From the Greek “soma” means body: people suffering from psychosomatic disorders express psychological distress through the body.
Historically, the term “psychosomatic” is associated with a series of somatic diseases, in whose etiology and pathogenesis a significant presence of mental factors has been demonstrated, such as stressful emotional experiences, personality factors and conflicting conditions of a psychological nature.
Even psychologists who refer to the APA (American Psychiatric Association) define psychosomatic as everything that refers to a constant and inseparable interaction between psyche (mind) and soma (body) (APA, 1980).
In the modern age, starting from Descartes (17th century), dualism undergoes an accentuation between res cogitans (thought and mind) and res extensa (everything that is subject to sensorial and perceptive dominance).
Subsequently, theories of the mind underwent a different elaboration with philosophers such as Locke, Hume in the 18th century and, with positivism and materialism, the emphasis was once again placed on the unity of the human being.
In more recent times, in the 19th century, with the avant-garde of the United States, the Chicago School, a particular current of medicine, identified a group of “specifically psychosomatic” diseases such as asthma and ulcers.
In this historical excursus, we cannot fail to also refer to the father of Psychoanalysis, Sigmund Freud, who in the nineteenth century developed one of the first models of interpretation of the correlation between psyche and soma, based on the first defense mechanism: conversion. Some affects, inexpressible by the conscious ego, would be controlled in a psychic area (in the unconscious that is practically not accessible to the state of consciousness) and then through repression, having not found an immediate and adequate discharge. Psychodynamic theory attributes considerable importance to the correlations between somatic and psychic aspects, considered within the unitary conception of the individual.
In alexithymia (lack of words to express emotions) a series of cognitive and affective characteristics are identified, with the person’s difficulty in identifying and expressing their feelings verbally, reduced capacity for symbolism and limited interpersonal relationships with little content. Where the schizophrenic, in the distribution of the sense of reality, creates a new reality that is more tolerable for him, the psychosomatic person empties the external reality and interpersonal relationships of the affective content, which should be an integral part of his thinking.
The symptoms are therefore not intentional, unlike factitious disorders.
What happens in most cases is that the patient is incapable of mentalizing his discomfort and therefore shifts it onto the body and physically.
Somatization is a defense mechanism against anguish, pain and a sense of danger. Therefore we must proceed with great caution when making possible interpretations, since the patient may feel attacked.
As long as he is unable to access a symbolic dimension, expressing his profound discomfort in other ways, for example verbally, he should not be deprived of this defense, to prevent him from slipping into a psychotic condition.
Often these patients turn to a doctor, requesting analyzes and further investigations, complaining of physical symptoms (for example stomach ache, migraines, frequent headaches) and generally the GP prescribes various tests, which however do not find any problems or lesions of an organic nature , which explain the physical symptoms. Therefore, hypothesizing a psychic origin, he sends it to the psychologist.
In psychological work, first of all it is necessary to analyze the motivation of these children, because they are not always aware that their symptoms are actually an expression of psychological distress. It is also necessary to explore their expectations and willingness to face a path not made of medicines, but of purely psychic work and the reworking of unconscious meanings and possible conflicts.
Finally, it is also necessary to explore what discomforts the boy is expressing through his body; because it affected a particular organ; which symbolic meanings can be conveyed by the parts of the body involved (head, belly, skin).
Since these symptoms can then offer secondary advantages, justifying to the patient the avoidance of certain situations such as school, university or work (due to possible problems in these fields, which therefore need to be explored further), this can lead to not “unconsciously” desiring to get rid of these symptoms.
The use of projective tests can be particularly useful, as they bring out unconscious contents that the patient is unable to verbalize, for example the Rorschach for adults, to be able to stimulate the emergence of deep anguish and conflicts.
The drawing of the tree can also be useful to provide indications on the structuring of the children’s ego; the drawing of the human figure, on the perception of oneself and one’s body; finally the TAT on motivations and needs.
After having motivated the patient to undergo a psychological support or psychotherapy process (in this case, after referral to a psychotherapist), it may be useful to set the objective of increasing awareness of the psychic dimension of the discomfort, which is initially mostly denied, in a defensive way.
Finally, with an expressive intervention it is possible to trace the true conflict, which is masked by somatization, one can rework the concerns regarding one’s health (as happens in Hypochondria) and physical form (as happens in Body Dysmorphism), to go to strengthen the ego and identify and build together with the psychologist another way of expressing discomfort and clarifying its origins.
BIBLIOGRAPHY
The current frontiers of clinical psychology. Fulcheri. CSE – Centro Scientifico Editore, 2004. DSM 5 – Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Raffaello Cortina Editore, 2013. Psychoanalysis – Clinic and theory. A. Ciocca. ESA – Abruzzo scientific editions, 2006. Clinical psychology: the psychoanalytic model. F. Zampino. Carocci publisher, 2006. Children’s drawing. E. Cannons. Carocci publisher, 2004. Rorschach: Compendium for the comprehensive system.E. Exner. FrancoAngeli Editore, 2014.
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