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Treatment of allergies became a part of psychosomatics, and subsequently psychoanalysis, following the work of the Chicago School, especially Franz Alexander and Thomas M. French in 1941. Alexander and French focused primarily on asthma rather than cutaneous allergic reactions, but later authors approached these initial studies quite differently. Distancing themselves from the idea of hysterical conversion, they established a link between psychic conflict and analogous somatic conflict. With respect to allergy, they looked for the conflicting elements they considered characteristic. For asthma, these conflicts were primarily conflicts between infants' dependence on their mothers and instinctual demands that threatened this dependence. The crisis itself was associated with an inhibition of emotional expression, especially tears.

Because these factors were not specific, other authors returned to classical methods of analysis. Phyllis Greenacre (1945) insisted that oral sadism can be masked by streams of crocodile tears; here emotional expression assumes renewed importance in an interpretive framework. Jacob Arlow (1955) considered an allergic attack to be a manifestation of transference essentially associated with sadistic fantasies of incorporation. Melitta Sperling (1963) also demonstrated the links between allergies and pregenital factors. Philip C. Wilson (1968) hypothesized that transferential acting may be involved. In the end, the dimension of conversion returned to the foreground. Michel de M'Uzan (1968) insisted on the need to clarify the formation of somatic symptoms, and he turned to the notion of psychosomatic structure.

Pierre Marty reinvigorated the concept of allergies through his description of the allergic character (1976), which followed his account of the allergic object relation fifteen years earlier. He gave the allergic character the following traits: absence or avoidance of aggressiveness, a capacity for identification, absence or avoidance of conflict, considerable merging with the other, and projection as a mode of identification. To describe these traits in turn, absence or avoidance of aggressiveness gives subjects a socially agreeable cast, but is based on a weak capacity for negation, which in turn indicates a weak superego. The capacity for identification was already included in the allergic object relation. Merging with the other (absence of anxiety in the face of the foreign) is also characteristic of certain forms of primary epilepsy and allergic epilepsy, described by Marie-Thérèse Neyraut-Sutterman. Projection, described in 1957, becomes a mode of identification. As a consequence, subjects are unable to project bad objects or to distinguish good from bad.

Only when the allergic child is able, through stranger anxiety, to be afraid do allergic mechanisms begin to diminish. The features above can be found together in a character neurosis (which Pierre Marty referred to as a common allergy bundle), or they can appear as simple, relatively invasive traits that form a more or less split-off component of the personality, manifested only during regression (Pierre Marty referred to these as lateral lines) or deep splitting (parallel lines).

An allergic crisis can be triggered by the overriding of identificatory possibilities, as when the child is presented with two equally invested objects where the identifications have been kept separate. For Pierre Marty, a somatic manifestation is seen as a way station within a regressive movement and not, as in the psychogenetic approach, as the somatic expression of a traumatic situation. For Michel Fain, the unconscious of the typical allergic is the seat of the mother's desire to have the child regress to a primary narcissistic stage of feelings of unity with her, a desire that keeps an entire portion of the ego of the allergic patient in an embryonic state.

For Marty, these properties and variations result in distinct therapeutic indications. In typical cases, the allergic individual is very adaptable, also in the allergic's relation to the analyst and to analysis. The down side of this is that there is a risk of an outbreak of somatic manifestations at the end of treatment. He therefore recommends psychotherapy as a prophylactic, which can help the patient to recognize unconscious factors and become aware of the danger of certain object relations. Marty believes that medical treatment is indicated for somatic disorders, and that analysis and psychotherapy should not be recommended for allergic manifestations.

This conception of an allergic quasi-structure has led to more recent work by Léon Kreisler (1982), Michel Fain (1969), and Gérard Szwec (1993), who have addressed these problems in children.

ROBERT ASSÉO

See also: Allergic object relationship; Asthma.