Judith Mitrani on Psychosomatic Conditions and Unmentalized Experience

"It might be concluded that certain unmentalized experiences in early object relations play a pivotal role in the emotional etiology of psychosomatic asthma in some patients. The selection or choice of the asthmatic symptom, as an expression of a deficient environment or as a sign of developmental arrest, is determined (as concerns the psychic component) by the unconscious phantasies, conflicts, wishes and fears of the primary object(s) which impinge upon the infant (and perhaps even the foetus) in the early, formative stages of development.

The concept of a psychosomatic aspect of the personality, rather than a psychosomatic personality or a psychosomatic patient may prove to be of some merit. Likewise, it may be worthwhile to consider a deficient area of alpha—function (or a circumscribed or limited deficiency in the holding and containing function of the primary object) with respect to a particular (rather than a general) vulnerability in the infant. This "coincidence of vulnerability" in both infant and the primary caretaker may be seen to have unfortunate consequences in terms of the subsequent development of mental structure.

Until recently, traditional psychoanalytic approaches to the treatment of psychosomatic asthma have been aimed toward seeking out conflicts and phantasies within the mind which seem to exert their pathological effects upon the body. With the introduction of the notion of unmentalized experience, an approach is implied in which the analyst attempts to shift somato—sensory memories and proto—phantasies from the body into the mind, where they may be represented for the first time. The aim of psychoanalysis then is to build psychic structure; to further develop a mind—ego from an original body—ego.

The capacity of the analyst to assist the patient in transcending and transforming early environmental failures as well as innate deficiencies is an essential factor in facilitating the gradual relinquishment of asthma as a self-survival tactic. By presenting him or herself as a reliable, durable and flexible (although transitional) object and as a benign, reflective, and understanding presence, the analyst serves to repair and promote growth within the internal world of the patient." (p. 338)

　

Mitrani, J.L. (1993). "Unmentalized" Experience in the Etiology and Treatment of Psychosomatic Asthma. Contemporary Psychoanalysis, Vol. 29 pp. 314-342.