Meetings of the New York Psychoanalytic Society

January 12, 1954. PSYCHOSIS AND PSYCHOSOMATIC ILLNESS. Melitta Sperling, M.D.

Dr. Sperling discussed the development and interrelationship of psychosis and psychosomatic illness. The pathogenic conflicts providing the basis for

the somatic reactions originated in the preoedipal or pregenital phases. The basic instinctual conflict between the child's destructive and libidinal impulses during these phases is reflected in its primary object relationships with people. The development of the psychosomatic pattern of response is rooted in a specific mother-child relationship which determined the outcome of the struggle between the two primary instincts. The outstanding feature of the mother is her need to keep the child in a lifelong dependence for the gratification of important bodily and emotional needs. The mother may complain about the burdens imposed upon her by the illness of the child, but she can give love and care only to the sick child. The child's dependence upon the mother, cemented by illness, creates a sort of magical relationship between them with reassurance to the child that it will not suffer a loss of the mother as long as it remains ill and dependent. The illness of the child provides the mother with a setting for acting out repressed unconscious impulses, often polymorphous-perverse, through physical ministrations to the child. The mother rejects the child when it is healthy and evidences strivings toward independence, encourages its illness and rewards it when it is sick. In cases of psychotic development, Dr. Sperling has found outright rejection of the child by the mother. In the psychosomatic illness, being sick means to re-establish the conditions for the immediate gratification of infantile libidinous needs and for the release of destructive impulses through bodily symptoms. The repressed destructive impulses and rebellion against the mother are discharged through the somatic illness. Another important gain is the appeasement of t