Pregnancy Fantasies in Psychosomatic Illness and Symptom Formation

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Abstract
Unconscious pregnancy fantasies related to somatic symptoms occur frequently. The literature does not distinguish them as a separate clinical problem. It is, however, important to recognize them as they indicate serious emotional illness often of psychotic dimensions. Attention is called to the difference between these patients and patients with pseudocyesis. In pseudocyesis the pregnancy fantasy is conscious. In the patients reported they are unconscious and only reveal themselves in somatic symptoms. How they reveal themselves during the initial interviews when the method of associative anamnesis is employed is demonstrated. The abundance of oral-sadistic material associated with the pregnancy fantasies is noted. The patient''s psycho-pathology is compared to schizophrenic and severe depressive reactions and a similarity is pointed out. Psychotic response to surgery is quoted as well as cases with definite physiologic (ulcer) and pathological changes. Extreme immaturity was observed in the majority of the patients. Loss of support precipitated symptoms which are considered as somatic expressions of primitive pre-verbal fantasies. They should be understood in terms of their pregenital precursors and serve as a disguise or ego-syntonic defense against primitive oral impulses. They represent the attempts of an archaic ego to gratify frustrated oral-receptive needs and to deal with primitive oral-sadistic impulses. On the deepest level they represent a regressive bid for the objectlessness of the womb. Thus, the pregnancy fantasy in these women represents both the wish to have "mother inside" and the wish to be "inside mother".

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