Clinical Treatment of Psychosomatic Symptoms1

Dr de Aisemberg spoke of the question of whether the clinical approach to somatic patients was psychotherapy or psychoanalytic therapy. She reminded the audience that, thanks to Alexander, Chicago became the cradle of Psychosomatic Medicine. However, we have come a long way in order to gain a psychoanalytic approach to the somatic phenomenon, or somatosis. What began as an extension of psychoanalysis, giving rise to important theoretical developments, has currently been established at the very core of Contemporary Psychoanalysis. This is a polemical position as the clinical approach to somatosis sometimes requires the commencement and/or continuance of treatment within a face-to-face setting, on a twice-weekly basis. All this involves asking ourselves whether we have embarked upon a psychoanalytic psychotherapy or upon the approach to non-neurotic or narcissistic functioning, which coexists with psychoneurotic functioning within Contemporary Psychoanalysis. In fact, this is her own position as she believes that somatosis points to another psychic functioning, which is the expression of the genuine unconscious or unconscious proper, the unconscious that was never conscious, while psychoneurotic functioning refers to the repressed unconscious.

She understands somatosis as the mise-en-scène of primitive, sensory traces - traces that are potentially traumatic - which have not been transformed, which are probably in between soma and psyche, within the Freudian id, deeply rooted in the soma. These traces, on being invested by excessive endosomatic excitation, a product, in turn, of the exteroceptive and interoceptive perception of the relationship with the object, fail to be transformed into drives and short-circuit to the soma. It is her view that this excessive quantity could be the essence of Thanatos. These traces are primitive experiences which have taken place before the acquisition of language, which have never been conscious and which are unchained by a trauma or m