object (the internal mother's breast) has been firmly established.

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