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I very much welcome the opportunity to discuss this paper as it brings to light many contemporary questions related to the nature of the relationship between the soma and psyche, and the permeability and accessibility of psychosomatic phenomena to psychoanalysis. The exploration of what Freud saw as the ‘puzzling leap’ (1917, p. 258) from the mental to the physical continues to exercise our imagination and stimulates analysts to further our understanding of the relationship between body and mind. Differences between dualistic and monistic ideas about the psyche-soma and their connection to notions of drive and representation are still far from being resolved.
It seems to me that this paper is the product of a critical dialogue with Pierre Marty and the Paris School of Psychosomatics, and has arisen from a questioning of the current paradigm, particularly surrounding the notion of ‘lack’. Press stresses the value of a theory that remains open in contrast to the saturation brought by the need to confirm existing formulations. I certainly agree with this statement and the value of having an exchange such as this one. While in agreement with many of the propositions made by Press I would also like to bring a different perspective.
One of the main points I think Press is making is that the Paris School's stress on the notion of ‘lack’ to explain what happens in psychosomatic patients is not sufficient to address this issue either theoretically and/or clinically. There is a debate with Marty's psychosomatic model and the therapeutic implications derived from it, particularly concerning transference and countertransference. I think Press is stressing the important role played by defences, hence by psychic conflict, in psychosomatic processes. In an earlier paper I have described the two major approaches to the understanding of psychosomatic illnesses. There are those who place the accent on a deficiency in the patient's psychic structure and those who see psychosomatic illne