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Marilia Aisenstein:Expressions of the Body in the Cure
Panel: Conscious and Unconscious Expressions of Body Communication
The body is always present in the psychoanalytic cure and the erotic body is at the heart of the cure through the attention we give to the drive. But while it is constantly present, it may nevertheless be absent from the patient’s discourse since a healthy body is silent. When it becomes ill, the body is noisy; it speaks and disturbs, it occupies and overruns the psyche, or sometimes it disappears all together and becomes an object of denial. In the history of psychoanalysis the sick body was long experienced as the limit of analysis, whenever it found itself the object of medical inquiry. It is true that Freud did not go into the psychoanalytic approach to somatic disorders, with the exception of a footnote of 1920 in which he stated that serious and established mental pathologies might temporarily disappear during intercurrent diseases. He concludes that this must be related to the distribution of the libido. It is a simple remark, merely two lines by which he laid down the premises of the psychoanalytic approach to somatic disorders. But he thereby opened the way for the field developed in the 1950s by the Paris school with its precursors, Pierre Marty, Michel de M’Uzan, Michel Fain, and Christian David, for whom the body is neither an obstacle nor a limit. Be that as it may, psychosomatics has long remained at the frontiers of classic psychoanalysis. I would like to assert here that the body ought to be considered as a ‘means’ and the ‘heart’ of the cure; this, moreover, in several ways: the erotic body is not only immediately present in analysis—Freud’s discovery well showed that the sexual is at the source of thought; but still more, a close study of mental functioning and its ups and downs during crises—disruptions in the balance in the distribution of the libido—like the illness, should enable us closely to circumscribe the transformations in the psychic apparatus, even in its usual registers. I will begin with a clinical sequence of two dreams lifted though they be from their context—and this for obvious reasons—, matching two series of possible interpretations of which the second, more peripheral, seems more fundamental to me and closer to the essence of the phenomena. We need only know that the patient was fifty years old. She came from a distant country and a non-western civilization. She experienced serious traumatism in her childhood and broke off all ties with her country and the traditional roots of her adolescence. The psychoanalytic work was carried out face-to-face and was indicated for serious but punctual and varied somatic decompensations (cervico-brachial neuritis, facial paralysis,
She put on the light. the meeting with the latent dream thoughts. the condensation in the face-to-face with me (the Kleenex session that was too ‘hot’). and in the bathroom noticed that her hands and arms were covered with a large urticaria. an entirely debatable gesture but which came to me spontaneously.’ She did not recall the end of the dream but vaguely knew that she found a solution and descended the stairs ‘light’. follows close behind her. I then handed her a package of Kleenex laying on the table. She’s dripping with sweat and opens the window. looking a little lost and odd. while fantasizing a dialogue with me during an 2 . but the young girl sticks around and lays down on the ground. A wave of hatred forces her to throw herself on the young woman whom she claws at with her nails to the point of making her bleed’.Marilia Aisenstein:Expressions of the Body in the Cure Quincke oedema. Unbearable jealousy takes hold of her. In the months preceding her narrative. for her. she cried a great deal which was. Here is the first dream. she didn’t have a tissue and she wiped her eyes with her skirt. determined to stay and wait for the man. did not let her find a way out. Rage and horror woke her. the heat is scorching. pyelonephritis. She took a powerful and calming antihistamine and made herself some vinegar compresses. but was not interested in imagining her. as the man in question had left her ten years before. and the old humiliation in which she had fled when faced with another (faceless) woman. At a red light. she finds herself facing a young woman whom she knows is the new mistress of the man who left her. moreover. A very young girl. but she thought that I might suggest the contrary. a distant friend. The patient attempts to push her and drag her. she’s sweating and feels sticky. She fell back asleep early in the morning and had the second dream. went to drink some water to try to calm herself down. she had been hurt but not jealous. She wants to drop off the dossier in the doctor’s empty office and leave. The first dream is a typical nightmare during which the dream depictions turn out to be inadequate as a means of extinguishing the excitation. and it eats away at her. the ardour preceding the dream which it diagnoses precociously (thanks to the hypochondriac magnifying power of the dream described by Freud in 1918) and attempts a representation that fails. We might question the appearance of the urticaria. ‘She is in the street filled with sun. suddenly overwhelmed by a stream of tears. shingles. something new and slightly humiliating. and so on). The interpretation she gave herself. listened to some Mozart sonatas she liked and wondered why she had this particular dream. she is very angry and fears being discovered with this mad person whom she’d like to get rid of. that her violence was such that she could not depict it. The first time. She thought that the urticaria arose following the dream as a refusal of violence. She knew that it was due to a woman. Beyond the strictly somatic excitation—the pruritus—motivating the attempt at construction. ‘She sees herself in the street. she has to drop off a letter at the gynecologist’s.
