Richard Kradin on the Symbolic Aspects of the Psychosomatic Patient

"Invariably, at the root of psychosomatic dis-ease, one discovers an ailing soul that requires attention and renewed meaning. With time and the containment provided within the therapeutic vessel, affective connections may be re-established between the ego and the Self. In such cases, the psychosomatic symptom may gradually transform or disappear spontaneously, just as it first appeared.

It has been argued that the psychosomatic patient has suffered a profound disturbance in the pathways of individuation. Psychosomatic integration has failed to occur and the ego-Self axis has been seriously interrupted. Whereas the psychosomatic symptom represents pathology, one might ask what synthetic purpose does it serve? I suggest that the psychosomatic symptom can be envisioned as an imaginal product of the Self — defined here after Jung with slight modification — as the totality of those psychosomatic processes that are responsible for generating, integrating, and directing the imaginings of the individual through the life cycle (Jung 1963). The psychosomatic symptom is hypothesized to be a derivative iteration of a ‘Self-state’. It is suggested that the psychosomatic symptom has the properties of fractals, that is they are self-similar iterations of form. Fractal forms permeate nature, and are readily identifiable, e.g. in the repetitive branching of trees, river beds, the vascular system and the neural networks of the brain (Bassingthwaighte 1994). As fractals are isomorphic, that is ‘self-similar’ with their source, both in form and function, the psychosomatic symptom necessarily displays the complexity of the Self. Such unfathomable complexity confers upon the psychosomatic symptom features of being both symbolic and paradoxical, so that no single meaning, or multideterminant set of meanings, can exhaust its possibilities. Like other hypothesized derivatives of the Self, including the fractal dream image, the psychosomatic symptom is informationally rich, both with respect to ego consciousness and the inter-subjective field. For example, Mary's symptoms focused my attention on her early narcissistic disturbance, reflected the poles of her mother and father complexes, and revealed her need to create meaning for her disengaged psychosomatic experience. In this way, I believe that her ‘Self-state’ was accurately communicated. Grasping the symbolic nature of the psychosomatic symptom is critical; and the failure to do so has led many to lose their way in its labyrinthine expressions. Freud barely escaped this fate, as he arduously quested after the specific cause of his patient's hysterical symptoms, only to find that uprooting one led eventually to the appearance of another. For like his beloved Oedipus, who attempted to save Thebes by an exercise of Apollonian logic (Hillman 1991), Freud had mistaken the source of the dis-ease and had confused the multifaceted metaphor of the ‘oracular’ symptom with a ‘sleight of hand’ concocted by a defensive psyche to disguise an unacceptable wish. Indeed, a major change in the direction of psychoanalysis may have been prompted by Freud's discovery that the eradication of the hysterical patient's symptoms was actually short-lived (Webster 1995).

As a fractal derivative of the Self, the purpose of the psychosomatic symptom must reflect the overarching purpose of the Self, which is to direct the process of individuation. I am suggesting that the psychosomatic symptom represents a persistent homeostatic effort by the Self to correct a developmental defect in psychosomatic experience. By focusing the attention of others on the dysphoric experiences of the body, the psychosomatic symptom urgently seeks to elicit empathy and psychological meaning for the disordered experience of interiority. Only when this has been achieved can the individuation process optimally proceed. Unfortunately, this persistent effort is often viewed within the intersubjective field as age inappropriate, and therefore fails to succeed. This must be especially true in a social milieu that is itself characterized by profound psychosomatic splitting and insufficient empathic resources. For these reasons, the issues of the psychosomatic patient are perhaps best treated in analysis, although theoretically any sufficiently empathic intersubjective dialogue could also suffice. However, it must be reiterated that these patients are notoriously difficult to treat, as they require a degree of psychosomatic empathy that may be near impossible to achieve within the boundaries imposed upon the analytical frame.

While the psychosomatic symptom cries to be relieved, it cannot be fixed. Its irrational nature can only be resonated with empathically. Unfortunately, the presence of those time-honoured guardians of irrational therapeutic approaches in modern society are dwindling. The therapeutic mainstream of our society no longer includes shamans and spiritual healers, and scientific progress also threatens the depth psychologists with extinction, as they are replaced by the behavioural and biologically oriented ‘scientists’ of the mind. However, it is clear that the psychosomatic symptom is an archetypal product of psyche, one that may change its ‘spots’ but not its nature. Therefore, the psychosomatic patient will continue to be a constant feature in society and each generation will be required to develop its own variant of the perennial therapeutic solution." (pp. 418-419)

Richard Kradin (1997). The psychosomatic symptom and the self. Journal of Analytical Psychology, Vol. 42, pp. 405-423