On Neurotic Disorders of Sensibility and Body Scheme—A Bioanalytic Approach to Pain, Fear and Repression1

I intend to study here the nature and origin of a mechanism which in certain morbid conditions obscures the psychological distinction between our physical Ego and the outside world. As we shall see later, this occurrence is intimately linked with the neurotic disorders of sensibility. Among the senses, those which bring us into intimate relationship with the stimulating object and thus play a greater rôle in our instinctual life, merit special interest. Of those senses the most important one is that which conveys the biologically most significant sensation, pain, which besides being communicated by specific receptors, results also from excessive stimulation of any sensitive organ.

We know hyperalgesia and analgesia in hysteria as neurotic symptoms. The organicists have failed to explain these symptoms by localizing elements, and only the psycho-analytic approach has succeeded so far in connecting them with the mechanism described as conversion, i.e. translation of psychic conflicts into physical disorders. Moreover, the so-called hysterical analgesia is not due to a simple interruption of the sensations just before they are conveyed to the cortex; for painful stimuli of the analgesic zone are not only not perceived but often even fail to produce the relative vasomotor and pupillar reactions. Only by a wider interpretation of the dominion and range of psychical force and even more of the instinctual impulses which form their energy basis, is it possible to understand why sensory suggestion, formerly considered a process altering only the act of perception, in reality loses its effect through the interruption of the sympathetic nerve ways. Thus hysterical anæsthesia, which some authors define as 'negative hallucinations', may also give rise to local changes of unquestionably organic nature. This fact constitutes an important step towards the understanding of those organic alterations which pathogenetically derive from psychic motives. I hope, however, to show