Mary Sidoli: When the meaning gets lost in the body
In this chapter I will explore severe physical symptoms exhibited by patients at crucial stages of their analysis, which tend to occur when a “big change” is foretold in dreams or
following interpretive work aimed at providing the patient with insight into his or her major psychic conflict.
My hypothesis is that, for some patients, when an interpretation manages to break through into a primitive deeply unconscious area, while the patient’s ego struggles to gain
psychological insight, the core of the personality offers extreme resistance to letting the infantile contents acquire a symbolic mental representation. In these patients, severe somatization occurs. The newly emerging insight appears to be too much for the patient’s psyche to deal with.
The upsurge of affect reaches the threshold of the “zone of meaning,” appears to shortcircuit it and to discharge itself into the body or into bodily organs. Thus, the body
provides the last bulwark against integration.
These primitive unconscious affective contents which I have observed refer to early life-threatening experiences which were defended against by extreme splitting.
My hypothesis is that the primitive affects, brought about by certain experiences in infancy, were not attributed any psychic meaning by the mother. That is to say, the
mother had not been able to process the excess of affective contents for her infant because she was either emotionally disturbed or absent, whether emotionally or physically.
In the course of my analytic experience, I have noticed that patients who react somatically, children and adults alike, are generally very gifted people who, at the beginning of analysis, exhibit strong ego defenses. These have allowed the patients to function well in certain areas of their personality, in spite of an extremely primitive core in which archetypal affects predominate, encapsulated by defenses of the self.
Michael Fordham hypothesized that defenses of the self are the earliest defenses which are mobilized within the primary self of the infant. They function as a total defensive
system for the purpose of survival when the mother fails to provide basic emotional care and the infant is exposed to survival panic and dread. These early undigested contents are not, as one might expect, ejected by these patients by means of a violent psychotic episode or psychic regressive breakdown. Rather, in some mysterious way, they enter the
somatic sphere and get lost in the meanders of the body, producing violent physical reactions rather than being transformed into mental images or fantasies that could then be
assimilated further.
My observation is that such patients do produce archetypal images, but these are disaffected (as in the case of alexithymia). These patients are emotionally detached
observers of their own images. They defend themselves against feeling the horror, panic, and tend to view the image as an artistic creation. In these patients, archetypal primitive areas have been split off from their otherwise often well developed personality. Their emotional memory has been lost in the archaic somatic memory of the body, used as a storehouse.
Jung’s theory of the bipolarity of the archetypes
My hypothesis is consistent with Jung’s theory of the archetypes as unconscious entities having two poles, the one expressing itself in instinctual impulses and drives, the other in
the form of fantasies.
My speculation is that, in the patient prone to somatization, the two polarities of the archetypal experience have been split into two distinct halves: the body and the psyche.
The instinctual part has remained lodged in the body and the spiritual part has become an empty image.
From the exploration of the personal history of these patients it emerged that they all had experienced early emotionally disturbed or traumatic relationships with their
mothers, who had been unable to mediate violent archetypal affective discharges in their infants. These shortcomings did not allow for the bodily archetypal experience to acquire
stable mental representation in the sense Jung meant when he wrote that the image represents the meaning of the instinct (1947:201).
The transcendent function and symbolic functioning
Jung wrote: “The shuttling to and fro of arguments and affects represents the transcendent function of opposites. The confrontation of the two positions generates a tension charged with energy and creates a living, third thing…a new situation” (Jung 1957a: 90). I would add, “whenever there is sufficient consciousness to be able to imagine a new situation.”
Jung again:
The transcendent function manifests itself as a quality of conjoined opposites. So long as these are kept apart—naturally for the purpose of avoiding conflict—
they do not function and remain inert. In whatever form the opposites appear in the individual, at bottom it is always a matter of a consciousness lost and
obstinately stuck in one-sidedness, confronted with the image of instinctive wholeness and freedom. (Jung 1957a: 90)
Here Jung tends to idealize instinctive wholeness, equating it with freedom. However, we know from observation and knowledge of infancy—which is the most instinctive stage of
human life—that instinctive wholeness is the opposite of freedom. It is overwhelming, unthinkable, and uncontainable in the human mind.
