The clinical treatment of adolescents who display serious intellectual deficiencies raises a number of questions concerning the possibilities of the work of adolescence within its double trajectory of access to genital sexuality and new temporal order, insofar as access to symbolization seems to be “ barred ” by lasting instrumental inadequacies which hinder overall development. Most often reduced to the space of the small child, the space-time of the mentally deficient youth does remain marked by very archaic modes of psychical functioning which tend to freeze all temporal unfolding and all otherness. Nevertheless, pubescent sexuality is not absent; but its elaboration follows paths that are skewed in relation to the usual paradigm of the neurotic theater. Contributions from theorization about childhood autism and recent work on the psychosomatic offer a field of research on the heterogeneity of symbolic modes that on encounters in certain forms of deficiency pathology, and opens up the impasse of mere deficiency to the complexity of these types of organization, particularly at the time of adolescence when the investment of the body in its drive and sensory dimension is at the forefront of the time of the other.
Hypochondriac somatization means that the adolescent psychological readjustment is stopped. Some clinical cases reveal how the actual neurosis stops genital sexuality and re-launches an archaic bisexual fusion fantasy, which is the expression of the quality of the maternal relationship. This fusion fantasy is reassuring but also persecuting, because it hinders the choice of sexual identity in adolescence.
If it is not possible for an adolescent to defend himself at the level of his ego by tolerating depression and if the ways of motor behavior are not open, the only thing left for the adolescent is the path of somatic unbinding which is a sign of experiences of de-subjectivation due to the intrusion of drive excitations into an immature ego. This is what happens with adolescents who are too well-behaved, too conformist, in whom the passage to the act is inhibited.
Through the case of a bulimic patient, the author aims to pinpoint the presence of crypts, in both the maternal and the paternal lines. Recourse to an external fetishistic object was necessary to prevent narcissistic drift : already sketched out in the early stages of infancy, it was provoked by the mediocrity of the establishment of the object bond.
This is a clinical reflection about the formation of a personality at risk for psycho-somatization in adolescence. The reappearance of childhood soma at puberty is indicative of early distortions in the mother-baby relation and of the failure of the early Oedipal phase, which fosters somatization and the allergic object-relation in the transference. The genital body then becomes the sick body.
The psychotherapy carried out in the post-puberty period enables these to be articulated with the history of the subject and with the adolescent process which is under way.
Through one adolescent’s journey, this work will explore the meanderings of his psychical functioning and the diversity of his psoriasis expressions, conduct disorders, drug addiction – all of which are desperate attempts to check drive invasion and assure his psychical survival. The links between psoriasis and the protective shield on the one hand, and conduct disorders and destructiveness on the other, are investigated in order to understand the evolution of the psychotherapy and the psychical elaboration which underlies it.
The psychoanalytical treatment of a boy, suffering Basedow’s disease at this period of life, offer the author an opportunity to discuss psychical modifications and their possible somatic involvement in the patient’s development. The difference between auto-soothing processes and masochism is considered in this clinical approach.
Adolescence, with its pubertaire and subjectivation processes, is an especially delicate moment when primary traumas are revisited as deferred action. In cases where these conflicts have remained on the margins of representation and have generated psychical defenses along the lines of splitting, the processes of puberty will lead to a return of what has been split off ; where repression has occurred, they will lead to a return of what has been repressed. In both cases, the risk is that what returns will be an unbound destructiveness, paving the way for drive disintrication, or even the “ de-driving ” of the drive, so that it turns into instinct, with the risk of somatic disorganization.
Hypochondriac complaints, frequent during adolescence, are a request directed at another and address an object of love and/or hatred. The adolescent is complaining about the traumatic breaking-in of puberty and seeking the witness of others. Hypochondriac complaints are carriers of a massive narcissistic investment. The organ about which the adolescent complains condenses the whole of the traumatized body through genitalization. The body, centered by its multiple complaints, is a place of projection, crystallizing in the body mass all thought, which then becomes meaningless. The hypochondriac adolescent, prompted by a very active underground fantasy of immortality, seems to substitute the time-space dimension of disease for the time and space of human existence ending in death.
The view, commonly held by psycho-somaticians, that adolescence with its body-changes is one of the phases least exposed to somatic disorders in the development of the individual, is far from being shared by psychoanalysts.
It is based on an economically unequal relationship between psychological problems and somatic disorders and will be submitted to clinical investigation conducted on allergy-prone asthmatic young adults and older adolescents.
Asthma attacks experienced during adolescence should not only to be considered in relation to the psychosomatic and structural nature of the individual, which conditions the ways in which they appear, but also, as can be seen in this study, in relation to a psychodynamic form of interpretation, for in many clinical cases they seem to constitute an incentive rather than an obstacle to maturation.
One can thus distinguish the “ regressive ” allergic attack aimed at avoiding an incoming puberty conflict situation; the “ constructive ” allergic attack caused by the build-up of fantasy activity that, once released, produces a strongly symbolically-marked stimulus; and the “ disruptive ” allergic attack that results from a psychosomatic disorder-like impulse-discharge.
The object of this paper is to show that whatever the age at which illness strikes, the extent of the initial disorder, or the worsening of the condition brought about by an asthma attack in the adolescence, none of these factors necessarily determine the adult’s somatic and psychological future life.