Introduction:
First I shall look at this topic from the point of view that somatising is a way of dealing with psychic pain. I shall try and explain why this happens, exploring what might have gone wrong in the early development of the individual to create this particular defence. I then look at what I think of a more creative way of dealing with psychic pain..
Early Development:
If early development has gone well, psyche and soma become involved in a process of mutual interrelation, the good psychological environment being a good physical one. (Winnicott, 1949) “The beginning of that part of the baby’s development, which I am calling personalisation, or which can be described as an in-dwelling of the psyche in the soma, is found in mother’s…ability to join up her emotional involvement, which originally is physical.” ( Winnicott, 1970:264) An infant’s earliest external reality is its mother’s unconscious in that this determines the quality of her presence and way of being. (McDougall, 1989) When the mother/infant relationship is good-enough, a progressive differentiation between their bodies develops, as the psychological becomes differentiated from the physical. A mother who does not unconsciously interfere with her infant’s tendency to both merge and differentiate, allows him to develop into a “somatic and psychic autonomy”.. (McDougall, 1989:34)
Infants move from the physical into the psychological, so that anxiety starts in the body, the skin binding the body together but also ‘holding’ parts of the personality, which have not yet become differentiated from parts of the body (Bick, 1968) thus serving as a physical as well as a psychological containing function. Infants can only integrate (and unintegrate) in a safe environment and part of this process is “a satisfactory working arrangement between psyche and soma. This starts prior to the time when it is necessary to add the concepts of intellect and verbalisation.” (Winnicott, 1970:270).
Skin, Containment and Identity Formation:
If the environment is not sufficiently safe, disintegration may occur as a defence. In a preverbal stage, mental functioning then replaces the good mother, the mind becoming opposed to the psyche-soma. (Winnicott, 1949) Lack of containment of an infant’s preverbal psychological needs as expressed through the body, can lead to a “‘second skin’ formation”. (Bick, 1968:485).
Infants learn quickly to distinguish between what brings mother closer and what is met with no response or rejection. Communication can thus break down early due to a lack of real emotional contact. When separation and difference are not experienced as positive, they become feared as they threaten self-image and psychic survival. (McDougall, 1989) It feels like a “psychosomatic explosion” (McDougall, 1989:21), as though there is only one body for two, it is uncomfortable to be in your own skin. There is a failure to create a separate identity, body and mind lose their connecting links so that there may be a withdrawal from the body to the mind in an attempt to deal with the difficulty of separation. (McDougall, 1974) The disavowal of certain body parts may take place, as well as the foreclosure of emotionally charged ideas, are undertaken. Ambivalence is made more difficult. (McDougall, 1989).
Somatisation and its Consequences:
When an infant is not shielded from traumatic overstimulation/engulfment or understimulation/deprivation, healthy differentiation and identity formation may not occur, because of a split between psyche and soma. Psychosomatic illness tries to reverse this process, “to draw the psyche from the mind back to the original intimate association with the soma.” (Winnicott, 1949:254).
This is obviously a very concrete way of dealing with psychic pain, because it is preverbal, not available to word or thought and therefore remains very unconscious. Illness thus becomes an unconscious attempt at giving external form to the internal “unformable”. (Perelberg, 1997:61) The body then contains the psychic pain. Henry Maudsley’s quote: “The sorrow that has no vent in tears makes other organs weep.” (McDougall, 1989:139) The body does its own ‘thinking’, taking over from the unthinking psyche so that symptoms are signs, rather than symbols and follow somatic laws, a regression to a more primitive relationship between body and mind..
When these neurotic or psychotic defences no longer cope, because psychic pain is not dealt with in the sense of being engaged with, psychic pain gets ‘pulverised’, (McDougall, 1974:24) discharged or dispersed, negative experiences never become psychic experiences. This is a defensive, self-destructive way of dealing with psychic pain, the body bearing the brunt..
An impoverishment of the capacity to symbolise means that instinctual energy bypasses the psyche, affecting the soma directly, with catastrophic results. Psychic pain is not dealt with/engaged with, but psychically bypassed and transformed into bodily complaints. The body is speaking, but the mind is not, because what has been pushed into the body has never been thought about and is therefore unthinkable, the mind using the body, rather than the body using the mind. Psychic pain thus stays in the body and in the deepest, darkest archaic unconscious. Feelings are not thought about or expressed. The body becomes a concrete signifier, the psychosomatic ego having choked the archaic elements of creative fantasy in their beginning and becoming split off from its instinctual roots. (McDougall, 1974) Lack of containment has created a lack of space to internalise good objects, so that there is a psychic gap, leading to projective identification and identity problems, the beginning of dysfunctional development. (Bick, 1968).
“Thing presentations”, rather than “word presentations” (McDougall, 1989:43) have not been configured. This is the blanking out of an ego function, which may lead to operational thinking, a pragmatic way of relating. (McDougall, 1989) The physically attacked body might be a way of attacking the internalised mother symbolically. (McDougall, 1989) There is a psychic gap where the good object should be, so that an addictive/concrete relationship with (m)other has developed, a total dependence on external objects. (McDougall, 1974).
Psychosomatic Issues in Therapy:
By acknowledging, interpreting symbolically and making meaning, the therapist serves as a container for somebody who feels himself to be in pieces. In analytic psychotherapy, which is an object relations therapy, in which the internal and external world is explored and the mother-infant relationship parallels the therapist-patient relationship, psychic pain can be dealt with in the sense of engaged with, as an interchange between fantasy and reality takes place. The analytic setting is like a healthy skin, containing and enabling engagement with internal psychic pain. Working through of “the primal dependence on the maternal object can strengthen this underlying fragility…the containing aspect of the analytic situation resides especially in the setting and is therefore an area where firmness of technique is crucial.” (Bick, 1968:486) The fear of not being heard or seen leads to the disappearance of the wish to communicate in case of another failed emotional contact. A voice has to be found..
Conclusion:
As the analytic process is creative, rather than (self)-destructive, it re-establishes separated links and makes new ones, which is the opposite of the psychosomatic process, which breaks links between mind and body. (McDougall, 1974) It is my observation that people who have had several years of analysis find they are in better health and more creative as there is a possibility to reconnect with split off archaic fantasies. This psychic growth helps patients to feel alive in new ways: “It is better to be mad than dead.” (McDougall, 1974:10) It is the therapist’s role to gain access to and transform that which is known but has never been thought about or verbalised. (Perelberg, 1997) These somatic communications must be listened to and rendered symbolic through language, if our patients are to move from a self-destructive way of dealing with psychic pain to a more constructive one by engaging with it..
Bibliography:
BICK, E. (1968) The Experience of the Skin in early Object-Relation. International Journal of Psychoanalysis 49:484-486.
MCDOUGAL, J. (1989) Theatres of the Body, Free Association Books, London..
MCDOUGAL, J. (1974) The Psyche Soma and the Psychoanalytic Process, International Review of Psychoanalysis 1:437.
PERELBERG, R.J. (1997) To be-or not to be-here in Female Experience, ed. By Joan Raphael-Leff and Rozine Jozef Perelberg. London, Routledge..
WINNICOTT, D.W. (1949) Mind and its Relation to the Psyche-Soma, in Through Paediatrics to Psychoanalysis, Karnac..
WINNICOTT, D.W. (1970) On the Basis of Self in the Body, in Psychoanalytic Explorations, ed. By Claire Winnicott, Ray Shepherd and Madeline Davis. Karnac, 1989..
