From the very beginning of psychoanalysis, Freud was captivated by the diagnostic distinction between the Abwehr-Neuropsychoses, (1894) or psychoneuroses of defense, and the Aktualneurosen, the Actual neuroses. The psychoneuroses, like hysteria and obsession, are situated in the psychic field, in the “representational and defensive elaboration of infantile sexuality” (see Verhaege, 2005, 496). Symptoms associated with psychoneuroses carry meaning and are open to interpretation; they are derivatives of memories which are operating unconsciously and are of an infantile sexual nature. The central notion here is that conflicts concerning sexual desires and defenses are operating unconsciously against this inner conflict. In contrast, the actual neuroses which Freud had also defined as “anxiety neurosis, neurasthenia to which he later also added hypochondria” have a sexual origin, but in a completely different way. According to Paul Verhaege, “The typical characteristic of the actual neuroses is the absence of a symptomatic superstructure and its associated representational development with regards to sexuality. Symptoms are limited to somatic phenomena, possessing no additional meaning. The central clinical phenomenon is automatic anxiety.” (2005, 496) The concept of “Aktualneurose” was gradually forgotten, largely because Freud did not believe that the somatic phenomena he observed, were accessible to psychoanalytic treatment. In contrast to the hysterical symptom which speaks and “ joins the conversation,” the psychosomatic phenomena cannot be addressed with words, they have no symbolic value and thus were thought to be untreatable by psychoanalytic interpretations. In his dictionary of psychoanalysis, Laplanche also notes this development from Freud’s early notion of Actual Neuroses to current conceptions about psychosomatic phenomena, he writes,
“…it may be remarked that according to Freud’s view of the matter of actual symptoms are chiefly somatic in character, so that the old idea of actual neurosis leads directly to the present-day conception of psychosomatic troubles.” (1973, 11)
With the discovery of narcissism and the dynamics of autoeroticism, the view gradually changed about the inaccessibility to patients suffering from psychosomatic phenomena, phenomena which are lodged inside the body with no relation to the Other and no symbolic representation. Psychosomatic phenomena gradually came to be seen as healing attempts, often warding off a psychotic breakdown and demanding other analytic approaches than free association. I would like to talk today about Jacques Lacan’s theory and understanding of psychosomatic phenomena which takes a somewhat different route than the psychosomatic French school of M’Uzan, Pierre Marty, and from Marilia Aisenstein. Lacan did not write very much about psychosomatics, but what he wrote in his second seminar The Ego in Freud’s Theory and in The technique of Psychoanalysis (1954-1955) and in his eleventh seminar, The Four Fundamental Concepts of Psychoanalysis (1973) has been ground-breaking and has lead, I believe, to a different comprehension of these patients, suffering from incomprehensible attacks upon their bodies. In my presentation, I will rely on the work of Jean Guir, a disciple of Lacan who developed further Lacan’s ideas about psychosomatic phenomena, including those he had voiced at a conference on “ Le Symptome” in Geneva, in 1973. In addition I will also cite the work of Silvia Lippi who discusses Guir’s contribution to the dynamics of psychosomatic phenomena.
Let me begin with an early quote by Lacan:
“If psychosomatic reactions suggest something, it is that they are outside the register of neurotic constructs. It isn’t an object relation. It is a relation to something which always lies on the edge of our conceptual elaborations, which we are always thinking about, which we sometimes speak of, and, which strictly speaking, we can’t grasp, and which is nonetheless there, don’t forget it- I talk about the symbolic, about the imaginary, but there is also the real. Psychosomatic reactions are at the level of the real.” (1954-1955, 96)
What is the real, you may ask? Lacan defined three different structures, the imaginary, the symbolic and the real, not as mental forces but as registers of human experience that structure the intra-psychic life of the subject. The imaginary register encompasses everything that has to do with illusions, images, resemblances, similarities and identifications while the symbolic order is the order of language, differentiation, order, rules, names ,culture and law. Both registers, whether by images or words are systems of representations which circulate and attempt to articulate the register of the real which is the register of the unsymbolizable, the unrepresentable, the traumatic, the impossible, the order without fissure that always returns to the same place. The real resists language, it cannot be represented by an image, and yet it surrounds and punctures the symbolic and the imaginary at all times. It exerts an effect, a reality which cannot be gripped but which grasps the human subject at and in its core. All three registers are interlocked in a Borromean knot where one register could not exist without the neighboring others. If you cut the knot at any point, it falls apart:
Borromäische Ringe[note]Quelle: Seminar 23, Version Miller, S.
