Experiencing the Body

A Psychoanalytic Dialogue on Psychosomatics

Jacques Press

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9780429594830
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Experiencing the Body: A Psychoanalytic Dialogue on Psychosomatics offers a range of perspectives on somatic illness, highlighting key points of convergence and difference between a range of psychoanalytic perspectives, to find a new understanding of this important issue.

Including contributions from experienced clinicians, each chapter presents contributions from two authors representing different points of view, before concluding with commentary from a third. It features discussion on key theoretical issues, including drive and affects, the role of the ideal ego, and the function of symbolisation, but also case studies of somatic patients, covering issues around depression and trauma, and exploring similarities and differences between somatic and borderline patients. Key treatment issues are also described such as psychosomatic investigation and the issue of transference and countertransference.

The result of a working party on psychosomatics of the European Psychoanalytical Federation, this unique book not only asks whether somatic illness arises from an impoverishment of the psyche or is primarily a form of communication through or by the body, but also tries to go beyond this classical opposition. It will appeal to any psychoanalyst or psychotherapist interested in this contentious and fascinating area.

Section IV
Theoretical issues

Chapter 6
Drives and affects

Marina Perris-Myttas

During the period of somatisation in Jasmine’s analysis, I witnessed her moving away from a self that had previously been alert to her own thoughts, mentations and feelings. Once Jasmine fell ill, she became almost exclusively absorbed with her somatic illnesses. How should we comprehend this transformation? That is the question which I shall address in this chapter.

Early in his work, Freud encountered a similar kind of transformation in patients suffering from hysterical conversion. In 1895 he introduced a metaphor, the ‘mysterious leap’ (Freud and Breuer, 1895d), to capture the shift he witnessed from the psychic to the somatic. The notion of the ‘mysterious leap’, which has been subsequently studied and developed by the Paris School of Psychosomatics (Marty, 1958, 1968; Smadja 2005, 2011; Aisenstein 2006, 2010) in their psychoanalytic work with physically ill patients, has proved a pivotal metaphor in the psychoanalytic understanding of psychosomatic illness.

In the course of the analysis of physically ill patients, or when our patients fall physically ill during their analysis, as happened to Jasmine, the conjunction of the mental and the somatic becomes the protagonist of the analytic scene. The study of this conjunction, of which the mysterious leap is one instance, became a central focus of Freud’s development of the theory of psychoanalysis. In 1905 in the ‘Three Essays on Sexuality’, he introduced the concept of the drive as a means of further understanding this conjunction of the somatic and the mental in all its complexity and elusiveness.

On the basis of my clinical experience, I am suggesting that psychoanalytic work with somatic patients offers a privileged vantage point from which to reflect on the centrality of the concept of the drive and its somatic origins, and on the related conceptualisation of the economic dimension in psychoanalytic theory and practice. As described in Section I, during the course of her analysis Jasmine ceased to be the patient she had been for the previous six years, as she became increasingly absorbed by her physical illnesses. What light can the concept of the drive shed on Jasmine’s transformation?

In what follows, I will discuss the concept of the drive, particularly in relation to beta elements in Bion’s metapsychology. These two concepts have been regarded as having an affinity (Green, 1998; Kohon, 2014; Reed, Levine and Scarfone, 2013; Perris, 2014). I will consider both the extent and the limits of this proposed affinity and I will do so in the context of considering their relative usefulness in grappling with the enigma with which psychosomatic illnesses presents us.

The concept of the drive

As mentioned above, the concept of the drive was first introduced by Freud in ‘Three Essays on Sexuality’ (Freud, 1905). He returned to the concept ten years later in the first of his Papers on Metapsychology, ‘Instincts and their Vicissitudes’ written in 1915, and he defined the concept as follows:

If now we apply ourselves to considering mental life from a biological point of view, a drive appears to us as a concept on the frontier between the mental and the somatic, as the psychical representative of the stimuli originating from within the organism, and reaching the mind as a measure of the demand made upon the mind for work in consequence of its connection with the body (Freud, 1915, pp. 121–22).

At that time the concept of the drive is explicitly established as a core metapsychological concept. The pressure exercised by the drive, ‘its very essence’ (1915, p. 122) amounts to the economic aspect which is ubiquitously present in psychic phenomena. When looking at the economic aspect we attempt ‘to track the vicissitudes of amounts of excitation and to arrive at least at some relative estimate of their magnitude’ (1915, p. 181).

Notwithstanding the problems generated by the choice of the word ‘drive’ to translate Freud’s term triebe into English, the concept of the drive, when understood as referring to power and force, is pivotal in psychoanalytic theory and practice. Indeed, it is from this perspective that Freud’s notion that affect is ‘the exponent of the drive’ becomes intelligible, especially when we think of the unremitting force of our patients’ affects when they are in the grip of the repetition compulsion.

