[Psychosomatic medicine--the future of an illusion]

This paper presents the phenomenology and the development of theories about alexithymia, a "behavioral neurosis" in psychosomatic patients, with background of the american (F. Alexander, R. Grinker and P. Knapp) and french (P. Marty) psychosomatic schools. Luminet's understanding comprises the combination of an object-relations-theory perspective of alexithyma with the clinical theory of "depréssion essentielle" of Marty. Primary and secondary shortcomings and dysregulations in the early mother-child-relation lead to essential insecurity in building up stable self and object representations with a specifically reduced libidinal tonus of the self and dependency of objects. These conditions lead to the formation of alexithymic disturbances in thought, interaction and object relations, as well as to impaired capacity for self reflection in perception and evaluation of affects, which do not become available as signals for the ego-functions. Moreover, as the capacity for self regulation, as a function of maternal care, could not be internalized, there is an increased proneness for somatisation. In literature, these characteristics were commonly taken for the main limitations for the success of psychoanalytic or psychodynamic treatments. Luminet's psychotherapeutic access in the treatment of alexithymic patients is based on activation and differentiation of the self and object representations through verbal and nonverbal techniques, aiming on actualisation and development of maternal functions; this implies the acknowledgement of the physical body within the therapeutic relationship and awareness of specific counter-transference reactions.