Discussion of Melitta Sperling's Article, Migraine Headaches, Altered States of Consciousness and Accident Proneness: A Clinical Contribution to the Death Instinct Theory

Dr. Melitta Sperling's long-standing interest and psychoanalytic study of patients with migraine headaches has led to a descripton of a number of dynamically associated conditions, such as depression and epilepsy, and now in her current paper, accident proneness, excessive pregenital sexual fantasies and altered states of consciousness. As she indicated in her 1952 paper, the co-appearance of these phenomena are probably best explained on the pregenital character orientation of these patients. The specific behaviors and symptoms represent the potential of these individuals to handle conflict, both in and outside of therapy. Any and all of these phenomena may occur in individuals who do not have migraine episodes.

The migraine syndrome is considered a somatopsychic-psychosomatic disorder. This formulation emphasizes the interaction between somatic predisposition and functioning during psychic development, which may lead to the somatic involvement in the subsequent expression of psychic activity and more specifically can lead to organic dysfunction at times of psychic impasse or unresolvable conflict.1

Dr. Sperling's emphasis on the dynamics of the migraine headache, accident proneness and altered states of consciousness as support for the concept of a death instinct is interesting but not convincing. As she states, the idea of the existence of the death instinct is a controversial one. The concept remains unproved and there are other formulations which explain her analytic material equally well. What Dr. Sperling calls the “psychosomatically accomplished symbolic murder and suicide” from an ego psychology point of view can be seen as an adaptive response to feeling overwhelmed and ungratified rather than a return or regression to a basic instinctual drive or a “sudden instinct diffusion.” The fantasied desire to destroy an object or self involves the turning of a passive experience of being overwhelmed into an active experience of adapting to the fantasied threat.

In my