and the taking of medication followed by her go at ‘calming herself’. suffocating. which in my view is not the issue—are there modes of ‘bodily’ communication that are not strictly expressed by words?—is as old as the world. while it has long been thought of as dissident in relation to psychoanalysis’ limits. But its aim is nevertheless a physiological function. dripping with sweat) should also draw our attention to the bodily sensation that must underpin the distressing affect. Its construction integrates endogenous and exogenous somatic excitations in elaborative psychic work made more complex by the timelessness of desire. the pursuit of sleep. Passing through this path would also—through her worry about probable pre-menopause at the time when. we must face up to the difficult cases that oblige us to consider extreme questions such as the one I have asked here.Marilia Aisenstein:Expressions of the Body in the Cure imaginary session. the brain as entity was first a ‘philosophical object’. namely. the representation of heat (red light. but also its very heart. The dream as the royal road of the model of the classic cure is not only thought of as included in the clinical practice of a sleeper’s sleep. and this is what I have tried to show by my short example. she was having renewed sexual desires and knew the experience of humiliation—provoked the memory of her exhausted and ill mother to return. on the contrary. It is related to the psyche-soma question whose reverse side is that of the substance of thought: where is the seat and origin of thinking? Well before it had become the ‘privileged object’ of the neurosciences. I would like to recall here Freud’s exemplary career and how. the less the body is psychically cathected and represented. that taking it into account is vital to our practice. We should return to the dream. If we are to think about pure psychoanalysis. he left behind him a few essential texts and he did so because non-neurotic. sweltering. ‘heat flush’. Nevertheless. made sleep possible and. thus. but perhaps at the risk of a disembodiment which must always be feared among somatic patients for whom. due to her analytic work. it seems to me that a reflection at the borders of a discipline can best shed light on its foundations. just as a young woman took her place even in the father’s bed. of homosexuality. Should we forget this—and this goes without saying—we become less attentive to the dream-work. So it is today. the more the silent somatic threat is present. which moved her a great deal as she had not been able to talk about it. for example. This dream may be understood in a distinctly Oedipal light. the thread of jealousy and. Thus. thus. after 1920. The aim of the detour I am proposing in this micro-fragment of a clinical illustration is to assert not only that the somatic is not a boundary of the psychoanalyst’s action. difficult patients had put technique into question. But also on a more theoretical level. It was certainly possible to get to this point more directly by following. the second dream. I suggested to her. psychosomatics is not only its logical extension. 3 . The starting point for the debate. but. sticky.
