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Joyce McDougall is interested in some of the most elusive areas of the mind—in this case the physical and physiological messages the psyche sends when mental
representations are not possible. The area of psychosomatic psychology must surely be of interest to all analysts, and McDougall has much to say. She draws on, Freud, Klein, Winnicott and Bion in order to formulate some theories of her own concerning the nature of psychosomatic illness as encountered in the personalities of her analysands. As she states (page 48) one aim of her book is ‘to study, from a psychoanalytic viewpoint, the unconscious significance of psychosomatic manifestations and to examine the extent to which these arc linked to the vicissitudes involved in becoming a person and to failures of the internalisation processes by which individual identity is constructed’.
McDougall takes issue with ‘certain psychosomatists with a psychoanalytic orientation’ who described a condition they call ‘alexithymia’. This is the discovery ‘that certain people have no words to describe their emotional states, either because they are unaware of them or because they are incapable of distinguishing one emotion from another. They may not distinguish anxiety from depression, or excitement from fatigue, or indeed, anger from hunger’. She wishes to emphasise that alexithymia, along with ‘operatory thinking’, that is, ‘a pragmatic and affectless way of relating both to oneself and to other people’, do not, as the Boston psychiatrists Nemiah and Sifneos propose, arise from neuroanatomical defects, but are defences against mental pain in general and psychotic anxieties in particular.
Actiological themes which recur throughout the book include that of a failure to introject, for one ‘reason’ or another, a sufficiently caring and thinking maternal representation; frustration, rage and despair in the infant; the construction of defences involving failure of symbolisation, the destruction or ‘foreclosure’ of feeling and meani