Hypochondria; some considerations regarding the analysis of a hypochondriac patient.

Abstract

Based on the material of a hypochondriac, the hypochondriacal defence and its relation with other defences and the structure of the internalised objets that form the confusional nucleus, whose conflictual relations cannot be lived in
the mind, are studied The general course of the analysis is divided into three stages: hypochondriacal, paranoic and confusional. It is supposed, according to this sequence of evolution, that in the analytical treatment one goes back on the way shown by Rosenfeld in the structure of hypochondriacal neurosis (mind-object-externalbody). In the first stage the functioning of the hypochondriacal defence is studied together with its relation with the obsessive defence. In the second stage the importance of paranoid anxieties is pointed out. They are interpreted according, not only to the modification of the hypochondriacal object projected in the external object, but also according to the defensive regression to a schizoparanoid stage to avoid experiencing depressive anxieties. The link between hypochondriasis and paranoia is then understood in a rather different way from the classical one.
The third confusional stage is considered as linked to the reintrojection of what is projected. The hypochondriacal nucleus, localized first in the body, then, handled projectively, has reached, through the interpretation, certain grade of
fragmentation and discrimination which permits reintrojection. The confusion is manifested clinically, not only because the reintrojected object is still confused, but also because the partially-destroyed objects that form part of it and the
intense jealousy linked to them, threaten to destroy the good objects and annihilate the Ego of the patient.
The hypochondriacal object, in this patient, appears formed by a heterogeneous mixture of objects both partial and total (in Wisdom’s spacial sense) that have the common characteristic of being partially-destroyed objects. They are live and dead parts of the Ego and of the objects, but more intensely persecutory and fragmented than the half dead-half alive object described by
W. Baranger. In this nucleus the oedipic couple is emphasised united to parts of the patient’s Ego. The dying character of this object does not allow us to place its genesis in an earlier stage than the schizoparanoid one, which differentiates it from the agglutinated nucleus described by Bleger. The intensity of the patient’s oral sadistic jealousy is emphasised and the multiple mechanisms of defense employed against same. The perverse fantasies are interpreted, it this case, as a defence from the
confusional nucleus. The following question then arises: whether a secondary relation between perversion and paranoia, acting both as defences against a confusional nucleus, can come into the picture in other cases of perversions.