Notes by Dr. Fernando Taragno
In Schilder's definition, Pichon-Riviére introduces a new dimension, the time factor: "The body schema is the four-dimensional image that each one of us has of ourselves." He conceives it as a social structure, configuring notions of space and time that govern many aspects of our relationships with others.
He considers the divisions established between mind, body, and the external world as formal separations, as phenomenological areas or dimensions of the self or person. He describes three areas: Area 1 (the mind), Area 2 (the body), and Area 3 (the external world). This division is purely formal, as everything that happens in the mind, body, or world is related to common basic situations across all of them. In other words, both neurotic and psychotic structures can be expressed in the mind, body, or external world. Nothing that happens in a specific area is not experienced by the entirety of the person. This three-dimensional schema is a phenomenological designation, a way to place different categories of good and bad objects in various areas.
He attempts to conceive this schema as a unity in constant function, where the totality is included, expressed through an outward behavior that is visible and called objective behavior, and through an internal behavior, the emotional life through the body, in a constant relationship with the object. Of the three areas, Area 2 (the body) is the most "scotomized" for the self, where the objects projected there are less recognized, as well as the connection and unconscious fantasy accompanying it.
This mind-body division, which has emerged as a result of one of the most primitive defense mechanisms (Scott), serves to separate the mind from the body, creating two "bags," if you will, to place the first introjected objects, both good and bad, so that they don’t mix and contaminate.
The child conceives his body and mind as a unit. In the progressive postnatal integration of his body schema, Pichon-Riviére introduces a new concept: these integrations occur around a prenatal axis that he calls the proto-body schema, which is made up of interoceptive, proprioceptive, etc., stimuli originating during fetal life. In progressive structuring, the body schema in a child develops particular characteristics based on oral, anal, or genital primacies. The interplay of projections occurs through these openings and primarily concerning problems of distance. For example, in hallucinations, we can see a pathology of space related to the body schema.
According to his theory of the unitary conception of neuroses, psychoses, characteropathies, and psychosomatic diseases, he establishes that the main difference between them lies in the area of expression of conflicts, whether in the mind, in the mental representation of the body, or in the mental representation of the external world. Always keeping in mind that the totality of the person is engaged, though one structure predominates.
The bond with the object is not only established with the psyche but also expressed through the body. Thought is manifested through the mind, but the entire organism is involved in the situation.
The basic psychotic anxieties underlying the different neurotic, psychotic, characteropathic, perverse, and psychosomatic structures are the same in all of them. They are depressive and paranoid anxieties, which shape the depressive and schizoparanoid positions. In the first position, the relationship is with a total object, both good and bad at the same time, before which the person experiences the feeling of ambivalence. In the schizoparanoid position, the objects are partial, divided into good and bad, creating what Pichon-Riviére has called "divalence," meaning the simultaneity of opposing partial feelings.
According to the technique used for controlling and managing these internalized partial objects, different nosographic pictures will be configured. It can be said that the basis of all mental pathology lies in the schizoparanoid position. When the partial bad or persecutor object is projected in Area 2 (the body), we have hypochondria. The persecution is experienced in the body. This is where the self feels the threat, the danger of death. It is posed as an alienation localized within the body schema. Madness is confined to the body or part of it; it has a particular meaning; the symptom appears in a specific situation, with a particular connection and an unconscious fantasy. This notion of the relationship with a persecuting object within the mental representation of the body is fundamental. The hypochondriac becomes megalomaniac by identifying with the internalized good partial object within his mind, feeling omnipotent when he manages to control his persecutors internalized in his body, control which he establishes through his mind. It can be said that he is a patient who specializes in controlling his persecutors by putting them inside his body.
In the internalization of this bad and persecuting object, a division and dispersion of the object throughout the body occur initially, resulting in generalized suffering. The fragmentation of the object is a mechanism aimed at making it easier to control the parts, it’s a "divide and conquer" approach, as M. Klein would say.
In the vast majority of cases, internalization occurs orally, within the digestive system, later spreading to other organs. As for the choice of organ within which the hypochondriacal situation is established, it falls on the one that, due to a previously learned "profession," has greater control within the limited space of the reference organ.
The hypochondriac often chooses a hypochondriacal woman who has failed to control her own persecutors. He projects his own sick organs, including the persecutors, onto her body. This externalization of his sick organs allows the hypochondriac to observe and control them from the outside. It’s what Pichon-Riviére calls externalized hypochondria. She, in turn, has chosen him because she feels he is capable of controlling her own persecutors, control in which she feels she has failed. Together, they form an inseparable pair.
