Hypochondria seems to
be an unexplored galaxy in the psychoanalytic world: there isnt’
a definition in the psychoanalytic Dictionary by Laplanche and
Pontalis and even S. Freud had mentioned hypochondria only in
his work “ Introduction to narcisism”. Once again
he has demonstrated to be a genius saying the main things about
this subject.
It is wellknown that the so called “hypochondriac neurosis”
(we shall see that the word “neurosis” is inadequate,
at least to describe how serious is the syndrome) is characterized
by an extreme wonder for the body and the deseases that might
involve it. The hypochondriac is always alarmed, not only in
case of psycho-physical insanity and he is all the time busy
in paying attention to the functioning of his body and in amplifying
any microscopic unimportant synthom. The hypochondriac patient
has a typical self-centred personality, has a masked tendency
to isolate himself (with a snobish behaviour toward people,
having only intellectual friends etc.) and when conditions get
worst he is almost monomaniac, as regards the attention he gives
to his body. The way he gets in contact with the world around
is thank’s to his exceptional kowledge of the body which
is better than the specialists’ (passion wins professional
studying). Sometimes he’s an expert of alternative medicine
(none of them are valid for the hypochondriac, who’s all
the time looking for somebody listening to him). He takes hundreds
of medical consultations and collects little chirurgical operations.
The passion for his body sometimes pushes the hypochondriac
to become a doctor (sic!) or a pharmacist or an erborist, or
he might become mad of health. In case of reaction formation
, one can observe an opposite manifest behaviour which may coincide
with a total indifference toward his health.
The syndrome’s name dates back to the ancient greeks who
were used to consider that the desease was caused by viscera
disorders situated under the xyfoideus cartlilage, and so the
word hypochondria.
First DSM edition did not include hypochondria as a separate
desease, “hypochondriac warry” was mentioned as a
malignant synthom observed in psychotic depression; the syndrome
was then included in DSM-II as hypochondriac neurosis and in
DSM-III and DSM-R as hypochondria.
Freud had discusses this subject talking about parafrenia. This
word was first used at the beginning of the 19th century to
indicate madness and it was used by Freud to distinguish schizophrenia
(parafrenia) from paranoia.
According to Freud the hypochondriac withdraws
his interest and libido from external objects and concentrates
both of them on the concerned organ. It is wellknown that Freud
assumes that each organ is erogenetic (which means that has
the capacity to send sexually exiting stimulus to the psyche)
and that an alteration of this function corresponds to an alteration
of the Ego libidinal investment.
In other words, hypochondriac withdraws libidinal investment
from objects world in order to concentrate it on himself and
this phenomenon is due to different factors such as his ground
and a false present familiar environment.
Let’s see what Freud wrote about the libidinal block: “…we
should ask ourselves the following question: why does the psychic
life need to go over the orders of narcism to the objects world.
According to our thinking we should say, once again, that this
need appears when the Ego investment has gone over a certain
range. A very strong egoism creates a protection against deseases;
nevertheless, soon or later we must start loving in order not
to get sick and if after a frustration one is not able to love,
he gets sick”. And here we can see that Frued was a real
genius where he makes an enlightening parallel between hypochondria
and paraphrenia (schizophrenia) and between actual neurosis
and psychoneurosis (hysteria and obsessional neurosis). The
word actual neurosis means syndromes due to somatic actual causes,
mainly at sexual function expenses (compulsory abstinence, compulsory
sexual excitement, uncompleted or interrupted coitus, inadequate
sexual discharge due to conflictual reasons) On the contrary,
according to Freud the etiological origin of psychoneurosis
can be find in infantile traumatic experiences that provoke
repression and that return in a masked way in the present events,
thanks to compulsion to repete. The sympthom of psychoneurosis
(or translation neurosis) are due to a block of object- libido
(I wish sexual possession of my mother, oedipus interdict releases,
the outstanding libido investment on my mother, remains joint
to that object and is going to receive several somatic elaborations).