Lacan used this concept of the Borromean knot to illustrate that the registers are interdependent, the imaginary holding together the symbolic and the real, the symbolic holding together the imaginary and the real, and the real mediating between the symbolic and the imaginary with neither register dominating over the other. In a first phase, the body is organized as an imaginary body, structured through the mirror stage which occurs between the 6th and 18th month. The mirror stage is a stage where the infant identifies with the image projected upon the mirror which he mis-takes as his own self-image. The child greets his own image with jubilation- an early jouissance, because the mirrored image holds out and promises a greater unity and mastery than the child experiences internallycat that time. The child sees his own image as a whole, and the experience of the perceived entity of this whole image evokes a tension between the perceived image and the body which is still felt to be left in pieces (corps morcele). The mirror does not simply refer to an actual mirror but also serves as a metaphor for the Other, who initially stands for the m(Other) through whose gaze and words the child comes into being and is delivered to himself. The specular image becomes an identity that is alienating because the child identifies with the view of the Other, the ideal image held out for him that he can only approximate but never meet. In this see-sawing process projective/introjective process, an internal division is established that leads the subject to search for a unity that never existed in the first place, but that has cast an enduring shadow upon his desire to be at one with the Other.
The Other also designates a symbolic place, as Lacan writes, “ the law, the language and the unconscious which determine the subject in his relationship with desire” (Roudinesco, 1997, 769). The Other is “ the one who sees me, the place of the signifier, unconsciously constituted as so, it is the place where the order of the singular difference is instituted.” (Garate, Marinas, 1996, p.123) Thus the domain of the Other is the keeper, the storage house of signifiers which registers language in the body. The imaginary relationship is held in a symbolic framework represented by the symbolic figure of the Father. His position functions as a Third, and through it his installment of the Law that the child can separate from the mother. It is through the name and the “no” of the Father that the child is pulled out of the imaginary register and is given a distinct and separate place in the symbolic order. For the child to move from one position to the other, from being the object of the mother’s jouissance to accepting the law of the father, the child must find a credible figure in the symbolic position for whom he can give up the phallic position in which he is placed to fulfill the lack of the mother. Besides finding a respectable figure in the position of the Third, the child must also be released from the mother’s desire to claim her child as her own exclusive property and rule over him. Alternatively the child must also recognize that the maternal figure is not exclusively invested in him but that her desire also goes beyond him and is directed to other objects outside the maternal dyadic orbit. “Something else is bugging her”. Hence, if the child does not meet a credible figure in the position of the Third, or is not released from the mother’s desire to fulfill her lack, the child risks to remain imprisoned in the universe of the maternal jouissance.
In order to understand more fully the psychosomatic phenomena, I still need to define more clearly Lacan’s important concept of jouissance. As is the case with many other concepts in Lacan’s theory, jouissance also went through some definitory changes, from being initially the simple jubilation of the infant recognizing his image in the mirror, to the more legalistic use of jouissance which refers to the right to enjoy a thing as opposed to possessing it. Jouissance is an enjoyment that is pursued for its own sake, it is limitless and has no use, yet the human being is hooked to this useless lust for its own sake. In contrast to desire which always implies the search and longing for a lost object, jouissance has no object but instead is fastened to the drive and is in constant pursuit of a pleasure that is not merely joyful but tense and painful at the same time. Jouissance is reminiscent of Freud’s concept of the pleasure beyond pleasure from his text “Beyond the Pleasure Principle” (1920) which implies an excess of gratification, readily turning its search of pleasure into an abyss of tension and pain. Jouissance could also be translated as a “thrill” that is often pursued with a great risk either though the use of drugs, or risk-taking, self-harming behaviors, activities and sports and is in this aspect closely connected to Freud’s death drive. Jouissance knows no boundaries and no objects, it is not graspable and part of this register of the real which is, as defined before, the order of the unsymbolizable and inassimilable experiences of human life. According to Lacan, “the real emerges at that which is outside language and is inassimiable to symbolization. It is that which resists symbolization absolutely” (S1, 66).