Jung’s image of the archaic man may be misleading, and it risks becoming romanticized and disconnected from the individual realm of experience. Thus, while he appears to value the compensatory function of the unconscious, which constellates the “archaic man,” in the very same paper he warns against the dangers of the “ego of the
rediscovered unconscious.”
One is here alerted to Jung’s fear of his own unconscious instinctual contents, because his language is heavily loaded with superegoic terms. He seems to alternate between
depicting “consciousness” as a rigidly defended ego which is split from “instinctive wholeness,” while at the same time advocating a flexible ego which would be able to
integrate conflicting opposites.
The point to emphasize here is that Jung does not describe ego-consciousness structuring within the context of a dyadic relationship. It seems to occur in a state of
isolation, where the ego has to “win” its own battle against the monsters of the archetypal world, or succumb.
Jung seems to be describing his own lonely quest, guided by his superego mercilessly driving the ego, rather than by a flesh-and-blood mother who could experience mercy for
his strivings. At the same time, by taking a moralistic position, Jung seems to contradict his own theory of the heuristic value of the unconscious.
Fordham’s contribution to new developments in Jungian theory
By conceptualizing the primary self (the self at the beginning of life) as a psychosomatic unity, a sort of blueprint on which conscious and unconscious will become differentiated
by the deintegrative/reintegrative dynamisms of the self promoted by archetypal activity, Michael Fordham has opened a new way to understand early and regressed psychic
phenomena.
The primary self deintegrates immediately after birth (or even before). That is to say, it opens up towards the environment in order to meet the object which will satisfy its
archetypal expectations. It then reintegrates by going back into itself in order to assimilate and digest that experience.
This dynamic occurs according to individual rhythms over and over again, and presupposes the expectation of an object which will provide satisfaction: the mother.
The value of this view is that it stresses the archetypal expectation of a relationship which then embodies itself in the mother-infant dyadic relationship.
Thus, we have to presuppose two archetypally determined concomitant dynamisms: the deintegration-reintegration of the primary self, and the to-and-fro of communication
within the nursing couple. In this sense, the concept of archetypes is helpful, since it refers to innate patterns of behavior with mental concomitants.
Let us now apply Jung’s concept of the transcendent function and embody it into the metaphor of the mother-infant couple where the “shuttling to and fro of arguments and
affects” has to be imagined in a two-body relationship model rather than in the lonely “heroic one.” According to this vertex, the “tension charged with energy [generated by
the confrontation] creates a living thing.” I would call this “emotional relatedness.” Symbolic creations develop within the relationship, metaphorically used as a stage where the interplay of the opposites can be safely experienced. According to Winnicott, “symbolic play” occurs when one is able to be “alone in the presence of another.”
If we then assume that, under normal circumstances, the mother helps the infant make sense of the world and of itself, we can picture growth of consciousness as a process
taking place within the container of the dyadic relationship. However, certain mothers—because of their own disturbances—behave addictively toward their babies. They cling to them as if to a part of themselves, which they cannot let go of, for fear of a catastrophic mutilation. These mothers split off highly charged unconscious contents which their own psyches cannot bear.
As a result, these emotions and thoughts become totally foreclosed and forbidden to their child. In the same way, bodily zones or physiological functions disavowed by the
mother become forbidden and disaffected for the child, in order to prevent a tearing apart of the mother-baby link. As a consequence, the dual aspect (both physical and emotional)
of the mother’s containing function cannot be differentiated by mother or infant alike.
Psychosomatic states and solutions
In her book Theatres of the Body, Joyce McDougall writes:
In psychosomatic manifestations, the physical damage is real and the symptoms do not appear to reveal either a neurotic or a psychotic story. The “meaning” is of a presymbolic order that circumvents the use of words. In psychosomatic states the body appears to be behaving in a “delusional” fashion…. One is
tempted to say that the body has gone mad. (McDougall 1989:18)
McDougall hypothesizes that somatic expressions tend to arise in place of unrecognized psychotic fears and wishes. She adds to the classic somatic disorders (asthma, gastric
ulcer, colitis, respiratory tract infections, arthritis, neurodermatitis) all cases of physical damage or illness in which psychological factors play an important role—accidentproneness, lowering of immunological shield, problems of addiction. She sees them as attempts to deal with distressing conflicts by temporarily blurring the awareness of their
existence by clinging to factuality.
