Emotional Vertigo

Between Anxiety and Pleasure

Danielle Quinodoz, Arnold Pomerans

• Publisher: Routledge
• Year: 2002
• Print ISBN: 9780415148351
• eBook ISBN: 9781134752676
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In this unique, prize-winning study Danielle Quinodoz unravels the unconscious significance of the feelings of vertigo which arise in situations where there is no immediate physical danger of falling and no organic cause. She traces the origins of such emotional vertigo to inner anxieties around separation which are expressed somatically at different levels according to the level of anxiety.

Through a detailed case study of a patient who developed the symptoms of vertigo during analysis the author offers some thought-provoking insights into the vicissitudes of the object relationship and the importance of the role of the analyst in helping the patient translate sensation into representation. She also reflects on the links between anxiety and pleasure in the experience of vertigo, clearly exemplified in sports such as rock-climbing or skiing, and shows how vertigo is inexorably linked to questions of equilibrium at the psychic as well as the physical level.

Emotional Vertigo is an excellent introduction to some of the central themes of current psychoanalytic thought.

1
What is vertigo?

I became interested in vertigo a long time ago—when Luc first came to consult me: he complained of vertigo and asked for psychoanalysis. His vertigo hampered him considerably, not only in his social and leisure activities, but also in his professional life. He had previously seen a number of physicians who had failed to detect a somatic cause. In the end, his family doctor, who had found Luc in perfect health, had advised him to consult a psycho-analyst. Luc had hesitated; he had first tried self-analysis, reading Freud and using introspection, but his vertigo had become more acute. He had then decided to see a psychoanalyst: he felt vaguely that his vertigo might be connected with his way of relating to people important to him; he also sensed that, if relationship problems were really involved, communication with the analyst would help him to get to the bottom of them. Actually, though he had not thought it through, Luc felt vaguely that he was in danger of repeating his relationship problems in the transference, and hoped that the analyst might help him to bring these problems into the open and to change them.

Luc simply said that he had vertigo. But what kind of vertigo? What was its precise nature? At first he mentioned his insurmountable fear of falling out of a cable-car; but that fear quickly turned out to be no more than a gateway to a very complex world: the world of vertigo.

Definitions

The various meanings of the word ‘vertigo’

In current French, the word vertige can refer to a variety of symptoms. To begin with, there is a difference between vertige—vertigo—and vertiges— giddy spells. If you say that you suffer from the first, you are indicating that you have a fear of heights or suffer from mountain sickness; in the second case you convey the fact that you tend to feel dizzy and may be physically ill. However, with these two meanings the ambiguities only begin, not only in the somatic but also in the psychic realm.

In fact, the expression I have vertigo can be used to express a physical sensation (for example, ‘I feel the room is starting to spin’), but it can also reflect a feeling of disquiet or anxiety about a psychologically daunting situation (for example, ‘The immensity of the task before me makes me feel giddy’), in which case the physical sensation of vertigo betrays a particular form of psychic or emotional insecurity.

Even when people say ‘I feel giddy’ to describe their physical sensations, we realize that they might be referring to a number of quite distinct experiences. What, then, do we mean by vertigo?

The word vertigo is derived from the Latin vertere, to turn; it reflects the mistaken impression that our surroundings revolve round us, but also the opposite false impression, that it is we ourselves who, having lost our balance, keep spinning involuntarily. Professor Rudolf Häusler, an oto-neurologist who is particularly interested in vertigo, provided this definition during his course of lectures at the Geneva faculty of medicine (1989): ‘Vertigo reflects a mistaken sensation of the body’s movement in space, or of the movement of space with respect to the body. It can give rise to a feeling of turning, reeling, or of the imminent danger of falling.’

He also distinguishes between vertigo (vertige), dizziness (malaise), and loss of balance (déséquilibre), three terms that are often confused in modern French. In the Journal: Questions et Réponses, he proffered the following explanations:

‘Vertige’ is derived from vertigo, which means whirling. The term therefore applies above all to rotatory feelings but can also describe the sensation of rolling, of pitching and tossing, or of an imminent fall. In short, it therefore refers to a disturbance of the perception of space combined with an illusion of movement.