In conversion hysteria, the basic situation is hypochondria. In pure hypochondria, which doesn’t actually exist, the inclusion of the bad object occurs without provoking any reaction from the organ in which it is included. When the organ reacts with its own functions, with the purpose of managing the persecuting object included within it, we find the phenomenon of conversion. For example, in hysterical paralysis, which is the prototype of neuroses that take part of the body schema and eliminate it from the rest, the self deposits the conflictual situation in a paralyzed limb, isolating it from the rest of the self through the mechanisms of division and repression.
Persecution in the body is not "psychologically" experienced because the body-mind division mechanism is permanently active. At the same time, a part of the body is isolated and its content repressed, giving rise to the feeling described by Charcot as "la belle indifférence."
The reason why conflicts are presented in the body dimension brings forth the issue of the choice of expression area, which would be related to the individual history, hereditary factors, and dispositional characteristics of each subject.
The hysterical symptom is situational because it includes a specific object relationship, which occurs in the body dimension, with that object being administered, controlled, expelled, etc., meaning it undergoes all the vicissitudes of objects, but within the mental representation of the body. In the body, defensive techniques are more limited, as they are confined to the specific functions of each organ.
The concept of conversion implicitly includes a dualism, i.e., the conversion of one system into another, or from something that belongs to it. This is why Pichon-Riviére thinks the word is beginning to be troublesome. Because if one considers that what happens in the body is relational, a specific way of approaching the object within a total situation with a particular fantasy, conversion disappears. This term complicates the total understanding of the phenomenon, the organic symptom. On the other hand, the concept of situational relationship, connection, or visceral behavior facilitates it.
Conversion hysteria can be divided into two groups, depending on the system that intervenes in the control of internalized persecutor objects. On one hand, we have true conversion hysteria, where control is carried out through the central nervous system, in the neuromuscular and sensory system, such as in paralysis, blindness, convulsions, etc. On the other hand, there are so-called psychosomatic diseases, where control is established through the autonomic or neurovegetative system, expressing itself in the visceral field. Psychosomatic disease must be understood, in relational terms, as the establishment of a particular bond with a given object, within the body schema, with the functions of the organ regressing to earlier stages, where certain types of bonds predominated. This regression in organ functions creates a mismatch in the total economy, leading to the disease (Pichon-Riviére). The regression is towards the dispositional point, which is the developmental moment when certain types of visceral behavior were organized, achieving at a given point the control of anxieties.
During the phenomenon of regression, this does not only occur in the sense that objects are deposited in the body, but the organ itself also undergoes regression regarding its functions. For example, the stomach of an ulcer patient is a stomach that has regressed to its infantile stage, as the rhythm of hunger and satisfaction is similar to that of that period. The painful hunger of the ulcer patient is equivalent to the painful hunger of the infant. Here, the regression of functions to a specific stage and particular connections can be seen, with the totality of the person returning to a type of behavior that was operative in defending against anxiety.
The illness would arise from the conflict between the regression of an organ to a more primitive function and the persistence of the rest of the body at a more adult level. This would explain the pathology specific to the organ and the influence of the organ on the total economy. According to Pichon-Riviére, the organ that becomes ill is not the weakest, as it has been considered so far, but rather the strongest, the most resistant. Because the chosen organ is the place where the ego is most entrenched, where there is the most communication between it and the functions of the organ in question. The choice is made for the organ that already knows the task. Thus, the ulcer patient has long been thinking and acting with their stomach, trying to control the pursuing objects that determine their paranoid anxieties.
From a dispositional perspective, the chosen organ is the one that, at a given moment, has tended to establish a defense from there.
In the phenomenon of conversion, the relationship with the internal object is not explicitly stated, but it is implied, although not visible. What is visible are the defensive mechanisms that cause all the symptoms of conversion, either through the central nervous system, the peripheral nervous system, or the neurovegetative system. These are different levels of expression of behaviors through the body.
The subject configures a psychosomatic illness at a given moment with the purpose of "escaping" from psychosis (Pichon-Riviére). From a social perspective, it has the great advantage that this illness does not appear in the category of alienation. The subject suffering from it is considered a body patient and not recognized as a mental patient.
We should consider it as a pattern of repetitive behavior expressed through the body. A pattern that includes both the organ and the object, its connection, and the unconscious fantasy in totality. There is always an alternation between a bodily expression and a mental expression, and quite frequently the succession of psychosomatic conditions with psychotic episodes.
It can be said that children who have been overprotected in a situation of illness in a particular organ tend to escape from the mental situation and develop a psychosomatic illness. Meanwhile, children who have suffered from a situation of bodily neglect tend to develop mental elaboration. Repeating a situation of bodily neglect is much more dangerous for them, so they try to elaborate the situation through the mind. Among these three nosographic pictures—hypochondria, conversion hysteria, and psychosomatic illness—only phenomenological differences exist, having instead a common dynamic unity.
