Most of us are familiar with the effects of irritations on the skin and/or various pains, palpitations, and angina pectoris, which do not receive an answer or relief, despite numerous visits, tests, and treatments with specialists. In fact, there is no explanation other than the mental explanation.
The common psychological explanation is that it is an unresolved mental conflict, which is expressed physically. It is important to know that this is an unconscious conflict. The person struggles to cope with different emotional mental situations. In order not to face emotional mental difficulties, the person chooses (unconsciously) to replace them with physical difficulties. It is usually easier to deal with physical pain than it is with mental pain. It is important to remember that when it comes to somatically, the unresolved pain/mental conflict is usually unconscious.
The process of somatization can be seen as a defense mechanism of the body against mental stress. As mentioned above, the problem worsens because the person is usually unaware of his unresolved internal conflict. He is preoccupied with physical morbidity (whether it is skin irritation, palpitations, asthma, digestive problems, reproduction, etc.) and begins the round of visits to doctors, tests and treatments, and as time passes and there is no way out for the problem, the level of anxiety and discomfort increases. And so the person lives in mental and physical discomfort.
Psychotherapy can help and even cure psychosomatic disorders.
Case study:
I will bring below a case description of a lovely woman, in her 40s, who came to me for therapy due to problems of family dysfunction. To present this case, I obtained her consent.
During the first introductory sessions with Tamara (pseudonym), I noticed that she never stops scratching. And in response to my question, she described a rash all over her body that created burns from itching. She also described other physical difficulties that make daily functioning exceedingly difficult for her, such as chronic gingivitis, heel spurs, erosion of the vocal cords to the point of mutism and multiple asthmatic attacks.
She was born to a mentally ill, depressive mother who was constantly lying in bed, in a dark room, dis functional at home, preoccupied with suspicions, whether her husband is cheating on her. It seemed that the mother lacked the ability care for her children basic needs.
Later, too, Tamara experienced the most severe traumatization of the loss of both parents in a violent way of burning as a violent act rather than an accident. Brought up in a family that tried to give her a home but had an atmosphere of violence and abuse.
Presumably, these traumatic experiences shaped the development of her personality.
It seems that the anxiety of death, of losses, of difficulty in coping with aggression, of not being able to develop a sense of self- being, created a complex internal and external environment for her, and over time she learned that in order to feel belonged and accepted, She should develop a rationale, and suppress expressions of assertiveness and authenticity, as Winnicott describes* in the concept of false self, with a very low perception of self-worth.
It is possible to understand the symptoms with which she came to therapy, and those that appeared during her life until she came to therapy, as symptoms of a somatopormic nature that express conflicts of a powerful emotional nature, around aggression, guilt and perhaps as an expression of the drainage of tensions and anxieties that she transmits to the body.
Presumably, through itching she created a burn in the body that symbolizes the fire. Perhaps the erosion of the vocal cords expresses helplessness, as one might assume that asthma expresses lack of air and suffocation, and the heel spurs the inability to move forward. Her physical suffering probably was experienced preferable, rather than dealing with mental suffering, because in order to survive such traumatic events, this wonderful woman had to develop a mechanism of dissociative protection. However, the events happened to her, and the mental conflicts remained unconscious and expressed through the body.
In the eyes of professional literature:
Tamara began therapy carrying on her body mental distress, in a state of dissociation from the trauma she experienced in early childhood. To deal with trauma (according to Horowitz and Dave Shapiro **) the therapist needs to create a framework for emotion by placing great emphasis on thinking as an emotion regulator. He points to the symptoms as psycho-somatic response and argues that they will remain, until all the information about the traumatic event has been sufficiently addressed.
It is aimed throughout the process to help the patient identify life conditions that trigger repressed traumatic memories. According to Horowitz & Shapiro, when the negotiations between repression and avoidance, and the desire to encounter traumatic memory reach balance, there is an opening for recovery. He calls these negotiations the "pendulum effect".
Judith Herman*** argues that recovery from trauma can happen within a relationship and should be based on empowerment. Recovery from trauma occurs in 3 stages: 1) creating confidence, 2) remembering and grieving, 3) a renewed connection with the outside world.
Joyce McDougall**** talks about communication that is not a language. She demonstrates how a patient attacks awareness of thoughts/fantasies/situations of conflict, which can stimulate strong emotions such as pain, fear, or over-excitement by creating a physical problem. She goes on to say that we all use action as a substitute for thought, whenever our protections against emotional distress collapse. The mind uses the body to convey a message: "We all tend to somatize in moments when internal and external circumstances subdue the ways of coping mentally in a way that is acceptable to us." According to McDougall, the roots of these phenomena are often found in early childhood. Since babies are unable to think through words, they respond to adversity only in a psychosomatic way. A baby experiences powerful physical experiences before he even has a body image.
Our joint therapeutic work:
At the very beginning of Tamara treatment, it was important for me to connect her to the trauma ("It happened to you too") and not to preserve the dissociation. Tamara came to therapy with many physical symptoms that indicated a deep distress. If, as a child, dissociation helped her cope with the trauma, today, it was not the case.
I follow Herman and Horowitz, who talk about the focus on the symptom and the connection to the dramatic event from the very first stage. I point out and dwell on the physical symptoms and try to show Tamara how she carries the emotional contents on her body. I have confidence in our relationship and believe in Tamara's power to carry the fracturing of dissociative protection. I feel her ripe to undermine the old consent and start creating the pendulum effect. While working, there is a great deal of anxiety that leads her to be asked and feel difficulty "what do I need this for". The defenses cracked and because of their loosening, the anxieties increased greatly. Given the safe relationship with me and the extreme fluctuations in her moods on the one hand, and on the other hand, her great motivation for change, I saw this worsening of her situation, as temporary, and one that would work in the long run to her advancement.
The therapeutic dialogue allowed her to understand, feel and process the magnitude of the tragedy and its impact on her life as a child and as an adult. After about a year, along with the processing of trauma and the weakening of anxiety, all the physical phenomena disappeared without medical intervention. Tamara began to show confidence and respect for herself, which was reflected both in her relationships with colleagues at work, as well as in family relations, between her and her children and her husband.
The therapy was not about healing the symptoms, but rather about bringing the unresolved and unconscious internal conflict, in which case the initial childhood trauma, consciously and processing it
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Reference:
* Vinnicott Donald W. (2009) True self, false self . . . psychoanalysis series, publishing with Yedid, Israel.
** Horowitz Mardi j. Jones Enrico E., Cumming Janice D., Another look at the nonspecific hypothesis of therapeutic effectiveness. Journal of Consulting and Clinical Psychology, Vol 56(1), Feb 1988, 48-55
***Horowitz Mardi j. (2003). Treatment of Stress Response Syndromes. American Psychiatric Publishing, Inc, Washington.
***Herman Judith Lewis (2010). Trauma and recovery. Ofakim School, Am Oved Publishing, Israel.
McDougall Joyce (1998). Body theaters. The Psychological Order, Dvir Press, Israel.