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When the Body Displaces the Mind

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Can the mind really generate a physical disease? Conversely, can the body cause mental illness? What do we know today about their interaction? The relations between body and mind are the source of many problems that are currently treated separately by psychoanalysts and doctors because of the compartmentalisation between their disciplines. Despite differences in clinical practice, we all stand to benefit from a common understanding of the reciprocal influences of the mind and the body and the ways in which these are interrelated. It is time to stop treating the body in isolation from treatment of the mind and to understand that where the psychic apparatus fails in its key task of managing the excitations generated by the tensions and frustrations of everyday life, it is the body that takes over. With a wealth of clinical examples, the author proposes an innovative theoretical and clinical approach that seeks to break down the barriers between biology and psychoanalysis; he also demonstrates its benefits for the health and recovery of patients and its implications for disease prevention.

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CHAPTER ONE: Emotions and traumas

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The desire to “heal” arose in that distant period of my childhood and in a sense I can say that in so far as possible I help to treat the “mind” of diseased bodies by incorporating in my therapeutic approach a consideration of the status of the illness from which patients are suffering, as well as the nature of the family and professional environment in which they are developing. Rather than taking the place of doctors who treat the body, I am exercising a complementary role that is necessary for returning to a form of mental functioning that is responsive to medical treatment. This consists in an inner mental attitude towards patients and their illnesses.

This attitude differs in certain respects from the perspective adopted by researchers and practitioners in various disciplines who operate within historically determined epistemological constraints and are accustomed to posing problems in a framework with which they are familiar, along the following lines:

•  If the mind is disturbed (a disorder caused by multiple factors), it can generate somatic illnesses and the so-called psychosomatic and/or psychiatric approach is then required;

 

CHAPTER TWO: The economic viewpoint and mentalisation processes

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“Clinical observation slowly taught me that all analysands (and analysts as well) somatize at one time or another, particularly when stressful events override their usual ways of dealing with mental pain and conflict”.

[Joyce McDougall, Theaters of the Body 1989, p. 20]

The strange death of Mrs S-cardiac impulses and turbulence. It is well-known how vulnerable cardiac patients can be to their emotions: I shall begin by reporting a case that unfolded in a hospital department in Boston in the United States. This concept of vulnerability11 is an important one to take into account because some patients seem to become more vulnerable in a hospital setting; in fact, patients cathect their illnesses and their organs or functions in highly specific ways. They are usually completely unaware of the full diagnostic picture and they lack authority in relation to the doctors who are tending them, despite the fact that it is their bodies that are calling for attention and are receiving all the care. In a situation of this kind, patients are highly sensitive to verbal and non-verbal cues from doctors for a wide range of reasons. These signals can either boost their healing capacities or exacerbate their illnesses, particularly if the doctor is not well informed as to the possible effects of his behaviour on his patients.

 

CHAPTER THREE: Amanda, Arnaud, Alice, Sandrine and Emma-somatisations and regressions

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“Somatic diseases generally stem from the individual's inadequacies with regard to the living conditions that he encounters”.

Pierre Marty (1990, p. 48)

When we examine somatic patients in a hospital setting at the request of doctors in the department, the conditions are different from those found in psychosomatic psychoanalytic institutions. The psychologist or psychoanalyst who is also a psychosomatician is in a difficult position because he is not conducting a psychiatric examination (with which somatician doctors are familiar) and he has to communicate the essential findings of his examination to doctors in a matter of minutes so as to assist in the patient's care in a way that complements the medicine being given. Beyond the difference in scientific approach, there is also the question of the terms in which the diagnosis is formulated: how are we to communicate the provisional findings of an examination to a doctor who has no knowledge of the psychosomatic and psychoanalytic models that form the point of reference? We can thus recognise the scale of difficulty surrounding the exchange and interaction between the various parties who are addressing problems of illness and health.

 

CHAPTER FOUR: Adrienne and Sanjay-progressive disorganisation and somatisations: the emergence of irreversible unstable equilibria

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Life may want to abandon me, but I shall never abandon it”.

A female patient

In the hospital, at the end of the corridor with pale green I walls that seem to be telling patients to have hope, but not JLtoo much, waits the cancer specialist, courteous and elegant, wearing a discreet tie and polished shoes” (1994, p. 23.) This is how a patient who had six years of treatment for a breast tumour describes her encounter with the doctor who has been overseeing her care throughout these years, whom she is returning to see for a routine check, believing that it is her last visit to the hospital. Trusting and cautious, she is then told by her doctor, who studies the chest X-ray to see a radiologist again, which ultimately leads to the removal of the upper left lobe of her lung. This patient, the heroine of Élisabeth Gille's novel, Le crabe sur la banquette arrière [The crab on the back bench], tells us her observations and thoughts in an impersonal and distant way that seems to caricature this medical universe that she will be inhabiting for the duration of her terrible illness. The patient, whose forename and surname are never revealed, conveys to us the fears and distress that she feels when confronted with the doctors’ aloof and distant attitude. Her literary style appears simply to be reflecting this particular doctor-patient relationship, which belongs to a specific culture and civilisation.

 

CHAPTER FIVE: The psychotherapy of somatic patients-the case of Nina, a woman from the Maghreb

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At her last therapy session, Nina, a young Jewish woman from the Maghreb, looked me straight in the eye and said: “You know, I think I'm pretty now; for all these years you've been like a father to me”. She then turned her back on me and walked away quickly and happily. Nina had been referred to me by a colleague nearly nine years earlier for some psychosomatic psychotherapy (Stora, 1996), which was necessitated by her illness, acute systemic lupus erythematosus. I had not thought that this therapeutic undertaking would last this long, nor had I known that it would take me down paths leading back to my childhood and adolescence and to the traditional healing practices of the Maghreb. In this chapter, I shall address the problems raised by the psychotherapy of somatic patients; the observations I have presented in this work have often featured patients from cultures beyond Europe. It seemed to me more appropriate to present a case example that is often found in hospitals and health centres, namely patients from the second generation of people who have immigrated to France. This will enable me to discuss both the technical and the theoretical problems posed by somatic patients, as well as to address the cultural dimension that is an essential part of the psychotherapeutic process.

 

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