Psychosomatic Symptoms

Nowadays, the term “psychosomatic symptoms” is particularly widespread and is being used more and more over time. However, the boundaries of its definition are often unclear, as “psychosomatic illnesses” lie at the intersection between the body and the psyche, which seem to interact with one another. “Psychosomatic illnesses” usually refer to the effects of certain psychological processes on the body, and more specifically on parts of the body. Dermatitis, irritable bowel syndrome, and a stomach ulcer are some examples among a wide range of psychosomatic symptoms. The body suffers, but for unknown reasons. Thus, physical symptoms highlight, even at a biological level, the dysfunction and disturbance that exist at a psychological level.

According to a group of psychiatrists who worked collectively in the field of psychosomatic symptoms, the psychosomatic phenomenon is linked to “operational thinking,” also referred to as “mechanistic thinking.” “Operational thinking” is a form of impoverished thinking, lacking openness to understanding. A person who thinks in this way cannot assign symbolic meaning to what is happening to them. As a result, they end up talking about the symptom and complaining about it, but are otherwise unable to attribute any meaning to it. For example, a stomach ulcer is the actual symptom, but the marital problems experienced by the individual—which caused the ulcer—are real. Emotional overload could not find an outlet within the individual’s psyche and remains at the level of the body, as it cannot find a means to be expressed elsewhere, and thus the organ becomes ill. M. de M’Uzan vividly wrote that the “psychosomatic symptom is stupid,” meaning that it lacks symbolic investment and value. The patient is unable to see what lies beyond their symptom and to find symbolic meaning in it. In this way, the illness itself becomes a motive for what one is experiencing to begin to acquire meaning.

In the course of studying the psychosomatic phenomenon, the same group argued that a frequent companion to the distress of “operational life” is “essential depression.” This form of depression differs from the classical form of depression, in which the individual blames themselves and believes they deserve punishment. It is a “depression without an object”: there is a sense of fatigue—a fatigue that resembles that of everyone, without particularity—yet it is an unrelenting fatigue that becomes exhaustion in the face of life, a weariness toward life itself. There is a diffuse discomfort; the person does not feel depressed, yet lacks enthusiasm, lives in conformity with the world, and does what they are supposed to do. Their thinking is practical and confined to the present. The individual develops into a state of “operational life,” living a repetitive and monotonous existence and maintaining only those activities governed by a strong sense of obligation.

The difficulty that arises in this condition is that the individual experiences a tension often described as a general state of stress, yet cannot connect it to any specific cause. However, they complain of various physical discomforts, as the body asserts itself through the pain it expresses. Psychosomatic dysfunctions appear due to the psyche’s inability to metabolize tension. The symptom through which they manifest may range from something relatively simple to something highly complex. For example, someone about to take exams may experience frequent urination. “They regress only in this particular aspect, and this does not mean that they regress as a whole. Otherwise, they function normally. The symptom lasts for a few hours. Once the exams are over, the symptom disappears. At this level, psychosomatic dysfunctions are very useful solutions and simple. They become serious when they persist longer and begin to organize into symptoms and illnesses.” A corresponding example of such an illness is what are known as “autoimmune diseases”: their particularity lies in the fact that the immune system turns against the organism itself. The immune system is the body’s organic defense that protects us from enemies, both external and internal. When it functions normally, it does so in a way that never attacks itself. However, in the case of an autoimmune disease, there is a misinterpretation of the body’s normal components as a threat to itself. Here, the body’s defense is reversed and attacks itself. All these, along with many others, are symptoms expressed by the body. The body speaks—but what is it trying to say?

Indeed, if we reflect on it, the body on its own cannot assign meaning to the various distressing events that weaken it, because it constitutes merely a mechanical or organic process. Therefore, we are compelled to move to the level of meaning par excellence—that is, the level of the psyche—where language, through its symbolic function, makes it possible to decipher the bodily symptom. However, we should not assume that the psychic dominates the bodily, because in essence they are two different fields in which the individual simultaneously finds expression. The bodily symptom and its psychological meaning do not constitute two separate, autonomous, and independent realities. Rather, they are the two aspects through which the individual’s Self is expressed, simultaneously and inseparably, in terms of both the body and the psyche.

In other words, the bodily and the psychic constitute two distinct yet parallel languages that translate, each with its own grammar and syntax, the same sequence of events. This sequence is precisely what forms each person’s sense of self. The psyche is what makes it possible to translate, in linguistic and symbolic terms, what in the body is merely a mechanical or organic process. Thus, we are not dealing with two different things, but with two parallel processes. The bodily symptom is always accompanied by its psychological counterpart, and to the extent that it remains unclear and confused regarding its organic causes, it remains equally unclear and confused regarding its meaning and interpretation. With awareness of this parallelism, the work of psychotherapy intervenes at the level of the psyche, deciphering the bodily symptom and restoring clarity of meaning. As Canguilhem aptly noted, “The patient is a person who feels the need to speak to another person.” This is precisely where the first—and most decisive step toward healing—lies.