Found an interesting psychoanalyst on psychosomatics

[Time2be]

Just a bit from my reading of Joyce McDougall, who was a reknown psychoanalyst. Some of her work is on psychosomatics and she says some interesting things in her book "Theaters of the mind". I ordered also her book with the title "Theatres of the body" - this might be even more to the point.
She says that psychosomatic symptoms are the effect of emotions that are not felt (at all!!) and which the patient is not able to recognize as such. Usually, she says, this pattern is already established during infancy. Parents that never address a child's tension and bewilderment, rage or other emotions make it difficult, if not impossible for the child to develop psychological tools to manage with a situation of deep insecurity etc. The child will learn the externalisation of the tension, and as adults we do that also, e.g. when we smoke, drink alcohol or with binge eating. But also the psychosomatic disorder is a sort of externalisation. It is not classical repression she says, but rather a replacement that erases all signs of an inner conflict. Instead of emotions the psychosomatic symptoms take over. She goes on "I think that in such situations (psychosomatic crisis) the body defends itself as if it is threatened by a biological disease and the body uses by mistake the same strategies as for survival." (my translation, I only have the German version at hand right now). I find that very interesting because this would explain the physical reactions. Survival strategies are fight and flight reflex etc. I don't think that she says something totally new, but I like the links she is spinning between psyche and soma.
Here a link to her obituary :
https://www.theguardian.com/society/2011/oct/24/joyce-mcdougall-obituary (Joyce McDougall obituary)

 

[Time2be]

Just an addition: the idea that the pain is self defense of the body against the mind or psyche seems to be quite intriguing. I for my part have a tendency to think of the body as the attacker, but defense and attack are easily confused and mixed up.

 

[Dorado]

Very interesting; thank you for sharing! I 100% agree about the body defending itself as if it's threatened by a biology disease in many of these cases - beautifully worded.

She says that psychosomatic symptoms are the effect of emotions that are not felt (at all!!) and which the patient is not able to recognize as such.

This is one thing I don't necessarily agree with, and it comes up quite a bit in TMS discussions. I think it's definitely possible for psychosomatic symptoms to pop up after directly feeling and being aware of specific emotions. One example is a migraine coming on or Raynaud's flaring up when someone gets into an argument or become self-conscious. I know my nerve pain heightened and still comes back (to a much lesser degree these days!) when I actively feel fearful or angry. Perhaps our subconscious has a deeper or maybe even an alternative interpretation of these emotions, but I do think we can consciously feel the emotions that bring on TMS in some cases!

 

[Time2be]

oh yes, Caulfield, TMSer are aware of some emotions and sometimes these emotions are pointing into the right direction - to were the problem is situated. That's right, I also have feelings and know that they are related to pain. But I must say that I often cannot say precisely what the feeling is other than feeling anxious or disturbed. I don't think that she claims that TMS people don't have a clue about their emotions and can never feel them. We learn to feel and express them. But many (including me) are very astonished about what is covered underneath the very rational and reasonable appearance. She also deals with severe cases of alexithymia. These patients have almost no vocabulary to express feelings. I guess they are somewhere in the autisme sprectre. For me the idea of the body in defense is an eye opener. I'll keep you informed if anything interesting pops up from the new book
I think what Sarno means is that no matter how far we got in uncovering our subconsciousness we never will be able to uncover the whole. What is hidden is also not always a specific trauma but a mode of reaction. Scrutinizing yourself for 'one' reason for your pain, like looking for this one trauma, sounds a bit Hollywood psychoanalysis for me. Like in the classic Spellbound with Ingrid Bergman as psychiatrist. At least it makes more sense to me that the body learned certain ways to react and these ways are deeply engraved and can be actualized by triggers. I see several steps in healing TMS and some might not have to go through all the steps:
1. the knowledge that you don't have a severe disease but just some psychosomatic reaction is enough for some. They calm down and the symptom disappears
2. Looking into your emotions, writing it down etc. is healing for some. This is integrating parts of your psyche that had not been recognized before. For others this is not enough.
3. A process that has the goal to reorganize your body and nerve system. Step 1 and 2 help, but to change the bodily reactions time is needed. You simply need to establish new circuits that could overrule the old ones. In a more humanistic language: you need to develop a different understanding of yourself. I think that Alan Gordon's program is addressing step 3 (of course including the other steps).
Does this make sense? I am kind a stuck in step 3, sometimes still struggling. And try to be patient

 

[Lizzy]

This sounds very interesting! Maybe this is a bridge between pure Sarno and the more soothing approach.

