What is the phenomenon of psychosomatic disorder? Some attribute any ailment to him, others try to find a connection between a specific disease and an organ of the body, others study a separate group of "psychosomatic clients", and still others refuse to believe in his existence. Practicing psychotherapist Maxim Pestov tells about what psychosomatics is, in what cases psychosomatic symptoms appear, how they save our psyche from overstrain, and ourselves from the threat of “non-existence” and when they become an obstacle to understanding our complexes and problems.
In this text I propose to talk about psychosomatic disorder in terms of how it functions in the context of a life story. Psychosomatics, from the point of view of the Gestalt approach, is a form of adaptation, but a paradoxical form, since it focuses on the harm caused by a symptom, which is more likely associated with a functional disorder than with a useful finding. However, the paradox is a paradox in order to hide the implicit behind the obvious. Let's try to figure out what a psychosomatic symptom carries in addition to bodily suffering and a deterioration in the quality of life.
The main paradox of the psychosomatic symptom is that what is the problem is also a way of alleviating it. To give an example: in a group, the client sits in a clearly uncomfortable position and suffers from muscle stiffness. An attempt to take a more comfortable posture, which is quite logical at first glance, leads to the fact that along with muscle relaxation, mental anxiety appears. This state is completely invisible when the body is tense in an effort to maintain an uncomfortable position. In other words, the body comes to the aid of the psyche at the moment when it cannot cope with the challenges of the situation. Physical suffering turns out to be more bearable than mental suffering.
Or another option. The client experiences anxiety in an unfamiliar group. If you look at it more closely, it turns out that anxiety increases when the desire to get to know meets with fears associated with past experiences. Anxiety arises like a crest from the collision of tectonic plates, whose names are curiosity and fear. It's good if someone curious comes to the rescue and satisfies the held interest. But if this does not happen, anxiety prompts either to leave the situation, or to create a somatic analogue of mental stress, which turns out to be a headache or muscle spasms.
The previous example demonstrates that from any situation there are not two, but three ways out. The organism has three dimensions at its disposal - motor, somatic and mental. Let's say someone comes in contact with the experience of fear of rejection. The simplest thing to do in this situation is to end all relationships with the object of this experience and never come into contact with him again. This reaction is realized through the motor component and, in other words, is called acting out. The second option is to try to ignore bodily cues, stay in the situation through personal effort, and earn a bodily symptom for more solid support. This method will be called psychosomatic. The third option, the most difficult one, is to try to maintain contact with a difficult experience without running away from it or ignoring it.but trying to give meaning to what is happening. The mental method of processing is the most difficult, because inside it you have to answer a lot of difficult questions. Thus, the psychosomatic answer comes to the rescue, removing questions from the psyche and “making life easier”.
Relief, of course, occurs only tactically, while strategically, things are not so rosy. A psychosomatic decision postpones the decision of a situation, as it transfers it from a state of high intensity to a low one. Actually, the symptom itself is a consequence of this translation: stopped mental excitement, not realized in the form of an action, is forced to remain packaged in a somatic disorder. With the help of the symptom, it is possible to avoid the frightening psychic reality. The beginning of psychosomatics is associated with intrapersonal splitting, when the body, at the level of sensations, says that something terrible is happening, while the head tries to pretend that everything remains under control. Body, as well as emotional-sensory sensations, are normally a contact function,that is, they regulate the relationship of the organism with its environment. A psychosomatic symptom closes the body's contact on itself: instead of clarifying what is happening in the presence of another, it begins to build relationships with its diseased organ. This is a simpler job, but does not lead to development.
The symptom appears when a certain part of emotional excitement is expelled into the body and thereby alienated from psychic reality. The reverse movement is quite painful, since the reintegration of the alienated experience into the whole picture is possible only through the exacerbation of symptoms. The symptom allows you to take control of the situation where the psyche is ready to plunge into chaos. The psychosomatic solution is to regulate chaos by suppressing vitality. This is due to the containment of one's own arousal through a protective mechanism called retroflection.
The retroflexion resembles the rim that compresses the barrel in order to maintain its shape. The impression is that the psychosomatic client is more regulated by external requirements than relying on his own feelings. Retroflection as an internal process was once a prohibition emanating from significant figures. A vicious circle arises: in order to turn the restrained excitement outward, that sensitivity to bodily signals is necessary, which is reduced as a result of the appearance of the symptom.
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It can be concluded that a psychosomatic symptom, one way or another, denotes a problem associated with the manifestation of vitality. The general principle is: psychosomatics arises where the weakness of the mental apparatus is found. In other words, when a person falls into the zone of difficult experiences that overexcite psychic reality, it is necessary to block the source of emotions, that is, to desensitize the bodily dimension. But you cannot reduce the severity of some emotions while preserving others. The symptom grows in beds of insensitivity. Or in other words: the symptom fixes this decrease in general sensitivity in the form of varying degrees of pronounced bodily suffering.
A decrease in vitality in a psychosomatic client leads to the formation of curious ways of compensation in him, brought into the interpersonal space. So, for example, one can observe a super-significant investment of relations, when the presence of the other becomes not only important, but guarantees survival. Relationships turn out to be so dominant in value terms that the psychosomatic client is ready for any sacrifice on his part in order to preserve them. Of course, such a position only aggravates his inability to be in a relationship completely, without adjusting to them and not exchanging a good attitude for complaisance. That is, retroflection is supported by a whole range of frightening experiences: shame, fear of abandonment and expectation of rejection, total guilt. You can talk aboutthat the guilt of the psychosomatic client no longer performs only a regulatory function, but becomes toxic, narrowing the freedom of personal expression to a very limited spectrum.
But back to the thesis that was voiced at the beginning of the text. It was important for me to show that the psychosomatic symptom is an assistant in the difficult matter of survival. It is in this place that the paradox is revealed: on the one hand, the symptom deprives of sensitivity, that is, that which constitutes the core of vitality, on the other hand, due to this it saves the psyche from intolerable stress. By the mechanism of its occurrence, the symptom points to the main problem of the psychosomatic client - the inability to enjoy the manifestation of his vitality. Then his own activity is largely regulated not by spontaneity, but by an orientation toward conformity. In psychoanalytic language, this is called primary narcissism deficiency. I can only be who I approve of. In a general sense, the problem of the psychosomatic client is fear of life. When this fear becomes unbearable, it can be brought under control through a symptom.
So the psychosomatic symptom is not an enemy that attacks suddenly and must be fought. Rather, it is an ally, but too weak to handle the situation completely. Paradoxically, the emergence of a psychosomatic illness turns out to be an attempt at healing. What is the psychosomatic client healing from in this way? In a general sense, it can be expressed as follows - from the threat of nonexistence. The symptom is the bodily expression of the phrase "I am" which is difficult to express in any other way. Let's remember what retroflection does: it literally squeezes the client's space, narrows it down to a minimal degree of presence. Retroflection realizes the message “I have no right to be” and is not accidentally supported by shame, as an expression of extreme dissatisfaction with oneself.
A symptom is such a desperate investment of mental excitement in the body, which turns out to be the last stronghold of individuality. If it is impossible for the subject to be in contact mentally, then he reserves the right to be present in it at least physically. A symptom is salutary if it can be invested, and thus it becomes the only available form of contact and self-presentation. Despite all the discomfort caused, he maintains an emphasis on the value of acting on his own behalf, even if that name is still the codes of the International Classification of Diseases.