‘Malaise” generally refers to an acute condition coupled to a sense of weakness, of being empty-headed, of having lost one’s physical and mental powers, and often of feeling faint (‘presyncopal state’). Malaise includes a whole range of neuro-vegetative manifestations such as cold sweats, nausea, vomiting, abdominal cramps, irregular pulse, and drop in blood pressure. It can even include rotatory vertiginous sensations.

‘Déséquilibre’ refers to disturbances of the postural sense, especially while one is stationary before or during a walk…

In modern usage, the terms ‘vertige’, ‘malaise’ and ‘déséquilibre’, inasmuch as they refer to medical complaints, tend to overlap. They may describe not only the sensations listed above, but also such purely psychic disturbances as phobias (fear of heights=void-related vertigo, agoraphobia) and depressive states (vertigo felt in the face of an insurmountable problem, the condition manifesting itself before a difficult situation).

Similarly, in respect of the clinical meaning of these terms, considered as symptoms, we find that vertigo is often accompanied by malaise, and also that it can cause loss of balance. In the same way, rotatory vertiginous sensations occur very often during malaise.

(Häusler 1985:12)

Vertigo of emotional origin has the same symptoms as vertigo of somatic origin, and hence fits into Häusler’s picture, although it is due to psychic rather than somatic causes. Nor can it be reduced to a form of vertigo elicited by particular external conditions, because, even when these conditions appear to trigger it off, they do not suffice to explain it. We must therefore try to get at the psychic mechanisms responsible for a set of symptoms that so spectacularly involve the body, and to discover what significance they have for the patients concerned.

It is obvious that, as a psychoanalyst, I should be primarily interested in vertigo of psychic origin, and that I should try to discover what psychic mechanisms might help to elicit that symptom. Even so, I shall give a brief summary of the manner in which the mechanisms of vertigo can currently be explained on the somatic level, if only to emphasize how firmly the psychic aspect is rooted in the somatic. It may be of special interest to note that the appearance of vertigo of somatic origin is connected with the difficulty of integrating the diverse data provided by different perceptual systems, and that the appearance of vertigo of psychic origin is bound up with the difficulty of integrating equally diverse psychic currents (needs, wishes, affects). Moreover, vertigo can be said to serve as an alarm signal in both cases.

Summary of the mechanisms of vertigo of somatic origin

Data provided jointly by three sensory systems

The sense of balance or of vertigo of somatic origin depends on the coordination of data supplied by three sensory systems: the optokinetic apparatus (optical data), the proprioceptive apparatus (which supplies data about muscles and tendons, and tells us about the position and changes in the position of the body) and the vestibular apparatus (which comprises the otolithic system and the semi-circular canals located in the internal ear, and keeps us informed about the static position of the head, about bodily movements and about gravitational pull). These three systems help us to take stock of our position and of our equilibrium in space, and to act accordingly. Of these three, the vestibular apparatus plays the most important role. When these three systems supply coherent data, these data are integrated to provide us with a sense of balance. When one of the systems provides data that do not agree with those provided by the other two systems, then vertigo may ensue.

The disparity between the various sets of data may be of pathological origin. There may be a lesion in one of the three systems, causing that system to produce abnormal data; most often such lesions occur in the vestibular system. Thus an otolith may have been displaced and jammed; it loses its mobility and provides erroneous information about the position of the head, that information no longer corresponding to the data supplied by the other two systems, with a consequent threat of vertigo. By manipulation of the patient’s head (Semon’s manoeuvre), the physician can sometimes unwedge the otolith, restore its freedom of movement, help it to function normally and to provide valid information; the vertigo disappears.

Vertigo can thus serve as an alarm signal, alerting us to a possible defect in one of the three systems that combine to help us to establish our equilibrium.

The sensation of vertigo is not necessarily of pathological origin

The disparity between the data provided by the three perceptual systems need not be of pathological origin, but can be due to special external conditions with which everyone is familiar.

