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404 Psychosomatics: Hearing the Body’s Discourse – 4 seminars

Course Leaders: Gavril Hercz, MD and Susan Moore, PhD, RP

Course Description

This 4 seminar introductory course addresses the evolution of psychosomatics, using a dual perspective. Initially a conflict model was elaborated by Freud, and subsequently others, including Groddeck, Ferenczi, Klein. This assumes symbolized communication becoming manifested physically. Freud also elaborated a nonconflictual deficit model of somatic expression, which was further elaborated by Alexander, Engel, McDougall and the French Psychosomatic School (Marty, de M’Uzan, Fain, Aisenstein). This latter perspective appreciates somatic expression as a lack of symbolization, with “unmetabolized” elements escaping psychic elaboration and therefore expressed somatically. Candidates will be encouraged to discuss their own clinical experiences concerning appreciated psychosomatic expressions, from their own case material.

Course Objectives

Candidates will be able to:

  1. [1.3 c] Appreciate the complex interplay between the psyche and the soma and how their mutual influences result in psychopathology.
  2. [1.2.g] Appreciate the impact of early or late physical trauma and how it becomes psychically manifested, especially at times of vulnerability.
  3. [1.3 d] Understand symbolized and nonsymbolized dynamics in somatic expressions and how they fit into the major diagnostic categories of psychic expression.

Seminar 1

This seminar explores the parallel evolution of these two models of somatic expression and the psychotherapeutic interventions that have evolved to address these manifestations. There will also be a consideration of newer perspectives of hysteria.

Required Reading

Bronstein C. (2011). On psychosomatics: The search for meaning. International Journal of Psychoanalysis, 92, 173-195.

Gottlieb R.M. (2003). Psychosomatic medicine: The divergent legacies of Freud and Janet. Journal of the American Psychoanalytic Association, 51, 857-881.

Supplementary Reading

Aisenstein, M. (2006). The indissociable unity of psyche and soma: A view from the Paris psychosomatic school. International Journal of Psychoanalysis, 87, 667-680.

Grotstein J.S. (1997). “Mens sane in corpore sano”: the mind and body as an “odd couple” and as an oddly coupled unity. Psychoanalytic Inquiry, 17, 204-222.

Verhaeghe, P. et al. (2007). Actual neurosis as the underlying psychic structure of panic disorder, somatization, and somatoform disorder: An integration of Freudian and attachment perspectives. Psychoanalytic Quarterly, 76, 1317-1350.

Bollas,C.  (2000). Chapter 2: Sexual epiphany. In Hysteria (pp.13-26). London: Routledge.

Seminar 2

With the introduction of clinical material, these two middle seminars will highlight how early traumas and maternal interactions shape mind/body relationship and may become manifested in the therapy.   As well, these two seminars will also touch on universal disconnections in the mind body continuum, e.g. adolescence, reproduction and pregnancy, aging, which we all have to navigate.

Required Readings

Egle Laufer, M. The body as an internal object. A Europe-wide Project. [Unpublished paper will be distributed].

Egle Laufer , M. (1991). Body image, sexuality and the psychotic core. International Journal of Psychoanalysis, 72, 63-71.

Supplementary Reading

Edgcumbe, R.M. (1984). Modes of communication – the differentiation of somatic and verbal expression. Psychoanalytic Study of the Child, 39, 137-154.

Seminar 3

Required Readings

Louis Mogul, S. (1980). Asceticism in adolescence and anorexia nervosa. Psychoanalytic Study of the Child, 35, 155-175.

Lombardi, R. & Pola, M. (2010). The body, adolescence, and psychosis. International Journal of Psychoanalysis, 91(6), 1419-1444.

Supplementary Readings

Nissen, B. (2018). Hypochondria as an actual neurosis. International Journal of Psychoanalysis, 99, 103-124.

Lawrence, Marilyn (2008). Chapters 2, 4 & 5. In The Anorexic Mind. The Tavistock Clinic series. London: Karnac.

Lemma, A. (2015). Psychoanalysis in times of techno-culture: Some reflections on the fate of the body in virtual space. International Journal of Psychoanalysis, 96, 569-582.

Seminar 4

This seminar highlights the trauma of severe physical illness and how it is navigated. Time permitting, the death drive will also be discussed, as observed in this group of patients. On a less traumatic basis, aging and chronic illness themselves result in similar dynamic which are eventually navigated by all of us.

Required Reading

McDougall J. (1974). The psychosoma and the psychoanalytic process. International Review of Psychoanalysis, 1, 437-459.

McDougall, J. (1989). Chapters 1 & 2. In Theaters of the Body: A Psychoanalytic Approach to Psychosomatic Illness. New York, NY: WW Norton & Co.

De Masi F. (2015). Is the concept of the death drive still useful in the clinical field? International Journal of Psychoanalysis, 96, 445-458.

Supplementary Readings

Winnicott, D.W. (1966). Psych-somatic illness in its positive and negative aspects. International Journal of Psychoanalysis 47(4), 510-516.

Lowental, U. (1986). Autodestruction and nonexistence: Two distinct aspects of the death drive. Psychoanalytic Review, 73(3), 349-360.

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