Panel report, IPA Congress Cartagena 2023: Concrete patients - a challenge for the psychoanalyst's mind.

Abstract

After an introduction to the topic by Benedetta Guerrini Degl ’ Innocenti, Lawrence J. Brown begins to discuss his work entitled “ On Psychic Flatness ” . He describes two kinds of “ psychic fl atness ” : the concreteness shown by patients with Asperger disease (a condition included in autism spectrum disorders, ASD) and that presented by patients with psychosomatic disorders. Brown highlights how both conditions, usually not considered related, and even in their mutual di ff erences, show disturbances of the representative capacity and in the emotional experience, with a dulling of emotions. These patients reveal an inability in the comprehension of the emotional experience and, in addition and accordingly, concrete thinking. This element of concreteness is common to apparently unrelated clinical situations, yet the common element is the imprisonment of the concrete patient, who, as expressed by Brown, “ casts a shadow of narrow meaning across all experience ” . In the primary relationship of the future ASD child, there is the experience of a premature tearing of the infant from the mother: this emotionally over-loads the child and, despite attempts, overwhelms him or her, thereby determining a fl atness of the infantile psyche with the feeling of being alone and threatened in a dangerous world. Brown underlines the importance of living an emotionally meaningful life, of developing the ability to represent emotional experience. When this representative function does not develop su ffi ciently, one is left in a fl at world of literal facts, limited in the capacity of psychic growth. This psychic situation determines what André Green calls “ hypercathexis of the factual and of reality ” , as it is possible to observe in psychosomatic patients and, according to what Brown adds, also in ASD patients. In keeping with Freud ’ s thought, there is a “ puzzling leap ” in the transformation of a somatic stimulus in psychic experience. Green introduces the concept of a somato-psychic frontier, where