Suppose, for instance, that we are standing at the edge of a precipice. Our inner ear informs us that we are standing still, our proprioceptive system signals that our feet are touching the ground as usual and that our position is stable, but our optokinetic system supplies data that do not tally with those coming from the first two systems: we look at the bottom of the precipice, and see the ground a thousand yards below us. There is a discrepancy between the data: two sources make us feel the ground under our feet, but the third makes us see the ground a thousand yards below; this incoherence can give rise to a non-pathological form of vertigo of somatic origin. That explains why mountain guides sometimes tell a climber overcome by vertigo in the midst of a climb: ‘Stop looking down! Look at the rock face straight in front of you!’

Now, a very interesting thing happens when the person who has vertigo at the edge of a precipice takes off with a para-glider or hang-glider: as soon as he leaves the ground his vertigo disappears. By eliminating the information that the ground is underneath his feet, he has also suppressed the disagreement between the information produced by his three sensory systems: the three systems now supply concordant data and the vertigo has vanished.

I could easily quote other, more common experiences. For instance, some people get vertigo when they read in a moving car: there is a discordance between information of vestibular origin suggesting that they are experiencing displacements, accelerations or rotations; and information from their optical system which tells them that they are looking at a stationary page of a book. If they then look at the landscape in the distance, the vertigo generally dies down. Or take the case of the person who having waltzed, say, clockwise for a long time, suddenly stops, and then feels so giddy that he is in danger of collapsing on the spot: when he stopped, his semicircular canal and otoliths, over-stimulated by the waltzing, continued to signal that he was still moving, while his optokinetic system presented him with static surroundings. The incompatibility of the data led to vertigo. Waltzers often deal with this discordance by ending their dance with a brief whirl in the opposite direction; that serves to slow down the movement of liquid in the semicircular canals, which are then able to convey the state of immobility more rapidly.

It is worth noting that these somatic mechanisms giving rise to vertigo and equilibrium do not affect everybody in the same way. Some people do not have vertigo at the edge of a precipice, some people can happily read in a moving car, and there are others who used to have vertigo at the edge of a precipice but have it no longer. Does that not suggest that some psychic component may intervene to modify the course of what is at first a purely somatic process? In fact, the person at the edge of a precipice can, by his own psychic action, correct the information received by one of his perceptual systems with the help of a partial deciphering process enabling him to restore coherence; experience and training thus play an important role and some persons subject to vertigo can, if no emotional factor is added, learn to overcome it. We also find that some people are better than others at compartmentalizing the data or at taking advantage of one system of information while pushing the rest into the background: in a car, some passengers are so absorbed by what they are reading that, to all intents and purposes, they ignore all the other information and hence do not suffer from vertigo; in short, some people have no problem in reading an exciting text in a car, but have vertigo if the text bores them.

All these facts lead us to think that a psychic component may intervene even in the case of non-pathological vertigo of somatic origin. More generally, people can learn to master physiological vertigo provided they do not also suffer from anxiety giving rise to vertigo of psychic origin.

Psychoanalysts and physicians in the face of vertigo of psychic origin

It is obvious that, as a psychoanalyst interested in the meaning of vertigo of psychic or emotional origin, I take a different view from that of Häusler and other physicians. Even so, their work and the information it provides are extremely valuable to me. Actually, in order to be able to analyse the symptoms of vertigo of psychic origin, or even the psychic components of a case of vertigo due to somatic causes, I consider it essential to obtain an expert medical opinion about the origin of the vertigo presented by patients who come to see me.

On the one hand, it is important for me to know if the specialists have been able to exclude, as far as possible, any possibility of a somatic cause; on the other hand, whenever they think that this symptom is of somatic origin, it is equally important for me to know how severe the patient’s somatic condition is. In no circumstances must the diagnosis of a grave somatic illness be brushed aside, the less so as its beginnings might well have manifested themselves by that particular symptom.

On this subject, Rentchnick and Häusler mention a study of a thousand persons suffering from vertigo who were examined between 1980 and 1982 at the onto-neurological unit of the ear, nose and throat clinic attached to the Cantonal University Hospital in Geneva. Häusler states that ‘in 29% of these cases it was not possible to determine the origin of the vertigo’ (Rentchnick and Häusler 1985:3097). He adds later that

what is important is that one can almost invariably determine the origin of those cases of vertigo that were caused by a grave illness, in which an early diagnosis is vital. In fact, it is estimated that from 5% to 10% of all vertigo cases have a serious cause, for example a brain tumour or a cerebrovascular accident that can endanger the patient’s life.

