The Psychoanalytic Approach to Psychosomatics and Eating Disorders

The Newsletter of the Psychosomatic Discussion Group of the American Psychoanalytic Association.



A Further Contribution to the Psychoanalytic Study of Migraine and Psychogenic Headaches.
Sperling, M. (1964) Int. 1. Psycho-Anal. 45:549


In this paper Melitta Sperling elaborates on her basic formulation regarding psychosomatic illness as it pertains to migraine headache. She cites her previous work in which she described "migraine sufferers as predominately orally fixated individuals with a low tolerance for frustration." In keeping with this understanding, Sperling observed in women patients, "...their attitudes toward sex resembled their attitudes toward food, with alternating insatiability and complete rejection." Male patients experience premature ejaculation with a preference for oral sexuality. Sperling also notes that there is evidence of anal-sadism with strong compulsive features. This early psychological configuration prevents these patients from discharging impulses in overt behavior. Indeed, they are not conscious of the impulse. Thus, the psychosomatic patient is not in conflict with objects, but rather with the self, ie, the symptom picture.

Sperling addresses the issue of symptom specificity. She acknowledges that it is not well understood and attempts to approach the problem by comparing the psychosomatic symptom and the conversion reaction. In the latter there is wish fulfillment and punishment. The psychosomatic symptom in contrast is a pregenital conversion designed to ward off unacceptable impulses. In the case of the migraine suffercr, the unacceptable impulses deal primarily with fantasies of "killing the frustrating object by an attack on the head." Sperling finds that it is the experience of excessive helplessness that is the precipitating circumstance which leads to the regression during which the early sense of omnipotence establishes control by seeking instant gratification and discharge of rage through body function. In the case of the migraine each attack represents a "repetitive unconscious killing of the frustrating object." This is in contrast to other forms of headache which Sperling maintains represent phallic conflicts as a result of castration anxiety. Basic to this notion is the "over-evaluation of the head in both male and female patients."

Sperling reports that migraine is very responsive to psychoanalytic treatment. She cites impressive follow up data of 23 patients (14 adults and 9 children). The author then describes 3 cases in which the patients presented with an alternating picture of depression and migraine. These are brief clinical descriptions of the symptoms and course of the analysis with no hint as to the analyst-patient process except for a very brief poignant intervention in which Sperling interpreted a transfercnce wish to the patient. The patient has a headache on the way to the session. She then thought of her analyst and the headache stopped. Sperling commented, "So you decided to let me live." Later the patient has anothcr migraine, but aborted it without medication - a goal which the author feels is much prefcrred.

In the final section of the paper Sperling expands on the alternation of depression with headache. This occurs because there is a change in object relationship. This is a complicated process which represents a threatened loss being compensated for by the binding of the object through the symptom. When depression supervenes there is a withdrawal from the external object with the struggle shifting to the superego and ego. This exposes the frustrating object with the fantasy of killing off the object with subsequent mourning for the loss, i.e. depression. Sperling concludes by proposing the hypothesis that migraine and petit mal seizures are related to the same unconscious configuration. Treatment progresses when the petit mal ceases and the headaches begin, signifying ego strength and the ability to find new ways of dealing with the same impulses.


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