Psyche-Soma and Soma-psyche: The Foregrounded Body in
Psychoanalytic Theory and Practice
Spring, 2015
Sharone Bergner, Ph.D.
sbergnerphd@yahoo.com
212 787-4577
From its inception, psychoanalysis accorded primacy to bodily experience,
expressed through the focus on drives, psychosexuality throughout development,
and in Freud’s view that the ego is first and foremost a body ego. However, since
the decentralization of drives in psychoanalytic thinking and the ascendancy of
ideas about the object relational world, the place of the body in psychoanalysis
has become less central. And yet, in our consulting rooms, we continue to be
presented with patients’ bodily realities and body-related fantasies. Our patients
bring in their bodily lives – via narratives of eating, sexuality, body image, aging,
as well as through ongoing development and key life experiences. There are
endless instances of the foregrounding of bodily experience in the clinical setting,
whether patients seek treatment with bodily-related concerns in mind, or develop
them in the course of an established analytic treatment: puberty, pregnancy,
breastfeeding, pregnancy loss, infertility, menopause, skin and intestinal
syndromes, unexplained medical issues, pain, illness. As we work, we are
embedded in psychoanalytic clinical and psychosomatic theory, which guides our
listening and contributes to interpretation and countertransference. We are
rooted in psychoanalytic conceptualizations of psychosexuality, development,
somatization, psychosomatosis, conflict, deficit, and the relational world. We are
also always embedded in our current cultural context, which shapes expectations
regarding the mind-body relationship. Our contemporary cultural context is
characterized by, on the one hand, cutting edge medical technological advances,
alongside with, on the other hand, nutritional, integrative, and alternative
practices and models – all presenting demands for renewed investigation of the
understanding and treatment of bodily life.
This course aims to push us to reconsider the presence/absence of the body
in/from our consulting rooms and theories, as well as to re-examine the term
“Psychosomatic.” We will pose and re-ask questions, such as: Where has the
body gone in psychoanalysis? How do we invite the body into our analytic
reverie? How do we position ourselves to analyze the body-mind? What is a
(somatic) symptom? Are somatic symptoms vehicles of meaning? How does the
nature of psychic functioning relate to somatic events? When we work with
psychic functioning via the analytic process, what is our relationship to the
sexual, hungry, decorated, changing, disappointing, or malfunctioning body?
The purpose of this course is to evaluate theory to the extent that is needed in
order to open the field for working clinically from a fresh position that makes
space for the patient’s historical and present bodily self, and that seeks to
understand the inscription of the bodily self in the self-other matrix of the patient’s
internal world and of the analysis. We will use especially the lenses of
transference-countertransference, reverie, unconscious and conscious fantasy,
in order to understand the relationship between the patient’s singular body and
his/her object-relational world.
The course is organized around two units: (1.) theory – about psychosomatics,
and about mind-body-in-development and in the psychoanalytic process, and (2.)
body -- providing opportunities for examining the interplay of the transferencecountertransference field and fantasy related to the historical and present body
utilizing specific bodily domains. Clinical material will be used extensively.
Overall course objectives:
At the end of this course, candidates will be able to (i) discuss the meaning
and limits of the term ‘psychosomatic;’ (ii) compare prevalent
psychoanalytic theories of psychosomatic presentations, and discuss how
these link to conceptualizations of psychopathology that are deficit-,
conflict-, and trauma-based; (iii) trace the development of the bodily sense
of self; and (iv) use interventions that widen the scope of the analyst’s
focus, to give greater space for somatic experiences.
I. CONCEPTUALIZING THE SETTING UP AND PSYCHOPATHOLOGY OF
PSYCHE-SOMA RELATIONSHIPS
Week 1: A. Where is the body in psychoanalysis today? B. Understanding the lay of the
land: critical appraisal of psychoanalytic psychosomatic theories – what’s useful,
what’s problematic?
At the end of this class, candidates will be able to critique prevailing
psychoanalytic psychosomatic theories and assess the influence of such
theories on the analyst's approach to clinical work with patients with
somatic complaints.
We will characterize the most dominant (and seductive) ways of thinking about
the psyche-soma relationship and conceptualizing psychosomatic presentations.
We will discuss the need for multiple models that can be particularly attuned to
specific body-self-other configurations, taking into account varied physiological
realities, developmental histories and psychic experiences. Emphasis will be
placed upon the need for complexity and non-linearity that are based upon
recognition of uncertainty.
Gottlieb, R. (2003). Psychosomatic medicine: the divergent legacies of Freud and
Janet. Journal of the American Psychoanalytic Association, 51:857-881.
Bergner, S. (2009.) The analytic environment in times of bodily dysfunction: The
effect of psychoanalytic psychosomatic theories. Psychoanalytic Psychology,
26:362 -378.
Optional additional reading:
Bronstein, C. (2011). On psychosomatics: The search for meaning (Education
Section). International Journal of Psychoanalysis, 92:173-195.
Weeks 2 and 3: The patient’s historical bodily self: understanding the roots
of the mind-body relationship in development
>Week 2: Configurations of the psychosomatic/somatopsychic self in
infancy and childhood
At the end of this class, candidates will be able to describe the
differentiation of somatic and verbal experience and expression that
develops in childhood and is shaped by infant- and child-caretaker
interactions.
Winnicott, D.W. (1949). Mind and its relationship to the psyche-soma. In:
Collected papers: Through pediatrics to Psychoanalysis. London: Tavistock,
1958. Pp. 243-254.
Edgcumbe, R.M. (1984). Modes of communication – The differentiation of
somatic and verbal expression. Psychoanalytic study of the child, 39:137-154.