(ibid: 3098)

He concludes: ‘Approximately 80% of all cases of vertigo have a spontaneous cure. This conclusion should enable the physician to reassure this group of patients ‘(ibid.: 3098).

Who turns to psychoanalysts in cases of vertigo?

The thousand cases of vertigo studied at the Geneva hospital between 1980 and 1982 are not representative of those who come to see psychoanalysts— in my own practice I have had to deal with quite different requests concerning vertigo. It is rare for vertigo to be, at least on the manifest level, the main reason for a request for psychoanalysis. However, it does happen that people ask for analysis as their last hope of being freed of a symptom that ruins their life. Generally, they have already consulted medical practitioners who failed to find a somatic cause for their vertigo. This, in particular, was the case of Luc, whose normal life was badly upset by this symptom. Luc used the general term vertige to describe his condition, but actually he presented all three related forms described by Häusler: vertigo, giddiness and loss of balance.

On the other hand, many analysands consulting me for reasons other than vertigo later disclosed that they suffered from this symptom; they had failed to mention it earlier either because the symptom was mild, or else because they had never thought that vertigo might have anything to do with psychoanalysis.

Moreover, I have often noticed—and many colleagues have told me that they had made the same observation—that numerous patients present isolated vertigo episodes of various forms during their analysis; this may even happen to patients who had not been subject to this complaint before to any great extent. It is therefore interesting to anyone concerned with the course of the analytic process to discover in what circumstances these episodes occurred and what their significance was.

Yet other patients consult a psychoanalyst aware that they suffer from vertigo of somatic origin, linked, for example, to Ménière’s disease, and identified and treated as such by medical specialists. In no case did they expect the psychoanalyst to replace the physician, but merely to help them to live as best they could with an illness that can sometimes be very troublesome, indeed frightening. Some medical specialists will encourage them to consult a psychoanalyst, in the knowledge that medical science cannot yet eradicate the cause of their discomfort.

In psychoanalysis, we also sometimes encounter patients who seem to treat vertigo as a challenge, who play with leaps into space, and who take special pleasure in flirting with what, while threatening to give them vertigo, also provides them with thrills they need not fear. Between the pleasure afforded by heady adventures and dicing with death, there is a no man’s land that may be worth exploring, however daunting the task.

I must mention yet another aspect of vertigo with which nearly all my patients have been confronted at some time during their analysis. I am referring to metaphysical vertigo caused by confronting the great existential questions: life, death, infinity, eternity, the sense of one’s own being or nothingness, the feeling of emptiness. This form of vertigo is defined by the answers to such questions as ‘What is the meaning of (my) life?’ or ‘What is the meaning of (my) death?’ I sometimes wonder if the need of certain patients to find a psychic meaning for their personal history in order to improve it, is not simply one way of warding off the anxiety caused by their failure to discover a meaning in life.

Psychoanalysts and the study of vertigo

Freud kept referring to vertigo (Schwindel, translated as ‘Vertigo’ by Strachey in the Standard Edition) throughout his writings; he considered it one of the major symptoms of anxiety neurosis. I have devoted part of Chapter 11 to the development of Freud’s thought on this subject.

After Freud, to the best of my knowledge, those psychoanalysts who made a special study of the symptom of vertigo concentrated mainly on vertigo of somatic origin, thus following in the footsteps of French (1929); however, Schilder (1939) and Rycroft (1953) contended that vertigo coul...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Foreword
• 1 What is vertigo?
• 2 Fusion-related vertigo
• 3 Vertigo related to being dropped
• 4 Suction-related vertigo
• 5 Imprisonment/escape-related vertigo
• 6 Vertigo due to attraction to the void: the emergence of internal space
• 7 Expansion-related vertigo
• 8 Competition-related vertigo
• 9 Vertigo, from anxiety to pleasure
• 10 What makes a candidate for vertigo?
• 11 Vertigo in the work of Sigmund Freud and Melanie Klein
• 12 Dangerous games with vertigo
• 13 Equilibrium: a continuous construction
• Bibliography