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Marilia Aisenstein:Expressions of the Body in the Cure

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 patients 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 MUzan, 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 analysisFreuds 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 crisesdisruptions in the balance in the distribution of the libidolike 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 contextand 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,
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Marilia Aisenstein:Expressions of the Body in the Cure

Quincke oedema, shingles, pyelonephritis, and so on). In the months preceding her narrative, she cried a great deal which was, for her, something new and slightly humiliating. The first time, suddenly overwhelmed by a stream of tears, she didnt have a tissue and she wiped her eyes with her skirt. I then handed her a package of Kleenex laying on the table, an entirely debatable gesture but which came to me spontaneously. Here is the first dream. She sees herself in the street. At a red light, she finds herself facing a young woman whom she knows is the new mistress of the man who left her. Unbearable jealousy takes hold of her, and it eats away at her. 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. Rage and horror woke her. She put on the light, went to drink some water to try to calm herself down, and in the bathroom noticed that her hands and arms were covered with a large urticaria. She took a powerful and calming antihistamine and made herself some vinegar compresses, listened to some Mozart sonatas she liked and wondered why she had this particular dream, as the man in question had left her ten years before; moreover, she had been hurt but not jealous. She knew that it was due to a woman, but was not interested in imagining her. She thought that the urticaria arose following the dream as a refusal of violence, but she thought that I might suggest the contrary, that her violence was such that she could not depict it. She fell back asleep early in the morning and had the second dream. She is in the street filled with sun, the heat is scorching, shes sweating and feels sticky, she has to drop off a letter at the gynecologists, a distant friend. A very young girl, looking a little lost and odd, follows close behind her. She wants to drop off the dossier in the doctors empty office and leave, but the young girl sticks around and lays down on the ground, determined to stay and wait for the man. The patient attempts to push her and drag her, she is very angry and fears being discovered with this mad person whom shed like to get rid of. Shes dripping with sweat and opens the window. She did not recall the end of the dream but vaguely knew that she found a solution and descended the stairs light. The first dream is a typical nightmare during which the dream depictions turn out to be inadequate as a means of extinguishing the excitation. We might question the appearance of the urticaria, 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. Beyond the strictly somatic excitationthe pruritusmotivating the attempt at construction, the meeting with the latent dream thoughts, the condensation in the face-to-face with me (the Kleenex session that was too hot), and the old humiliation in which she had fled when faced with another (faceless) woman, did not let her find a way out. The interpretation she gave herself, while fantasizing a dialogue with me during an
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Marilia Aisenstein:Expressions of the Body in the Cure

imaginary session, and the taking of medication followed by her go at calming herself, made sleep possible and, thus, the second dream. This dream may be understood in a distinctly Oedipal light. Nevertheless, the representation of heat (red light, suffocating, sweltering, sticky, dripping with sweat) should also draw our attention to the bodily sensation that must underpin the distressing affect. I suggested to her, heat flush, which moved her a great deal as she had not been able to talk about it. Passing through this path would alsothrough her worry about probable pre-menopause at the time when, due to her analytic work, she was having renewed sexual desires and knew the experience of humiliationprovoked the memory of her exhausted and ill mother to return, just as a young woman took her place even in the fathers bed. It was certainly possible to get to this point more directly by following, for example, the thread of jealousy and, thus, of homosexuality, but perhaps at the risk of a disembodiment which must always be feared among somatic patients for whom, the less the body is psychically cathected and represented, the more the silent somatic threat is present. 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 psychoanalysts action, but, on the contrary, that taking it into account is vital to our practice. Thus, while it has long been thought of as dissident in relation to psychoanalysis limits, psychosomatics is not only its logical extension, but also its very heart. We should return to the dream. 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 sleepers sleep. Its construction integrates endogenous and exogenous somatic excitations in elaborative psychic work made more complex by the timelessness of desire. But its aim is nevertheless a physiological function, namely, the pursuit of sleep. Should we forget thisand this goes without sayingwe become less attentive to the dream-work, and this is what I have tried to show by my short example. But also on a more theoretical level, it seems to me that a reflection at the borders of a discipline can best shed light on its foundations. I would like to recall here Freuds exemplary career and how, after 1920, he left behind him a few essential texts and he did so because non-neurotic, difficult patients had put technique into question. So it is today. If we are to think about pure psychoanalysis, we must face up to the difficult cases that oblige us to consider extreme questions such as the one I have asked here. The starting point for the debate, which in my view is not the issueare there modes of bodily communication that are not strictly expressed by words?is as old as the world. 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, the brain as entity was first a philosophical object.
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Marilia Aisenstein:Expressions of the Body in the Cure

