The body in obsessional neurosis

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The body in obsessional neurosis:
Psychoanalytic reflections illustrated in a single case study[1]

Shana Cornelis

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Abstract

From a Freudian-Lacanian point of view, neurotic symptoms are always to be conceived as embedded in the interpersonal relation of the subject towards significant others. With respect to this interconnectedness, the symptom specificity hypothesis (Blatt, 1974, 2004) – which can be considered an empirical operationalization of Freud’s theory on the psychoneuroses (Desmet, 2007) – states that a univocal association exists between type of neurotic symptom and mode of interpersonal functioning. More in particular, reminiscent of Freud and Breuer’s (1978 [1895d]) ‘Studies on Hysteria’, bodily symptoms are claimed to occur solely in hysterical neurosis; whereas obsessional neurosis, as Freud (1978 [1909d]) indicated in his famous Rat Case, is specifically characterized by the return of the repressed in the mind. Our contribution focuses on possible contra-indications for the presumed absence of bodily symptoms within obsessional neurotic pathology. In a first step we therefore investigated both research-oriented and theoretical writings as well as clinical case studies. We found that, although bodily symptomatology in obsessional neurosis has not often been commented upon, several authors (e.g. Fink, 1997; Skolidis, 2008; Soler, 1984; Strubbe, 2004) have explicitly denoted the crucial impact of/on the body in some cases of obsession. Secondly, we concretise this impact by means of a specific case study of a Lacanian psychoanalytic therapy with an obsessional patient. We indicate that in this patient, bodily symptoms do appear, but in a different, more obfuscated way than is classically the case in hysteria. Framed within an overview of the therapeutic process, we will elaborate on the function and evolution of the subject’s symptoms within his relation towards the Other, as expressed in his singular way of positioning himself towards the desire of significant others. Finally, these findings are discussed in the light of the psychoanalytic approach of the (bodily) symptom.

 

Introduction

In this presentation, I will focus on the appearance of the body within obsessional neurosis. More specifically I will focus on the function of bodily or somatic symptoms in obsessional neurotic patients. I will start with a short notion on the current descriptive psychiatric approach of symptoms, as opposed to the psychoanalytic view of neurotic symptoms, as always being embedded in – or interwoven within – important interpersonal relationships of the patient. Next, I will briefly elaborate on the theoretical elaborations of some authors who exclusively or predominantly link certain types of symptoms with certain modes of interpersonal functioning. It so happens that, within these elaborations, the presentation of bodily symptoms is often exclusively linked to the hysterical personality structure, whereas obsessional patients are viewed to only display mental or cognitive symptoms. This contribution will concentrate on possible contra-indications for the presumed absence of somatic symptoms within obsessional psychopathology. In a first step, I will highlight the theoretical contributions of a selection of authors on this matter; in a second step, I will illustrate these remarks by means of a specific case study of a Lacanian psychoanalytic therapy with an obsessional patient who presented with severe tinnitus and back pain complaints.

 

Descriptive ‘versus’ structural diagnoses and the function of the symptom

Within the enormous field of psychopathological phenomena patients display, clinical psychiatry and psychology usually discern different subsets of symptoms on a phenomenological basis (e.g. Derogatias & Cleary, 1977), i.e. based on their overt, often visual manifestations. Accordingly, contemporary diagnostics – as conceived in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, American Psychiatric Association, 2013) – is based upon this description of symptoms. In other words, a diagnosis is based on a sum – or a list – of all the different, overt symptoms a patient presents us or tells us to suffer from.

However, a few important drawbacks have been discerned with this form of diagnostics. Most importantly, due to an absence of a theoretical framework that helps to structure both inter- and intra-individual varieties in the overt presentations of complaints, this plurality in the phenomenological field of symptoms cannot be reduced (Desmet, 2007). Hence, the diagnostic system becomes ineffective, as is illustrated in the large – and still increasing – amount of diagnostic categories in the DSM-V, with which comorbidity is the rule rather than the exception (Stefanis & Stefanis, 2002, pp 22-24).

