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See discussions, stats, and author profiles for this publication at:https://www.researchgate.net/publication/234029833

Understanding alexithymia within a

psychoanalytical framework

ARTICLE in THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS DECEMBER 2012

Impact Factor: 0.86 DOI: 10.1111/j.1745-8315.2012.00657.x Source: PubMed

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Pirlot Grard

University of Toulouse II - Le Mirail

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Understanding alexithymia within a psychoanalyticalframework

Gerard Pirlot*1 and Maurice Corcos**

*54 Rue Pargaminie`res, 31000 Toulouse, France [email protected]; **Service

pe` dopsychiatrie, Institut M. Monsouris, 42 Boulevard Jourdan, 75014, Paris,

France [email protected]

(Final version accepted 23 August 2012)

The object of this paper is to provide a metapsychological definition of alexithy-

mia as described in 1967 in terms of operational thinking and negative hallucina-tion. This is a familiar and established concept in the fields of psychopathology,psychology, and of clinical and psychosomatic medicine. From a psychoanalyticand psychosomatic point of view, the term is conceptually close to P. Martysoperative thinking, as described in 1963, even though we know they do notbelong to the same epistemological field: on one hand Neuroscience, Psychiatryand the objectalization of the symptom at different levels, and on the other, asregards mechanical functioning, a psychoanalytic clinical approach within thedynamics of the relationship between transference and counter-transference. The

present authors consider that Freudian metapsychology, as now complexified byAndr Green, allows for a metapsychological approach to alexithymia insofar as itrelates to Martys operative thinking. Thus does Greens conceptualization of themothers negative hallucination, of negative introjection, of a psychically dead(and insecure) mother, now provide us with the opportunity to describe, in metap-sychological terms, the genesis of this particular mode of psychical functioning.Given the mothers negative hallucination produces a host structure as a back-

ground to negativity that will fit future object representations, we will assume thatin the case of future operational or alexithymic ?, this negative hallucinationwill pathologically and defensively involve the endo-psychic perception of affect.

Keywords: affect, alexithymia, mechanical [mental] functioning, metapsychology,mothers negative hallucination, negative introjections, operative thinking, psychosomatic,somatization

IntroductionThe aim of this article is to relate the concept of alexithymia to the meta-psychology of operative thinking and negative hallucination. Alexithymia isa known and accepted concept nowadays in psychopathology, psychiatry,psychology, medicine and psychosomatics. Although it does not fall withinthe epistemological domain of psychoanalysis, this concept described in1967 belongs to a quantitative objectivizing approach and comes under ascale-based methodology the Toronto Alexithymia Scale.

Unlike methodologies that objectivize alexithymia, the operative thinking(or mechanical [mental] functioning [Aisenstein, 2006]) described by Marty

and de MUzan (1963) is found in a psychoanalytic clinical practice that

1Translated by Sophie Leighton.

Int J Psychoanal(2012) 93:1403 1425 doi: 10.1111/j.1745-8315.2012.00657.x

Copyright 2012 Institute of PsychoanalysisPublished by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ, UK and350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis

e International Journal of
https://www.researchgate.net/publication/6930615_The_indissociable_unity_of_psyche_and_soma_A_view_from_the_Paris_Psychosomatic_School?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/6930615_The_indissociable_unity_of_psyche_and_soma_A_view_from_the_Paris_Psychosomatic_School?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==


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involves in the dynamics of the transferencecountertransference relation-ship and in the investigators (psychoanalysts) experience. However, interms of clinical and phenomenological description, alexithymia is closelyakin to the concept of operative thinking, which comes within a psychoan-

alytic approach that deals with specific characteristics. Although operativethinking undoubtedly precedes alexithymia and appears to have differentunderlying theoretical premises, the two concepts are not incompatible(Girard, 1992).

In our view, early disturbances in defence mechanisms cause a displace-ment of the negative hallucination of the mother on to affect, which pointsthe way to a metapsychological account of the genesis of this particular psy-chic functioning with its now proven impact on somatizations and addictivebehaviours.

Clinical vignetteMiss K, who is 33 years old, comes for psychotherapy, referred by a hospi-tal-based psychiatrist colleague who presents her on the phone to the first ofthe authors as alexithymic with asthma attacks, somewhat depressive, andworking in the same hospital as him. Sitting opposite me, Miss K tells methat she has a sense of being unwell, with a sub-depressive mood andasthma attacks if not daily, at least several times weekly, especially at timeswhen she feels stressed or alone. She is a nurse, slim and tall, pretty, wholives alone with her 3 year-old son. She agrees to come twice a week forface-to-face psychotherapy.

Three types of trauma very quickly emerge from her history: (a) a fatherwho left at a very early stage, when Miss K was 3 years old; (b) a motherwho was cold, oppressive and depressive at the same time; (c) a lover whoimmediately vanished without a trace when she told him she was pregnantand wanted to keep the child.

Having completed a scientific baccalaureate, Ms K presents herself in theearly months of the therapy as not very fond of reading, with a practicalmindset, not highly associative in her thinking (operative, alexithymic think-ing), while being happy in an occupation that gives her life a meaning,but profoundly alone, with hardly any desire for anything but her son and

this occupation: she never goes to the cinema, has few friends, at the week-end only ever goes to visit her mother whom she hates with her son. Itis a dreary existence, without excesses, rather joyless, and withdrawn.

She admits to having been scarred three and a half years earlier by thesudden disappearance of her childs father and to being distrustful of menwho, like her father and her lover, abandon women after seducing andusing them. The transference is therefore similarly intense (she attends reg-ularly), ambivalent and characterized by a certain coldness characteristicof a blank relationshipembedded in the materiality of facts and the literal-ness of speech, making me a doubleof herself as the subject who monitors

my reactions. The sessions are often difficult in that she very rarely associ-ates, never mentions any dreams and only talks about highly factual things:

1404 G. Pirlot and M. Corcos

Int J Psychoanal(2012) 93 Copyright 2012 Institute of Psychoanalysis


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her work, her son, her journeys into town, the difficulty of economic life,the exhausting schedules and her frequently difficult patients.

Within a few weeks my countertransference is imbued with boredom andlassitude, mingled with some stirrings of interest in the traumatic and pas-

sionate elements that are concealed by her affective life.From the third month I notice that Miss K often scratches her forearms

during the sessions. Nine months into the therapy, she has a dream thatdepicts a doctor in the department where she works and one of the nurses inan unusually violent quarrel scene in which blood appears and she does notknow whether it is coming from the doctor or the nurse. She then wakes up,anxious, and has trouble getting back to sleep. She has difficulty telling thedream; her account emerges only at the end of a session. In the followingsession, she immediately returns to this dream and tells me she has thoughtit over again. For the first time, she makes a connection with the material

of a previous session. With an ostensibly benevolent attitude, I ask her tocontinue: she then associates about the nurse who resembles both hermother and herself, and who annoys herfor some unknown reason. Thenshe tells me that the doctor looks like me: same figure, same attraction.

I then say to her: As of fathers?Immediately she blushes and tells me: Ah, yes! Thats it! In fact you also

look very like the father of my son! [not associating, initially, to her ownfather] And I have to say that, since the beginning of this therapy, you vebeen annoying me a lot without my knowing why Im always angry withyou for no reason and I never show it!

In this session and in those that follow, several important things thenemerge about which she makes associative connections but there is one par-ticularly remarkable thing: since the session in which she talked about theaffective irritation that I had been causing her since the beginning of thetherapy, the skin irritation and scratching her forearms during the sessions has(permanently) ceased.

1. The anger [hatred] towards me, when her son is 3 years old, was viathe transference the anger felt towards both her sons father and herown father who left when she was the same age as her son at the time ofthe therapy: this intense anger prevented a depressive breakdown, a dis-tressand a fear of this breakdown recurringin my absences over the week-end and holidays.