When the subject enters language, something is always left out and left un-translated, which is the order of the real dimension that corresponds to what cannot be said and symbolized. This unsaid may have its roots in the body, it is a part of the body that cannot be symbolized and it is here that the dynamics of the psychosomatic phenomena take root. In contrast to the neurotic subject, separated in and through language and separated from the maternal object, the subject suffering from a psychosomatic phenomenon, stays glued to body of the M/Other , there is no signifying structure, no paternal metaphor that can separate the subject from the object. Lacan identifies psychosomatic phenomena as “headless subjectivation, a subjectivation without a subject, a bone, structure, an outline which represents one side of the topology. The other side is that which is responsible for that fact that a subject , through his relation with the signifier, is a subject-with-holes (sujet troue). These holes came from somewhere“ (1973, 184). How does it come to this headless subjectivation? What goes awry for the subject who is eventually subjected to these psychosomatic phenomena?
When the subject become signified through and by the symbolic order through the paternal metaphor, he is to separate from the jouissance of the mother and from the phallic position in which he was placed and is pushed to subject himself to the Law of the Other. In this process the child enters into an early either/or choice between his being or his being accepted and placed into the symbolic order. According to Stephanie Swales, “In the child’s encounter with the Other of language, his choosing subjectivity means electing to lose his being. In permitting a signifier to represent him, the subject disappears beneath the bar, losing his being and becoming a subject divided by language“ (2012, 39). This process of separation is called “alienation” and it indicates the limit, the bar against the mother’s jouissance. It is only after the child’s access to the mother is restricted that the child can realize the loss of the mother and can thus form a desire for her. When the subject becomes constituted through and by the Other, the subject fades underneath the signifier (the word spoken by the symbolic father) and allows itself to be represented by a signifier for another signifier. The subject is represented by a signifier under which it is registered, but this representation is always in relation to other signifiers that are opposed and differentiated from one another. Lacan describes the process of subjectivation in the following way:
“What we find once again here is the constitution of the subject in the field of the Other …If he is apprehended at his birth in the field of the Other, the characteristic of the subject of the unconscious is that of being, beneath the signifier that develops its networks, its chains and its history, at an indeterminate place.” (1973, 208)
The graph of the discourse of the Master may illustrate this process of subjectivation more clearly:
The master signifier (S1) is the signifier which comes from the symbolic Other and establishes the first identification with the father who connects the child-now represented by language with another signifier (S2) which is then linked in turn with the chain of other signifiers. The introduction of the second signifier produces the process of aphanisis, the disappearance of the subject which in turn generates the division of the subject. This significant process of alienation is intricately linked to the process of separation; separare comes from the Latin and also means “to dress oneself”, “ to defend oneself”, but most importantly, “to create/to engender”. In other words, the subject can only establish his desire for and by the Other through his own disappearance, since his desire lies in between the first and second signifier. In accepting the name-of the –father, the desire -of –the mother slides underneath the bar and pushes the now divided subject towards other signifiers through him it is placed into the signifying chain. By losing the desire of the mother, the subject frees himself for other substitutive objects and creates his desire retroactively for the lost object. The loss engenders, creates desire and a metaphoric or metonymic space within which the subject can establish his own desire, freed from the encapsulating jouissance of the mother.
In the case of the psychosomatic phenomenon, there is no aphanisis and no alienation. The process of separation is disrupted and the space between S1 and S2 is jammed. The signifiers are blocked or, as Jean Guir writes, “ gele”, which means in French both “frozen” but also “glued to one another”. Guir states that “There is a kind of gelification of the signifier of the body of the subject, a short–circuit that will be responsible for the later bodily lesions. This amalgamation of signifiers in the body is defined by Lacan and later Guir, as a “holophrase.” Lacan describes the process as follows:
“I will go so far as to formulate that, when there is no interval between S1 and S2, when the first dyad of signifiers becomes solidified, holophrased, we have a model for a whole series of cases-even though, in each case the subject does not occupy the same place. ….This solidity, this mass seizure of the primitive signifying chain, is what forbids the dialectical opening that is manifested in the phenomenon of belief.” (1973, 237/238).