 

I will not go into this any further; I just wanted to roughly outline the current psychiatric approach of psychopathology, and oppose this to the structural diagnostic system of Freudian-Lacanian psychoanalytic theory and practice. For, ever since the beginning of psychoanalysis, attempts were made to further structure the large set of psychological symptoms on the basis of their underlying, determining structures. In a Lacanian reading of Freud’s work, we could say that throughout his clinical work, Freud (1856-1939) has developed a diagnostic system containing three main categories: neurosis, psychosis and perversion. In this presentation, we will specifically focus on neurosis. At the most basic level of his theoretical model, Freud situated the ‘cause’ of psychopathology at the level of the libidinal drives (Freud, 1915c), which, in his view, determined both character formation – which mainly comes down to a characteristic, stable mode of relating to other people (Desmet, 2007) – as specific types of symptoms (Freud, 1908b).

As Freud’s analyses of neurotic symptomatology systematically led him into the interpersonal sphere, he described the underlying, determining structures of symptoms in interpersonal terms. Within the field of neurosis, two positions were discerned (e.g. Verhaeghe, 2004), based on the two interpersonal dimensions of the Oedipus complex. Simply put, the hysterical pattern is settled in the attraction towards a parental love object and later manifests itself in interpersonal behavior directed at fusion with others. The obsessional dimension, on the other hand, is rooted in aggression towards the parent who possesses the love object and who is thus experienced as a rival. Hence, this transference pattern results in interpersonal behavior aiming at isolation and distance from the other. Although both tendencies – towards fusion with and isolation from others – are present in every neurotic subject, generally one of these two dimensions predominates upon the other and marks the interpersonal functioning of a particular subject.

 

Next, following Freud, Lacan states that symptoms arise within these underlying structures, that they are products of these determining structures. In a Freudian-Lacanian view, symptoms are viewed as subjective expressions of an underlying psychic conflict between different elements that are experienced by the subject as vital to his or her conscious piece of mind (Freud & Breuer, 1895). Hence, these conflicts entail a considerable amount of psychic tension, in current terms ‘stress’. When the subject isn’t capable or willing to choose one part of the conflict over the other – as a choice would imply a profound loss in one way or another, something that the subject isn’t willing to give up – one part of this conflict is intentionally, but unconsciously, repressed (in Freudian terms) or pushed aside from the surrounding signifiers (in Lacanian terms); so that the consciously experienced tension decreases. This repressed or isolated material then returns in symptoms, which consequently carry ‘stories’ or symbols that have profound meanings in the subject’s life (Verhaeghe, 2004).

By consequence, a symptom is always inextricably bound up with the way the subject relates to others, or more specifically: relates to the lack and desire of others, and consequently to his/her own lack and desire. Lacan states that the hallmark of neurosis – compared to psychosis and perversion – is precisely the positioning of the subject towards this desire of the other, and, consequently, towards his/her own desire. While both hysterical and obsessional neurotics try to find a way to adapt themselves to this desire, hysterical subjects generally feel the need to meet the desire of others (with the accompanying feeling of “it’s never enough” and the keep-on-trying), while obsessional subjects try everything to keep this desire at bay, out of the fear of complying too much to it, which – in their experience – would mean they would disappear as a separate individual.

 

Types of symptoms linked to modes of interpersonal functioning

Having commented upon the Freudian-Lacanian psychoanalytic approach of symptoms as being products of underlying structures that determine the way the subject relates to the lack and desire of significant others, I will now – very briefly – go into the link between type of symptom and type of interpersonal functioning.

Our central thesis here is that throughout psychoanalytic literature, several authors have explicitly linked the aforementioned return of repressed material in the body with hysteria, and the return of the repressed in the mind with obsession. In other words, (psycho)somatic symptoms would only – or predominantly – occur in hysterical neurosis, whereas obsessional subjects would only – or predominantly – present mental or cognitive complaints.