2. The dream revealed, in the transference regression, a violent primal scenein which the parental objects were both differentiated and undifferentiated(No one knew where the blood was coming from), which is fairly typi-cal of allergic subjects(Marty, 1958).

3. The re-sexualization of the affect of anger by the attraction in the transfer-ence [transference love] had allowed a representation of this unrepresent-able aspect disguised by the primitive anger: the terror (feared andanticipated in my absences) of an abandonment leading to an early

breakdown (Winnicott, see below).4. This psychically unrepresentable affect of anger (negative hallucination;

cf. below) had always been translated before the dream and the

Alexithymia within psychoanalytical framework 1405

Copyright 2012 Institute of Psychoanalysis Int J Psychoanal(2012) 93
https://www.researchgate.net/publication/9991424_The_allergic_object_relationship?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/9991424_The_allergic_object_relationship?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==


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subsequent associations by a vague irritation indicated mainly throughthe body by scratching, sometimes to the point of bleeding (as in thedream), in each of our face-to-face meetings.

5. The transference through the charge of attraction and repressionlift-

ing of repression of the intrapsychic conflict that it conveys has thecapacity to hysterize a previously frozen affect by connecting it withrepresentatives of the sexual drive, changing the symptom with an ini-tially psychosomaticappearance into the more hysterical one.

6. It is conceivable that, initially, with Miss K, the body may have served asa substitutive third object for a deficient primary object, a configurationconducive to psychosomatic pathologies(her asthma). The transference onto the analyst object then revived a previously unused drive potential,that of a body serving as substitute for a deficient third object, the father(Rupprecht-Schampera, 1995), a configuration conducive to a somatiza-

tion akin to hysterical conversion (her itching skin). The recollection(through the transference) of an early triangulation could then be devel-oped with all the violence, ambivalence and ambiguity of parental imagosrepresented in the dream of the primal scene.

7. The advantage of the face-to-face setting, at least initially, with thesepatients is that they can readon the therapists face as well as hear himarticulate affects that have not previously been subjectively perceived inthem. When I intervene to name the attractions of fathers, without anyostentatious smile, without excessive warmth, and benevolently, Miss Kreads on my face at the same time as imagining it that the attraction is

not only traumatic but qualifiable, nameable

because after all human,which then allows a discussion about her earlier desperate anger as a

child and then as a woman abandoned by the seducer.8. Much later in the therapy she was able to remember that she had been a

wise, well-disciplined child, good at school and always concerned to carefor and help a mother who was depressed although affectively cold hence the naturalchoice of the nursing profession.

Affect, operative thinking, alexithymia

Affect in Freuds metapsychologyIn the Project for a scientific psychology, affect (particularly pain) is pro-duced by a sudden liberation or unbinding of the previously accumulatedexcitation by facilitation (Freud, 1950, p. 322). As early as the Project, affecthas the status of a signal: every time a series of mnemic traces is activatedand brings into play a facilitation that releases excitations, an affect ensues.Usually, in the 1893 to 1915 period, the theory emphasizes the quantitativeaspect of the cathexes in play in affect. Later, in the metapsychological writ-ings (Repression and The unconscious), affect is defined as the quantitativefactor of the instinctual representative (Freud, 1915a, p. 153)and the

quantitative factor in the instinctual impulse (Freud, 1915b, p. 178). ThereFreud identifies the subjective and therefore qualitative aspect of affectand the energic processes that condition it.


https://www.researchgate.net/publication/15639724_The_concept_of_'early_triangulation'_as_a_key_to_a_unified_model_of_hysteria?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/15639724_The_concept_of_'early_triangulation'_as_a_key_to_a_unified_model_of_hysteria?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==


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Affect is thus conceived as this offshoot of the drive, being separate inessence and in nature from the representations while also the impetus of theirtransformation. Affect is then this residue that, originating from the drive,cannot be reduced by the representation (Green, 1995) and thus retains a

certain toxiccapacity to trigger somato-biological excitations.This is in accordance with Freuds use, in parallel with affect, of the

term quota of affect, which emphasizes the economic: The quota of affect corresponds to the instinct in so far as the latter has become detachedfrom the idea and finds expression, proportionate to its quantity, in pro-cesses which are sensed as affects (Freud, 1915a, p. 152). Unconsciousaffects thus constitute the original stages of what generates the perceptualand representative path: Does affect not fundamentally consist in a psychicevent connected with a movement in anticipation of a form? according toGreens expression (1985 , p. 781, translated quotation). As an internal act

in movement like the drive, it can strive as much towards somatic (or bodily,cf. Miss K) discharge as towards fractionations in series of connections andgroupings of sensations, representations and motor effects (Green, 1999a).

Reference can therefore be made here, with de MUzan (1977), to theprocess of affectation. This affectation process involves the body and all thepsychic systems, whereas the affect itself remains connected to (self)-aware-ness. This attests the mnemic function of affect (cf. Miss K) and, we wouldadd, the representational perspective of the emotions and the developmentalnotion of the reflexive function put forward by Fonagy and Target (2002).The admission of affect to consciousness is usually subject to a link with a

representative that takes the place of the representative to which this (theaffect) was originally connected (Green, 1999a, p. 44).Affect in psychoanalysis enables the ego to experience itself in its relation

to the body (Green, 1999a, p. 95). The affect may be accepted by the ego orrejected by it(1999a, p. 164, italics added). In any case, one may speak ofaffect in the proper sense of the term only if there is an ego to experience it affect is bound up with a certain relationship between the ego and theid(Green, 1999a, pp. 1545).

Analytic treatment, like any form of therapy, has a cathartic impact onaffect by allowing it to be expressed and liberated (Miss K). The frozen

affect

of hysteria finds the context for unfreezing

in the transference.Sometimes the treatment even produces what Vallenstein termed affectual-ization, consisting in the production of a surplus of affect, the mainpurpose of which is to prevent it from reaching consciousness this time(1961, p. 93).

Operative thinking

In 1962, at the 33rd Congress of Romance-Language Psychoanalysts, Martyand de MUzan put forward the concept of operative thinking, worked outbased on some clinical research conducted over some 15 years in psychoso-

matic consultations. This concept is directly connected with the paper byFain and David on the dream function, emphasizing the binding value ofdrive tensions conferred on this dream activity.




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This concept is adopted and well illustrated by seven clinical observationsthat appeared in 1963 in the work, Linvestigation psychosomatique. Theidentification of this particular mental functioning is inseparable from thetransferencecountertransference relationship: as seen in the beginnings of

Miss Ks therapy, the presence of a blank relationship(Marty, de MUzanand David, 1963, p. 198) is felt by the psychoanalyst as an unease in thecountertransference, lassitude, boredom resulting from the patients speechcharacterized by the factuality of events. This blank relationship,cut off fromthe patients subjective history, particularly the fantasmatic and imaginativehistory, appears ahistorical.

To this is added a type of relationship in which the therapist is perceivedon the model of the subject himself, testifying to a projective reduplicationphenomenon that impedes subtle identificatory movements (the other beingnothing but a reduplication of the subject himself), the see-saw movement in

relation to this psychic functioning appearing at the time that a dreamemerges.Operative thinking is defined as essentially a conscious thinking that may

be found (like alexithymia) in nosological contexts other than solely psycho-somaticsubjects, such as those suffering from addictions. It is characterizedby:

1. A utilitarian, factual thinking, orientated towards the literal, the object,matter, technique: it does not use neurotic or psychotic mental mecha-nisms that are part of a sexualized thinking (with a relative phobiaabout the inner life, memories, feelings, emotions etc.).

