Obsessive mechanisms and hypochondriacal defense

Abstract

This paper deals with the relationship between obsessional and hypochondriac defences. It is divided into three parts: assumptions, thesis and conclusions.
1) Assumptions
Related to unconscious phantasies: 1) body characteristics of unconscious phantasies; 2) the importance of the pathology of body
experiences and/or hypochondriacal phenomena as an expression of primal stages of unconscious phantasies.
Related to hypochondriacal phenomena: 3) a concept of hypochondria which embraces a variety of phenomena having in common the expression, through body experiencies, of the relationship with internal objects, located in the body; 4) there exists a group of hypochondriacal phenomena which underlie the mechanisms described by Rosenfeld (18), in the case of chronic
hypochondria, but which also underlie certain cases which do not come, from the clinical point of view, under the heading of hypochondria (16); 5) hypochondria in women is of a defensive nature and is due to a confusional situation which expresses itself through the phantasy of a cloaca. 2) Thesis Material from analysis of various patients is presented in this paper to
illustrate how the breaking down of hypochondriacal defenses enforces the obsessional mechanisms of the ego.
Thus controlling the contents which cause anxiety, splitburied in the body. This appears quite clearly in those cases where the special splitting of a part of the self takes the configuration we have described in previous works under the name of “hypochondriacal cyst”. The rupture of such an insulating envelope is experience by the ego as a threat of invasion equivalent to death and madness. This is why the defensive work is characterized by a close watching and control of any process implying that something comes out from the inside, such as talking, menstruating, etc. The ego keeps also a mistrustful eye on every
body opening, which for the unconscious phantasy is like the mouth of a volcano.
Conclusions
As a result of the points I discussed in this paper, I think the following conclusions are valid:
1) A wider understanding of obsessive neurosis based in the first place on a wider concept of analityc, including phantasmatic relationships of expulsionretention of any object through the intervention of any zone not only of the anus (“dirty mouth”. “dirty look”, etc.) and in the second place on the aknowledgement of the hypochondriacal root (foundation) in many obsessive cases, since
hypochondria implies indiscrimination of phantasies, impulses and zones. 2) An hypothesis for investigation: I think that the presence of obsessive mechanisms always indicates that the object they fall on include projected body
experiences. I base this assumptions on the fact that genetically those mechanisms are linked to phantasies about corporalized object relationships. 3) The existence of a specific relationship between obsessive defense and
hypochondriacal defense characterized by a) an attempt of an ego-part to reinforce the hypochondriacal splitting through obsessive control; b) intensification of obsession when hypochondriacal defenses break down; c) the concrete, corporeal modality of obsessive defenses when they control the body itself and its contents. 4) Obsessive exploration of the object through the smell in hypochondria is a technique using the renifleur’s trends (3) in order to control confusion. 5) The neurosis of examination in those patients represented the displacement of hypochondriacal anxiety about an examination of the body. The question wight arise too if at the root of every neurosis of examination there could not be found, apart from other phantasies, a hypochondriacal phantasy
which could be the most active in some cases. 6) An application in technique. Since obsessive mechanisms can work in
two stages, they must be reduced following those two ways in the direction of regression. In the first stage, the displacement for instance works from the object towards the body (or a part of it) and in the second stage it works from
the body towards some thought or feeling. If the interpretation skips over corporality and tries to link up directly mental phenomena with internal objects it may be unsuccessful because it leaves the basic defense untouched