The massive occupation of the main signifiers, which are now organized without a gap, does not allow for a metaphoric, i.e. substitutive process, but instead produces a holophrase, the expression of a complex of ideas, tied together by a single word. In the psychosomatic phenomena, the injury emerges when the body is taken literally. The injured part of the body is not taken in a metaphoric way, but is taken in the register of the real, excluded from the symbolic register. The distinction between “being a body” and “having a body” is lacking. The metaphoric function remains frozen or glued in the part of the body that was taken as an object of demand by the Other. The subject, afflicted by the psychosomatic phenomenon, responds to the demand of the Other with the body itself, with a piece of flesh where the lack of being is situated in the real body and is not metaphorically represented by language. The massive presence of the maternal Other and the lack of the paternal metaphor prevents the subject from becoming a separate subject, instead he is subjected to the Other through a sacrifice of a part of his own body. Thus his body remains in pieces (corps morcele) and he donates a part of his body as a way to ward off the mother’s jouissance and this becomes then the injured, suffering organ. In the case of the psychosomatic phenomenon, language has lost its protective and damming function against the excesses of jouissance, the word becomes a body and a trace of that body causes the early trauma. The subject is not protected from the real, he is subjected to the real and cannot find a representation in the symbolic register, the substitution of S1 and S2 is barred. The subject defends himself against the real with his body since the real was unhinged, not traversed by the symbolic and no longer tied to the imaginary. The cut, usually instituted symbolically through the Name-of the Father, is now directly expressed in and by the body of the subject. Body and language have exchanged functions, now it is the body which assumes a symbolic function and language which assumes a bodily function since signifiers can violently and passionately seize upon the body and leave their injurious mark behind.
According to Jean Guir, the rupture and injury in the body functions like a stigmata, rendering visible the impossibility of losing the Other. Not being able to separate from the Other, the subject donates his sick organ to the Other, the ruined, injured part of his body. The injured subject, bequeathing the part of his body to the demand of the Other, unconsciously also enjoys this “donation” since it signals back to the subject an insolvable union with the Other. Guir remarks that many skin pathologies, like acne and psoriasis exhibit an auto-erotic aspect, a joyful suffering (jouissance) with that part of the body which causes so much pain and serves as a marker of the unfettered separation from the Other. As we can see, the signifiers are blocked, they do not form links to other signifiers. The freezing and gelifying effect of the signifiers in the subject’s body is responsible for the psychosomatic injury. Instead of assuming its metaphoric or metonymic functioning, the signifier acts like a seal, fixing and freezing the subject in his own injured part. Again, I think the punctured skin serves as a suitable example for the breakdown of the signifying function, as it lays open the permeability, rather than the protective and holding function of the skin. The subject suffering from acne or psoriasis draws and fixes attention upon his skin and in and through this shame that the open wounds exhibit, affirms his own subjectivity. According to Lacan, there is a straight connection between the psychosomatic phenomenon and the proper name: it is now the body in its symbolic function which delivers a name to the subject. The subject attempts to reconstitute itself through his illness, searching in it and through it the function of a prohibition, which is lacking because of the absence of the paternal law. Since the paternal metaphor is missing, the subject glues itself to a part of his body that assumes a regulatory function and institutes a kind of self- imposing law.
According to Jean Guir, the subject suffering from a psychosomatic phenomenon is in search of an identification, an identification other than the frozen link with the maternal Other. Guir suggests that the injured part of the body, the sacrificed, torn up part of the body also functions as an attempt to call for the father and to revive him through the tormenting lesion. The sought-for identification with the father, is of a violent and passionate nature, traversing the tearing of the body and the tearing of the father. Guir links this brutal identification to Freud’s theory of the fantasm of “The Child is Being Beaten” (1919): one has to be beaten by the father in order to be loved by him. The subject is “the beaten one” and at the same time the one who beats, while the father is dead and alive at the same time. Love – the shots are a source of pleasure for the subject- so that it may be possible to pass through the transgressions and punishments as well through the destruction of the self and the other. Guir links this idea to the Ursadismus of Freud. With the psychosomatic phenomena, the register of the imaginary bursts, it cannot hold the body together nor contain it and instead it provokes a tear. In the illness, the body is torn apart, affirms itself, it lives intensely while suffering feverishly at the same time. The body enjoys. “Il jouit” but always in a particular way and always in proximity to the Other even if it may exclude the enjoyment of the Other. The psychosomatic phenomenon is an act and not a symbolization of an unconscious conflict as is the case with the hysterical symptom because the psychosomatic phenomenon modifies the organization of the subject: the body makes itself a name and the subject maintains itself thanks to the tear and the injury in his body.
