The Analytic Environment in Times of Bodily Dysfunction: The Effect of Psychoanalytic Psychosomatic Theories

This article examines the analytic environment in which psychoanalytic work occurs when patients struggle with complex somatic experiences, such as disease or physiological dysfunction. Patients express fantasies and beliefs about the etiology of their somatic experiences; they elaborate theories about why infertility, irritable bowel disease, or some other disease, syndrome, or crisis is happening to them. I consider these to be patients' multiply determined, fantasy-saturated psychosomatic theories, and suggest that the analyst's understanding of patients' ideas about their somatic experiences is organized by the analyst's both articulated and not articulated psychosomatic theories. Using brief clinical vignettes, I highlight the potentially constricting effect of clinicians' theories on their analyses of patients' psychosomatic theories. I examine psychoanalytic theories of psychosomatics, suggesting that adherence to the theories we have, which often posit linear psychogenesis of somatic phenomena, can result in collusion with, rather than analysis of, the psychic stances reflected by patients' theories. To address the problematic adherence to our theories, and characterize a less constricting clinical and theoretical stance, I critique aspects of the theories and suggest directions for replenishing them.