It appears that psychosomatic patients lack fantasies. In them the link between the instinctual pole of the experience and its mental representation has been broken, or never
established. Thus, the proto-images—as archaic proto-fantasy/bodily elements—have remained buried or encapsulated in the unconscious bodily pole of the archetype. Not having been given a name by the mother, they have remained silent, are inarticulate, and have no access to preconscious or conscious thought or dreams. I will now introduce three patients, two women and one child, each of whom has shown a dramatic tendency to somatize in the course of their analyses. Two of them were in three- or four-times-per-week analysis and the third in once-a-week analytic psychotherapy.
Ronnie used his bronchi as containers for the bad stuff he had accumulated in the early days of his life. He was three when he was referred to me. Ronnie was a highly intelligent
and verbal child who presented a variety of neurotic symptoms at the stage of separating from his mother, such as nightmares, clinging behavior, and phobias. He was born two months premature and spent the first two weeks of life in an incubator, where he had been severely ill with pneumonia and close to death. I have written about this case in The Unfolding Self and will mention here just one dramatic episode in the course of his analysis.
That episode occurred right after a meeting I had with his parents, which had made him very anxious. At the next session Ronnie complained bitterly about his parents’ badness;
he accused me too and told me he did not want to come back to see me any more. That session was followed by several others during which he refused to enter the room without his mother. Then he eventually became ill so he could not come at all. He remained absent for four weeks, suffering from bad bronchitis and severe respiratory tract infection. Analysis was impossible. His parents were worried, because the antibiotics did not seem to work.
I understood his somatization as both a regression to his early days in the incubator, and as a way of dealing with his rage which would be acceptable to his family, i.e. being
ill. They could both comfort him and remove him from my presence, which was causing him so much upset.
Following his illness, I had to be absent for a week. When he came back, we had to work through a strong negative transference. He wanted to shoot me and bite me, and
occasionally he managed to hit me hard. I withstood these attacks and talked to him about his feelings about my not visiting him when he was sick, which made him feel as he did
soon after birth, that is to say abandoned by his mother, unprotected in the hospital where the bad doctors were torturing him.
In response to my interpretation he started coughing and carried on coughing for a long time. He looked very miserable, so I commented that he felt bad and that, like the
doctors, I was making him feel worse. After my comment, he stopped coughing and went back to playing.
The following session he was well again. He came into the session pretending to carry a baby horse in his hands. He told me the horse had been born at the time he had started
analysis and that he was ill with a bad cough now. He built what looked like an incubator
(a warm, womblike place) and told me that the horse had to stay there and keep warm until he recovered. He took great care of the horse and talked to it. He eventually said that
the horse was better now and left the session in a very good mood.
In the course of this severe somatization Ronnie had managed to regress to his dreadful infantile experience which I could contain in my mind and empathize with.
Thanks to the analytic work, the elements that had not acquired a mental form but were communicated by the body as a replay of his early catastrophic (near-death) experience
found a symbolic expression. After this severe somatization his tendency to somatize improved dramatically.
Mary was in her late thirties when she came to me for therapy. From the recounting of her early history I expected the transference to constellate her early deprivation, and I
wondered whether she would be able to tolerate the frustration and pain that it would bring about in such a loose analytic timeframe. On the other hand, she was lively, bright,
and determined, which encouraged me to take her on.
She needed three- or four-times weekly analysis but could manage to come only once a week. This limited attendance created a real difficulty, which I knew would make her psychological work extremely hard. We talked about the difficulties the treatment would bring about. She seemed ready to take these on as a challenge to her heroic side, and she did not appear to be discouraged.
She was working with adolescents as a school counselor. She had brought up a child on her own and had been married and divorced more than once. She told me that she
wanted to understand her moods and her deep feelings of worthlessness. Her bodily posture struck me from the beginning; I fantasized that she was wearing a rigid corset.
She was of medium height and had an interesting face with expressive eyes and an attractive smile.
She told me that when she was eleven weeks old her mother, who was pregnant again, was hospitalized for a long time due to a life-threatening ulcerative colitis. Mary and her
two older sisters were left to the care of her father and maternal grandmother. At first, she was unable to connect the feelings caused in her infant self by the dramatic separation
and illness of her mother to her fears and difficulties in the present.