a dissident mode of thinking if ever there was one in relation to all the other philosophical and medical thinking that precedes it. of the body as reference. wrote Man a Machine. is based on and springs up in keeping with the monist movement. We should not forget that not long after the this era was born Hippocratic medicine. ideas were ‘conceived and 4 . as Dominique Lecourt (1993) has called it. throughout the centuries. Why have I made this brief historical overview? As I see it. ‘How does one think. Galileo of Pergamum proved through dissection the preponderant role of the cortex. For him. went hand in hand an idea that repudiated the tie of efficient causality and of eminence of one mode of expression over the other. he explains in Timaeus). although thought is always attributed to it. the source of vital heat. an ontological abyss: the first pertains to divine supernature. 1993). the soul precedes the body. Opposed to this is the materialist. he thus furnished a scientific basis for the ancient idea according to which the noble part of the human resided in the cranium. and thus a tie of real causality. In the middle of the eighteenth century. Julien Offray de La Mettrie. which ‘instituted between the soul and the body a radical hierarchy. of which it was the divine part. situated in the rounded form of the head (the standing position protects it from shocks.Marilia Aisenstein:Expressions of the Body in the Cure The ‘philosophers’ brain’. Lecourt. The place of the soul is not specified. Shortly afterwards. The true break between the soul and the body was instigated by Christianity. It is true that the main tradition of western philosophy takes as its dominant theme the question. and with what?’ For Plato. the other only to nature’ (D. One may also mention here the great philosophical currents which will underpin philosophical-scientific thought. medical doctor and thinker quite disparaged but often cited by Diderot. monist current whose main thinker. suggested that philosophers take the body as their reference. For Aristotle. and yet it takes roots. Spinoza. He turned the brain into a matrix of the spirit and referred to the enjoyment and sensual pleasure of the study and exercise of thinking. Descartes lodged the soul in what he saw as the seam tying the spirit to the body—the pineal gland—and he did not depart from the model establishing the superiority of the spirit over the body. psychoanalysis. was. A resolute dualist. which made illness into a natural phenomenon and at last proposed a reflection on the body detached from religion. In between these two currents lie several constructions that are more or less weighed down with fantasy. the notion of the soul became more complex: the brain is described as a ‘cold organ’ as opposed to the heart. is a unique and original reply to the very old psyche-soma question. an object of study and dissention as scholarly as it was passionate. be it dualism or monism. With this new. even revolutionary idea. a writer. he imagined the union of two substances within the human being: the first making way for God while the other was fated to be disciplined by the spirit.
From that point on. and consider its clinical implications. an interesting metaphor for psychoanalysis. A THEORETCIAL APPROACH TO UNCONSCIOUS EXPRESSIONS OF THE BODY IN THE CURE According to the theoreticians of the Paris psychosomatic school. the founder of the Paris psychosomatic school. psychoanalysis attributes the source of all thinking to what is sexual and even establishes through this the somato-psychic specificity of what it means to be human. It allows us better to understand the theoretical substratum implicit in the marvelous expression of Diderot. and it displaces psyche-soma dualism onto drive dualism. Sade is the author of a veritable philosophical system that rules out God and the idea of Nature. In a certain manner. in the sense that one may speak of a Copernican revolution. the notions of rights and laws no longer had any meaning. ‘beautiful walkers’. but ‘to knock them all up’. moreover. acted upon by the body. the accursed philosopher who was long relegated to the category of pornographer. the Marquis de Sade. It is not the passage of the mental to the biological that differentiates the psychic from the somatic since on the same places in the body there may be opposed contradictory motions and. I should now like to discuss an assertion by Pierre Marty. whom he liked to tail and then leave. in my view. A century and a half later. Thought was bodily. the ego and the superego—in my view. The space of fantasy is contained in a body of writing which establishes the double valence—destructive and vital—of Eros. This is the very creation of a new field that. Precession of the drive and drive antagonism are prefigured in an oeuvre definitively breaking with morality. in the more complex ‘second topography’. but that it may also make one fall ill. renders the psyche-soma debate null and void. This is a radical notion that takes much from theatre since it proceeds scene by scene. and the most abstract ideas were likewise subject to ‘Sade’s pleasure principle’. who makes Rameau’s nephew exclaim: ‘My thoughts are my dolls!’ Diderot himself was accustomed to comparing his ideas to girls. in effect. more enlightening and quite different. about which he deftly showed its deistic residues. we witness the Freudian revolution. there is a somatic quality to language. In many of his texts we come across the hunch that sexuality is at the origin of thinking. Here is what Pierre Marty wrote: ‘The unconscious of these patients receives but does not 5 . For Sade. A few years later. the id. The primacy of the body was affirmed. the preconscious and the conscious—which becomes in 1923. he went farther than Spinoza. the body was erotic and straightaway a fantasy. The psychosomaticians are thus particularly attentive to the functioning of the preconscious. As an epistemological rupture.Marilia Aisenstein:Expressions of the Body in the Cure impregnated’. It is a matter here of the first Freudian topography—the unconscious. established desire as the motor and first reality of the human being. somatic patients often present failures in preconscious working-through.