The phantom limb highlights a serious disturbance of the bodily schema. It is of particular interest because it poses the problem of alienation in the body. It is characterized by the compensatory illusion of the amputation on an amputated limb. It occurs in an unconscious, conflicted, and situational context. It appears in some cases, and specifically in front of certain people, with specific unconscious content. The phantom, by occupying a spatial position, that empty space from the stump, raises the problem of externalization, in the same way as in visual or auditory hallucinations, for example. The essential mechanism is the division of the bodily schema, followed by repression. It appears mainly in narcissistic structures, where internal relationships in the bodily domain are fundamental. The illusion of the amputee is a mechanism for recovering the object through the phantom limb (Pichon-Riviére). Thus, we find: 1) a narcissistic structure; 2) the loss of the limb; 3) the depression following the loss of the object included in that part of the body, and 4) the recovery or establishment of the lost bond through a hallucinatory mechanism. The reintroduction of the object occurs through the stump, a displaced oral route. The phantom detaches itself from the rest of the body through the mechanism of division.
In any kind of hallucination—whether visual, auditory, etc.—the problem of externalization is posed. There is an alteration of the bodily schema in the sense that a part of oneself is placed outside, through the mechanism of division and projection. It is the situation of one divided into two, and one of those parts placed outside and later perceived as though it belongs to someone else. This occurs during waking in hallucinatory delusions, where, for example, the voice heard from outside is produced by the extension of the bodily schema, which has been divided and functions by creating a situation of two.
The "influence apparatus is, ultimately, a part of the body itself that has been placed outside through the projection mechanism. It then appears as the representation of the own penis or sexual organs projected into the outside world.
In depersonalization, the bodily schema is massively compromised. It can involve both the sphere of the mind and the body. The first symptom of a hypochondriacal delusion evolving into a Cotard delusion is the estrangement from the body. It appears before the specular vision as different. In Cotard syndrome, the first situation that occurs is the internalization of the persecutor in the body, configuring hypochondria. It then denies the incorporated object, including the organ where it has been included, expressing, for example, that they have no stomach, heart, etc. Finally, they rationalize the reason for not having that organ by constructing the delusion of denial.
Anosognosia is the failure to perceive a zone of the bodily schema, whether altered or not, functionally and organically, for example, in the case of hysterical paralysis, blindness, etc. Here we find the mechanism of denial through the bodily schema.
Negative external autoscopy is the failure to perceive one’s own specular image in the mirror, i.e., not perceiving the image reflected in the mirror. Positive autoscopy occurs when the subject sees their double outside, in any place, as if in front of the mirror.
In the phenomenon of levitation, sudden sensations of lightness occur, with alterations in body weight and consistency. It is the expression of a manic bond in the bodily area (Pichon-Riviére).
In epilepsy, sudden alterations of the bodily schema occur, with paroxysmal character being the most typical element. These disturbances are very frequent and should be systematically searched for.
During the application of biological treatments, very frequent and significant changes to the body schema occur. Upon awakening from an insulin coma, alterations can even reach experiences of metamorphosis (Pichon-Riviére). The same occurs with the administration of mescaline and LSD-25. Electroshock, electronarcosis, etc., also cause changes in the body image, as does prolonged sleep application.
Space is comprised of three areas: mind, body, and external world, functioning with a given time and situation, the dynamic origin of which is constituted by the bond, a functional structure that includes the subject, the object, and a two-way communication that can suffer disturbances specific to each neurosis, psychosis, characteropathy, perversion, and the so-called psychosomatic phenomena.
Summary:
Schilder defines the body image as "the three-dimensional mental representation that each of us has of ourselves." This image is constructed based on multiple sensations that dynamically integrate into a Gestalt of the body. It is a structure in constant disintegration and restructuring. Libido plays a fundamental role. He describes the space of the ego, the objective space, and the space of the id, where affections bring objects closer or push them away. There is also the body space and the external space.
Scott suggests that the mind-body division arises from an early defense mechanism aimed at resolving specific anxieties. The phenomenon of the bodily surface is fundamental for establishing the domain of the self and the non-self.
Pichon-Riviére describes three phenomenological areas of the self or person: mind, body, and the external world. The integration of the schema is based on a prenatal proto-body schema. According to his theory of the unitary conception of neuroses, psychoses, character disorders, and psychosomatic diseases, he establishes that the main difference between them is the area of conflict expression. When these conflicts are expressed in the body (Area 2), and depending on the technique used to control the internalized pursuing objects, we have hypochondria, conversion hysteria, and the so-called psychosomatic diseases. The control is established, respectively, through the mind, the central nervous system (expressed in the muscular and sensory territories), and the neurovegetative system (expressed in the visceral field). The organ that becomes ill is the strongest, not the site of least resistance.
The author proposes the designation of the self-schema as a conceptual, referential, and operational schema that includes the three dimensions: mind, body, and the external world, functioning with a given time and link that includes the subject, the object, and their communication.
Acta Neuropsiquiátrica Argentina, 1959.