In the transference, she exhibited a fear of emotional closeness for which she compensated with a desperate search for physical intimacy in love relationships which
usually turned into sadomasochistic ones.
It felt to me that being in therapy only once weekly was a torture for her infantile needs, but she could not let herself acknowledge it. She denied any difficulties and
seemed to feel that my insistence on the matter was having a rather smothering effect on her.
In the counter-transference I was aware of her frustration and I interpreted it to her, but to no avail. I often felt concerned by her acting out, which I could only contain from a
distance, or would hear about afterwards. I felt anxious and impotent. The feelings I was experiencing referred to her infantile emotional state when her mother had left her. I had
to hold onto them for her for a long time because they were unreachable to her.
It took a long time for me to help her try to reconnect her early dramatic experiences with the split-off affects related to them. She talked about severe scoliosis, for which she
had a spine operation and had to wear a cast throughout her adolescence. At first she talked about her sufferings in a factual way, as if she were giving a medical history to a
doctor. I wondered what it must have felt like for her to be confined in such a way during most of her adolescence. How much fear, pain, anxiety, and feelings of inferiority and
worthlessness she must have experienced, while the other teenagers, her siblings included, could participate in sports and enjoy themselves.
A tremendously ambivalent love/hate relationship with her younger brother emerged in the course of the sessions. She admitted that she had felt responsible for her brother’s
unhappiness, remembering that she had wished to get rid of him who in reality had been he cause of her mother’s illness.
In fantasy, however, at a much deeper level, she blamed her mother’s hospitalization on her own infant greed and demands. In the transference she was extremely attentive not
to demand anything from me for fear that I would become sick and abandon her too. A couple of sessions I arrived late at our appointment; despite my attempts to reach her
obvious annoyance and anger, she kept reassuring me that it was all right and that these things could happen! She would become very under standing, making excuses to protect
me, terrified as she was to feel any negative feelings toward me.
Not long before coming to therapy, her brother, a professional skier, had been caught in an avalanche and had lost one leg. Mary had been totally devastated by his mutilation.
During our sessions we were finally able to explore the unconscious feelings of hostility and rivalry she harbored towards him.
In the second year of her therapy, we focused on her back problem. She took up martial arts and worked just as seriously in making her body flexible as she applied herself to gaining insight into her psychic conflicts.
At breaks she denied her distress, but tended to develop a love relationship to fill the gap of my absences from her, as she had done at the time of her mother’s illness by
becoming attached to grandmother in order to survive. It took three years for her to be able to admit that she missed me during a therapy break.
Soon after my return, some forgotten memories of her childhood surfaced, together with feelings of distress which she had previously fended off. I felt that the early defenses
against the pain of the catastrophic separation in infancy had started to give way. Then she fell ill with severe bronchitis, high fever, and pains in her chest which lasted
for several weeks and resisted treatment. During her illness she could not come to therapy and she experienced the depth of her misery and abandonment, coupled with fear of
dying, just like in her adolescence when her back was operated on.
At the first session following her sickness she told me that she felt weak, lost, confused, and frightened, but that she could not put into words what her fear was about. I
asked her to try to give it a name. The following week she returned feeling much better. “I have thought about it,” she said immediately, “the name which came up is ‘death.’”
We began to explore her terror, and it emerged that the day on which she fell ill had been the anniversary of her operation. For the first time, twenty-eight years later, she was
able once again to feel the panic and terror she had denied and repressed in the past. “It was awfully painful and I could not move. That same day John Kennedy was shot, and
everybody was preoccupied with the news. He was more important than my pain.”
She went on to describe how much she had been in pain and added out of the blue, “You know, my aunt had died of the same operation because of a mistake of the surgeon
a few months earlier. We all knew about it, but both my parents and I blocked it at the time.” The horror of her aunt’s death had reawakened the early panic and dread
experience at the time of her mother’s hospitalization.
Neither one of these emotions had ever been connected to Mary’s operation by her parents, and the dread and panic related to both experiences had remained unnamed, a silent event in her life which had no access to her consciousness but which was dramatized by the body. ~Mary Sidoli, When the Body Speaks The archetypes in the body, Page 80-86
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