2. It is indisputably efficient and adapted to different kinds of reality fromthe affective or fantasmatic and it lacks any detachment from things.

3. It duplicates and illustrates action: it does not try to indicate the actionbut duplicates it verbally. There is no association of ideas to be found,nor any trace of the slightest identification with the consultant. Theverb seems to be severed from its substance, reduced almost to a vocalactivity expressing apparently rudimentary observations, affects or rep-resentations that concern certain realities at that time (Marty, 1985,p. 97, translated quotation).

4. It is unconnected with fantasmatic activity.

5. It is devoid of associations and directly related to sensorimotricity.6. The isolation of the repressed unconscious does not appear to be obses-

sional since it does not proceed from a distancing by a mental or verbalmanifestation of the psychic material.

7. It illustrates an original mode of object relationship.8. It always lacks reference to a truly alive internal object.9. It seems to lack any libidinal quality.

10. It does not allow any externalization of sado-masochistic aggression (cf.Miss K).

11. It testifies to the malfunctioning of the first topography, of which the

linch-pin is the preconscious that requires permanence, thickness and flu-idity. The malfunctioning of this first topography is manifested by thepoverty or absence of dream life, the presence of rawor desperately lit-




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eral dreams that refer only to working life, with few manifestations ofdisplacement, condensation or dramatization mechanisms.

12. In these conditions operative thinking serves as a cognitive container fora psychic apparatus with no internal good object, hence also the essen-

tial depression.Evidently the concept of operative thinking belongs to a metapsycholog-ical corpus in which notions of mental elaboration and mentalizationlead to notions of well-mentalized neuroses (defensive psychoneuroses)and badly mentalized neurosessuch as:

13. Behavioural neuroses: no mental adjustment of traumas, no objectal in-ternalisation, hence the recourse to external objects (addictions) and tobehaviours.

14. Character neuroses: conformist social adaptation, but abnormality inthe capacities for mental elaboration and the functioning of the first

topography.In these types of neuroses in which the activity of representation (of

affects) is inadequate by deficiency and unbalanced with regard to the drivelife that is prematurely overloaded, operative thinking offers a cognitive con-tainer for the conflict between the mental organization and the affective life:Although some affects are connected with the mental organization at itsvarious levels of elaboration, other more primitive ones exist independentlyof it(Marty and de MUzan, 1963, p. 350, translated quotation).

Coupled with essential depression (reduction in psychic tonus and sexual,objectal, creative desires) and cut off from primary thought processes, oper-ative thinking has a functionalvalue as a secondary process, except that thisrelates to things and never to products of the imagination. The partitioningbetween the repressed unconscious does not prevent short-circuits betweenthe ego and the id (second topography), emerging at behavioural raptusesor, specifically, in somatizations following affective upheavals, or in rawdreams that evidence the lack of any work of displacement, condensation ordramatization.

Concerning the connections between operative thinking, mourning, essen-tial depression and breast cancer, we will refer to Jasmins (1990) works.

Alexithymia

Alexithymia, a concept created by Sifneos (1967) after several years ofresearch in the quest for specific modes of psychological functioning in so-matizingpatients, literally designates the lack of words for emotions (priva-tive a in Greek, lexis: words; thymos: mood, emotions). We should mentionthat Sifneos (1995) compares alexithymia with the operative thinkingdescribed by Marty and MUzan, acknowledging that their descriptions pre-ceded his account.

Alexithymia, measurable using reliable scales, comprises four traits (Sifn-

eos, 1972):1. The incapacity to express emotions or feelings verbally.2. The restriction of imaginative life (no dreams, fantasies, daydreams).




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3. The tendency to resort to action to avoid or resolve conflicts.4. The detailed description of facts, events; physical symptoms.

The affects of alexithymia patients seem inappropriate (Haviland, Shaw):

their speech is characterized by the lack of any notable fantasmatic activity,the emphasis placed on details (Demers-Desrosiers, 1982) and the rare men-tion of dreams (Haviland, McMurray and Cummings, 1988), by their rigidposture and their impoverished interpersonal relations with a tendency todependence (Jaffe, 1987), giving rise to boredom and emptiness in the thera-pist (Lesser and Lesser, 1983).

Alexithymic individuals exhibit difficulty in recognizing and describingtheir feelings and have difficulty distinguishing between an emotional stateand a bodily state: the sensation appears in the place of the emotion (redden-ing of the skin, itching [e.g. Miss K], palpitations etc.).

Sifneos describes two forms of alexithymia:

1. Primary alexithymia appears as a deficiency of feelings rather than emo-tions. In his view, the limbic system and the neocortex are poorly con-nected in these cases: a stimulus arising from nuclei in the amygdalaarouses emotions such as fear and anger, which, without any contributionfrom the imagination and with thoughts originating from the neocortex,are expressed in various forms of fight-or-flight reaction.

2. Secondary alexithymia,in contrast, originates from a traumatic experiencethat is devastating and sudden at the preverbal age and that can make achild incapable of expressing emotions through language (Sifneos, 1995,

p. 31, translated quotation), which is conductive not only to psychoso-matic conditions but also to post-traumatic stress disorders (PTSD), drugaddiction, chronic alcoholism, anorexia and bulimia.

Critique of the neurobiological approach to alexithymia

McDougall (1989)takes issue with the idea that alexithymic patients are suffer-ing primarily from neuro-anatomical disturbancesor that they are poorly men-talized. She considers instead that psychosomatic phenomena may be self-protective responses to early, inexpressible psychic pain. For her, alexithymia,

the alexithymic mode of functioning, remains closely linked to the original situ-ation of the child who is incapable of imagining psychically what he is feelingand whose body is totally dependent on the mothers body. In her view, alexi-thymia can be considered a defence mechanism that enables the subject to pro-tect himself from early childhood against anxieties of object loss that could notbe mentalized because a good enough maternal object could not be integrated.

Concerning somatizing subjects, McDougall (1984) finds the alexithymicconcept an inadequate explanation of the psychosomatic economy: she putsforward the idea of two defence mechanisms at work in this type of organi-sation: disaffectation and dispersal. Disaffectation consists in ejecting prema-

turely then preventively any representation overloaded with affects from thedomain of consciousness. It leads to a disaffectivized speech in which wordsare deprived of their affective and drive contents. Closer to alexithymia andoperative thinking, dispersal is a defence mechanism consisting in dispersing


https://www.researchgate.net/publication/232554021_Theatres_of_the_Body_A_Psychoanalytic_Approach_to_Psychosomatic_Illness?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/16721885_The_'dis-affected'_patient_Reflections_on_affect_pathology?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/232554021_Theatres_of_the_Body_A_Psychoanalytic_Approach_to_Psychosomatic_Illness?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/16721885_The_'dis-affected'_patient_Reflections_on_affect_pathology?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==


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a painful emotional experience by the predominant recourse to action or tothe addictive form of solution. In this sense, McDougall considers addictivebehaviours to be the expression of a resomatization of affects resulting fromthe incapacity to elaborate them.

Therefore, while in borderline personalities the affectrepresentation dis-crimination(Green, 1999b)is inoperative, involving rapid and frequent emo-tional torrents as well as repetition compulsions and passages to the act, inthe alexithymic or the operative thinker, this non-discrimination leads to theemotions being experienced as sensations due to the lack of any prior abilityto find the pathway of representation.

For Guilbaud (2007), primary alexithymia may reflect disturbances ofempathy, whereas secondary alexithymia reflects a defensive strategy aimedat self-protection from affects that are traumatic for the early ego. As aresult of fixations or micro-fixations during the self-sensuality phase (Mah-

ler, 1974), autistic protective manoeuvres have paved the way relatively earlyfor an alexithymic functioning with a certain distortion in the capacity torecognize feelings in oneself and in others. Alexithymia may be connectedwith a substantial and premature use of identification by dissolution, gener-ating an excessive recourse to the process of negative hallucination (endo-and extrapsychic) of areas of emotional life that have been either rejected[Verwerfung] (primary alexithymia) or traumatic.

