Maria Claudia Loreti
Associazione Italiana per lo Studio della Psicologia Analitica
This study on cancer patients at the onset of their illness is the result of twenty years of clinical work and research conducted by psychoanalysts from different schools. Professor Claudio Modigliani was the first to work on the psychosomatic hypothesis of cancer from a Freudian-type psychodynamic point of view.
In his article, “Psychic suffering nowadays. Neurosis as a health model”, Modigliana claims that
unperceived, unconscious psychic suffering, a component of stress, undermines physical integrity, and is one of the most important joint factors in the two principal causes of death in the Western world: cardiovascular disease and cancers. Manifest illnesses which are a sign of non-adaptation in psychoses and the like, or of conflictual and painful adaptation in neuroses, indicate that life-protection mechanisms are in action. Our psychic structure sets up this defence with the aid of regressive processes that are less involutional than psychosomatic illnesses. That is to say, psychosomatic illness is the result of more advanced psychotic regression. Life is the product of a biological system that includes a psychic tool designed to be used for adaptation and preservation. If a total or partial fault occurs in this instrument, the soma will be subjected to a more or less serious threat”. [Thus] “cancer is an illness affecting the Es, while psychosis affects the Ego. From a psycho- dynamic point of view, this means that the Ego’s defence mechanisms have failed at the neurotic and psychotic level, and that the Ego has transferred defence to the Es which acts in a self-destructive fashion.” (1981-1983). (See diagram)
In “normal” subjects who are well adjusted to the social rules and collective values of present- day society, unconscious psychic suffering remains latent. However, this entails a high psychosomatic risk on account of the type of introverted reaction arising from stress. The personality appears to remain normal and to carry out its social intellectual functions adequately, but deep structures fail with regard to emotions and respect for personal identity. Finding itself unable to cope with further tension resulting from emotionally meaningful and stressful situations, this deeper, more instinctual side of personality regresses to primordial phases of evolution, to a pre-verbal and pre-symbolic level, to the cell chaos where the soma becomes the only channel for expressing tensions that seek healing by manifesting illness.
Studies on early childhood have also shown that painful somatic disorders appear in young children when their psychic structure has not yet had time to create defence mechanisms. (Spitz, 1969)
As a Jungian analyst, I have used an approach based on the analytical psychology of Carl Gustav Jung to understand neo-plastic illness.
I noticed that sick patients invariably used their physical suffering to express a deep meaning that went far beyond that of the illness itself. Medical science tends mainly to treat the body according to accepted protocols and models and to neglect the soul, and more specifically, the intimate and inseparable link between the two. Since the causal laws that sustain scientific reasoning cannot fully explain the human mind and individual destiny that transcend such reductive rules, Jung’s theory of synchronicity provided me with a basis for reflection. It offers an alternative and an integration to the laws of cause and effect by helping us to understand phenomena that lie deeper than conscious ones. We know that Jung elaborated a theory of limited synchronicity related to two concurrent events that have the same meaning, and a theory of enlarged synchronicity concerning the coordination of two complex systems such as the psyche and matter, or the conscious and unconscious.
In cancer patients, researchers have observed a significant concurrence between a psychically traumatic event, or particularly difficult life-phase, and the onset of illness. The theory of enlarged synchronicity can therefore be used to understand the relationship between cancer and psychic activity. Psychically traumatic events, in conjunction with unconscious chronic depression, can determine laceration of the psychic system, a breakdown in the self-regulation mechanism, and cause what Jung refers to as a “loss of meaning”. A tumour is in fact a breakdown in the self-regulating mechanism of cell reproduction. This results in a kind of cell “madness”, or never-ending growth. The immune system can no longer depend on its NK (Natural Killers) to recognize cancerous cells that under normal circumstances are eliminated on a daily basis. Synchronically-linked physical and psychic events therefore coincide to bring about a combined loss of “meaning”.
Accordingly, illness is the evident sign of an interruption in the complementary functioning of body and psyche. Paradoxically, it also becomes an attempt to put the two systems together again. In fact, in modern physics, energy becomes a unitary concept that combines characteristics of both physical and psychic reality.