The question that emerges of course is how to listen to these patients and how to treat them when free association does not work and when the transference is primarily of a narcissistic, self protective, autoerotic nature. The patient does not let you in, but sticks closely to a discourse of the injured organ. Lacan was of the persuasion that “the body lets itself go and writes something along an order of numbers.” (conference in Geneva, 1975) and in order to illustrate that point, he described a female patient who suffered from a facial cancer and narrated her history through a series of dates and numbers. She discovered her illness the same day- 63 years later- as the day when she lost almost all her family, most of whom were gunned down by the Nazis. Her father, who had narrowly escaped death that day, but who died a few years later, was 43 years old at the time, like the friend of her daughter who was also 43 when Lacan’s patient discovered her facial cancer diagnosis. In addition, the execution of her family also took place in 1943. Lacan continues to explain that the relationship between the patient and her daughter was very strong: for him, it was not difficult to see that the mother transferred to her daughter’s 43 year old boyfriend the function of –the prohibited, in other words, the paternal function which she calls out for in order to continue to live and unfold her desire. This woman confided to Lacan: “I have rediscovered my interest in living only thanks “to my hurt”/ “ mon mal”, before that I had no interest in living.” So, it is conceivably the paternal function which allows for this numeration and which introduces the possibility of recounting a traumatic history across dates and numbers rather than words and sentences. Patients, suffering from psychosomatic phenomena, tend to have a particular way of recounting their lives, often through the enumeration of fixed dates, periods and numbers which write themselves into their body.
In preliminary interviews with patients suffering from psychosomatic phenomena, the discourse keeps close to the facts – like in operational thinking; everything revolves around the moment of diagnosis, medical examinations, surgery, hospital stay, pain, procedures and medication. The body, its discontents, and the disease are constantly reviewed, measured and observed in minute detail. As the psychosomatic phenomenon is not a decipherable symptom in the way of a hysterical symptom, but rather a physical injury or a pathophysiological lesion, the engagement with that patient is also of course of a very different order. Even though many of these patients ask for a psychoanalytic treatment, it may take some time to differentiate whether the patient suffers from a hysterical symptom or from a psychosomatic phenomenon. By noticing their incapacity to reflect upon their symptoms or to put them into question, or to search for different meanings in them, which at first may appear as pure resistance, the analyst gradually comes to realize that he needs to pursue other avenues to speak with these patients afflicted by psychosomatic phenomena. While the more object-relational school relies more on their countertransference reactions in order to bring back into the discourse the patients’ warded-off affects and terrors – see Marilia Aisenstein’s shocked and angry reaction when she discovers that her patient Claudia had never revealed to her paroxysmal heart beats (conference on Psychosomatics, Lviv, Ukraine 2019)- the Lacanian treatment / analysis stays closer to finding a way to seize upon key signifiers in the patient’s discourse which may eventually tie together a story that includes the warded off early, pre-narcissistic trauma that could only be “symbolized”/ assembled in a coagulated holophrase.
At this point, I would like to reference also the work of Gabriel Burloux , a psychoanalyst and psychiatrist at the Neurological Hospital in Lyon. Even though Burloux is not attached to any particular psychoanalytic school, he strikes me as working in a Lacanian manner, closely attuned to working clinically “at the rim of the real.” His work with patients suffering from lumbalgics, is particularly noteworthy. He writes,
“The pain these lumbalgics suffer is due to a trauma. The abrupt appearance of the genuine internal foreign body that it becomes in a psychic economy forms a second trauma which prolongs the original one and joins with it. The result seems to be the after-shock of the traumatic period of infancy. Although the lumbalgics are different, their discourse is similar in the sense that four main points are expressed quite early on, sometimes even in the first conversation:
- The painful, incurable present, which is a complaint.
- The accident stated to be the cause, despite often being minor, and its circumstances;
- The recent past, hyperactive, wonderful, but lost;
- The ancient past of the disastrous beginnings, experienced in distress.