The philosophers brain, as Dominique Lecourt (1993) has called it, was, throughout the centuries, an object of study and dissention as scholarly as it was passionate. It is true that the main tradition of western philosophy takes as its dominant theme the question, How does one think, and with what? For Plato, the soul precedes the body, of which it was the divine part, situated in the rounded form of the head (the standing position protects it from shocks, he explains in Timaeus). For Aristotle, the notion of the soul became more complex: the brain is described as a cold organ as opposed to the heart, the source of vital heat. The place of the soul is not specified, although thought is always attributed to it. In between these two currents lie several constructions that are more or less weighed down with fantasy. We should not forget that not long after the this era was born Hippocratic medicine, which made illness into a natural phenomenon and at last proposed a reflection on the body detached from religion. Shortly afterwards, Galileo of Pergamum proved through dissection the preponderant role of the cortex; he thus furnished a scientific basis for the ancient idea according to which the noble part of the human resided in the cranium. The true break between the soul and the body was instigated by Christianity, which instituted between the soul and the body a radical hierarchy, an ontological abyss: the first pertains to divine supernature, the other only to nature (D. Lecourt, 1993). One may also mention here the great philosophical currents which will underpin philosophical-scientific thought, be it dualism or monism. Descartes lodged the soul in what he saw as the seam tying the spirit to the bodythe pineal glandand he did not depart from the model establishing the superiority of the spirit over the body, and thus a tie of real causality. A resolute dualist, 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. Opposed to this is the materialist, monist current whose main thinker, Spinoza, suggested that philosophers take the body as their reference. With this new, even revolutionary idea, of the body as reference, went hand in hand an idea that repudiated the tie of efficient causality and of eminence of one mode of expression over the other. Why have I made this brief historical overview? As I see it, psychoanalysis, a dissident mode of thinking if ever there was one in relation to all the other philosophical and medical thinking that precedes it, is a unique and original reply to the very old psyche-soma question, and yet it takes roots, is based on and springs up in keeping with the monist movement. In the middle of the eighteenth century, a writer, medical doctor and thinker quite disparaged but often cited by Diderot, Julien Offray de La Mettrie, wrote Man a Machine. 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. For him, ideas were conceived and
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Marilia Aisenstein:Expressions of the Body in the Cure

impregnated, an interesting metaphor for psychoanalysis. It allows us better to understand the theoretical substratum implicit in the marvelous expression of Diderot, who makes Rameaus nephew exclaim: My thoughts are my dolls! Diderot himself was accustomed to comparing his ideas to girls, beautiful walkers, whom he liked to tail and then leave, but to knock them all up. In many of his texts we come across the hunch that sexuality is at the origin of thinking, but that it may also make one fall ill. A few years later, the Marquis de Sade, the accursed philosopher who was long relegated to the category of pornographer, established desire as the motor and first reality of the human being. Sade is the author of a veritable philosophical system that rules out God and the idea of Nature, about which he deftly showed its deistic residues. From that point on, the notions of rights and laws no longer had any meaning. The primacy of the body was affirmed. In a certain manner, he went farther than Spinoza. For Sade, in effect, the body was erotic and straightaway a fantasy. Thought was bodily, acted upon by the body, and the most abstract ideas were likewise subject to Sades pleasure principle. This is a radical notion that takes much from theatre since it proceeds scene by scene. The space of fantasy is contained in a body of writing which establishes the double valencedestructive and vitalof Eros. Precession of the drive and drive antagonism are prefigured in an oeuvre definitively breaking with morality. A century and a half later, we witness the Freudian revolution, in the sense that one may speak of a Copernican revolution. As an epistemological rupture, 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, and it displaces psyche-soma dualism onto drive dualism. This is the very creation of a new field that, in my view, renders the psyche-soma debate null and void. 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, moreover, there is a somatic quality to language. A THEORETCIAL APPROACH TO UNCONSCIOUS EXPRESSIONS OF THE BODY IN THE CURE According to the theoreticians of the Paris psychosomatic school, somatic patients often present failures in preconscious working-through. The psychosomaticians are thus particularly attentive to the functioning of the preconscious. It is a matter here of the first Freudian topographythe unconscious, the preconscious and the consciouswhich becomes in 1923, in the more complex second topography, the id, the ego and the superegoin my view, more enlightening and quite different. I should now like to discuss an assertion by Pierre Marty, the founder of the Paris psychosomatic school, and consider its clinical implications. Here is what Pierre Marty wrote: The unconscious of these patients receives but does not
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Marilia Aisenstein:Expressions of the Body in the Cure