For instance, (a) in his ‘Studies on Hysteria’ (1978 [1895d]) – in which he dedicated a whole chapter on ‘Conversion hysteria’ – Freud described ‘conversion’ as the transformation of ‘psychic energy’ into ‘somatic energy’, a mechanism he identified as typical for hysteria; (b) in his comparison of ‘organic’ to ‘hysterical’ motor paralyses (1978 [1893c]); (c) in ‘The Neuro-psychoses of Defense’ (1978 [1894a]), in which he stated that in obsession “the total change has remained on psychic grounds” (p.205); (d) and finally in his famous case study of obsession, the ‘Rat Man’ (1978 [1909d]).

 

After Freud, a series of other authors – both post-Freudian and Lacanian – have explicitly commented upon or implicitly referred to this association between type of neurotic structure and locus of the repressed material (e.g. Blatt, 2004, pp. 155-157; Anna Freud, 1966; Soler, 1996).

 

Body and bodily symptoms in obsessional neurosis

In this paper, however, I will specifically focus on possible contra-indications for the presumed absence of somatic complaints in obsession.

It so happens that Freud himself already implicitly placed question marks next to his clear statements on this absence. For example, in ‘The neuro-psychoses of defense’ (1978 [1894a]), he wrote that the more serious cases of obsessional neurosis much less seek analytic treatment than do hysterical patients. In daily life, too, they mostly keep their conditions secret and only attend doctors in far advanced stages.

This claim is endorsed by Skolidis (2008), who wrote a very informative case study of a restless, agitated obsessional man who described to “never find peace in his body/to never be at ease in his body” – a condition that was very overwhelming and determining in his life, that occupied much of his time and energy, but about which no-one knew anything, except his wife and his psychoanalyst, because he didn’t present it, he didn’t stage it to others.

In ‘Further remarks on the neuro-psychoses of defense’ (1978 [1896b], p.771-772), Freud links a specific type of obsession with hypochondria as the fear for the physical harmful consequences of the sexual act performed during infancy, on which a self-blame is directed.

Further on, in ‘Three essays on the theory of sexuality’ (1978 [1905d]), he discusses the frequent intestinal disorders in obsession (p.64), for instance constipation.

 

Following on from Freud’s contributions, especially from his theory on the drives – which balances on the edge between the psychic and the somatic – Lacan made some crucial remarks on the body in psychoanalytic thought, which are very instructive to our understanding of the possible appearance of bodily complaints in obsessional neurosis. In fact, in Lacanian ontology, the body plays a principal part (Strubbe, 2004). For the construction of the psychic reality, in fact, runs parallel to the construction of the bodily reality. As such, when clinically working with patients – all patients, not just hysterical ones – subject and body cannot and may not be independently approached. The subject is pre-eminently a bodily subject and the body is pre-eminently a subjective body, which should be listened to as such (Strubbe, 2004).

To start with, the Lacanian annotator Nasio (1998) points out that ‘the body’ as viewed and approached by the psychoanalyst, is not the same as ‘the body’ as conceived or studied by the biologist, surgeon or philosopher. He adds that the psychoanalyst doesn’t study the ‘total body’, but the body as a symbolic-imaginary marker, in other words: the body as affected by speech (signifiers) and by images (meaning), as defense against a traumatic real, similar to the aforementioned concept of “object little a”. These three registers in Lacan’s work – Symbolic, Imaginary and Real – are also highlighted by Strubbe (2004), who provides an informative, chronologic overview of the Lacanian theory on the body. In Lacan’s early work, it was the Imaginary – the body image and meaning – that occupied a central place; which afterwards shifted to the Symbolic, highlighting the crucial impact of language, speech and signifiers. In Lacan’s later work, it was especially the register of the Real – of the traumatic, fear and enjoyment – that dominated.