Initial therapy concerns the subject’s reaction on learning about his condition. The tumour inevitably makes him consider the fragile and precarious nature of his body, the possible mutilations his body or its functions may have to undergo, the loss of something that will never be the same again and the reality of death.
There may be symbolic meaning attached to where the tumour is located, especially if genital regions are affected, as in the case of breast and womb cancer in women or prostrate cancer in men. Patients experience a strong loss of identity that is connected with their sexual image and the ability to procreate. Since identity usually coincides with body Ego, self-perception is dramatically altered.
In this dramatic situation, the time-space function becomes relative. The psyche attempts to set up regressive defence mechanisms that enable the subject to reach the profound layers of his own being and personality structure where there are traces of his life-history from the earliest childhood experiences starting with the Self.
In my work as an analyst, I have witnessed a betrayal of the Self in Jungian terms, i.e., the totality of the conscious and unconscious psyche, of the psychic and somatic sphere. Without using words or images, the ‘mad’ cells scream out an ancient despair that erupts in the somatic manifestation of cancer. At these profound, even archetypal levels, instinctual and imaginal aspects of the self that are activated and recognized during psychotherapy can interrupt this self-destructive process, thus giving rise to a dynamic mechanism capable of transforming personality, an essential step on the road to self-healing. We must not forget that neoplasia means new formation. To complement cancerous disintegration, the Self seems to promote psychic centering. It thus becomes the focal point for the continual psychic processes of differentiation and integration, as it adjusts to new circumstances.
In point of fact, several of my patients abandoned introjected models and security. Some revolutionised their life-style by giving up a steady job or a staid relationship; others were less drastic in their soul-searching, but all of them tried to give a meaning to their illness and to understand the truth and essence of their own being and existence.
At the onset of illness, patients have to face depression related to the emergence of the disease. This is accompanied by a myriad of symptoms that vary according to the structure of the patient’s personality and to the individual’s complexes. Moreover, subjects begin to assess the Ego’s ability to come to terms with this traumatic event. Patients appeared to have a personality in which a rigid super-ego structure adapted to prevailing collective values. Consequently they suffered from deep negation of the levels of the Self. Initially many of these subjects had difficulty in remembering dreams and were unable to use their imagination.
A state of regression and the need for support favour the setting up of a relationship based on emotional dependence. This can lead to successful therapeutic transference during which powerful parental images are constellated and archetypal instinctual roots are activated to enable patients to attain energy for a possible cure and past, present and future libidinal vitality.
At a psychodynamic level, most patients have a personality dominated by an archaic narcissistic Super-Ego that absorbs all instinctual energy. By being “perfect” they sacrifice themselves to a false, primordial concept of love in which they heroically forego their identity by destroying their Ego. By curbing their anxiety, they can set up a relationship based on projections of a strong and positive parental authority that is able to take care of them like Winnicott’s “relatively good mother”.
In this way they are able to process their fears of disintegration and non-sense, and also create a shared inner and intermediate space in which they can attempt to give meaning to their life and illness, thereby discovering the unknown aspects of themselves that determine crucial changes.
Although each patient has her own individual story, they are all linked by a common denominator: each one experienced failure in her primary relationship. Their mothers – themselves affected by similar unresolved problems – failed to provide them with holding, the empathetic nucleus in which they reflect themselves and can learn constancy, intimacy and sharing. These women always had to live up to the wishes of others, they had to be “as You want me”.
According to Jung, by referring to the Self as the central archetype responsible for the process of individuation, we are dealing with primitive levels of psychophysical functioning. “Archetypes are behaviour patterns that coordinate unconscious psychic processes. They have a specific impact as they develop numinous effects that manifest themselves as affections. As such, they represent an impalpable, psychoid element of the collective unconscious”. (“Synchronicity: an acausal connecting principle”, Vol. 8, p. 465, 1952)
The term “psychoid”, in Bleurer’s concept, defines sub-cortical processes involving “adaptation mechanisms related to the reflection and development of the species”. This concept which lies between somatic and unimaginable, unconscious, psychic spheres is useful in helping us to understand the role of synchronicity in the onset of cancer.