It is these effractive affects for the early ego that, in our view, in second-ary alexithymia, lead to failures in the process of reversal-return prior torepression, resulting in an accentuation of the endopsychic negative halluci-

nation of affect in the absence of any exopsychic hallucination of the motherin order to guard against any perception of separation from her (cf. eight-month anxiety).

We should add that this mode of functioning is therefore residually pres-ent in every individual and belongs to an autistic register of the ego. But itis the exclusive recourse to alexithymic functioning that indicates its patho-logical quality, with a risk of psychosomatic decompensation in the case ofemotional torrents that are not ultimately containable by these protectivemanoeuvres.

Connections between alexithymia and somatizationConcerning alexithymia and the risks of somatic accidents, some authorshave discovered a significant reduction in the level of circulating lympho-cytes in alexithymic subjects in comparison with non-alexithymic subjects. In97 healthy subjects, Dewaraja (Dewaraja et al., 1997) discovered a signifi-cantly lower level of circulating NK (Natural-Killer) lymphocytes and K(Killer) lymphocytes in subjects defined as alexithymic on the Toronto Alexi-thymic Scale. Tordarellos study (Tordarello et al., 1997) on screening pre-cancerous cervical lesions in 123 women found that alexithymic patients hada lower level of circulating (CD4 and CD3) lymphocytes than non-alexithy-

mics. In alexithymic subjects there is an activation of the basal tonusof theautonomic nervous system, in conjunction with a mild immuno-suppression.


https://www.researchgate.net/publication/12936163_On_discriminating_and_not_discriminating_between_affect_and_representation?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/247911388_L'alexithymie_dans_ses_rapports_avec_un_mode_de_fonctionnement_autistique?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14120373_Decreased_Cytotoxic_Lymphocyte_Counts_in_Alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14120373_Decreased_Cytotoxic_Lymphocyte_Counts_in_Alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14120373_Decreased_Cytotoxic_Lymphocyte_Counts_in_Alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/247911388_L'alexithymie_dans_ses_rapports_avec_un_mode_de_fonctionnement_autistique?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14120373_Decreased_Cytotoxic_Lymphocyte_Counts_in_Alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/12936163_On_discriminating_and_not_discriminating_between_affect_and_representation?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==


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Some studies have revealed connections between alexithymia, vulnerabilityto stress, malfunctioning of the autonomic nervous system and neuro-endo-crine axis (Dewaraja and Sasaki, 1990; Lumley et al., 1996), even theimmune system(Guilbaud et al., 2003; Solomon et al., 1997).Animal exper-

iments have underlined the effects of stress on the rate of growth in tumours(Riley et al., 1981). As neuro-endocrinological studies have demonstrated,the stress reaction stimulates the orthosympathetic branch of the autonomicnervous system (Cannons emergency reaction) and the corticotropic axis(Selyes general adaptation syndrome) (cf.Alexander, 1952).This activationof the sympathetic and then the corticotropic system, following a stress-inducing stimulus, causes neurophysiological and immune disorders. Thecorticotropic axis seeks to eliminate or attenuate the effects of acute stress,especially those induced by catecholamines.

Several studies (Fukunishi et al., 1999; Nemiah, 1977; Wehmer et al.,

1995) have discovered a modification of physiological indicators (cardiac fre-quency, skin reactivity, oxygen consumption) that promotes a disturbance ofsympathetic reactivity in alexithymic subjects.

In fact the deficiency in affect-regulation is associated with a basal modifi-cation in the tonus of the ascending reticulate (which relates to Martys con-cept of vital tonus) as well as the cortisolic profile, which constitutes afactor of vulnerability to stress. There are also studies that demonstrate adisturbance in the functioning of the hypothalamo-pituitary-adrenal axis(hypercortisolaemia) in both depression and chronic stress (Sapolsky, Kreyand MacEwen, 1986). In depression, the level of corticotrophin releasing

factors in the cephalo-rachidien fluid is significantly higher than in controlsand positively correlated with hypercortisolaemia. Moreover, this hypercort-isolaemia cannot be decelerated by the dexamethasone suppression test indepressed and alexithymic subjects (Lindholm et al ., 1990) or in non-alexithymic depressed subjects.

Alexithymia, operative thinking and the negative hallucinationof emotions

The negative hallucination of emotion

Classical psychiatry long ago revealed the existence of Cotards negationdelirium, which is observed much less frequently now because the develop-

ment of the medical condition during which it appeared is prevented bymedication. This syndrome described by Cotard is a negation deliriumthatoccurs during some melancholias. The patient initially expresses some ideasabout organic transformation (putrefaction, obstruction, disappearance) thathe sometimes links with demonic intervention. Then he goes on to deny theexistence of certain organs (stomach, heart) and consequently to believe thathe is in the process of becoming immortal. As Green observes, the negationof organs causes a delusional megalomania: The absence of organs leads to

the idea of immortality and at the same time the body, losing its limits, feelsit is expanding so that it comes to occupy the whole universe (1999c,p. 174). Thus it is noted that the individuals sense of his own body that


https://www.researchgate.net/publication/14177216_Alexithymia_social_support_and_health_problems?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14177216_Alexithymia_social_support_and_health_problems?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14177216_Alexithymia_social_support_and_health_problems?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/9089621_Is_there_a_psychoneuroimmunological_pathway_between_alexithymia_and_immunity_Immune_and_physiological_correlates_of_alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/9089621_Is_there_a_psychoneuroimmunological_pathway_between_alexithymia_and_immunity_Immune_and_physiological_correlates_of_alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/9089621_Is_there_a_psychoneuroimmunological_pathway_between_alexithymia_and_immunity_Immune_and_physiological_correlates_of_alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/9089621_Is_there_a_psychoneuroimmunological_pathway_between_alexithymia_and_immunity_Immune_and_physiological_correlates_of_alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/9089621_Is_there_a_psychoneuroimmunological_pathway_between_alexithymia_and_immunity_Immune_and_physiological_correlates_of_alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/49309271_Psychosomatic_Medicine_Its_Principles_and_Applications?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14788053_Self-perceived_fatigue_and_cortisol_secretion_in_a_community_sample?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14788053_Self-perceived_fatigue_and_cortisol_secretion_in_a_community_sample?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14788053_Self-perceived_fatigue_and_cortisol_secretion_in_a_community_sample?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/49309271_Psychosomatic_Medicine_Its_Principles_and_Applications?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14788053_Self-perceived_fatigue_and_cortisol_secretion_in_a_community_sample?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/9089621_Is_there_a_psychoneuroimmunological_pathway_between_alexithymia_and_immunity_Immune_and_physiological_correlates_of_alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/14177216_Alexithymia_social_support_and_health_problems?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/21190033_A_Left_to_Right_Hemisphere_Callosal_Transfer_Deficit_of_Nonlinguistic_Information_in_Alexithymia?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==


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forms the basis for the most direct awareness of his own existence can besubjected to a disavowalthat annihilates its perception.

Now Green considers alexithymia and operative thinking to be much sub-tler forms of this delusion of organic negation found in Cotards syndrome.

In fact, he writes:Alexithymia, as described by Sifneos, does not only designate an absence of words to

name affects but also the inability to experience affective states, that is to say, to

become conscious of them. J. McDougall has gone more deeply into the analysis of

patients presenting manifestations of this kind, postulating that unconscious affect is

cut off from the system of word-presentations. In other words, without an appropriate

readingwhich would make it possible to think about their meaning, affects can never

be nominated. All these cases are similar to those studied by P. Martys Psychoso-

matic School.

