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Nr 20 2009 sid. 53–68
STEPS TOWARDS SYMBOLISATION
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Freud’s very first discoveries on hysteria concerned the use of the body as the location for expressing unconscious conflict. Although the meaning of hysterical symptoms lay outside conscious awareness, Freud’s approach to them implies the importance of verbal associations; in other words, it implies that a substantial degree of symbolic capacity entered into the formation of the symptom. For example, he explains some instances of paralysis of the legs as expressing the idea that the patient had taken ‘steps’ in the wrong direction (Breuer & Freud, 1895). Similarly, he explains compulsive dieting in the Rat Man (Freud, 1909) as showing the patient’s wish concretely to eliminate his rival in love, Dick, by not becoming fat (in German: dick) himself. In other words, the language of the body in hysteria is based on at least some degree of mastery of verbal, symbolic language, unlike the situation in those conditions that Joyce McDougall (1989) has called ‘archaic hysterias’. In fact, this is not uniformly so across cases and symptoms. Although all the symptoms of these early patients are physical, they encode relationships with significant others that vary in terms of the degree to which separateness is acknowledged and, therefore, the degree to which symbolisation becomes possible. For example, Dora’s cough (Freud, 1905) turned out to represent her identification with her father’s heavy sexual breathing: in other words, something she had overheard of the primal scene, where by definition the excluded child is separate from the parents. In contrast, Elisabeth von R.’s muscular pains were located precisely in that region of her legs that had come into physical contact with her ill father’s body (Breuer & Freud, 1895). That particular component of her symptom had no linguistic base, and indeed was not a symbol: it was a bodily memory, or sign. My aim in this article is to outline the stages in the treatment of a boy who was referred for behavioural difficulties, but who turned out to suffer from the extreme bodily anxieties that are characteristic of the autistic spectrum. These anxieties include falling forever, spilling out, burning, freezing, and losing the skin or other parts of the body – most typically the limbs or parts of the mouth (Tustin, 1972, 1981a, Haag, 1991). Children on the autistic spectrum characteristically protect themselves by focusing on self-generated sensations (Tustin, 1981a). They can use the hard sensations engendered by so-called autistic objects (Tustin, 1981b) to make themselves feel strong, while the soft sensations provided by so-called autistic shapes (Tustin, 1986) produced by means of their breath, flatus, saliva, and so on promote self-soothing. Autism, then, is a condition in which profound anxieties are experienced on a physical level, and in which the child seeks to protect himself by physical, non-symbolic means. ...
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Copyright: Allt material ©
MELLANRUMMET 2011-10-29 |
Maria Rhode är
professor vid Tavistock Clinic/University i Lon-don och psykoterapeut i
privat praktik. Hon är convenor för Clinical research workshop on
childhood autism, och en av redaktörerna för böckerna “Psychotic
States in Children” och “The Many Faces of Asperger's Syndrome”
samt “Invisible Boundaries: Psychosis and Autism in Children and
Adolescents” (EFPPs bokserie). Hon är engagerad i ett projekt för
tidig intervention för att nå små barn med risk för att utveckla autism.
I artikeln beskrivs terapin med en pojke med grava beteendestörningar,
men som visade sig lida av extrem kroppslig ångest. Artikeln bygger på
en tidigare version publicerad i Analytische Kinder- und
Jugendlichenpsychotherapie (2006), 129, 7-30, med titeln ”Koerper,
Selbst und Anderer: Schritte zur Symbolisierung”. Mellanrummet har
fått tillstånd att trycka den i en engelsk redigering och översättning.