The drive, as a concept lying on the frontier between the soma and the psyche, has been explored and elaborated by the Paris School of Psychosomatics. They see the concept of the drive and its economic dimension as central to an understanding of somatisation processes. Their clinical and theoretical work has expanded and elucidated Freud’s metaphor of the ‘mysterious leap’ (Freud and Breuer, 1895d), from the body to the mind and vice versa. At the heart of this elaboration is their emphasis on the quantitative dimension of the drive which serves as a bridge to the notion of affect, the ‘exponent of the drive’. Andre Green highlights this point clearly and succinctly when he writes that ‘the psychical representative of the drive, synonymous with the instinctual impulse, is what will give birth to affect, once the meeting with the object presentation has occurred’ (Green, 2005).

To turn to Jasmine, her transformation, as described in Part I, can be seen as an instance of the ‘mysterious leap’: that of the drive from the psychic to the somatic. From this perspective, the onset of her somatisation occurred at the moment of an excess of drive activity mobilised by intense erotic feelings in the transference which had not achieved psychic representation, could not be psychically elaborated, and in this way they reached a traumatic dimension. The drive regressed to its somatic origins and prompted a physical illness. The unfolding of the analysis of this situation pointed to early maternal traumatism. (For an elaboration of this transformation through the lens of the analytic relationship, see Chapter 5.)

The Freudian drive, Bion's beta elements, the somatic and the psychic

As already mentioned, a number of analytic writers have suggested that Bion’s beta elements bear a close affinity with Freud’s concept of the drive. What requires further discussion is the nature of this affinity as well as its limits. Exploring the nature of this affinity will hopefully help us to start contemplating whether the concept of beta elements, like the concept of the drive, can offer insight into the process of somatisation.

In tracing Bion’s definition of beta elements in the 1960s, we can see that he employs different definitions (Perris, 2014). To summarise, in Cogitations, beta elements are pronounced as ‘dead, unreal objects’ (Bion, 1992), while in Learning From Experience, beta elements are defined as ‘sense-impressions’ (Bion, 1962). In A Theory of Thinking they are seen as ‘raw-sense’ data (Bion, 1962) and in 1963 in Elements of Psychoanalysis they are regarded as ‘bodily sensations’ and later as ‘aspects of personality, linked with a sense of catastrophe’ (Bion, 1963). To my mind, these different notions of beta elements provoke questions regarding their conceptual specificity and clarity. Indeed, it has been observed that ‘Bion’s own approach to the subject of definition and nomination was to make a study in its own right even as he used it’ (Mawson, 2017, p. 18). Be that as it may, and acknowledging the potential lack of clarity in Bion’s definitional accounts, in what follows I will offer some thoughts on the extent of the conceptual affinity between beta elements and the drive.

First, if we were only to focus on the definition of beta elements primarily as ‘bodily sensations’ (Bion, 1963) we can see that the concept of beta elements is very close to Freud’s notion of the drive, in that they both belong to the somatic register. Both concepts seem to be embedded in the same bodily territory of human experience. André Green has emphasised this similarity between the two concepts when he states: ‘The id [in Freud’s structural model] is made up from impulses, that is a concept that is very close to Bion’s b-elements’, and he adds, ‘He [Bion] is aware of that’ (Green, 1998, p. 652).

But also with regard to the limits of this affinity, Green observes that the Freudian drives originate only in the somatic, whereas beta elements do not always originate there. ‘The main difference between Bion and Freud’, Green suggests, ‘could be that for Freud the drives always had their source in the inner part of the body, whereas for Bion b-elements may also arise from external stimuli upon the primordial mind. What is sensuous in the b-elements is more their relationship to the primitive body that lacks a thinker than to the source of the element’ (1998, p. 652).

Secondly, when we move from comparing the concepts of drive and beta elements in terms of their origin, to comparing them in relation to the theory of transformation from the somatic to psychic that each implies, we find them to be radically different. For Freud, as for Bion, this transformation is mediated by the primary object, but the process of this transformation is very different in the two. For Freud, the transformation occurs within the subject, rather than externally, and the transformation is inherent in the very concept of the drive. From the moment of the baby’s original ‘experience of satisfaction’ afforded by the object (Freud, 1900, p. 565), the drive acquires the potential to be constituted in the process of the meeting of the ‘demand for work’ that the body exerts upon the mind. (Freud, 1915, pp. 121–22), henceforth engendering psychic representations.¹

For Bion, on the other hand, the subject’s beta elements have to be transformed by the object’s alpha-function in order to be usable in psychic work. Indeed, without the object’s alpha-function, beta elements remain untransformed; they remain b-elements, ‘thoughts without a thinker’, until such time as the object’s reverie will bring about the transformation’ (Bion, 1967, p. 116). It is ‘the mother’s capacity for reverie’, Bion continues, which ‘is the receptor organ for the infant’s harvest of self-sensation gained by its conscious’ (Bion, 1962, p. 116).

Thirdly, in my opinion there exists a further source of affinity, as well as of disparity, between the drive and beta elements, which comes from Freud’s early work, specifically his ‘Project for a Scientific Psychology’ in 1895. In this work, Freud identified a process of an amassing of stimuli, an ‘accumulation of quantity’ Q (Freud, 1955 [1895d]) within the mental apparatus. The accrual of stimuli, Freud suggested, can cause an excessive and escalating excitation which burdens the psyche, leading to a primary impulse towards discharge. Such a discharge is required to protect the mental apparatus, which during its early development lacks any protective shield.