(Green, 1999c, p. 174, italics added)

and to operative thinking subjects in particular.There is therefore a common denominator in the alexithymic and the

operative subject an overactive negative hallucination in the emotionalsphere: whatever its origin and its nature, this (the emotion) remains aliento the ego for fear of being experienced painfully. For McDougall, the psy-chosomatic organisation of the personality represents a massive andarchaic form of defense against mental pain in all its forms in relation tooneself, to instinctual demands, and in contact with others(1990, p. 442).

In operative, alexithymic or essentially depressed patients, as emphasizedby McDougall (1990) and, more recently, by Smadja (1999, p. 26), the

expression of psychic pain is often lacking to a greater or lesser degree. Withthese patients, the enigma of pain changes sign. It turns from positive tonegative; that is, it becomes psychically silent. They have an affective frigid-ity (Smadja) that various authors have attributed to specific mechanisms ofimmobilisation, freezing, disorganization, elimination (of affect) or elimina-tion of psychic representations of the drive. This therefore raises the ques-tion of an early existence of a form of negative hallucination applying toemotion itself.

Disturbance of the reversalreturn mechanism

Considering how early alexithymia (Sifneos) and operative thinking areestablished, it may reasonably be wondered how we can tell whether thesepathogenic processes are not part of the failure to establish an early defencemechanism prior to repressionresulting from what Sifneos terms devastatingearly traumas. This is the reversalreturn process prior to the repressionmechanism (Freud, 1915a, p. 146), which is concomitant with establishingthe negative hallucination (of the mother) and the first appearance of therepresentative2 of the drives and therefore of the affects.

2The representativedesignates a general category that includes various types of representations (psychicrepresentations, representative-representations, drive representations) involved in the movements andactivities of representation.




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The reversal into the opposite (in which both the transition from activityto passivity and the reversal of the content feature) and the turningagainst the self [Wendung]; are usually enmeshed and part of the same pro-cess with a defensive function(LeGuen, 2008, p. 1332),but they can be con-

sidered separately. In Lenfant de a [The child of that], Green recalls thatthis reversalreturn function that he calls double-return is the precondi-tion of repression:

Reversal of an instinct into its opposite resolves on closer examination into two differ-ent processes: a change from activity to passivity, and a reversal of its content. The twoprocesses, being different in their nature, must be treated separately. S.E. 14, p. 127.

(Freud, translated quotation)

In 1966, Green had already indicated the importance of this single pro-cess involving two operations. This concerns, firstly, the orientation the

change of which indicates that the centrifugal orientation has become centripe-tal and, secondly, the mode of reversal which should be thought of as adecussation (2001, p. 79, italics added). In this return by decussation, it isas if the response expected from the object were carried along by thismovement in which the extreme positions of internal and external in theinstinctual current change places. An overlapping thus occurs between thatwhich, on a surface, can be localised on the left and right of a hypotheticalfrontier(2001, p. 79). This primary decussationallows what is most internalto the psychic apparatus and what is most external to it to intersect whilechanging places, as in the Mbius strip, problematics that Green later devel-ops with the notions of double limits and insideoutside.

Reversal-reduplication and negative hallucination

This double returnthus produces for Green a sort of internal enclosure thatduplicates the external protective shield (Donnet and Green, 1973, p. 273,translated quotation) which, in this subject as we think in future alexithy-mics and operatives then proves inadequate and leads to a failure in theconstitution of psychic spaces (a minima, blank psychosis). This failure isalso due to the anachronistic maintenance of earlier more archaic disavowalsthat nevertheless provide effective protection from the drive-related and

emotional effraction.Now, this double-return mechanism can only be constructed by a negativiza-tion of the mothers presence or of the object in her presence: what therefore occurswith the establishment of the framing structure, sheltering the loss of the per-ception of the maternal object: the negative hallucination of heris the precondi-tion of any representation, a symbolization of the absence of the primary object.

Green writes:

I make the assumption that the child is held by the mother against her body. When

contact with the mothers body is broken, what remains of this experience is the trace

of the bodily contact as a rule, the mothers arms which constitutes a framing

structure sheltering the loss of the perception of the maternal object, in the form of anegative hallucination of it. It is against this negativized background that the futureobject presentations, sheltered by the framing structure, will be inscribed.

(2005a, p. 161, italics added)


https://www.researchgate.net/publication/229852597_Dictionnaire_freudien_Freudian_Dictionary?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==https://www.researchgate.net/publication/229852597_Dictionnaire_freudien_Freudian_Dictionary?el=1_x_8&enrichId=rgreq-73ccb0e0-ccbe-4c1a-8b20-3ffd63c617cd&enrichSource=Y292ZXJQYWdlOzIzNDAyOTgzMztBUzoxMDIwMTAxNjI1MTU5NzlAMTQwMTMzMjUyNjY2Ng==


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It is clear here that the negative hallucination applies to an external per-cept, the mother.

Now, it is our hypothesis that when she is deficient (depression, affectivecoldness) and becomes lacking as a secure internal object (operative think-

ing) or, instead, presents herself as too attached to her child and fusional,the negative hallucination then applies to an internal percept: affect (disaf-fectation in McDougalls sense, above) primary decussation then reorien-tates both the positivity of perception towards the external sensation andthe negativity of perception (the negative hallucination) towards the endo-perception of emotion.

Operative thinking, alexithymia and negative hallucination

Perception, hallucinatory, hallucination

This disturbance in the establishment of the processes prior to repressionand the perceptual positivitynegativity (negative hallucination) allow aform of somapsyche separation to subsist. This separation is to beunderstood less as Spaltungor splitting (Klein) than as non-elaborationof the mind from the psychic part of the psychosoma. This accords withWinnicotts suggestion that: One of the aims of psychosomatic illnessis to draw the psyche from the mind back to the original intimateassociation with the soma (1949, p. 254). We should remember that inan earlier text, Primitive emotional development, Winnicott (1945) refersto the need for in-dwelling: establishing the psyche in the body (person-

alization). These early disturbances in the processes that precede repres-sion impede in-dwelling.In confirmation we can recall the simple fact that the infant is an emi-

nently psychosomatic being before he can speak. The infant feels (sensoryperception, proprioceptive feeling) rather than thinks about the loss of theobject and the bond. The infants reaction is therefore psychosomatic if theabsence continues without being compensated. This is demonstrated by thechild psychoanalytic practice of Kreisler, Fain and Soul (1974) or Debrayand Belot (2008): three months colic, childhood insomnia, merycism, child-hood asthma and so on.

Concerning this positive or negative (drive) polarity of perceptions, weshould add that for Roussillon (1995) what returns in somatizations is a split-off primary trauma. Based on the hypothesis of the existence of a hallucinatoryfoundation of the psychic apparatus, the somatization corresponds to the hallu-cinatory activation of mnemic traces of the early bodily trauma. In psychoso-matic situations, what has failed to be inscribed representatively (failure of thedrive representative) returns later in sensations and perceptions.

Negative hallucination of the mother andor of affect

Green develops the idea of the containing structurethat shelters the loss of

the perception of the maternal object when it has gone. The inside is con-structed with the outside and this is explained by the model of the doublelimit (between inside and outside, between conscious and unconscious


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through the preconscious). In this primitive psyche and the work of the neg-ative (Green, 1998), it is therefore this containing function (Bion) of thematernal framing structure that has emerged from the negative hallucinationof her that later allows the elaboration of the work of representations that

undergo transformations relating to the transition of the psychic representa-tions of the drive to the word presentations and judgements derived fromthe experience of reality.

