SOMATIC COMPLIANCE

The notion of somatic compliance was introduced by Sigmund Freud within the framework of certain so-called somatic symptoms found exclusively in the hysteric, pointing toward what he calls "conversion phenomena."

Freud uses this expression for the first time in the case of Dora ("Fragment of an Analysis of a Case of Hysteria" [1905e]): The hysterical symptom requires input from both sides, and "cannot occur without the presence of a certain degree of somatic compliance offered by some normal or pathological process in or connected with one of the bodily organs" (p. 40). It is this "compliance" at the somatic level which "may afford the unconscious mental processes with a physical outlet" (p. 41) and which, accordingly, becomes a determining factor in the choice of neurosis. Meanwhile, this somewhat enigmatic notion of somatic compliance helps explain the equally enigmatic leap from the mental to the somatic level. "Conversion" is posited as one of the outcomes of unconscious processes, providing a privileged medium for the symbolic expression of unconscious conflict and especially well able to signify the repressed. Conversion is thus part of the framework of symbolization, in contrast to the somatic symptom properly speaking. Freud provides examples of somatic compliance, and thus of the phenomenon of conversion, in the case of Dora. In the same context he mentions "secondary gain from illness" and "flight into illness."

Aside from hysteria, somatic compliance in a more general sense raises the question of the expressive power of a given organ or body area that is in some sense hystericized or erogenized, as indeed of the whole body as a means of expression—as a vicissitude of the narcissistic cathexis of the body.

Can the notion be used, as in the conception of Jean-Paul Valabrega, to buttress a theory of psychosomatic phenomena as the outcome of a general process of conversion occurring outside the realm of hysteria, but clearly investing somatic symptoms with meaning? If so, the notion of compliance would take on another dimension altogether.

Alain Fine

See also: Psychosomatic.

Bibliography

Freud, Sigmund. (1905e [1901]). Fragment of an analysis of a case of hysteria. SE, 7: 7-122.

Valabrega, Jean-Paul. (1974). Problèmes de théorie psycho-somatique. In Encyclopédie médico-chirurgicale (Vol. Psychiatrie ). Paris: EMC. (Original work published 1966)