The notion of ‘creating’ is important to draw attention to. Soler (1984) describes that the body – as conceived in Lacanian thought – has, just like the Ego, the statute of a constructed reality. Meaning that the body doesn’t exist from the start, from birth of the subject, but is constructed in relation to the Other.

In his first period of the Imaginary, Lacan places the concept of the body image to the fore, as that image of a ‘whole’ body, of a unity, which the child sees in the mirror and which is named by the mother (“this is your arm, this is your leg,” etc.) (Strubbe, 2004). In response to the gap the child experiences between this image of a whole and the disintegrated experience of its body, it identifies with this image, which has no lack, which ‘has’ something the child does not possess. In this context, Lacan explicitly stresses that this ‘knotting’ of the Imaginary with the Real does not occur in a vacuum, but in relation to the Other. The child learns to ‘know’ and experience its body as surface from outside, out of the gaze and the words (signifiers) of the Other (initially the mother).

In a second period (i.e. from 1953 onwards), Lacan’s focus shifts from the Imaginary to the Symbolic, to speech and to the signifier, as a condition for the coming-into-being-as-a-subject and the parallel construction of the bodily reality (Strubbe, 2004). In a nutshell, this is the speaking body, more specifically: the body as inhabited by signifiers that speak. As stressed before, these signifiers origin from the Other and both support as perforate the constructed body image. Soler (1983, p.49) emphasizes that these signifiers not only give us a body, but also mark this body, shape this body in a particular way. According to Strubbe (2004), one of the central lessons of Lacan’s theory is that language, the symbolic functioning of the body can modify its organic structure. Bodily functions – like the functioning of our hearts, our lungs, our intestinal tract, our movements – are not just biologically steered, but can be influenced by signifiers that nestled down into it. Like O’Brien (in Roth, 2001) said: “The body contains the life story just as much as the brain”.

Lastly, from his eleventh seminar onwards, Lacan turns to the register of the Real, as the traumatic, both fear- and enjoyment-inducing, part of the subject that cannot be symbolized and, therefore, keeps insisting in the chain of signifiers. It is the traumatic core around which all symbolic-imaginary material rotates, in an attempt to master it, to control it; which in the end always fails, as the Real always escapes every defensive attempt. This is why the subject can never completely coincide with his/her body; this is why our body is – in some way – always a strange “other”, a strange entity that surpasses our rudimental knowledge-system, on which our understanding of ourselves and of our surroundings is based (Strubbe, 2004).

 

In sum, a major merit of Lacan’s work pertains to the importance of acknowledging that psychic and bodily reality are inextricably interwoven in the life of every subject, that a principal part of the clinical work with all patients is working out how the body – or bodily parts – is affected by speech, images and enjoyment the patient is not consciously aware of, and that there exists an unbroken continuity between internal body processes and external interpersonal meanings and influences. The subject’s psychic and bodily identity/structure is constructed – and is constantly being constructed – in relation to the Other. By consequence, the symptoms the patient displays are always to be conceived as embedded within the relationships of the patient with significant others.

However, that doesn’t alter the fact that, generally, in psychoanalytic and other psychological literature, bodily symptomatology was and is still much more discussed, commented upon and both theoretically and clinically illustrated from the angle of hysteria. Theoretical contributions and clinical case studies on bodily phenomena in obsessional neurosis are scarce. Perhaps the reason for this is precisely to be found in the function of the symptom in relation to others, that is: to keep the other at bay, to annihilate the constraining desire and demand of the other in order not to disappear in it. Whereas hysterical subjects often stage their symptoms and their suffering to others and loudly complain about it, obsessional subjects don’t make a show of them, don’t go whining about it, but keep them hidden for the outside world – in Freud’s words: keep their conditions secret and, for instance, only attend a therapist or doctor in far advanced stages, when the suffering largely exceeds the gain the subject obtains from his/her symptom. This is what Soler (1996) refers to when she talks about the hysteric’s ‘intersubjectivity’ and the obsessive’s ‘intrasubjectivity’: when confronted with a problem, the immediate tendency of the first is to go out and talk with people (p.262-263), whereas the latter’s is to put his hand in his head and think without stopping (p.263).