emit. This sentence has always seemed to me to be a clinical truth, but at the same time it is entirely enigmatic; indeed, it is incomprehensible in metapsychological terms. To me, a clinical truth means that it may be verified in my practice. Here are two examples of it. 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. There were neither affects nor anxiety in his discourse. One morning he sat down, looked at me and remained silent. He twisted his body like a terrorized child. I asked him what was happening. Im afraid, he told me. I asked him: Afraid right here and now? . . . So youre afraid of me? Yes, the patient told me, I feel that youre not the same, youre angry. That morning I had had a nightmare whose mad rage was tugging at mea furious anger that was badly damned up and poorly elucidated when Id awoken, but it was nevertheless set aside. Another example. 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, a patient noisily erupted in an asthmatic crisis. As I became worried she got angry and yelled at me: Dont move, shut up! Its your fault, you abruptly let go of me . . . In both cases it was a matter of patients whose discourse was present and factual. For each of them, it was a matter of a rare moment in which an affect suddenly gushed upof fear in the first instance and of anger going through a fit of asthma in the second. As in each cure these were highly eventful moments, they are surely worth further examination. I would dare to assert that no neurotic patient would have perceived these imperceptible internal movements in the analyst. Nor is it a question of projection, which, classically, is absent from these cures. One might compare them to what one calls psychotic insight, but this too remains hardly satisfactory. Freud never proposed a theory of unconscious perception. Nevertheless it exists but is implicit as it underpins all theories of dream construction: latent thoughts are reactivated by condensed diurnal residues, and so on. Without the notion of unconscious perception the entire theory of chapter seven becomes impossible to understand. When Pierre Marty says that the unconscious does not emit but receives, 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, any derivative of the unconscious, nor any compromise-formations. It all occurs as if there was no trace of the conflicts between the psychic forces opposing themselves. It is a mater of discourse or narrative cut off from its drive roots. This is not particularly novel and it has been described by numerous authors in terms of mechanical thinking and mechanical functioning but also alexithymia, bereaved discourse, white depression, and so on. Lets now return to the other half of Martys axiom, namely, the same unconscious receives. Martys insistence suggests a warning that goes something like, These patients
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Marilia Aisenstein:Expressions of the Body in the Cure

are very vulnerable, you see how their unconscious is very sensitive and perceptive. This is what I tried to show in my clinical examples. This is also why I raised the question of unconscious perception which, as I see it, is present but unmentioned in Freud. When patients afflicted with somatic illnesses present failures in the preconscious, how should we consider the system Pcs-Ucs? Must we imagine the unconscious as, aprs-coup, 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, if I have the time, on the ego and the id such as Freud speaks of them after 1920. Here are a few definitions drawn from the article of 1915. The repressed does not cover the entire unconscious but it nevertheless belongs to it. The essence of repression is to prevent representations representing the drive from becoming conscious: We know [...] 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, SE 14, p. 178). 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. The drive may only be represented by the representation that attaches itself to it, or it appears in the form of an affect. But the question of affect is complex. 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. Are they unconscious perceptions of an affect in the object-analyst? All the same, if the repressed representation remains in the unconscious as an actual formation, the unconscious affect is only a potential beginning which is prevented from developing (Freud 1915, SE 14, p. 178). Strictly speaking there are thus not unconscious affects but formations laden with energy seeking to break through the barrier of the preconscious. Moreover, Freud will compare affect to motility. Both are under the authority of the conscious and have the value of discharge. 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 subjects own body without reference to the external world; motility, in actions designed to effect changes in the external world (Freud 1915, SE 14, note 1 p. 179). (In my view this suggests the importance of the body in the cure in addition to the face-to-face setting.) I had thought I knew this text well but, as so often, when I reread Freud I always discover new and fascinating aspects of his thinking. 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. It may only be modified in the transferential-countertransferential
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Marilia Aisenstein:Expressions of the Body in the Cure

process in which the treatment by the analysts preconscious confers it its status as an affect. But furthermore, in chapter 6 of The Unconscious, Freud studies the communication between the two systems. Any passage from one system to the other implies an alteration in the cathexis. All the same this does not sufficiently explain the steadfastness of originary repression. He will have to consider the hypothesis of a process enabling it to endure: in effect, the preconscious protects itself from the push of the representations by a counter-cathexis fed by the energy withdrawn from the representations. Saying, failures of the preconscious, remains descriptive. 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. For we must not forget that the unconscious is naturally living. It communicates with the other systems and is subject to the influence of the preconscious and of external perception. Here is perception, of which Freud does not mention that it is unconscious. And yet, he writes afterwards: It is a very remarkable thing that the Unc of one human being can react upon that of another, without passing through the Cs (Freud 1915, SE 14, p. 194). Then Freud wonders how all preconscious activity may be excluded from this incontestable clinical phenomenon. Eight years later, in The Ego and the Id, we are given tremendously complex and interesting answers which I will not summarize here because they merit an article specifically dedicated to them, so critical are their implications. 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. In the id, the ego wrestles with what Freud calls, in the New Introductory Lectures, a chaos (Freud 1933, SE 22, p. 73). It is filled with energy reaching it from the instincts, he writes, but it has no organization, produces no collective will [...] (ibid.). And further: We picture it as being open at its end to somatic influences (ibid.). As a conclusion to these perhaps too theoretical reflections on the somatic expressions of the unconscious in the cure, I wish to emphasize that most of them pass through the affect. In classic cures the phenomenon is banal but among certain more difficult patients it is the interpretative work, taking into account the countertransference, 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, Paris)

Marilia Aisenstein:Expressions of the Body in the Cure