How are we to perceive the lack of container, the antecedents ofunpredictability, depression and emotional neglect to which the futurealexithymic or operative patient may have been subjected? In the counter-transference he will suddenly appear in the lacunae they have left: the ana-lysts silence experienced as abandonistic and anxiety-inducing, absencesexperienced as distressing, for example. They reflect the fact that, for thepatient, it is less a matter of full-scale traumatic experiences than lacunary

traumas: the mothers decathexis of the child

s body, experienced as an alienbody; or mechanical hypercathexis in a control of a childs body undifferen-

tiated from the mothers (the child remains an extension of herself; the loveof the child is therefore purely love of herself, of what he may yet becomethat she has not been); and usually of course a combination of these twoforms of cathexis in alienness (soon familiar) and unpredictability gives riseto an insecure attachmentin Bowlbys sense.

This lacunary dimension, with a truly pathological negativization of emo-tions and imagination, emerges in the early developmental phases of anexcessive recourse to the process of negative hallucination of which one of

the functions is to insert a blank, a figurative empty screen, where the egomight be confronted with the affective perceptual pole that is intolerable tothe representative pole (Pirlot, 1997).

It is therefore conceivable that the phenomena of negative hallucinationwhen used preponderantly affect not only emotional experience but also thesensory perception of the object, the self-image, language and, finally, theinternal perception of the body, opening a new pathway to a psychosomaticsolution (Corcos and Speranza, 2003).

These functions of operative behaviour testify to an economy of helpless-ness of survival. This concurs with Krystals (1979) and McDougalls

assessments, in considering alexithymia as a mode of pathological mentalfunctioning associated with malfunctionings in early interpersonal relations.According to Krystal, there is a lack of identification with a security-givingprimary object, which is reminiscent of the dead mother and, concerningoperative thinking, a maternal function as emphasized by Marty in whichthe protective shield buffer function between her and her child has beendefective (1976, p. 165; 1985, p. 122).

Dead mother, operative thinking and alexithymia

The dead mother complex is probably Greens best-known work. Green

argues that in the dead mother complexa narcissistic wound in the motherputs an end to the happy period between the infant and herself: the loss oflove is then equivalent to a loss of meaning. He adds that this is not the


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mothers actual death but a death that occurs psychically in the eyes of theyoung child in her care (2001, p. 170):

The first is that of object-loss as a fundamental moment in the structuring of thehuman psyche The second is that of a depressive position Both ideas arelinked to a general situation referring to an unavoidable event in the process of devel-

opment.(2001, p. 171, italics added)

The depressed mothers decathexis then results in a hole being constitutedin the object-relationship and in personality disorders (cf. Miss K, above):

The object has been encapsulated and its trace has been lost through decathexis; there

has been a primary identification with the dead mother, transforming positive identifi-

cation into negative identification, that is, identification with the hole left by the

decathexis (and not identification with the object).

(Green, 2001, p. 1823, italics added)In the conditions of a good enough mother, this erasure of the (mater-

nal) primary object becomes a framing-structure for the ego, sheltering thenegative hallucination of the mother (Green, 2001, p. 193, italics added).This period in which the child can negativize the mothers presence to buildhimself a framing structure from this presence enables him to constitutethe background against which his representations and the play of hisauto-eroticism will be inscribed (the mother covering the childs auto-eroti-cism). Everything is then in place for the childs body to be substitutedfor the external world; the negative hallucination of the mother, without in

any way representing anything, has made the conditions for representationpossible the creation of a memory without content (2001, p. 86, italicsadded).

As Green recalls, one of the most productive applications of the negativehallucination of the mother is to imagine the holding situation described byWinnicott as a framing structure, the memory of which will remain when theperception of the mother is no longer available owing to her absence (Green,2005a, p. 221, italics added).

What is borrowed from the (primary) object is therefore not a representa-tion but the feeling ofego unity that comes from the supporting role to the

protective shield (ineffective confronted with the drives without the projec-tion on to the object) that is provided by the mother or her substitute. Onceconstituted, the negative hallucination therefore provides the limits of anempty space that is ready to be filled with auto-erotic material and that ofsubsequent object relations. The dead mother complex in fact illustrates astructuringuse of the negative.

Now, in other cases, such as the future alexithymic or operative subject,it can be destructuring (perceived, for example, in the psychoanalystssilences manifested in Miss K by an excessive anger accessible not psy-chically but somatically through the scratching). The introject of a mater-

nal object that is too depressed,

psychically dead

, joyless, neglectful orrejecting towards her child thus prevents the establishment of a negativehallucination that builds containers for figurations and representations,




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psychic containers. The potential for a protective shield interface screen anda contact barrier (normally a place that yields the meta operation of imagi-native symbolization) is used here to ultra-defensive ends against affectsthat are too destructive for the ego (its narcissism) fear of breakdown,

annihilation, endless falling, dread. The protective and anti-traumatic func-tion of the negative hallucination is diverted from its function to consti-tute a real anti-affective perceptual shield for the ego by using, as in theexample of Miss K, irritating skin perceptionssensations in each of ourencounters.

With the operative thinker, the possible resurgence of intense affects thatare destructive to the ego lead to this protective and anti-traumatic functionof the negative hallucination being used as a barricade against the life ofthe drives and affects, as well as their representatives. This will be detectablein the limited dream activity and the weakness of the preconscious, and in thealexithymic subject by the absence of any naming of emotion. The absenceof any good reading of representations and meanings of the affects illus-trates in these cases a form of unbinding between the perceptual and therepresentative, giving the subject a simultaneously cold and empty aspect(inhabited by a depressed dead mother), having lost his vital affects anddefending himself against the fear of breakdown induced by the transfer-ence objects.

Failure to introject the alpha function, early denial confronted withfears of breakdown and lack of emotional attunement between

mother and childThe alpha function described by Bion (1962, p. 21 ff) combined with Winni-cotts notion of transitional space accounts for the degree of intersectionbetween the childs psychic functioning and the mothers functioning. Themother experiencing difficulty in her role will have trouble perceiving bothher own and the childs affects, and in attuning imaginatively with thechilds inner world. The neglect subsists there as a cold trauma, as alacuna. This is akin to what Winnicott referred to as fear of breakdown,namely the fear of a past event that has not yet been experienced (1974,p. 107, italics added). It is therefore very much the active absence of percep-tion through the negative hallucination of an affect that is too intense for theego that prevents it from being felt.

The incapacity of operative and alexithymic subjects to identify someemotional experiences associated with particular relational configurationsand to use imaginative activity to communicate and modulate emotionsseems to originate from this lack of an experienced perception of the fear ofbreakdown discussed by Winnicott (leading to the inclusion of a dead time[Green, 1975]). This absence of perception and the fear of breakdown pro-ceed from the shield constituted by the negative hallucination towards theaffect that is dangerous for the integration of the ego. In that sense, this

extreme operation, for the ego, of the negative hallucination on the affectprotects this ego from primitive agonies characterized by the return to anunintegrated state, the sensation of falling for ever, the failure of indwelling,




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the loss of the sense of the real and the loss of the capacity to relate toobjects(Winnicott, 1974, p. 104, italics added).

Metapsychological approach

We will conclude here by putting forward a topographical, dynamic andeconomic account of the concepts of alexithymia and operative thinking,even if the chronological anteriority of operative thinking is not in questionand the theoretical premises that underpin operative thinking and alexithy-mia, as we have emphasised, diverge without making the two conceptsincompatible.

