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David Rosenfeld is an Argentinian psychoanalyst who has successfully treated both children with autism and psychotic adults. In The Body Speaks, he presents a small collection of psychoanalytic case studies concerning work
with severe disturbance that is expressed in fantasies about the body, in body image delusions, and hypochondria of both chronic and acute duration. The clinical focus of the book is on the use psychosis makes of the body, and those of us working in this field will be familiar with the way in which psychotic delusions can become expressed through physical delusions about violation and breaching of the body boundary. Rosenfeld first outlines his theoretical construct, of a primitive psychotic body image, before introducing the reader to a number of his cases: Pierre, who believes he has no blood; Katherine who has changed her fantasy about her body image following a traumatic car accident; Philippe who has a psychotic hypochondriac delusion; and a young male who believes that bats are flying out of his cheeks.
In his introduction, Rosenfeld states that his intention is to show what it means to work and think as a psychoanalyst about transference and the internal world of a psychotic patient. He writes in particular about patients who express their mental states through fantasies about their body image. In this sense, he invites us to explore the presence of terrifying infantile fantasies which are primarily experienced in the body and which emerge in later psychosis as delusions such as total loss of body fluids (emptying of the self), or as bleeding lips and tongue (early separation experienced as the nipple tearing away the mouth). What he particularly researches are the first months and years in the life of these patients.
In his view the extreme notion of what can be conceived of as primitive psychotic body image is the thought that the body contains only liquid, or vital liquid or another derivative of blood, surrounded by an arterial or venou