ABSTRACT
Aloupis, member of the Paris Psychoanalytical Society, presents the clinical case of a man suffering from heart disease in order to illustrate the dangerous liaisons between the somatic ailment and the death drive. Freud’s 1930 letter to Pfister says: “The death instinct is not a requirement of my heart, it seems to me to be only an inevitable assumption on both biological and psychological grounds.”
Viewed in this light, Aloupis argues, psychosomatics studies the path from instinct to drive, from the soma to the body. Using and expanding Freud’s economic point of view in reference to the death drive and psychic trauma, he illustrates that the somatic disorder constitutes a trauma, insofar as the person is subjected psychically to an aggression that actively invades his/her psychic space, requiring adjustments and readjustments for which the subject may not be ready or adequately equipped to face. Using the Winnicottian concept of impingement, Aloupis illustrates how the trauma of the somatic ailment can be experienced as an impingement of a surplus of traumatic excitation that cannot be worked through (metabolized), psychically provoking, in return, aggressiveness and destructiveness that can go as far as putting the body in danger. As for Winnicott, where the space between mother and child is essential for the good enough mothering function to take place, the distance from the object is important for the treatment of psychosomatic patients. The therapist in the role of the good enough mother should take into account the effects of the death drive, facilitated by projective identification, in order to evaluate the danger it represents, but also its stratagems, adjustments and its role in the psychic conflict.
