17 Self Psychology and Somatization: An Integration with Alexithymia

A revision of the psychoanalytic theory of psychosomatic conditions is long overdue (Deutsch, 1980). Although a prominent topic in the 1930s, '40s, and '50s, the theory and practice of psychoanalysis for psychosomatic conditions now occupies very little attention in the psychoanalytic literature. The most obvious reason is pragmatic: an average, expectable course of psychoanalysis or psychoanalytic psychotherapy is not beneficial for most psychosomatic cases and often is associated with exacerbation of the medical condition (Kellner, 1975; Sifneos, 1975). Exceptions are notable (Engle & Schmale, 1967; Sperling, 1978; Winnicott, 1966) and probably are attributable to some undetermined but gifted application of psychoanalysis.

Despite these difficulties and the shift of therapeutic techniques to pharmacological and nonanalytic methods, a small number of analysts have continued to accrue observations about psychosomatic conditions, which have coalesced under the term “alexithymia”, or “alexithymic syndrome” (Krystal, 1977; Marty & M'Uzan, 1963; McDougall, 1974; Nemiah, Freyberger, & Sifneos, 1976; Rickles, 1981; Sifneos, 1973; Taylor, 1977). These findings are beginning to shed some light on the propensity of some people to fall ill medically when subjected to environmental stress, disappointment, object loss, or humiliation, while others under the same conditions may become heroic, depressed, psychotic, neurotic, or creative, or may act out. Further, we are beginning to understand, with psychoanalytic tools, why such people often have so much difficulty getting well and why some are prone to develop