The case study I’m about to present, illustrates that bodily symptoms do appear in obsessional patients, but maybe in a different, more obfuscated way than is classically the case in hysteria.

 

Case study: Pete

The case concerns an 89-session psychoanalytic treatment, conducted in a private group practice, which lasted for approximately three years, with an average frequency of one session per week. The therapist had received training in Freudian-Lacanian psychoanalytic psychotherapy, and at the start of treatment, he had six years of clinical experience. With the informed consent of the patient, all therapy sessions were audiotaped and transcribed, which made up the research material for this case study.

The patient, who I will name Pete, was a White, 33-year-old, married man who worked as a student counsellor at the local art school for high school students. After working hours, he spent most of his free time playing music in a hard-core band and riding his mountain bike. After a comprehensive diagnostic procedure, he was referred to the therapist by the University Hospital for severe tinnitus (a whistling sound in the ears) that could not completely medically be explained. Besides tinnitus, he also complained of periodic back pain, which, likewise, was medically unexplained.

During the whole course of therapy, Pete was very forthcoming as to the formal framework of therapy: he was always on time, always had the exact money ready and only once missed a session, because of overtime hours at work. At several times throughout the process, he stated that the reason why he came into therapy, was to gain insight into what he called “the mechanisms” of his tinnitus and back pain complaints, so that he could deal with it “more objectively”. He explained that it was not the “objective”, “physical” pain itself (in his ears or in his back) that he found so disruptive – “the pain is bearable”, he stated – but the (subjective) “dramatizing” of the pain, i.e. “the radars” in his head that started working and the anxiety and panic it provoked, which made him feel the pain a lot more intense “than it objectively is.”

Noteworthy, he always spoke of the mechanisms, the dramatizing, the fear, the tinnitus, and so forth – in a very rationalizing way, like he was talking about some interesting, general theory or about what he observes happening inside him in an observatory way, like he was not a part of it, like he stood outside and made notes.

 

Next, right from the start of therapy, Pete was incessantly concerned about and thinking through these mechanisms, brooding about his own share in the cause and worsening of the symptoms, what he might have done wrong, and how the consequences of it could possibly impede him in certain tasks in his life.

So, certainly at the beginning of therapy, there was no hysterical accusation of others, but the constant repetition in his discourse of two – rather obsessional – themes, namely: what have I done wrong and what am I doing wrong concerning these physical complaints, including the accompanying guilt feelings; and how do the consequences of this, the physical injuries I caused – by doing what I liked, playing both loud and physically intense music (which was very much against the will of his parents, as I will discuss in a minute) and by training hard (with his bike, before during kick boxing) – so, how do these consequences inhibit me in carrying out certain tasks in my life? (to which I will return in a minute)

Hence, during this first part of therapy, the therapist’s stance was mainly characterized by asking Pete to contextualize and concretize his statements, intending to widen Pete’s tight focus on the manifest symptom and his own blame in it to the broader context in which it occurred, including the involved protagonists. In doing such, the therapeutic labor exposed a series of contexts, which always turned out to be interpersonal and ambivalent in nature, revealing the function of the symptoms within his singular way of positioning himself towards the desire of significant others.

 

With regard to the tinnitus, it turned out Pete suffered since a few years from so-called “disco-tinnitus”, which means he had minor hearing damage due to playing loud music – and in the hours after playing this loud music, he temporarily heard this whistling sound. Back then, Pete was proud of this tinnitus, it was part of his hard-core identity, most serious musicians had it.