a clinical truth means that it may be verified in my practice. . To me. ‘I feel that you’re not the same. Marty’s insistence suggests a warning that goes something like. white depression. a patient noisily erupted in an asthmatic crisis. That morning I had had a nightmare whose mad rage was tugging at me—a furious anger that was badly damned up and poorly elucidated when I’d awoken. This sentence has always seemed to me to be a clinical truth. He twisted his body like a terrorized child. bereaved discourse. . you abruptly let go of me . is absent from these cures. This is not particularly novel and it has been described by numerous authors in terms of mechanical thinking and mechanical functioning but also alexithymia. he is describing in a phenomenological manner the proportion of clinical material that does not bear the mark of the dynamic character of the unconscious. The analyst does not detect any resistances.Marilia Aisenstein:Expressions of the Body in the Cure emit’. classically. Another example. A patient whose mechanical functioning was patent and exemplary had the habit of telling me the facts and events of the week in a chronological order. he told me. shut up! It’s your fault. which. Here are two examples of it. Freud never proposed a theory of ‘unconscious perception’. namely. indeed. There were neither affects nor anxiety in his discourse. I would dare to assert that no neurotic patient would have perceived these imperceptible internal movements in the analyst. ‘the same unconscious receives’. nor any compromise-formations. For each of them. Let’s now return to the other half of Marty’s axiom. As in each cure these were highly eventful moments. it was a matter of a rare moment in which an affect suddenly gushed up—of fear in the first instance and of anger going through a fit of asthma in the second. When Pierre Marty says that ‘the unconscious does not emit but receives’. looked at me and remained silent. Nevertheless it exists but is implicit as it underpins all theories of dream construction: latent thoughts are reactivated by condensed diurnal residues. they are surely worth further examination. So you’re afraid of me?’ ‘Yes’. It is a mater of discourse or narrative cut off from its drive roots. and so on. I asked him what was happening. you’re angry’. In the course of a long silence during which my associations had brought me back to the affect of sorrowful nostalgia related to the recent death of a dear friend. I asked him: ‘Afraid right here and now? .’ In both cases it was a matter of patients whose discourse was present and factual. Nor is it a question of projection. Without the notion of unconscious perception the entire theory of chapter seven becomes impossible to understand. . ‘I’m afraid’. and so on. One morning he sat down. but at the same time it is entirely enigmatic. ‘These patients 6 . but this too remains hardly satisfactory. the patient told me. One might compare them to what one calls ‘psychotic insight’. any derivative of the unconscious. but it was nevertheless set aside. . it is incomprehensible in metapsychological terms. It all occurs as if there was no trace of the conflicts between the psychic forces opposing themselves. As I became worried she got angry and yelled at me: ‘Don’t move.