The principal archetype constellated concerns the polar opposites: birth and death. At a certain point during analysis, patients report the appearance of a baby or young child whose psychic significance seems to indicate rebirth. According to Jung, “the symbolic Child” who emerges from deep levels of the psyche, signifies the possibility of individuation and a successful prognosis. In Jung’s interpretation, individuation represents the aim and the meaning of our existence. These special cancer patients activate this process very quickly as time is running out for them. They have no time to waste in accomplishing their destiny. In their sick body, inner space becomes an alchemical receptacle in which they can heal the body and soul through the psychic transformation of their own individuality.
Patients begin to listen to themselves and to their own body. They examine feelings and events to find meaning in their personal life; they develop a new way of relating to their dreams. The symbolic Child is welcomed into their life as a living reality. This demonstrates their immediate need for looking after themselves without further delay. Their plan for inner growth must be sustained and nurtured; they realize they can influence their own fate.
In these special patients, this process sets in motion two essential functions involving adaptation to time and space. When a person is affected by cancer, processes apparently come to a halt. Time runs out and there is a drastic decline in cell replication of the physical space inside the body.
On the contrary, during therapy, subjects who had chosen ‘thinking’ as a way of adjusting to life, discover that ‘feeling’, previously discarded as inferior, is a hidden treasure. This insight alters their values and the way they relate to themselves and others in their new existence. Other individuals who had adopted a rational approach to life, cultivating atheist tendencies or never giving thought to spiritual matters, find a religious and spiritual inner dimension that stems from the need to give sense and meaning to their life.
Death and rebirth become symbols for periods of transition – narrow doorways that must be crossed in order to embrace new horizons. The synchronicity factor, which is actively present in the psychoanalyst as he observes a patient, comes into play both during and after the psychoanalytic session.
The emergence of the symbolic Child (itself a synchronic revelation) is a psychic occurrence resembling synchronicity which becomes the third element in the psychoanalytic relationship. For both the patient and therapist it is the living symbol of the recovery of meaning; it must be heard, nurtured and respected.
The Child can be likened to Fordam’s primitive Self. That is to say, he stands for the completeness of psyche and soma that existed in germinal form from the beginning of life in the womb. Fordam describes the primordial Self as a “constant state of integration” whence the child’s Ego and physical development will develop by dynamic processes that he called “deintegration-reintegration”.
The archetype theory implies that the child has a predisposition for developing archaic concepts, fantasies and feelings without any input from the outside world, and without any introjection on his own part. The archetype theory brings together body and psyche and gives deep meaning to their dual polarity. Archetypes are unconscious entities that have two poles: one expresses itself through impulses and instinctual urges, the other through spiritual aspects. Parents build and influence the archetype’s spiritual pole when acting as mediators between the cultural pattern of society and the child. (Fordam, 1976)
Unlike neuroses, where traditional clinical analysis aims at attaining revelation, the analytical objective with cancer patients is to recover and construct what was not developed in previous relationships. In this context, interpretation means building up new meanings with the patient by encountering and countering the two essential intrapsychic and interpersonal models.
By the grace of God, phenomena linked to synchronicity have sometimes occurred even during a psychoanalytic session.
I remember a case in which a woman was about to undergo a check-up after being affected by cancer. She was so worried that it was as if a dark destructive force in her chest was trying to destroy her. Together we worked on this body image that had taken on the shape of an archaic anger associated with her birth and the negative relationship she had had with her mother. Her mother, who nearly died during childbirth, had seen her baby as a kind of assassin. After giving birth she rejected the child and left her with her own mother. During the tense psychoanalytic session, the pain in the patient’s chest and belly gradually eased. A bad thunderstorm added more drama to the situation. When the patient got off the couch, she was drawn to the view from the window: the leaden sky, that was still full of grey clouds, had lifted. On the horizon, the setting sun was bathing the treetops and terrace flowers in a warm golden light. A rainbow was clearly silhouetted against the sky. As we took in this wonderful sight, we looked at each other, silently sharing our emotions and the deep sense of rebirth we felt to be in and around us. Even when Nature is violent, the sun is always ready to appear from behind the clouds so that light overcomes the darkness. A rainbow has the transcendental function of uniting earth and sky in a “coniunctio oppositorum”.