However, a couple of months before the onset of treatment, the tinnitus suddenly became a guilt- and fear-laden fixation point, which assembled a series of affects into it. “With the tinnitus, everything accelerated”, Pete stated. The immediate cause was the hearing of information on the news that a certain musician had committed suicide because of his tinnitus. Suddenly, Pete became intensely worried and anxious about the seriousness of the condition tinnitus, about the effects it could have on someone’s life. Because he attributed his own tinnitus to the playing of loud music, he suddenly became very anxious of loud noises, even hypersensitive to noise in general, and was afraid that if this would go on, in the near future he was not going to bear any noise – after which he gives the example “like the sound of mowing the lawn” – which refers to his “duty” as a husband and future head of the family to take care of the house and the garden, something his wife longs him to do. As a consequence, the panic “spreads unchecked”, he says, and gives him the subjective feeling he is not going to be able to manage “the tasks of life”. For instance that would not be able to work anymore, that he would had to sit at home all the time – which would mean, he said, he would not be able to pay for his loan for the house he recently bought with his wife; the loan he’s fixed to. He added that it was not him, but his wife, who wanted to buy a house; he wanted to further rent a residence, because buying corners you, makes it so definitive. Eventually they bought a very old house that needed much renovation work – “which means”, he said laughing, “that there is always something to worry about” and this worrying obstructs him in doing what he needs to do.” “I lose so much time by worrying and retrieving information on what I need to do”, he says, “(while, actually, I always know beforehand what I need to do), that in the end I have done nothing”.

 

Concerning the treatment process, I do not have the time to discuss all the various and complex elements in Pete’s life that were connected to the onset and the evolution in his tinnitus and back pain – that were, like all symptoms, “over-determined”. Therefore, I have selected the most important, central lines in his discourse, in which these symptoms were embedded.

All lines revealed profound ambivalences, experiences of incompatible elements between which he could not or wished not to chose – choices he avoided by becoming ill, as Freud said.

 

A first central line relates to the desires of his wife – to which I referred earlier when discussing how Pete felt constrained by the choices his wife “forced through” to buy a house and start a family. Pete and his wife had been together for over 10 years. At the beginning of therapy, he spoke very ambivalent about her: in the same spate of words he described they had a very good relationship, that they understood each other. “For instance”, he immediately added, “she senses when I’m angry and I’m better left alone to cool down. “I am not angry with her”, he said, “just angry”.

In the course of therapy, he learned to better articulate this anger and the aggressive outbursts he sometimes had towards her. He said he often blamed her for certain things, especially that she was the one who chose to buy a house and “that a child was coming”. Both a house and a child made him feel “restricted in the future”. “Just as with the back pain and the tinnitus,” he said, ‘one of my biggest fears is to encounter restrictions in the future”. So on the one hand, he went along with the desires of his wife, to which he actually had a lot of resistance; on the other, the creation of tinnitus and back pain permitted him to hold the immediate realization of them. In a nutshell, tinnitus prompted him to withdraw from all the bustle and noise around him and to retire to his study; intense backaches prevented him to continue working on the house, while he didn’t want to hire any workmen either. The thoughts about the renovation work “heavily weigh on my shoulders”, he often stated. In addition, anticipating the birth of his future child, he often worried if he would be able to carry the child in the first place, “with my back pain and such”.

That these physical complaints weren’t present all the time in all its intensity, but surfaced more in relation to these pressing desires of his wife, is further illustrated by the fact that – to his great surprise – at school, during work hours, or while training, he wasn’t bothered a bit, or only slightly by them. “Weekends are the worst”, he stated. At school, he was always taking initiatives, fixing problems, proving his worth, being patient, being busy. “But from the moment I come home”, he stated, “it disappears”. In session 3 he said:  “Saturday I was rushing myself like mad, I kept going off at a tangent, I have done something, but only for two hours (laughs). I mean, I can ride the mountain bike for three hours without feeling anything of pain and I have always been kick boxing and stuff and I had a little back pain because of the intensity of the sports, but at a certain moment, like this weekend, the pain becomes so unbearable and at that moment you link up the pain with something serious; just like with the tinnitus, it’s actually the same feeling,” after which he began to discuss the possible negative consequences of both complaints – for instance of becoming invalid, and thus unemployed, and thus being unable to pay for the loan of the house and to take care of his wife and child.

