Cancer as a defence against depressive pain

An association between object loss and the predisposition to develop physical illness is well established in the psychosomatic literature. This paper describes a psychotherapeutic consultation with a woman who developed breast cancer after the death of her father by cancer, and the loss of her mother by dementia. Her cancer was preceded by persecutory dreams which ‘predicted” the cancer, and which ceased when the cancer was diagnosed. It is argued that the cancer represented a somatic defence against intolerable guilt and despair, which constitute depressive anxiety as described by Klein and Riviere. Cancer is felt by such patients to be preferable to grief and madness. Possible unconscious meanings and functions of the dreams and the cancer are discussed, as well as the patient's inability to avail herself of psychotherapeutic help.