I know what causes some of my symptoms. For instance, I found out that my estranged father is dying and my big toe has hurt to various degrees now for almost 6 months, depending on news I hear. Thankfully, most of the time it only hurts when fully bent, and doesn't stop any activity. However, other symptoms are a mystery as to specifics.

If we could better understand the specific type each of our TMS symptoms are, maybe we could make better progress. Soothing might work for my toe, but maybe I also have a repressed rage causing other symptoms that won't respond to soothing? Hmm.....

Thanks Time2be! Very intriguing!

Lizzy

 

[Time2be]

Now I can give you an update. I have read the book by Joyce McDougall "Theatres of the body. A psychoanalytical approach to psychosomatic illness" (1989). It's not like she is telling us revolutionary new things. But I got some insight into the child-mother relation that lies in the background of psychosomatic illness. As she is a psychoanalyst she uses a lot of typical psychoanalytic terminology and sometimes also explanations (oedipal crisis etc.) which I just skip for now. Her main point is that psychoanalysis (and this goes also for some approaches to psychotherapy) has focused solely on language and the symbolic world a patient has developed. Usually with neurosis the underlying conflict comes to surface with dreams, metaphors etc. Not so with psychosomatic patients. The neurotic conflict - something that also could be present - is not the underlying problem. Psychosomatic patients simply don't bring the material a psychoanalyst is used to and the body speaks an entirely different language. Psychosomatic patients are able to say something about emotions but are not 'emotional'. She found out in her long practice that she needs to address psychosomatic patients differently. The reason why individuals react psychosomatic rather than neurotic lies in the very early relationship between the child and the mother. If a mother not enables a child to integrate a soothing and positive representation of the mother, the child will in later life not be able to calm itself down. It will search for external help (drinking, smoking etc). The feeling of being overwhelmed by reality (which stems from the fact that the infant is not in control of its body and the satisfaction of its need) is very disturbing and is usually soothed by the mother. If the mother is either not really interested in the child or is overstimulating the child, these emotions can not be processed psychologically in the right way. The child doesn't learn how to deal with these emotions. It will either act out or feel the emotion directly in the body. Because this is what the baby does: feeling everything somatically. Very simply put: psychosomatic individuals have a baby-like way of dealing with overwhelming emotions.

She also says that psychosomatic patient often have a very fundamental insecurity: "The self is therefore reinforced against a feeling of inner death that stems from disturbed infancy" (29). I think that resonates with lot of us. The feeling that there is something missing deep inside. Or even that we don't have a right for existence. This again would be a difference to a neurotic patient: the neurotic patient feels to have no right for certain desires and represses them. The psychosomatic patient feels to have no right for existence as such. Something very fundamental. I think the psychologist Eriksen has called this missing ontological security.

I have to say that psychosomatic illness for her is also somatic illnesses like asthma or colitis ulcerosa. From a psychoanalytic point of view there is no purely somatic disease. This can of course be debated. But I think there is truth in this and research in immunopsychology also goes in this direction.

"In attempting to conceptualize the body-mind relationship outside the role of language we must formulate at least one pivotal question: What defense mechanisms can the infantile psyche use to protect against the return of early traumatic experience and the reexperiencing of the accompanying anguish which might prove intolerable to the individual?" (102) I think this is the also the question Dr. Sarno posed and today we are in the fortunate position to be able to answer this question also with knowledge from neuroscience. The short circuit between the traumatic experience/reexperience and bodily symptoms can also be explained by the pathways of the brain. I think it is therefore for some patients not enough to know that the pain is psychosomatic, but they need to unlearn these pathways (Dr. Schubiner).
Journalling and feeling the emotions is therefore so central. In her words (and here it is dreams that take the role of journalling etc. ): "When we are able to give expression to primitive feelings and fantasies through our dreams (where we are permitted to be deluded and hallicunated) and through freedom of daydream, it is possible that these may prevent the body from acting in a 'delusional' way, that is, reacting with somatic responses that obey no biological need. " (66). Otherwise the individual is just acting out, going to doctors, smoking, drinking ... whatever helps to get rid of this horrible feeling of being overwhelmed by feelings that cannot be controlled.
For me this is very helpful to understand this incredible tension that can built up in the body, the correlate of emotions. She also says that some patients have difficulties in pointing to a particular emotion because the body just indicates 'turmoil'. To learn to distinguish is part of the healing process.
I don't know if this is helpful for others. It helps me to understand some of my reactions and being also more patient with myself. And she also has some case studies where the client has been helped. That's at least encouraging. I don't think that pure psychoanalysis is the way to go. I find it still too much limited to 'talk' and there is a danger of intellectualizing.