Throughout therapy, he progressively articulated his symptoms in relation to the signifiers “taking care of”, which brought along “pressure”. Pressure that nestled down onto (1) his head, leading to severe headaches – he once said “All that responsibility means that you have so many things on your head, in your head” – you could say while “releasing the steam through his ears”; and (2) onto his back, leading to periodic back pain attacks. Both tinnitus and back pain answered to Freud’s concept of ‘somatic compliance’, this is: he had minor hearing damage due to having played loud music and his back showed some signs of wear, due to becoming older and to having exercised much and intensely. At a given, significant moment in time, these minor physical damages became fixation points that gathered a sum of affects that formerly wandered around in his psyche.

Passing on to a second central line of symptom determination, it was noteworthy that while his discourse shifted to the crucial signifiers “taking care of” and “pressure” – which he suddenly began to relate to a lot of incidents in his past and current life – his discourse about his parents, and especially his father gradually began to change. Whereas at the beginning of therapy, his father was all bad, his absolute anti-model, and his mother was the poor victim, he gradually began to recognize some identification points with his father – which he formerly wouldn’t acknowledge, unless unconsciously via his symptoms – and recognize his wish to obtain recognition from his father; a third signifier that began to dominate his subsequent discourse.  Pete’s father was an alcohol addict, who – as the son of poor farmers – was occupied with “making safe choices” in life that led to financial security; certainly never doing anything risky. According to Pete, his father held others back in their initiatives, because of this pessimistic stance in life. In this sense, his father always advised against his desire to play music. He also sees the alcoholism and pessimism of his father as the main cause of the psychic troubles of his mother, who frequently (almost daily) called him up to complain about his father, about how she cannot stand it anymore, and to talk about her medical condition. Both his parents and his younger sister – about whom Pete never talked much – took a lot of medication. They never talked much about their feelings with one another, but often complained of headaches and other ailments, for which “medication was always present at the house”, he stated.

As someone who never accomplished anything in his life and made others’ lives a misery, his father was a huge anti-model for Pete. He certainly not wanted to become “the back pain suffering, beer drinking, chunk of frustration who gets totally absorbed by all the possible negative consequences whenever he hears about an initiative”. This prompted him to avoid his father as much as possible, as talking to his father always blocked him completely.

On the other hand, however, Pete gradually began to acknowledge that he actually always longed for the recognition of his father for his accomplishments. He described how the only times when his father wasn’t negative in relation towards him, were when he began working full-time as a student counsellor and when he bought the house.

In a nutshell: on the one hand, his father was – consciously – an anti-model for him and someone his mother always wanted him to push aside; on the other, unconsciously, his symptoms – especially back pain – enabled him to imaginary identify with his father. However, still on another plane, this back pain also prohibited him to fully realize the desire of his father, i.e. for him to inhabit a finished, safe house. In contrast, in his job – the second element that fell within the lines of his father’s silent approval – he did well and felt good, for him it was the only place where he felt he meant something, he was useful. Still, although he was very ambitious and had very innovative plans that could help improve the functioning of the school and its staff and students, he was very anxious to take up more responsibility and only felt comfortable working under the wings of a superior. As a consequence, he never got promoted to a function with more financial security – something that his wife would also have fully approved of.

When talking so much about his father during therapy, the theme of aggression also began to surface. He said he has always been afraid of aggression. Going from memories of how his muscles frequently tightened up in confrontations with his father – and linked memories of how his mother repeatedly asked him to stand up against his father for her sake, because – she said – “you’re the only one he is afraid of” – he progressively started to recognize that it was he who tightened his muscles (for instance the muscles in his back) especially in contexts in which he was angry at someone (for instance at his wife for having “imposed” her will on him).