Topographical perspective

During affective torrents that cause it pain, the emerging ego splits prema-

turely: the perceptual exterior is invaginated, via the negative hallucination,to serve as a rigid internal shield for rejecting the internal perception ofemotion, affect and the drives. This involves a particular type of (perceptual)disavowal: unlike perversion, which applies to disavowal of the perception ofgender difference, here the disavowal of perception applies to the differencebetween insideoutside, externalinternal, presentabsent and subjectiveobjectobjective object (Winnicott). The transitional space, allowing the sub-

jective object to be transformed into an objective object, passing throughthe transitional object that is not an internal object (Winnicott, 1951, 1969p.118), will not be able to assume its role completely.

This corresponds with Roussillons (2006) suggestion that the defences areestablished before the organization of the no, before the early forms of the

mirror stage and the emergence of reflexivity and before the organizationof the constant representation of the object and the organization of second-ary anality.

This perceptual disavowal using the negative hallucination is then consoli-dated in the dynamic retreat of an anal fixation that Fliess considers to bethe dividing line between neurosis and psychosis. Primary anality, inGreens sense, expressed not by the sexualization of thought [as] in theobsessional neurosis of the Rat Manbut by the sexualization of anti-think-

ing

(Green, 2005b, p. 115, italics added) as in the borderline case, is usedby the operative and the alexithymic subject to reinforce the phenomenon ofthe negative hallucination of emotion.

It should be remembered that, for Green, this primary analityis related tothe feeling of the end of symbiotic omnipotence: however, in the future bor-derline case, it is not the mourning process with a reparative wish that willbe established but a perpetuation of the original helplessness that confirmsthat the world (the object) is bad, cruel, and that the subjects acts are val-ueless and bring no entitlement to a recognized existence.

As early as 1982, Green indicated a specific feature of the transference in

borderline cases that led him to theorize

primary anality

as an entity. Heobserves: The patients projection attributes to the analyst a power andeven an omnipotence that leaves the analysand no alternative but to struggleagainst the transference and to deny any capacity in the transference object




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(Green, 1982, p. 210, translated quotation). This subjects ego in these casesis trapped in the obsessional defences of his boundaries, the object beingeither the intrusive enemy or the other who is indispensable to the feeling ofexistence. The anal fixation is indicated by his wounded narcissism. The

analyst has the feeling that he is dealing with a hypersensitively thin-skinnedindividual.

Beyond repression, even splitting, the defences can assume a massive qual-ity in painful traumatic conditions, leading the subject to deny both theobjects existence and his own. The denial enables the subject to beconvinced of the others impotence towards him. Not being able to thinkabout this impregnable distress and despair induces a sexualization of anti-thinking.

Now alexithymic functioning in fact resembles anti-thinking and anti-repre-sentational behaviours that enable the subject to cut himself off temporarily

or permanently from his psychic problematic when confronted with affectsthat are too painful for ego (its narcissism) (Jeammet, 1991).The difference between a borderline case and an operative or alexithy-

mic subject is that in the former the recourse to the act is favoured todischarge the affect (dismissal) whereas in the latter, as McDougall (1989)suggests, there is a diffusion of affect that, if the negative hallucination ofaffect diminishes, at risk of destabilizing the ego, redirects it towards thesoma from the driveaffect organizational barrier constituted by primaryanality.

Economic perspectiveFrom the economic perspective, the alexithymic and operative dimension ofmental and relational functioning have an anti-traumatic function withregard to a risk of disorganization if the subject accedes to the representa-tive pole of what for him has remained fixed to the perceptual pole, ofaccess to a representation that is itself empty and blank or painful anddark.

The lack of reactivity, extending to behavioural immobilism in contrastto the borderline case is only a short-circuiting of fantasmatic activity. Itis the external presentation (unlike the presentation in psychopathic or psy-

chosomatic functioning acting out or acting in) ofthe absence of an inter-nal presentation (self-representation and representation of the other,intersubjective bond).

The external conflict is not negotiated, nor even evacuated it does notreach consciousness due to the lack of any internal referent to counterbalancethe intrusive capacity of the affect, the emotion (lack of protective shield), forWith the affect, it is the Other that insists by its intrusive presence (Green,1999a, p. 166, italics added).

The subject functions perfectly in terms of cognitive tasks (cataloguing,removing inappropriate items, assembling various components for organiz-

ing the response to a task), but has difficulty associating and comparingpresent and past experiences.


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From the dynamic perspective

With alexithymia and operative thinking, we are confronted with a mental-izationthat grasps:

1. what is externally perceptible, stores it (without integrating it into theego), catalogues and classifies it cognitively but without integrating itinto the narcissistic structure of the ego to avoid causing it any objectalanxiety: a cognitive subjective functioning, an operative thinking splitoff from any preconscious functioning and the psychic ego.

2. what is internally perceptible by an excessive recourse to the negative hal-lucination applied to affect that overwhelms the ego.

As we have said, for Roussillon (2006) this arises from subjective experi-ences that affect the subject before the organization of the no (Spitzs third

organizer); that is, in approximate terms, before the anal reorganization ofsubjectivity that usually occurs between 18 and 24 months; we emphasizethese different analysers, these different markers of subjectivity, as theirfailure to be organized will specifically imbue the type of communicationconveyed by the language of the act. It will testify to a primary and veryincompletely organized drive organization, to an extreme difficulty in theexpression of negation, a failure and a quest for reflexivity and a dependenceon the objects forms of perceptual presence.

The language of both the alexithymic and the operative thinker has morethan any other to be interpreted: it is only a potential for meaning, amessenger potential; it is meaning not yet accomplished, in search of a guar-antor; its meaning is never exhausted in its expression alone as the object sreaction or response are required for it to be meaningfully integrated.

From the dynamic perspective, there is a difference between the alexithy-mic subject and the operative subject:

1. The alexithymic subject does not function according to the modes ofidentification-introjection support in the neurotic sense of the term, norin the form of incorporationencryption as in melancholic depression,nor even in the form of imitation, as frequently in psychosomatic regis-ters. Instead this entails an identification process in which the subject

clings to the absence, vagueness or unreality of the primary object, com-bined with incorporation phenomena (giving rise to an anaclitic depres-sive vulnerability).

In conclusion, the subject iteratively embodies the object that was absentfor him in childhood and returns its absence and decathexis to it in a mir-ror. In the treatment the subject does not transfer (in the neurotic senseof the term); he imitates without identifying and the countertransference isimpaired.

There is an evident similarity here between alexithymic functioning andHelene Deutschs (1934) as if personalities, Winnicotts false-self organiza-

tions, or Balints organizations with the basic fault. Freud himself had previ-ously described intermediate psychic structurings in which: It will bepossible for the ego to avoid a rupture in any direction by deforming itself, by




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submitting to encroachments on its own unity and even perhaps by effecting acleavage or division of itself (1924, pp. 1523, italics added). He thusdescribed, in substance, a specific functioning in which the defences adhereto structural lines so closely that they become indistinguishable so as to

demarcate a void andor an overabundance of unrepresentable anxieties, toestablish its impaired unity, which is without the aid of speech or even acts.

2. In operative subjects: some have (1) an allergic character organizationwith no distinction between self and the others in whom the subject isinterested, whom they cathect affectively, giving them an astoundingcapacity for empathy; (2) a great ease in establishing relations in generalwith plants, animals and human relations in particular; (3) an astoundingaptitude for replacing one set of object-cathexes with another object-cathe-xis; (4) a lack of aggression towards others. The cathexis of new objectsusually quickly follows this separation [from the early cathected objects](Marty, 1985, p. 152).

Others present with an essential depression indicated by the reduction ofvital tonus and often going unnoticed while psychic life is limited by a hy-percathexis of the perceptual, speech turning out to be factual, with noimaginative elaboration, the subject seeming cut off from his inner life. Theoperative state (operative thinking combined with essential depression) isthen conceived as the end-point of a counter-developmental disorganizationthat accords with the malfunctionings of the mother(environment)babydyad (Smadja, 2001).