It is to the fate of the affect between the unconscious and the preconscious that I will devote myself to here since in my two short examples we are witnessing the appearance of an affect of fear in the first patient and of anger in the second. when I reread Freud I always discover new and fascinating aspects of his thinking.. p. not re-nourished by a process of secondary repression? Is it a matter of an unconscious isolated from the system? I would like to try to understand these clinical facts better by basing myself on the description of the system Ucs-Pcs of the first topography and then. This is also why I raised the question of unconscious perception which. p.] that to suppress the development of affect is the true aim of repression and that its work is incomplete if this aim is not achieved’ (Freud 1915. Here is what Freud writes in a footnote: ‘Affectivity manifests itself essentially in motor (secretary and vaso-motor) discharge resulting in an (internal) alteration of the subject’s own body without reference to the external world. Freud will compare affect to motility. The hypothesis of the separation of the systems Ucs-Pcs implies that a representation may be simultaneously present in both and move forward from one to the other. But the question of affect is complex. if I have the time. 179). motility. Are they unconscious perceptions of an affect in the object-analyst? All the same. note 1 p. Moreover. you see how their unconscious is “very sensitive and perceptive”’. The drive may only be represented by the representation that attaches itself to it. how should we consider the system Pcs-Ucs? Must we imagine the unconscious as. The essence of repression is to prevent representations representing the drive from becoming conscious: ‘We know [. This is what I tried to show in my clinical examples. It may only be modified in the transferential-countertransferential 7 . Thus a preconscious affect that is kept to myself is perceived by the patient and will meet in him an unconscious ‘rudiment’ seeking to break through. Both are under the authority of the conscious and have the value of discharge.) I had thought I knew this text well but. the unconscious affect is only ‘a potential beginning which is prevented from developing’ (Freud 1915. SE 14. 178).. in actions designed to effect changes in the external world’ (Freud 1915. SE 14. après-coup. is present but unmentioned in Freud. When patients afflicted with somatic illnesses present failures in the preconscious.Marilia Aisenstein:Expressions of the Body in the Cure are very vulnerable. if the repressed representation remains in the unconscious as an actual formation. Here are a few definitions drawn from the article of 1915. Strictly speaking there are thus not unconscious affects but formations laden with energy seeking to break through the barrier of the preconscious. The repressed does not cover the entire unconscious but it nevertheless belongs to it. (In my view this suggests the importance of the body in the cure in addition to the face-to-face setting. on the ego and the id such as Freud speaks of them after 1920. or it appears in the form of an affect. SE 14. 178). as so often. as I see it.
he writes afterwards: ‘It is a very remarkable thing that the Unc of one human being can react upon that of another. Here is perception. Any passage from one system to the other implies an alteration in the cathexis.Marilia Aisenstein:Expressions of the Body in the Cure process in which the treatment by the analyst’s preconscious confers it its status as an affect. in the New Introductory Lectures. As a conclusion to these perhaps too theoretical reflections on the somatic expressions of the unconscious in the cure. we are given tremendously complex and interesting answers which I will not summarize here because they merit an article specifically dedicated to them. ‘but it has no organization. Saying. without passing through the Cs’ (Freud 1915. I wish to emphasize that most of them pass through the affect. produces no collective will [. taking into account the countertransference. Paris) 8 . SE 22. All the same this does not sufficiently explain the steadfastness of originary repression. In the id. so critical are their implications. 73). He will have to consider the hypothesis of a process enabling it to endure: in effect. Then Freud wonders how all preconscious activity may be excluded from this ‘incontestable’ clinical phenomenon. It communicates with the other systems and is subject to the influence of the preconscious and of external perception. the preconscious protects itself from the push of the representations by a counter-cathexis fed by the energy withdrawn from the representations. It seems more interesting to me to imagine in our patients a preconscious emptied of its force by a counter-cathexis that is so drastic that it paralyzes this system and isolates the other. remains descriptive. And yet. the ego wrestles with what Freud calls. that yields a status of affect and reintroduces the body into speech cut off from its drive roots. (Translated from the French by Steven Jaron. p. a ‘chaos’ (Freud 1933. For we must not forget that the unconscious is naturally living. And further: ‘We picture it as being open at its end to somatic influences’ (ibid. In classic cures the phenomenon is banal but among certain more difficult patients it is the interpretative work.. SE 14.]’ (ibid. ‘failures of the preconscious’. in chapter 6 of ‘The Unconscious’. Eight years later. of which Freud does not mention that it is unconscious. The second topography gives us an anthropomorphic and psychodynamic vision of a less demarcated ego that is also a repressing agency whose defensive operations are in large measure unconscious. But furthermore. Freud studies the ‘communication between the two systems’. in ‘The Ego and the Id’..’ he writes.).). p. 194). ‘It is filled with energy reaching it from the instincts.
Marilia Aisenstein:Expressions of the Body in the Cure 9 .
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