On the contrary, hypochondria and parafrenia sympthoms are due
to a libidinal withdraw from objects which goes back to the
Ego. I would like to add that, according to personal ground,
libido migh be fixed to the Ego, provoking its ipertrophisation
and consequently paranoic megalomanic delirium, or migh be projected
on an actual external object; the result will be an erotomaniac
paranoia or persecution delirium. It migh olso determine splitting
of the Ego precessus(schizofrenia) or a soma investment: hypocondria.
As we can see, we’re talking about a serius syndrome, a
bordeline stage more than a neurosis.
A 40 years old woman was caracterized by a false presence family
ground: psyhotic mother, an absent father, mother’s victim,
many borderline or neurotic relatives. She was an abandoned
child who had only one signifiant relationship with a person
who had allowded a sketch of object relation and probably saved
her from the identification-projection to an absent or false
present environment which might have filled her Ego of persecuting
objects. She had stopped in the middle of the way; she had a
character neurosis which became hypocondria each time she was
separated by family objects. The investment objetc was her body
and her family’s body. She was a perfect and efficient
mother who checks all your freckles to make sure that everythng
is ok, take appointments with doctors and in spite of herself
will make you become a cavy.
Character neurotic does not present specific synthoms, but very
often he has a compulsory behaviour. According to a very punctual
definition of Jones, character neurosis is structueted inside
the character, by producing an extreme pedantry, a meticulous
life organisation and an intellectual sadism.
The patient had denied her childhood situation by keeping in
her inconscious, idealized objects and by shifting her aggressivity
on married life.
When she came for the first examination, she was continuosly
fighting against her husband, but she couldn’t’ recodgnize
it and was engaged in a non-stop activity for the organization
of her childrens’ life.
She had serious hypocondriac symptoms, as well as several somatic
disorders that gave her a strong pain (it is worthwhile to remind
that somatic libido cathexis is energetic; try, for example,
to put a body tissue under a lamp for many years: it will get
burn, at least).
After a long micropsychoanalytical work, the patient became
aware of the abandoned situation in which she spent her childwood.
Consequently she could replace the aggressivity against her
infantile objects and events releasing the present from the
conflict. This elaboration was stimulated by watching a tv programme
that showed desertic hills which surround Jerusalem. The patient
said:” These two people are fighting for a desert?”
In a little time she got rid of the projection defense and became
aware of the affective desert of her life. At the same time
pathological caractheristics of her character neurosis were
reduced, but she got in contact with the hypochondriac pressure
thanks to a revealer dream.
In the session she started by saying that the somatic disorders
and hypochondriac manifestations that had desappeared, came
back again few days before and she told the following dream:
I’m in the same room with someone sick, maybe one of my
children and I can smell something discusting, like a suppuration
wound, a death odor. I try to open the window to get fresh air
come in, but the odor is very strong.
At the begining she gives an hypochondriac interpretation of
the dream by saying: “If unconscious is able to understand
what happens to the soma, is it suggesting me that I have a
terrible desease?” and then “ Before I had that terrible
pain I had a bitter taste in my mouth. She delays few more minutes
describing her bodily sensations, but it is enough for me to
say that the expression “to have a bitter taste in sombody’s
mouth” indicates a very particular mood, to activate the
elaboration.
The patient, with a high emotion, starts talking about her life
as a desert: the marriage is braking down, her children are
leaving since they can (finally) enjoy a free life, other people
arroud are leaving too.
Due to compulsion to repeat, she used the desavowal as defence,
as well as she did in the childwood : she didn’t see the
desert, but she had to manage a sudden libido return, which
was withdrawn from objects and according to her psychic ground,
the elaboration was impossible . The obvious consequence was
a strong cathexis of the body. The surrounding world was in
a decomposition state, but she was blind and liked better to
see her body ruined than to face her loneliness and abandoned
experiences which would have put her in front of the desert
of her childwood.
This is the reason why hypochondria may be defined a “somatic
paranoia”: Ego refuses a psychic experience, but instead
of using projection (as in paranoia) it uses soma cathexis,
by developping, as in the case described, an hypochondriac worry
about a tissue being decomposed.