We have set out to consider the psychiatric concept of alexithymia and toshow how it can be integrated into a psychoanalytic conceptualization byusing the concept of operative thinking developed by Marty and the notionof negative hallucination developed by Green. In particular, we havedescribed how early traumatic experiences lead to a change of function rela-tive to affect in the negative hallucination of the mother.

We have also described how alexithymia can be introduced into Freudsmetapsychology based on dynamic, economic and topographical perspec-tives. It is less the comparison of theories not intercomparable that wehave sought to do here than to explain alexithymia in metapsychological

terms by integrating it as a variation of operative thinking and an unfavour-able outcome, to early defensive ends, of a negative hallucination relating tothe affective life.

Translations of summary

Alexithymie im psychoanalytischen Rahmen verstehen. Ziel dieses Aufsatzes ist eine metapsycho-logische Definition von Alexithymie zu liefern, wie sie im Jahr 1967 beschrieben wurde. Alexithymie istein vertrautes und etabliertes Konzept auf den Gebieten der Psychopathologie, der Psychologie und derklinischen sowie psychosomatischen Medizin. Aus psychoanalytischer und psychosomatischer Sicht istder Begriff konzeptionell dicht an P. Martys 1963 beschriebenem ,,Mechanistischem Denken, obwohl

wir wissen, dass die Begriffe nicht dem gleichen wissenschaftstheoretischen Bereich zugehren: auf der ei-nen Seite sind da die Neurowissenschaften, die Psychiatrie und die Objektivierung von Symptomen durchSkalen, und auf der anderen Seite finden wir fr das mechanistische Funktionieren ein psychoanalytis-ches klinisches Verstndnis in der Dynamik von bertragung und Gegenbertragung. Die heutigen Auto-




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ren sind der Meinung, dass die Freudsche Metapsychologie, die durch Andr Green sehr viel komplexergeworden ist, einen metapsychologischen Ansatz fr die Alexithymie insofern ermglicht, als sie sich aufMartys mechanistisches Denken bezieht. Auf diese Weise bietet Greens Konzeptualisierung der negativenHalluzination der Mutter, der negativen Introjektion, einer psychisch ,,toten (und unsicheren) Mutterjetzt die Mglichkeit, die Entstehung dieses besonderen Modus psychischer Funktionsweisen in metapsy-

chologischen Begriffen zu beschreiben. Wenn die negativen Halluzinationen der Mutter einen strukturel-len Rahmen als Grundlage der Negativitt produzieren, in den zuknftige Objektreprsentanzeneingepasst werden, knnen wir annehmen, dass sich diese negativen Halluzination in den zuknftigensubjektiven Funktionsweisen bzw. der Alexithymie auf pathologische und abwehrende Weise auf die in-nerpsychische Wahrnehmung von Affekten auswirken werden.

La comprension de la alexitimia desde un marco psicoanal tico. El objetivo de este trabajo esproporcionar una definicin metapsicolgica de la alexitimia descrita en 1967. Este es un concepto co-nocido y establecido en los campos de la psicopatologa, la psicologa y la medicina clnica y psicosomti-ca. Desde un punto de vista psicoanaltico y psicosomtico, es conceptualmente cercano al trminopensamiento mecnicode P. Marty, descrito en 1963, affln cuando sabemos que no pertenecen al mismocampo epistemolgico: de un lado, las Neurociencias, la Psiquiatra y la objetalizacin de los sntomasmediante escalas; y del otro lado, para el funcionamiento mecnico, una clnica psicoanaltica en la din-mica de la transferenciacontratransferencia. Los autores consideran que la metapsicologa freudiana,

con la complejidad de hoy gracias a Andr Green, permite un enfoque metapsicolgico a la alexitimia enla medida en que se relaciona con el pensamiento mecnico de Marty. De este modo, la conceptualiza-cin de la alucinacin negativa de la madre, la introyeccin negativa y la madre muerta (e insegura) anivel psquico de Green nos brinda hoy la oportunidad de describir, en trminos metapsicolgicos, lagnesis de este modo particular de funcionamiento psquico. Si la alucinacin negativa de la madre prod-ujo una estructura husped como teln de fondo de negatividad que habr de encajar en las futuras rep-resentaciones de objeto, asumiremos que en el futuro, operatorio o alexitmico, esta alucinacin negativatendr que ver patolgica y defensivamente con la percepcin endopsquica del afecto.

Comprendre lalexithymie par lapproche psychanalytique. Lobjectif de cet article est doffrir unedfinition mtapsychologique de lalexithymie telle quelle fut dcrite en 1967. Ce concept est bien connudans les domaines de la psychopathologie, de la psychologie et de la mdecine clinique et psychosoma-tique. Dun point de vue psychanalytique et psychosomatique, le terme dalexithymie se rapproche de la

notion de pense opratoire dcrite par P. Marty en 1963, bien que ces deux notions n

appartiennentpas au mme champ pistmologique: dun ct nous avons affaire aux neurosciences, la psychiatrie et lobjectivation des symptmes sur des chelles de mesure, et de lautre, en ce qui concerne la pense op-ratoire, la clinique psychanalytique au sein de la dymanique transfrentiellecontre-transfrentielle.Les auteurs de cet article considrent que la mtapsychologie freudienne, telle quelle fut labore parAndr Green, permet une approche mtapsychologique de lalexithymie dans la mesure o cette dernireest mise en relation avec la pense opratoire de Marty. En effet, les concepts dvelopps par Green, qu ilsagisse de lhallucination ngative de la mre, de lintrojection ngative, de la mre psychiquement morte (et vulnrable), nous offrent la possibilit de dcrire, en termes mtapsychologiques, la gensede ce mode particulier de fonctionnement psychique. Si lhallucination ngative de la mre a produit unestructure sur fond de ngativit qui abritera dsormais les reprsentations d objet venir, il est suppos-er quen ce qui concerne la pense opratoire ou lalexithymie future, cette hallucination ngative marqu-era de son sceau pathologique et dfensif la perception affective endo-psychique.

Lettura dellalessitimia in chiave psicoanalitica. Scopo di questo lavoro quello di delineare unadefinizione metapsicologica di alessitimia, una condizione che fu dapprima descritta nel 1967. Si tratta diun concetto affermato nel campo della psicopatologia, della psicologia e della medicina clinica e psico-somatica. Da una prospettiva psicoanalitica e psicosomatica, il termine si avvicina al concetto di pensi-ero operatorioproposto nel 1963 da Pierre Marty, nonostante il fatto che tale concetto appartenga a uncampo epistemologico diverso da quello di alessitimia. Questultima riguarda infatti la neuroscienza, lapsichiatria e loggettivazione del sintomo mediante scale; il pensiero operatorio, daltro canto, riguardala psicoanalisi clinica, con particolare riferimento alle dinamiche del transfert e controtransfert. Gli auto-ri sostengono che la teoria freudiana, cos come stata complessificata da Andr Green, consenta un ap-proccio metapsicologico dellalessitimia, nella misura in cui questultima si riallaccia al pensierooperatorio di Marty. Pertanto i concetti di allucinazione negativa della madre, di introiezione negativa, dimadre psichicamente morta proposti da Green ci offrono adesso lopportunit di descrivere in terminimetapsicologici, la genesi di questa particolare modalit di funzionamento psichico. Se lallucinazione

negativa della madre produce una struttura interna negativa su cui viene ad innestarsi ogni futura rap-presentazione oggettuale, si pu assumere che nel futuro alessitimico, tale allucinazione negativa influen-zer in modo patologico e difensivo la percezione affettiva intrapsichica.




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