Naturally, the next day the patient underwent her check-up in a more serene state of mind. The results were negative and the dramatic psychoanalytic session gave her renewed faith in the possibility of bringing about a change. This woman was destroying herself to atone for the guilt she felt for being born, and at the same time (vedere) to annihilate the negative maternal archetype she had inside her. The only way she could do this was by destroying herself.
Neumann says that,
Human life acquires meaning when confronted with a “coincidence”. I coincide with the world, I coincide with myself, the Ego-Self and world coincide with one another, they belong to each other, they are one and the same thing, they are forever and everywhere. If the individual lives his life as if it were his destiny, as the “whole world”, as the attainment of meaning, he reaches accomplishment not only with the passing of time, but also in an extra-temporal dimension. In the process of becoming, of living out his own destiny, he accomplishes the unity of the Ego and the Self, the conscious and the unconscious, but also the projection of himself and his Self in a wholeness of inner and outer becoming. (Neumann, “The Self, the individual and reality”, Psyche and levels of transformation of reality. A meta-psychological experiment. 1952).
Another female patient who was undergoing chemotherapy after a mastectomy reported three parts of a dream:
I’m walking hand in hand with a child of about six towards a mountain lake.
I’m on a horse that has gentle eyes and seems to be real. I see a stiff, inanimate horse that starts to defecate something that looks like solid cannon balls. To my surprise, as I watch carefully, the horse turns into an adolescent boy of about 15 or 16. We develop an understanding based on glances and gestures.
During a frenetic party, I go outside and find myself on the wooded paths of my childhood. Walking along a grassy path, I bend down and find some earrings: first a terracotta-coloured drop-earring, then a pair of dangling earrings with small emerald-green beads. This reminds me of the children’s game of “finding treasure!”
In the symbolism of this game and the pattern woven by free association activation during analysis, “finding treasure” seems to indicate sacredness. This transference is steeped in meaning, referring as it does to a positive mother imago that compensates for the severe lack of libido the young woman had experienced in her early relationship with her mother. As victim and persecutor of her sick husband, the latter had been unable to love her daughter who was the fruit of this pathological relationship.
Winnicott conceptualised early mental states, linking them to the presence of a healthy mother who was capable of holding and reflecting. He also took into account the paradoxical nature of the Self that needs the Other in order to develop its inner and outer characteristics.
Masud Khan claims that the Self is built from symbols that represent it. The Self draws on inherited anatomy and physiology but is also made from its own symbols which both constitute and represent it.
Children are terrified of being eliminated. To overcome this fear they need protective boundaries. Cancer patients experience a similar kind of fear with regard to their illness as this represents an inward threat to the boundaries of their identity.
Clinical cases give analysts the opportunity to work on multiple levels of depth and transference at the same time. One of these levels, which we can call Winnicott’s “little Self”, pertains to early childhood natal and pre-natal experiences. The other is Jung’s “great Self”. During analysis, both of these continually appear and intertwine. On the latter level, the predominantly archetypal images take the shape of the child, the great mother and the mostrum or all-consuming cancer. However, as Neumann suggested, there could be a deeper layer or Self sphere that governs a region higher than that of the archetypes. It is here that synchronic phenomena may occur.
Miracles occur at these levels. A female patient who underwent analysis for six years following cancer of the liver, has now suspended all treatment because she has fully recovered. For over a year her liver has shown no signs of cancerous formation. She has transformed her destructive tumour into a full and different life. This patient has also started studying again and has qualified as a music therapist. She has written a wonderful thesis on pain as her inner path to transformation. Now she uses her experience to help others, rather like Orpheus who, after descending into the underworld, was born again to give voice to the Soul.
