The psychoanalyst Joyce McDougall, who has died aged 91, made significant contributions to the understanding of perversions, psychosomatic symptoms, female sexuality, creativity and addictions. Her clinical insights, theoretical originality, open-mindedness and lack of dogmatism made her unique throughout her 60-year career and enabled her to create a valuable link connecting the Anglo-Saxon and French psychoanalytical schools.
In the first of her four major books, Plea for a Measure of Abnormality (1978), McDougall challenged the boundary between normality and abnormality in sexual and gender development. The patients she described cover a wide range of disorders, including perverse sexuality, male and female homosexuality, psychosomatic disorders, narcissistic states and, in her view, the least analysable of all, normality. McDougall denounced courageously what she named "normopathy", the fear of difference, and emphasised the creative insight of those who were thought of as perverse or abnormal in other ways.
In Theatre of the Mind: Illusion and Truth On the Psychoanalytical Stage (1982), she went back to her favourite metaphor, presenting patients enacting fantasies on a kind of inner stage, in response to the pain of earlier parts of their life. The perverse sexual act functions like a dream, a kind of hallucinatory creation of an alternative reality and serves as a solution to avoid painful internal conflicts.
In a landmark contribution to the study of psychosomatics, Theatre of the Body: A Psychoanalytic Approach to Psychosomatic Illness (1989), McDougall presented a bold revision of the approach to the question of the relationship between the mind and the body. She created the term "disaffectation", a form of what was later to be known as alexithymia ¨C the inability to put words to feelings ¨C to describe those who had experienced overwhelming emotion that threatened to cause a breakdown in their sense of identity. Such individuals, unable to repress the ideas linked to emotional pain, simply ejected them from consciousness by "pulverising all trace of feeling, so that an experience which has caused emotional flooding is not recognised as such and therefore cannot be contemplated". These patients were not suffering from an inability to experience or express emotion, but from "an inability to contain and reflect upon an excess of affective experience".
"Human sexuality is inherently traumatic," begins The Many Faces of Eros (1996). As McDougall demonstrated convincingly, the psychic conflicts arising from the tensions between the inner world of primitive drives and the constraining and denying forces of the external world begin in earliest infancy, but have ramifications throughout life.
Born Joyce Carrington in New Zealand, she was the daughter of a family of traders who had emigrated from Britain. As a little girl, she used to spend holidays at her grandparents' house, and regularly developed rashes when she arrived. She realised, when she was five, that it was the presence of her grandmother that was causing this symptom, perhaps giving rise to her interest in psychosomatics.
She discovered psychoanalysis in her teens through reading Sigmund Freud's The Psychopathology of Everyday Life and resolved to study psychology. After marrying Jimmy McDougall, whom she met at the drama club of the University of Otago, she moved to London in 1949 to pursue her psychoanalytical training, accompanied by her husband and two young children. When she arrived, she wrote to the analysts whom she knew from her reading, including Anna Freud and Donald Winnicott.
She was accepted to start her train ing in child analysis by Freud at the Hampstead Child Therapy Course and Clinic, later the Anna Freud Centre. There she had her first experience of intensive five-times-a-week analysis with children. She was employed as a child psychologist at the Maudsley hospital, south-east London, and also attended Winnicott's seminars at Paddington Green ¨C a decisive influence.
In London, she experienced the hostile divisions following the death of Sigmund Freud: the "controversial discussions" dividing the followers of Anna Freud and Melanie Klein. She maintained her independence, refusing to become a follower of either and encouraging dialogue, an eternal exile wherever she found herself.
In 1952 she had to suspend her training and her work in London to follow her husband to Paris. On arriving, she found again a fragmented analytical society on the verge of a civil war between Jacques Lacan and Sacha Nacht. She eventually joined the Paris Psychoanalytical Society (SPP), and attended Lacan's seminars. As she spoke English, she was asked to treat a psychotic American child under the supervision of Serge Lebovici, which led her to publish Dialogue with Sammy: A Psychoanalytical Contribution to the Understanding of Child Psychosis (1960). This remains a major contribution to the study of infantile psychosis, detailing an intense therapeutic relationship with a boy who had been diagnosed as schizophrenic.
Her second husband, Sidney Stewart, an Oklahoman, had settled in France in 1948 to study and became a psychoanalyst and member of the SPP. A survivor of the Bataan death march in the Philippines and of three years in Japanese captivity during the second world war, he wrote Give Us This Day, an account of how the prisoners endured their suffering. He shared with McDougall a concern with psychic survival in extreme circumstances and a deep interest in the nature of creativity.
Elected as supervising and training analyst of the SPP in 1961, McDougall became involved in exchanges with British psychoanalysts and invited Winnicott, Wilfred Bion, John Klauber and Hanna Segal to give seminars and conferences in Paris. She also developed links with American analysts, as an honorary member of the Association for Psychosomatic Medicine in New York, a member of the New York Freudian Society and teacher at the Object Relations Institute of New York.
She gained a substantial international reputation as a clinician and theoret ician, and her many publications, elegantly linking the French, British, and American traditions, found a widespread welcome. Her work was translated into 10 languages, including Japanese and Hebrew. When invited by the Dalai Lama in 1993 to explain to him the aim of psychoanalysis, she replied: "To find one's truth about oneself." He responded that this was also the aim of Buddhist meditation.
A vivacious, generous, smiling woman, always elegantly dressed, McDougall wrote that "each person in his psychic complexity is a masterpiece". Sidney died in 1998. She is survived by her son, Martin, her daughter, Rohan, and three grandsons.
Hilary Joyce McDougall, psychoanalyst, born 26 April 1920; died 24 August 2011