Joyce McDougall on Psychosoma and Psychoanalytic Process

　
With sadness we note the passing of Joyce McDougall on August 24th, 2011.  She was a renowned French psychoanalyst and author of many books, including: Theaters of the Mind, Theaters of the Body,  The Many Faces of Eros, and Plea for a Measure of Abnormality.

"The inherent difficulty facing the infant in his task of becoming an individual is of a more global, more 'psychosomatic' nature than the problems encountered in coming to terms with sexual realities. Failure to sort oneself out from the 'not-me' environment and so to create a sense of personal identity produces more catastrophic results than does a similar failure in the acquisition of sexual identity and the rights which belong to it. Yet such catastrophic failure does not necessarily result in a startling psychosis. It may go unnoticed while its insidious effects continue, silently, like the Freudian death instinct. When this occurs, body and mind have somehow lost their connecting links.

In the earliest attempt to deal with physical pain, frustration and absence psychically we have the first 'mysterious leap' from body to mind. We know very little about it. Considerably more knowledge has been garnered by psychoanalysis about that still more mysterious leap in the other direction, the leap from mind to body which underlies hysterical conversion and the various inhibitions of bodily functioning. Long before such complicated psychic creations are absorbed the baby must first have been seduced to life by his mother, for herein lies the initial movement which stirs the first glimmerings of psychic life.. This much we know: the structuring of the psyche is a creative process destined to give each individual his unique identity. It provides a bulwark against psychic loss in traumatic circumstances and in the long run in man's psychic creativity may well lie an essential element of protection against his biological destruction.

This brings me to the first point of my paper: the importance of man's innate capacity for symbolic activity and psychical creation, and in particular, the heterogeneous character of these creations. In the attempt to maintain some form of psychic equilibrium under all circumstances, every human being is capacle of creating a neurosis, a psychosis, a pathological character pattern, a sexual perversion, a work of art, a dream, or a psychosomatic malady. In spite of our human tendency to maintain a relatively stable psychic economy and thus guarantee a more-or-less enduring personality pattern, we are liable to produce any or all of these diverse creations at different periods in our lives. Although the results of our psychic productions do not have the same psychological, nor indeed the same social value, they all have something in common in that they are the product of man's mind and their form is determined by the way his psyche has been structured. They all have inherent meaning in relation to his wish to live and to get along as best he can with what life has dealt out to him. From this point of view it is evident that the psychosomatic creations appear the most mysterious since they are the least appropriate to the over-all desire to live. If their psychological function is conspicuous by its absence, their biological meaning also eludes us. In many respects they are the antithesis of neurotic or psychotic manifestations. Indeed it is frequently when the latter cease to function that psychosomatic (as opposed to psychological) illness declares itself. My reflections on this particular phenomenon have been much enriched by the extensive research into psychosomatic illness carried out by my colleagues in the Paris Psychoanalytical Society. I refer in particular to the works of Marty, Fain, David and de M'Uzan. My personal interest in psychosomatic symptoms and their relation to symbolic processes has come from a different direction which I hope will become clear.

My second point is that man's irrepressible psychic fertility of whatever order is coexistent with life itself. If we admit that something like psychic death may occur then it is possible that when psychic creation faulters or comes to a halt man may be threatened with biological death. The psychic processes that create and maintain psychic health as well as those responsible for maintaining psychic ill-health are nevertheless on the side of life. When we, for any reason, fail to create some form of mental management to deal with psychic pain, psychosomatic process may take over.

This brings me to my final point. The psychoanalytic process is itself a creative one in that it re-establishes separated links and also forges new ones. Like our psychological creations, these links too are of a heterogeneous nature: liaisons between past and present, conscious, preconscious and unconscious, affect and representation, thought and action, primary and secondary processes, body and mind. I would suggest that psychoanalytic processes are the antithesis of psychosomatic processes. Psychosomatic transformations pose special problems in the course of an analysis and it may be that they demand a different approach from that required to understand the neurotic parts of the personality. I do not wish to suggest that there are special 'techniques' for dealing with man's different psychical manifestations but simply, that further insight into the processes at work may alter our way of listening to our patients. Itten, in his remarkable book on colour and painting (1961), writes of artists in words which might equally apply to the intuitively creative aspects of the analyst's task: 'Doctrines and theories are best for weaker moments. In moments of strength problems are solved intuitively, as if of themselves.' So is it with analytic work. Itten goes on to say. 'If you, unknowing, are able to create masterpieces in colour, then un-knowledge is your way. But if you are unable to create masterpieces out of your un-knowledge, then you ought to look for knowledge.' "(pp. 438-439)

Joyce McDougall (1974). The Psychosoma and the Psychoanalytic Process. International Review of Psycho-Analysis, Vol. 1, pp. 437-459.