At a certain point during therapy, I advised another female patient to draw with her left hand. She produced a series of scribbles that gradually turned into a kind of alchemical process whereby images took on meaning and began to guide the process of individuation, using a plan whose authority went well beyond conscious knowledge. …
I assisted this patient for a period of time during which she made significant progress in accomplishing her destiny as regards important affective relationships with others and herself. She also published a book about the condition of women and had a deep spiritual experience that linked her to the Tao.
At a certain point, her illness took the upper hand. I stayed with her until the end. She phoned to ask me to go visit her because she did not have the strength to come for an analytic session. The following morning I went to her house but was unable to speak to her as she was sleeping under the effect of tranquillisers. I stayed quietly by her side in the home she had lovingly put together. I talked with her husband about approaching death and how he too was preparing for this event.
On the evening of the same day, I was at the cinema when I felt a sudden pain in my heart. Breathing in deeply, I tried to relax and feel my body. I had a vision of my father who was in hospital at the time. I thought he was dying. I looked at my watch. It was a quarter past nine. The pain continued. I thought I was having a heart attack but was comforted by the fact that the hospital was only a stone’s throw from the cinema. I focused my attention on my heart, breathing in to expand it. Gradually the pain went away. As soon I could, I rang my mother to know if she had received any telephone calls from the hospital. She assured me that my father was well. That night I dreamt that “the patient came to visit me in what had been my childhood bedroom. She woke me up. Light as air, she solemnly informed me that she had come for the analytic session we had missed. She wanted to say goodbye as she was about to leave. Her farewell left me with a feeling of gratitude and affection, and also the impression that something had been left unfinished. I tried to get up but she went away, passing through the window like a breath of air, going in a northerly direction”. The next morning her husband told me that his wife had “left” the previous evening at a quarter to nine.
This episode of synchronicity shows the depth of the bond that links the unconscious in the Self sphere of two individuals. This can become a gestalt in which even the other person’s body is a receptor of messages full of real and symbolic meaning about fateful transitions that involve us and of which we are witnesses in a totality of meaning.
We must not forget, at this point, the importance of the personal involvement on the part of the psychoanalyst who, during analysis, experiences and works through the descent into the underworld and rebirth into the light. Moreover, in these particular cases, careful control is needed to deal with any psychic involvement that may occur at an unconscious level and that could lead to numerous somatizations. In fact the body of the psychoanalyst can experience what the patient is unable to feel and imagine.
A child of five came for treatment after her mother died of brain cancer. Having been told nothing of this, in the play session she expressed all the drama of the loss that had been denied. At the end of the session, I had a bad headache and felt the need to drink a glass of warm milk. After a while my headache disappeared. The next morning an insight enabled me to link my headache to the dead mother’s cancer and to understand that in my acting-out, the warm milk represented, from a therapeutic point of view, a good mother’s gesture of awareness and recovery.
In its original etymology, the word “sense” (German Sinn, French Sens, Italian Senso, Spanish Sentido), a synonym for ‘meaning’, leads us to the body, to its interrelated sensorial functions, to intuitive knowledge and judgement. It is as if we were listening to the language of the soul turned into flesh since everything contained in the psyche is the result of consciousness perceived through the body. It expresses our moods, our feelings, our past experiences; it highlights any incongruity between words and being; it enables us to satisfy our needs through actions, and it fulfils our desires.
We have seen how patients who were brought up to control their feelings have difficulty in expressing them sincerely, both at a real and at an imaginary level. However, when a powerful feeling i.e., an irrepressible message of the soul, is prevented from expressing itself in the real world or through imagination, it is reflected and turns back on the body where there is a synchronic, essential and meaningful link between feeling and expression. It is not a causal relationship like the one between feeling and its physical, extroverted manifestation. In the synchronic functioning of the two body-psyche systems, cell differentiation is an illness resulting from emotions repressed at the conscious level, or never expressed at all. At the same time, it is an attempt at rebirth that has failed on account of the release of destructive forces arising from unconscious depression or pent up anger. There is a return to an archaic embryonic state. For reasons that are still not clear, our DNA reactivates cell reproduction typical of the early stages of embryonic growth. If we look carefully, we can see the logic in this infinitely small mechanism: our DNA carries the deep “meaning” to be accomplished in each individual life. It has the blueprint to characterize the cells of specific organs which, when working together, constitute that higher harmonious system known as Man.