As I see it, this notion of an amassing of stimuli, can usefully be seen as the conceptual precursor of both Freud’s concept of the drive, as it developed from 1905 in the ‘Three Essays on Sexuality’ onwards, and of Bion’s beta phenomena described in ‘A Theory of Thinking’ (Bion, 1962). This common ancestry is, I believe, the third element which lies at the root of the affinity between the two concepts. However, as the two concepts evolved out of this common ancestry they followed singular paths, both in their theoretical development and in their clinical implications. For Freud the early notion of accretions of stimuli necessitating their discharge was the precursor of the core concept of his metapsychology, the drive, whose very constitution entails the notion of representation; the Freudian drive is no longer just a drive for discharge. Almost to the contrary, in some sense, the drive comes into being as ‘the psychical representative of the stimuli originating from within the organism, and reaching the mind as a measure of the demand made upon the mind for work in consequence of its connection with the body’ (Freud, 1915, pp. 121–22).

For Bion, as well, the early accumulation of stimuli is identified as ‘the conceptual precursor of the beta phenomena’ (Mawson, 2017). As Bion’s own thinking developed, however, he moved away from Freud by not following Freud’s trajectory from his account of an accumulation of quantity within the mental apparatus to his conception of the drive. Instead, Bion advanced his own metapsychology based on a constellation of concepts (like b-screen and b-elements and β-phenomena), all of which are core constructs in Bion’s model of dreamwork-alpha (α-function), and belong in his theory of container-contained. Further, it seems to me that Bion’s own trajectory, in and of itself, designates the limits of the affinity between Freud’s concept of the drive and his own b-elements: while drive remains a representative of the somatic, b-elements are core constructs in Bion’s model that pertain to the mind, to the dream-work alpha, encompassed in his ‘Theory of Thinking’; the links with the somatic are no longer quite as present.

Freud’s 1915 conceptualisation, as already noted, lends itself most significantly to the study of the conjunction of the mental and the somatic. This definition preserves the link between the soma as physiological organism and the mind, and thus the drive serves as a mediating concept which can elucidate the ‘leap’ between the psychic and the somatic. It acts as a bridge, helping us to understand and work with physically ill patients. As discussed in Section II: ‘Clinical pictures’, the Freudian concept of the drive in its bridge function, and developed as it is by the Paris School of Psychosomatics, allows for a clinically serviceable understanding of the transformation in patients like Jasmine and Kate, at the time of the development of physical illness.

Furthermore, the bridge concept of the drive helps us move away from an exclusive consideration of either the psychic or the somatic realm. With the concept of the drive, we move away from purely somatic functioning to the domain of the psyche: the domain of internal object representations created psychically by drive cathexis, the domain of narcissism, and the domain of psychic elaboration. In other words, the concept of the drive enabled us to explore the different registers where Jasmine’s struggle was coming into existence, shaping the life of the analysis.

This bridge concept is precisely the one which from my perspective is lacking in Bion’s theory of container/contained, where beta elements belong. Bion’s model veers away from the physicality of the soma as such. For him, it seems to me, it is only the body as a conception of the mind that is of relevance to psychoanalysis. The actual physical soma as the source of energy is not an object suitable for psychoanalytic inquiry. Bion, or at least the way his theories have been received and developed, claims that only the workings of the mind can qualify as objects of psychoanalytic exploration (Bronstein, 2015) If that should be the case, one can see that bridging concepts, yoking the psychic and the somatic, would not be of interest – or even pertinent – within Bion’s theory.

To conclude, from the perspective outlined above, I have come to think that it is difficult to envisage how the concept of beta elements, notwithstanding their theoretical affinity with the concept of the drive, can be of service either in studying transformations like the one Jasmine went through at the period of somatisation, or in the study of the development of her somatic symptoms. It may be that further study and re-conceptualisation of the mechanisms underlying the a and b phenomena, on the one hand, and of the status of the actual soma in Bion’s theory, on the other, could open up new avenues of understanding and working clinically with physically ill patients from the perspective of his metapsychology. But that work remains to be done.

Christian Seulin

In a view that is consistent with the idea of a psychosomatic unity, following Freud, drives appear like forces which, originating in the soma, find expression in the individual’s psychic life and behaviour. This is why Freud (1915) claims that the drive is a limit concept on the border of the psychic and the somatic. Affects – and we can refer to Freud’s notion of ‘quota of affect’ (Freud, 1915) consist of the drive’s energetic manifestation that is qualified at the psychic level. The drives originate in the soma, and their psychic elaboration consists first as the creation of a representative of the drive where there is no distinction between representation an...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Notes on contributors
• Foreword
• Acknowledgements
• Introduction
• SECTION I Two cases
• SECTION II Clinical pictures
• SECTION III Treatment
• SECTION IV Theoretical issues
• Index