Even if the patients do not connect these four periods, an obscure intuition and a confused feeling of the continuity of their life allows recollection of them. They offer a traumatic model of their pain, in the image of the trauma they believe is responsible: the accident. It is from these points and the signs that emerge from them that what will later become the psychotherapy can be developed. Psychogenic lumbalgics represent a pure form of physical pain because it is free from any associated somatic lesion liable to have caused it….. In failing to find doctors who can understand their pain, the lumbalgic repeats the original situation, the lack of consolation and the same lack of response around them as they experienced in their early childhood. He also repeats the situation of passivity and impotence of the first periods of life when outside help was needed. The small affects they sometimes experience, have found no meaning and have not been symbolized but have left “amnesiac traces” , susceptible to physical or behavioral and also painful discharges….. Treating these patients involves listening attentively to their endlessly repeated laments, which feed their nostalgia by going over and over their memories. But occasionally new memories are discovered that are valuable through the spark they evoke in the psyche, tenuous evidence of possible processing. One needs a finely tuned ear! The lumbalgic repeats everything: the circumstances of the accident, the various pains and his lamentations and regrets for his lost self-worth. (2004, 136-137)
Burloux, elsewhere, asserts how important it is to listen to the minor variations, the hesitations, slips of the tongue and particularly the associations. Burloux’s aim is not to cure but to offer the patient a system within which he can live better with his pain. He asserts, “Our work is rarely or never interpretative, but we often construct, offer information and links and facilitate inter-systemic psychic exchanges. Therefore, no furor sanandi. (no furor/ haste to heal) We are aiming for integration of the pain into the patient’s psyche.“ (2004, 225). Burloux ‘s four points of how a painful lesion comes to be, echoes Jean Guir’s theory of how a psychosomatic phenomenon unfolds which he traces along three moments:
- a brutal separation (loss) from a cherished person. The subject submits to this extraction, to this rupture which he cannot assume as his own. (Abandonment/ Helplessness) No mourning can take place.
- Certain signifiers remind the subject of the trauma of impossible loss.
- The lesion/ injury/pan appears. The particular lesion captures the trauma of the initial violent separation from the “cherished Other” and with the fact that this brutal loss cannot be mourned, the original trauma is being commemorated by a kind of painful transgression that pushes beyond the pleasure principle.
In the end, Guir argues that the psychosomatic phenomenon works like an open plea, a trauma that tries (again and again) to appeal to the Other to be heard and to be seen. Given how difficult it is to treat these patients and to know the origins of their often inexplicable suffering, patients with psychosomatic phenomena are bound to repeat their “early bad and missed encounter” with the Other and to go through their excruciating dis-appointments again. But now and then with an attuned ear, “in the place”, as Lacan writes, “ where the unspeakable object is rejected in the real, a word makes itself heard…” (1966, 1977, 183).
References:
Burloux, G. (2004) The Body and its pain, London: Free Association Book
Freud, Sigmund
Freud, S. (1894) The Neuro-Psychoses of Defense, S.E. III, (25-61)
Freud , S. (1920), Beyond The Pleasure Principle, S.E. XVIII, (3-84)
Guir, J. (1986) Phenomenes psychosomatiques et function paternelle,
Le Phenomene psychosomatic et la psychanalyse, Paris: Navarin
Guir, J. (1983) Psychosomatique et Cancer, Paris: Point Hors Ligne
Lacan , J. (1954-55) The Seminar of Jacques Lacan, Book II, W.W. Norton &
Company
Lacan, J. (1977), Ecrits, W. W. Norton and Norton Company
Lacan J. (1973) The Four Fundamental Concepts of Psycho-Analysis, W.W.
Norton & Company.
Laplanche, J. (1973) The Language of Psychoanalysis, London: The Hogarth Press.
Swales, S. (2012) Perversion, A Lacanian Psychoanalytic Approach to the Subject,
New York: Routledge.
Lippi, S. (2008) L’Acte psychosomatique, La Clinique Lacanienne, Paris: Eres.
Roudinesco, E. (1997) Jacques Lacan, New York: Columbia University Press
Verhaeghe, P. & Vanheule S. (2005) Actual Neurosis and PTSD: The Impact of the Other, Psychoanalytic Psychology, 22, 493-507