Here we can witness the process that begins with destination and ends with destiny.
If disaster strikes and is not worked through by the psyche, destruc tive emotional forces distort the plan designed to attain order and wholeness by regressing towards a primitive state. Following their basic primitive genetic pattern, cells reproduce themselves in an anarchic fashion: they simply want to be themselves! They return to being primordial arche-cells in the autonomous state in which they existed before becoming part of an organized whole. They return to a primitive, unsystematic, undifferentiated maternity, devoid of meaning or direction, to a state of original chaos before the arrival of time. Their ‘madness’ is a kind of rebellion against hierarchical order, an introversion and a condemnation of the psychotic functioning of the whole system.
The contents of the psyche become concrete reality in matter in a process that resembles limited synchronicity. In the concept of “entelechy”, where the idea of a primordial energy is simultaneously accompanied by its inherent plan, we find a similar project for the realization of the total man.
If man does not follow this plan, his psyche signals the lack of harmony and cancer becomes the synchronic expression of suffering in the deepest layers of the Self. The individual fails to understand the significant relationship between illness and destiny which demands a radically different approach to “being in the world”.
The lack of harmony resulting from illness requires the patient to undergo a “phase of transition”. The patient must understand the “meaning” of his own destiny by questioning himself about the disease: “Why is this happening to me?”
By entering the field of synchronic occurrence, therapy can modify regressive, self-destructive mechanisms so as to build up a new order based on the recovery of “sense” from “non-sense”, thus creating links between matter and psyche.
In this way a bridge is built between destiny and cell destination, and vice-versa.
In cancer patients, the relationship with the Self and their own Soul has ceased to function. These subjects have adapted to collective morals, created false pseudo-sexual and pseudo-authority values based on external images that convey non-authentic “identities”.
In the course of our work we see that when the conscious mind does not communicate with its unconscious potential, when our Ego refuses to face up to problems and to take on responsibility in accordance with our own personal ethos, this potential energy can become a destructive force in man and society.
The reification of illness therefore contains a message in which the psyche demands a transformation of awareness. This then leads us to make a further consideration about this illness which is so personal, original in its manifestations and non-contagious in a collective sense.
Every society in some way influences and determines the death of its members. Suicide – a supremely individual act – is in reality influenced by social factors. Durkheim claimed that the high suicide rate in western countries is related to anomy, a typical characteristic of western culture.
In-depth psychology provides us with instruments for understanding this phenomenon. In fact, when Jung observes the psychic dynamics at work during individuation, he grasps the instinct of awareness.
So when the desire for widening knowledge is unfulfilled, at a collective level, a species-related destructive mechanism eliminates unsuitable individuals. We can see this phenomenon at work in the mass suicide of some animal species.
Man’s destiny is to face up to the anxiety of existence. He cannot flee from himself, otherwise shadows will attack and destroy him. His task is to attain zeitgeist, the unexpressed potential, concerned with the spirit of the age, which, apart from shared values, requires changes in basic feelings and thoughts, and a renewal in attitudes and respective institutions.
Man is a microcosm that has all the potential of a macrocosm. Through his experience the universe accomplishes the creative process that produced him as the goal and centre of existence. Man cannot escape from the unconscious creativity of Nature which, through his suffering, leads to transformation and constructs the history of science and civilizations.
Not all men are destined to be “geniuses”, but all of us should learn to cope with the stress entailed in the process of individuation which requires us to accomplish day by day our own creativity in a personal way. If this does not occur, man becomes ill. From a synchronic point of view, the illness, which is an extreme type of experience, is like a double-faced Janus suspended between sense and non-sense, capable therefore of becoming a provocation and leading to awareness.
This quiet, continuous research on the frontiers of experience confirms the fact that Jungian psychoanalysts have the vocation to be “High Priests of the Self” who, according to Professor Giancarlo Tedeschi, are ever ready in their Sacrum facere to greet the unconscious and its manifestations, so that they may humbly bring to conscious knowledge all that is still unknown.