Psychoanalysis : a case of chronic pain
Authors
O'Keeffe, Cathal
Issue Date
2008
Degree
MA in Psychoanalytic Psychotherapy
Publisher
Dublin Business School
Rights holder
Rights
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Abstract
In medical clinics, clinicians are faced with many patients complaining of symptoms that, after numerous examinations are deemed to be unexplainable and thus are termed Medically Unexplained Symptoms (MUS). I propose here that through a refocusing on the Freudian concept of the Symptom and analysis of the relation of this symptom to the life of those who produce them, a greater understanding can be reached for the clinician faced with these baffling symptoms. I will show this through an in-depth analysis and discussion of a case of a man whom I refer to as K, who presented to the outpatients department of a University teaching Hospital suffering with chronic pain due an accident at work 3 years previously. K took a litigation case against his previous employer and by building his case he has been referred to and from different specialists who all believe that K's symptoms of pain should have dissipated. Now that K has engaged in his own analysis he has been faced with the signification of his pain and has begun a re-translation of his signifying chain. During K's analysis it has come to light that the truth of his suffering preceded his accident at work and every attempt is being made (preconsciously) to isolate and undo what is being represented in his dream work and his fantasies. The results of this case show that through these defence mechanisms and the active sadistic component his dreams and fantasies, a case of an obsessional structure could be posited, as K had not negotiated the Oedipus complex due to a lack in the symbolic function. The symptom, at the level of chronic pain, is a regression to the anal sadistic phase of development and fragilistation in the mirror stage of development is secondary. where Lacan believed that the mirror stage is organised around a fundamental experience of identification in the course of which the child becomes master of his own body image. The child's primary identification with this image promotes the structuring of the "I" and puts an end to a singular aspect of psychic experience that Lacan calls the fantasy of the fragmented body or the Imago (Lacan, 1949, p. 5). I will then support these views with my clients case to show the value of psychoanalysis in relation to the language and transference of the patient that is most often overlooked or simply not explored. This is often due to a major workload, which reduces the amount of time spent with patients. The problems we see in the clinic today is one of desire on the behalf of the clinician to come up with a cause and cure within the space of one interview and thus, they may in fact miss the bigger picture as their focus is on the symptoms. The symptoms are a demand and Freud said that, "A symptom is a sign of and a substitute for, an instinctual satisfaction, which has remained in abeyance: it is a consequence of the process of repression. Involved is the instinctual demand and a cathexes around repression" (Freud, 1926, p. 91). Thus there is something else that is expressed through its manifestation but is in fact behind it. I believe that the mental aspect of an individual's presentation is more often than not considered moot. Specialists are all too familiar with individuals that complain of pains when there is clearly no biological cause. It took K three years to be finally referred to a psychiatric out-patients department. He had been told each time that he would be "relieved of his pain" with each of the procedures, from each of the specialists that reviewed his case. This does not mean that the pain is false. The pain is quite similar to that one may experience through being physically hurt but usually lasts a few moments and at most a few days. I propose that to relieve this "chronic" pain, it is the repressed ideas that need to be linked to the rest of the signifying chain for K. They must go through a new translation.