Introduction to the Paper by Pierre Marty1: The Narcissistic Difficulties Presented to the Observer by the Psychosomatic Problem

This article by Pierre Marty was first published in French in 1952 in La Revue Française de Psychanalyse. In order to more fully understand his contribution, we must situate this article in the course of Marty's life and work. During the 1950s he had just begun to elaborate his theory of psychoanalytic psychosomatics. His research at that time was based primarily upon his observations of patients suffering from movement disorders, back pain, nerve root syndromes, headaches and allergies.

In the same year as the meeting of the International Psychiatric Congress in Paris Marty met Franz Alexander and the two exchanged views on the subject of gastric ulcer disease. A year later Marty presented the case of ‘Marie’ — a patient suffering from headaches who had been cured by psychoanalysis — to the Parisian Psychoanalytic Society; this is the case to which he refers in the present paper. At this conference he made reference to ‘a painful inhibition of thought’ that, as for back-pain syndromes, he thought of as related to a failure of the dreamwork and therefore of the process of representation itself. Thus it was not a question of looking for the content to give sense to the somatic symptoms but rather of observing the inhibitions or failures of psychic elaboration that precede or accompany them.

Here we offer an illustrative simple schema based on the painful contractures of back pain: the blocking of the representation of a violent or raw movement too close to the drive — in the midst of a dream or a wakeful experience — could provoke the discharge of the same movement in the muscular system and preserve it as an abnormal symptom.

At that time Marty had at his disposal certain methodological tools:

• his vast experience observing somatically ill patients in the general hospital and in the specialized services of neurology and gastroenterology

• his knowledge of Freudian metapsychology

• his knowledge of the prevailing models of psychosomatics of which there were essentially two:

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