Somatization, Schizophrenia, and Spirituality as Defenses in the Case of a Young Woman

Defenses serve to protect the ego from conscious awareness of unacceptable thoughts and feelings associated with the sexual and aggressive drives. One of the contributions of modern psychoanalysis to the understanding of severe emotional pathology, including psychosomatic states, is its conceptualization of the narcissistic defense. The regressed patient, who fears that his aggression will obliterate the object on whom he depends for narcissistic supplies, protects the object by invoking the narcissistic defense, in which his aggressive impulses are turned inward upon his psychological and/or physical self (Spotnitz, 1969).

The case of Virginia Seton illustrates how three seemingly diverse symptoms—acne, hallucinations, and systematized religious thought—were related in being complementary manifestations of the narcissistic defense. The psychosomatic component exemplifies the turning of aggression onto the self in an attack on one's own body, and the choice of organ provides a clue in determining the period of development at which the conflict arose. The schizophrenic component, consisting of both auditory and cenesthetic hallucinations (sensations arising from bodily organs), illustrates not only the damage that can be done to the thought processes and perceptual apparatus by turning aggression back upon the mind, but also the disguised, fantasy wish-fulfillment that can be accomplished in the process.

Religious practices and experiences, while not usually described as symptoms, can be used in the service of the narcissistic