Pyschosomatic School of Paris
As you all know the term psyhosomatics was used by J.C. Heinroth (1773-1843) for the first time . Until that time, explanations about the psyche and the soma assumed that the two are separate from each other. Heinroth’s combining the two terms into psychosomatics, in a sense, constituted an acceptance that both states coexist until the end of life. In addition to psychosomatic schools that adopt a rather medical and broadly-defined attitude to the issue, psychoanalysis also currently approaches psychosomatic illnesses in a different light that has evolved in time. Psychosomatic medicine bases its search for the causes behind biological etiological and psychological symptoms on the concept of illness. The psychoanalytic-psychosomatic approach, on the other hand, tries to explain the environment that gives rise to a somatic illness by considering the patient and his/her psychic functioning. This currently opened road has its position on the opposite of psychosomatical medicine. Soma has always been included in psyhoanalytical work. However we think the unvoiced is healthy if it is not stated by the patients. When the soma is in trouble, it makes noises and we find ourselves listening what the sufferer tells. The word psychosomatics was never used in Sigmund Freud’s writings directly, as it’s known psychoanalysis was born by working with the hysterical patients. Successor psychoanalysts of Freud aimed to consider the distresses of soma in a more different, and broader, sense. After Freud, many psychoanalysts adopted a different perspective when dealing with patients who have somatic distresses and do not benefit from classic psychoanalysis. Especially Ferenczi’s starting approach found advocates also in USA and major theories with significant contribution to psychosomatic medicine have emerged. Here the basic purpose is to look for the psychic functioning of the origins of the somatic illnesess and to understand in which circumstances the they develop. The very first systematic searches were the ones started for the health insurances, by the birth of the psychosomatical medicine, the student of Frenczi Alexsander and the successors like Dunbar, Valebra, Groddeck has improved the field. F. Alexander, by pointing out the connection between psychic functioning and the illness and by classifying the personality types according to the different illnessses, created works which established connections between illness and the psychic world.
In France moving from the idea of “everyone of us is a psychosomatic individual”, psychoanalyists Pierre Marty, M. Fain, Christian David and Michel de M’Uzan by establishing the Paris Psychosomatic Institute in 1970s , had a distintive place to work. Here the basic investigation was to search for answers for two crucial questions “what is the psychosomatic patient?” and “what is the psychosomatic illness?“ and thereby searching answers for patient and illness concepts. Initial studies focused on patients who had headaches and allergies, and it was observed that the psychic functioning behind their illnesses was inadequate, and that the patients perceived their symptoms as devoid of any meaning.If we simplify their opinions, we can express the approach as giving meaning to the illness by looking at the psychic functioning of the patient on the contrary to the medical perspective as looking at the patient from the point of the illness itself.
According to the psychosomatical perspective if the excitations cannot be discharged, it leads to accumulation and this also leads to problems in somatic psychic apparatus. The dynamic functioning of our psychic apparatus steps in while trying to cope with the stimulus coming from within and outside of ourselves. Psychic representations are the basics of our mental lives. These representations, which express themselves through fantasies during the day and through dreams at night, have a crucial role in terms of our ability to create associations, develop ideas and build relations with others. In order to form these procesess , new concepts and new perspectives coming from psychosomaticians and psychoanalysists are very helpful for us to understand the psychosomatical functioning.
In addition to these we should add the contributions of Pierre Marty, the founder of Paris Psychomatics School, to Freud’s drive theory. P. Marty who conducts long sessions which are called as “ Psychomatical Investigations” in 1950s, explains the development of drives as separated from each other. While explaining why he deliberately avoids the term “libido” despite thinking that it’s a suitable concept for psychoanalysis, he says that “libido” cannot be used to explain the functioning of psychosomatic processes in terms of energy. As a developmental theorician Marty , claims that drives change developmentally. He frequently interchanges the concepts which are used for neurotic patients like “sexuality” and “erotisation” with the concept of “excitation”. Marty refers to specific cases to explain how drives become irregular developmentally, within the context of psychosomatic functioning in a clinical setting.
