What is Psychosomatic Illness?

I am going to attempt to explain this in a way that’s accessible, probably over-generalized, and therefore not in-depth and satisfactory to everyone suffering – but it’s a start.

Before diving in, let’s clarify that just because an illness is qualified as psychosomatic, or as having psychosomatic components, it is still absolutely real to the person experiencing it. Nothing about the psychosomatic quality of the problem means that the suffering isn’t real, or that it should be taken less seriously.

We are all familiar with the small (and not-so-small) child who complains of a stomachache before a challenging event – the first day of school, a swim meet, getting on stage - we understand that this may be related to their stress over the situation. Adults too can find their stomachs getting “funky” when dealing with stress, along with a lack of appetite, or trouble with sleep.

These situations are clear to us because we can easily identify the stressor for ourselves or our children. We can even feel the effects of the hormones our adrenal glands produce (cortisol, adrenaline) in our bodies. Our hearts pound faster, our skin tingles, and in addition to the nervous stomach we may have a lot of nervous energy. These are psychosomatic effects, but they don’t constitute a psychosomatic illness.

Psychosomatic illnesses are divided into four categories. Here is a very basic rundown.

1. Conversion symptoms.

This is what we see in the famous case of Anna O (one of Freud’s early patients), who suffered from paralysis along the right side of her body, as well as disturbances of vision, hearing and speech. There was no physical cause that could be found for her symptoms. She became better when she began talking about her guilt and resentment, things that were poisoning her unconsciously. She discovered that her symptoms actually had symbolic meaning, and there were reasons she was “paralysed.” Though this case happened about 150 years ago, the useful conclusion is that unconscious negative emotions can be devastating for the body.

2. Concrete symptoms.

These symptoms differ because they are actual medical problems, rather than the disparate complaints of conversion symptoms. Sometimes very anxious people create symptoms that have no symbolic meaning. For example, someone may become very caught up and aware of their digestive processes, actually creating a medical symptom of constipation, or dyspepsia, or nausea. Other than a sense of anxiety about their symptoms, there’s no awareness of any other psychological difficulty (unlike with Anna O. above). The complaints aren’t related to any medical organic dysfunction – the dysfunction is created psychologically.

3. Hypochondria symptoms.

Hypochondria sufferers are frightened and ask for attention from the medical profession and their family. Oftentimes the fear of a real organic illness is terrifying, and there can be a quality of paranoia in the complaints. These patients may feel they aren’t being taken seriously and can take offense at the idea of hypochondria. The difference with a Concrete Symptom is that the latter actually becomes a real medical symptom, whereas hypochondria speaks more to the attitude one has towards illness.

4. Organic illness

When one is truly sick, the psychological consequences can influence the evolution of the illness. For example, patients with asthma or other allergies find that their mental states can affect how severe their symptoms become. Others have noticed, anecdotally, that trauma or stress bring about diabetes (a hormone-controlled illness). Managing one’s psychological reaction to an illness is just as important as managing the medical issues around it.

We often see psychosomatic illness during times of trauma or stress in someone’s life.

For example, a child frightened by a change in situation develops a chronic cough making it impossible to go to school, which she enjoyed before. This is an illness based on regression, or a desire to go back to a previous state where things felt more secure. A very different example would be those who are unaware of their inner psychological states, and don’t have access to any feelings surrounding their frequent headaches/stomach issues/skin breakouts/etc. but suffer the constant effects in their bodies.

It’s not terribly mysterious to treat psychosomatic illness in psychotherapy, though it can seem that way. We all accept the idea of stress affecting our bodies, yet it can seem strange that we have feelings we aren’t aware of, that short-circuit themselves into somatic conditions.

Sometimes these patients don’t have words to describe their everyday emotional states, though they may be quite adept at describing their physical sensations. In therapy, it’s helpful initially to just talk about what an average day is like with the physical symptoms. It may take a while to connect with an internal world of feelings. The feelings aren’t accessible – yet.

Developing one’s curiosity and compassion is important in any psychotherapy, but especially when the body isn’t cooperating (or the mind is too anxious to cooperate with the body – either way). Easing the pressure and staying in the moment are essential, but so is a lot of patience.

Instead of analyzing what these symptoms mean, it’s more important – at least in the early days of therapy- to begin changing one’s attitude towards them.

This can often bring not only rapid relief from anxiety but allow for something creative and new to emerge – dreams, desires, fears, but especially – hope. Hypervigilance is exhausting and can be rather boring – but you don’t know it until it’s behind you.

A patient of mine no longer mentions her migraines but talks about sewing a quilt. Another patient whose digestion wouldn’t let him travel is going to China. Their initial reasons for consulting – migraines, digestion – are no longer a topic in their sessions – except to occasionally marvel that they are no longer a topic. How did this happen?

When we can begin to open up creative, associative thought we get the hormonal circuits flowing – metabolizing stress and anxiety by processing it through thinking, and potential solutions.

This isn’t miraculous, it’s what dynamic psychotherapy can offer – a solution that isn’t a recipe to follow, but simply a discourse that’s focused, attentive, and subjective.

The illness/anxiety/energy- vampire loosens its grip, and you too could make quilts or go to China or learn the guitar or write a novel.

Getting your body to cooperate with your head and your head to cooperate with your body can open up a whole new world even after years of suffering. You don’t have anything to lose by giving it a try.

IPSO in english - IPSO Pierre Marty

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