Library
APS Bulletin • Volume 17, Number 3, 2007
Resource Reviews
John D. Loeser, MD, Department Editor
The Body and Its Pain
Reviewed by Enid B. Young, PhD
Gabriel Burloux, London, Free Association Books, 2005. Soft cover, 295 pages, ISBN 185-343-794-8, $33.95
In The Body and Its Pain, Gabriel Burloux, MD, guides the reader into the internal world of the chronic pain sufferer, suggesting that chronic pain is the body’s attempt at healing. Burloux explains that the body and its physical pain protect against more intense mental suffering, and he presents a much-needed new approach to the conundrum of chronic pain.
Historically, psychoanalysis has rarely been considered a suitable treatment for chronic pain. The author emphatically shows why this viewpoint needs to change. Burloux, a psychiatrist and psychoanalyst with more than 20 years of clinical experience with chronic pain patients at the neurological hospital in Lyon, urges psychoanalysts and neurophysiologists to forge a link with each other.
Burloux’s observations began when doctors on the neurological ward at his facility, who were dismayed by their repeated failure to treat chronic pain successfully, called upon him for assistance. He discovered that when he listened with a “psychoanalytic” ear to patients, their intractable, repetitive complaints gradually gave way to a lively personal narrative, revealing traces of psychic pain with traumatic origins. This discovery led him to formulate his psychoanalytic model, which he used at a chronic pain clinic he established in the hospital. The description of his model in The Body and Its Pain specifically addresses the conundrum often faced by doctors treating chronic pain, giving meaning to what had been incomprehensible.
Burloux asks: Why is it that pain sufferers typically resist all change and often get worse after treatment? In spite of a significant number of studies correlating early childhood trauma with proclivity for chronic pain in adulthood, the prevailing medical approach to chronic pain has failed to take this into account. Burloux begins with Sigmund Freud’s exploration of pain, both personal and theoretical. He also draws upon psychoanalytic theorists such as Jacques Lacan, D. W. Winnicott, Wilfred Ruprecht Bion, and the French somatic school, and, most importantly, his own clinical experience with chronic pain sufferers, concluding that chronic pain is an “aftershock” of a previous traumatic event. He helps the reader understand chronic pain as a lack. The chronic pain sufferer has not been able to develop an integrated psyche that can process experience. Instead, the story is told through painful sensations in the body rather than affects in the mind. This trauma happens when the psyche and the body are one, undifferentiated. He answers the compelling question, “Is pain physical or mental?” by illustrating that it is simultaneously both. Pain becomes a psychic defense in the body, a protection from unbearable unprocessed memories.
Burloux moves toward a profile of the chronic pain sufferer by comparing and contrasting four different ways in which the body is used when the mind is insufficient to process experience: hypochondria, hysteria, psychosomatic illness, and traumatic neuroses (chronic pain falls into this category). His main emphasis is on the traumatic aspect. He places the beginning of chronic pain in a failed early motherchild dyad. He refers to Freud’s distinction between “satisfaction and suffering,” which are connected with the mother. If the mother creates “mutual understanding,” the child is able to fantasize, repress, and develop a psyche in which expression can occur through language rather than through the body. A child who is not sufficiently enveloped in maternal responsiveness can only cathect painful sensations and, therefore, cultivate them because he or she cannot express them. A “painful microspace” may be formed where old agonies and pain are projected. This is the seed of chronic pain.
There is an inability to access and mourn the failed relationship, which can manifest as physical pain. The chronic pain sufferer lives, therefore, in a “melancholic body.” The melancholic complex behaves like an open wound, draining the ego to the point of impoverishing it completely. This is what Burloux calls the “black hole,” the location of “algosis,” defined by him as the attachment to pain. There is a refusal to revive the dreaded painful affects of the old relationship. Instead, the black hole, the trace of the unexpressed trauma, is covered with an armor of hyperactivity. But the black hole cannot be forever escaped. A “date with fate” leads to an accident, great or small. Regardless of whether a lesion exists or not, chronic pain develops. The lament, repeated over and over, is that once there was heaven and now only hell.
The Body and Its Pain provides a clinical model that allows us to include a psychoanalytic therapy as a part of a multidisciplinary treatment approach. Along with the more typical practitioners in pain clinics, Burloux’s treatment team includes two psychoanalysts for each patient—one more supportively oriented, the other available for the countertransference-transference dynamic that is the basic tool of psychoanalysis.
The patient’s language provides the evidence of improvement. The initial repetitive style gives way to a narrative tone that regains its liveliness. The psychoanalyst has an essential role in loosening the grip of the defense. It is in the relationship between doctor and patient that an exchange can emerge that will gradually allow affects to replace sensation and break through the barrier of the pain. The patient begins a dialog with the self through the therapist, which allows a self-observation that was previously impossible.
The success of Burloux’s treatment model is described in vivid clinical examples. He relates that it is indeed possible for the pain patient to either free himself from pain or to sublimate pain and live productively. The Body and Its Pain offers a detailed roadmap for doctors who treat chronic pain. It demonstrates that psychoanalysis can be incorporated into a chronic pain clinical setting. In a treatment situation that calls for research, patience, and hope, Burloux’s book is essential.
Dr. Young is a faculty member and training and supervising analyst at the Psychoanalytic Institute of Northern California, Northern California Society of Psychoanalytic Psychotherapy, and Berkeley Psychotherapy Institute.