Essentials of psychosomatical pyschoanalytical concepts :
Mentalisation : The concept of mentalisation which forms the basis of Pierre Marty’s theory is key to understand the psychosomatical patients. Psychic representations are the basics of our psychic lives. As mentioned before, these representations, which express themselves through fantasies during the day and through dreams at night, play a crucial role in terms of our ability to create associations, develop ideas and build relations with others. This is all achieved by the preconscious, which is a sign of successful mentalisation. Preconscious corresponds to the first topic in Freud’s psychic apparatus . Preconsious which is placed between conscious and unconcious acts as a mediator and is linked to the mental processes and fantasies. P. Marty draws the attention to the process of preconscious as the basic conflict point for psychosomatic patients. It’s expected to be fluent, permeable and flexible as it connects the mental representations to each other. Through the mediation of the preconscious, the psychic apparatus is expected to continuously accomplish all functions acquired through maternal functioning in earlier stages. However, while every person can from time to time experience irregularities in his/her psychic functioning, in psychosomatic patients, the long-term existence of such processes results in irregularities. Inadequate functioning of the preconscious, i.e. inadequate mediation between the conscious and the unconscious, causes elements of the unconscious to reach the conscious in their raw forms, without any censorship.
Operational World: Primarily one of the basic factors of the operational world is the operational thinking. Operational thinking is the way of thinking which is only current , unrelated from the representational world and far away from symbolization. In fact it’s the way of thinking which lost connection from drives, concrete and too much related to the reality. In fact it’s possible for everybody to face with this kind of thinking.But when this becomes chronic and permenant, it’s possible to talk about an operational way of living. At that point, we can talk about a system that is free from drives, and is very delicate. With this impoverishment of the world of drives, the operational life of the psychosomatic patient gets impoverished by such persistent thinking, drive-based excitations and representational richness are replaced by a monotonous, unexcited, unexplainable life, a life lived just for the sake of living. For this kind of living it can be mentioned a decline of the quality of the superego and a strong positioning of the ideal ego. The ideal ego which exposes the person to the never ending orders, doesn’t let the person regress passively and causes collapse psychicly and somatically.
Essential Depression/ Objectless Depression: This type of depression was formerly known as “basic depression”, a term coined by Pierre Marty in 1996, which was gradually replaced by the term “objectless depression”. Here, unlike in other types of depression, the depression occurs after generalized anxiety attacks that are not linked to an object (unlike in neurotics), when the psychic apparatus fails to deal with emotions and articulate traumatic events. It’s experienced without guilt feelings or any other kind of affection and somatic complaints are not expressed. Mostly, it’s a situation that people around do not detect and the patients are far away from affection and do not express any kind of wish. Fatigue, stress and boredom are the usual ambigous expressions and the situation which is not detected by the environmet is easily detected by the psyhoanalists’s counter tranferences.
Paris Psychosomatics School (IPSO) which was established in 1972 , has been currently working with children, adolescent and adult patients and has been giving supervisions under the head of International IPSO –Pierre Marty Institution. There are also psychoanalysts who have been in training in this field in our own institution.
Publications in Turkish on Psychosomatics:
- Pierre Marty, "Zihinselleştirme ve Psikosomatik" Bağlam Yayınları 2012.
- Rosine Debray, "Beden Deneyimi Psikopatolojisi" Bağlam Yayınları 2015.
- Yansıtma 3-4 Sayısı, "Psikosomatik" , Bağlam Yayınları 2000
- Psikanaliz Buluşmaları 3. Sayı, "Psikosomatik", Bağlam Yayınları 2008
- Psikanaliz Yazıları 11. Sayı, "Psikosomatik", Bağlam Yayınları 2005
- Tevfika Tunaboylu-İkiz, “Psikosomatik" ve "Yorumlama" Maddeleri, Psikanalitik Psikoterapiler El Kitabı, Türkiye Psikiyatri Derneği Yayınları, 2011.