>Week 3: Adolescence and the demand for reconfiguration of the bodily
self
At the end of this class, candidates will be able to (i) explain the change in
a person's psychological relationship with his or her body, and the shift in
a person's sense of his or her bodily self, that is brought on by puberty and
related features of adolescence; and (ii) discuss the importance of focusing
upon memories of puberty-related experiences in adult analyses.
Laufer, E. (1991.) Body image, sexuality and the psychotic core. International
Journal of Psychoanalysis, 72:63-71.
Lemma, A. (2010.) An order of pure decision: Growing up in a virtual world and
the adolescent’s experience of being-in-a-body. Journal of the American
Psychoanalytic Association, 58:691-714.
Week 4: corporeality in the psychoanalytic process
At the end of this class, candidates will be able to describe manifestations
of analysands' relationships with their bodily selves in analytic sessions,
and to compare and evaluate the appropriateness of two types of
interventions that analysts can make regarding such manifestations: (i)
ones involving the analysand's self-to-body relationship; and (ii) ones
involving the analysand's self-to-other relationships.
Lombardi, R. (2008). The body in the analytic session: Focusing on the bodymind link. International journal of psychoanalysis, 89:89-109.
Lombardi, R. (2002). Primitive mental states and the body: A personal view of
Armando B. Ferrari’s Concrete Original Object. International Journal of
Psychoanalysis, 83:363-381.
II. THE SPECIFIC BODY IN THE CONSULTING ROOM
Weeks 5 and 6: Pregnancy, infertility, childbirth
At the end of this two-session class, candidates will be able to (i) discuss
the psychological aspects of the experiences of pregnancy, childbirth,
pregnancy loss, and infertility, and related events (such as breastfeeding
and termination of pregnancy;) and (ii) explain the importance of focusing
upon the somatic-, affective-, and relational aspects of these experiences in
the psychoanalyses of women patients.
This arena brings together issues of sexuality, development, intergenerational
transmitted meanings, and the wish for the control of psyche over soma. We will
focus upon the interplay of fantasy and psychic functioning with the real body,
omnipotence, repetition, and the nature of the psychoanalytic context in which
these are explored while the related somatic events unfold.
Balsam, R.H. (2013). (Re)Membering the Female Body in Psychoanalysis:
Childbirth. J. Amer. Psychoanal. Assn., 61:447-470.
Balsam, R.H. (2003). The vanished pregnant body in psychoanalytic female
developmental theory. Journal of the American Psychoanalytic Association,
51:1153-1179.
Friedman, M. (1996). Mother’s milk: A psychoanalyst looks at breastfeeding.
Psychoanalytic Study of the Child, 51:475-490.
Leuzinger-Bohleber, M. & Teising, M. (2012). “Without being in psychoanalysis I
would never have dared to become pregnant”: Psychoanalytical observations in
a multidisciplinary study concerning a woman undergoing prenatal diagnostics.
International journal of psychoanalysis, 93:293-315. (This article addresses
pregnancy loss and the effect of technology and knowledge of genetics in the
context of a psychoanalytic process.)
Apfel, R. and Keylor, R. (2002). Psychoanalysis and infertility: myths and
realities. International Journal of Psychoanalysis, 83:85-104.
Additional recommended readings:
Pines, (1990). Pregnancy, miscarriage and abortion: a psychoanalytic
perspective. International Journal of Psychoanalysis, 71:301-307.
Fun and provocative additional readings:
Balsam, R., Harris, A. (2012). Maternal Embodiment: A Conversation Between
Rosemary Balsam and Adrienne Harris. Studies in Gender and Sexuality, 13:3352.
Week 7: Illness and (ph)fantasy in the consulting room
At the end of this class, candidates will be able to describe the challenges
of working psychoanalytically with patients who suffer from physical
illness. Candidates will be able to (i) explain patients’ affective experience
of the malfunctioning body; (ii) apply an understanding of the importance
of focusing on patients’ fantasies regarding the etiology of their illness to
clinical material; (iii) describe the analyst’s countertransferential response
to patient’s illness experience and its influence on the psychoanalytic
process.
Here our focus will be on specific clinical cases, and especially on the way that
the patient’s body-related fantasy and object relational world shape the clinical
process. We will highlight the dilemmas and pitfalls of certain kinds of
interpretations, and the challenging countertransferential scenarios that give rise
to them.
Bergner, S. (2011). Seductive symbolism: psychoanalysis in the context of
oncology. Psychoanalytic Psychology, 28:267-292.
Solano, L. (2000.) Glycaemic dysregulation and relational/affective dysregulation
in a patient with diabetes mellitus. International Journal of Psychoanalysis,
81:291-305.
Clinical vignettes distributed in class.
Week 8: Holding a mind-body split in treatment: embracing complexity and
the non-linear, multi-directional interplay of the physical and the
meaningful
At the end of this class, candidates will be able to (i) diagnostically assess
and differentiate among various clinical presentations in which somatic
symptoms are primary; (ii) discuss the clinical usefulness of recognizing
the presence of a mind-body split in certain patients; and (iii) explain the
importance of analyzing somatic experiences in depth, in relation to
developmental and diagnostic considerations.
By way of synthesis, we will articulate more explicitly the clinical stance that will
be characterized throughout the course – one that reflects openness to multiple
models and possibilities regarding the specific psyche-soma relationship
understood developmentally and within the context of the transferencecountertransference matrix.
Shapiro, B. (2003). Building bridges between body and mind: the analysis of an
adolescent with paralyzing chronic pain. International Journal of Psychoanalysis,
84:547-561.
Winnicott, D.W. (1966.) Psycho-Somatic illness in its positive and negative
aspects. International Journal of Psychoanalysis, 47:510-516.