While I could go on for hours about this case, discussing all the complex determinations of the symptoms, I will finish here, having commented upon how these symptoms were meaningfully embedded in a few of the most important relationships the patient maintained with significant others; having illustrated the appearance of somatic phenomena in a case of obsessional neurosis and what function they – among other possible functions – fulfil for the patient within this interpersonal context.

I thank you for your attention.

 

Shana Cornelis

Missoula, 2014 August 1

 

 

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 5. Washington, American Psychiatric Association, 2013.

Blatt, S. J. (1974). Levels of object representation in anaclitic and introjective depression. Psychoanalytic Study of the Child, 29, 107-157.

Blatt, S.J. (2004). Experiences of depression: Theoretical, clinical and research perspectives. Washington, DC: American Psychological Association.

Derogatis, L. R., & Cleary, P. A. (1977). Confirmation of the dimensional structure of the SCL-90: A study in construct validation. Journal of Clinical Psychology, 33, 981-990.

Desmet, M. (2007). Hysterical and Obsessive-Compulsive Depression: A Psychometric Study. Doctoral thesis.

Fink (1997). A clinical introduction to Lacanian psychoanalysis: Theory and technique. Cambridge, MA: Harvard University Press.

Freud, A. (1966). Obsessional neurosis: A summary of psycho-analytic views as presented at the congress. The International Journal of Psychoanalysis, 47, 116-123.

Freud, S. (1978 [1893c]). Some points for a comparative study of organic and hysterical motor paralyses. Standard Edition 1: 155-172. London: Hogarth.

Freud, S. (1978 [1894a]). The neuro-psychoses of defense. Standard Edition 3: 41-61. London: Hogarth.

Freud, S. (1978 [1896b]). Further remarks on the neuro-psychoses of defense. Standard Edition 3: 157-185. London: Hogarth.

Freud, S. (1978 [1905d]). Three essays on the theory of sexuality. Standard Edition 7: 123-245. London: Hogarth.

Freud, S. (1978 [1908b]). Character and anal erotism. Standard Edition 9: 167-175. London: Hogarth.

Freud, S. (1978 [1909d]). Notes upon a case of obsessional neurosis. Standard Edition 10: 151-318. London: Hogarth.

Freud, S. (1978 [1915c]). Instincts and their vicissitudes. Standard Edition 14: 109-140. London: Hogarth.

Freud, S. & Breuer, J. (1878 [1895d]). Studies on hysteria. Standard Edition 2. London: Hogarth.

Nasio, J.-D. (1998). Five lessons on the psychoanalytic theory of Jacques Lacan. Albany: Suny Press.

Roth, P. (2001). “Conversation in London with Edna O’ Brien”, Shop Talk, London, Jonathan Cape, p.105.

Skolidis, V. (2008). Het anale object in het spel brengen. iNWiT Het lichaam en zijn objecten in de psychoanalytische kliniek, p. 217-222.

Soler, C. (1984). Le corps dans l’enseignement de Lacan, Quarto, 16, 44-59.

Soler, C. (1996). Hysteria and obsession, In Reading Seminars I and II, Lacan’s return to Freud. New York : State University of New York Press.

Stefanis, C., & Stefanis, N. (2002). Diagnosis of Depressive Disorders: A Review. In M. Maj and N. Sartorius (Eds.) Depressive Disorders. (pp. 1-51). West Sussex: Wiley.

Strubbe, G. (2004). Het lichamelijk subject en het subjectieve lichaam binnen de kliniek. Pleidooi voor een terugkeer naar het verdrongene. Psychoanalytische Perspectieven.

Verhaeghe, P. (2004). On being normal and other disorders : A manual for clinical psychodiagnostics. New York : The Other Press.

[1] This paper represents the written record of the oral presentation held at the EPIS conference 2014 (Missoula, MT).