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The Differentiation of Somatic Delusions from Hypochondria. Donald Meltzer. Pp. 246-250.
Comment on Dr. Katan's and Dr. Meltzer's Papers. Paula Heimann. Pp. 251-253.
According to Katan, the fetishist shows a splitting of the ego by at once denying the possibility of castration and accepting it. The denial takes place during sexual excitement, the acceptance after the excitement has passed. The fetish is formed in the preoedipal period when the mother is regarded as phallic, while homosexuality springs from the Oedipal period when the mother's lack of a phallus is accepted and castration fears toward the father are of central concern.
Meltzer believes that a somatic delusion is the physical and psychic expression of a wide and deep split in the self and, with a portion expelled, it takes possession of a body part and becomes a concern in relation to others. A delusion of incontinence of flatus is an example. Hypochondriasis, on the other hand, is concentrated largely on the inside and is the consequence of double identification with internal objects damaged by projective identification. It tends to be present early in analysis before re-integration of split-off parts of the self is possible, while somatic delusions tend to occur later when an alliance of good internal objects (especially the good breast) and good parts of the self has been established.
Heimann's analysis of a case of fetishism confirms Katan's hypothesis of preoedipal trauma, but also contains Oedipal and latency conflicts. In the fetishist, denial of castration followed by acceptance suggests a split in the ego more apparent than real. If Katan also considers that there is repetition of this sequence, Heimann agrees there is indeed failure of integration of the ego and the equivalence