The Psychosomatic Personality Structure

Cornfield with Cypresses, Vincent Van Gogh

Joyce McDougall (1920 -2011) was a psychoanalyst who worked throughout her career with psychosomatic patients. Through her accumulated clinical experience McDougall developed the idea of the Psychosomatic Personality Structure. She argued that psychosomatic patients have a character structure  which is characterized by lack of emotions, wishes and internal conflicts and a quite mechanical way of thinking. These characteristics make the psychosomatic patient quite different from the psychotic or neurotic patient.

Main Characteristics

The psychosomatic patient often uses a language that lacks emotional words and develops relationships with little or no emotional investment. This happens because the psychosomatic patient has excluded a whole range of emotions from their lives and this makes it difficult for them to fully relate with other people. Psychosomatic patients also don't exhibit neurotic symptoms like depression, phobia and hysteria that can be more easily discussed and processed in therapy and instead of that they develop somatic symptoms. Last but not least, many times therapists who treat psychosomatic patients see physical pain where one would expect negative feelings. For example, in the case of loss and separation many psychosomatic patients instead of experiencing sadness, anger or desperation they start having stomach or chest pains.

  
Psychosomatic Illness vs Hysteria

McDougall further differentiated psychosomatic illness from hysteria. She argued that in hysteria the body lends itself to the mind in order for the emotional conflicts to be expressed whereas in psychosomatic illness the body seems to have its own processes divided from the mind. The drama enacted in psychosomatic illness is more archaic and the way symptoms are created is different. In hysteria the links between body and mind are repressed and unconscious but they are still there. In psychosomatic illness the links between body and mind are completely broken because the mind has suffered such a great damage that has detached itself from the body. It is as if psychosomatic patients suffer an internal death of emotions.

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Regression of the Psychosomatic Patient

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Severe regression of the psychosomatic patient happens in three situations. The first situation is when separation or death of a loved person is imminent. In this case the psychosomatic patient cannot process their grief and they develop somatic symptoms. McDougal, a very famous psychoanalyst, noted that many of her patients who faced a potential separation instead of letting themselves experience their sadness they developed physical symptoms.

The second case of severe regression happens when the partner of the psychosomatic patient exhibits characteristics that are not expected and cannot be enclosed in the relationship. For example, when the partner wants to distance themselves or expresses beliefs and emotions that are not anticipated. This happens because the new personality characteristics create cognitive dissonance that leads to stress.

The third case happens when the patient has invested in two different people who argue and have serious differences with each other. This causes internal conflict which has its roots in the Oedipus complex of the childhood years. Young children experience great stress when their parents argue because they feel caught in the middle. The psychosomatic patients are sensitive to these situations and can sometimes reproduce them in their adult life.

In all of the above three situations the psychosomatic symptoms cause somatic pain which paradoxically is more endurable than the psychological pain. At the same time the psychosomatic symptoms become a defense that protects the self from further disorganization. It is as if the somatic symptom takes the place of a psychological defense mechanism that is not there. In the cases of severe regression the somatic symptom deteriorates and can last for longer periods of time.   

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Somatization and Essential Depression

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The idea of essential depression was introduced by P. Marty in his 1966 article “La depression essentielle” and became central in the theory of psychosomatics. The term suggests a kind of depression which is not caused by the loss of a loved person but a depression related to more archaic phases of development.

Marty suggested that essential depression is not characterized by sadness or pain but by a lack of desire. Patients with this kind of depression feel tired and empty. They don’t complain about anything and they don’t seem to have emotions or fantasies. They remain motionless, unmotivated and with no desire for life. This is why essential depression is also called “white depression” or “depression without an object”.

Essential depression is further characterized by a reduction of the libido invested in other people (object libido) or the self (narcissistic libido). Patients with essential depression don’t seek the company of other people and lack the desire to create bonds. They remain secluded to themselves in an isolated world and they communicate only through their body symptoms. 

According to P. Marty the absence of emotional bonds, the flattened emotion and the breaking down of mental processes, which are all symptoms of essential depression, are also characteristics of alexithymia. Alexithymia is a mental condition in which the patient cannot access their own feelings. The more the patient cannot bring into words their feelings the more the somatic symptoms deteriorate. If this situation persists, emotional disorganization becomes more severe leading to the somatization of the symptoms and the gradual disorganization of the whole body.

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Psychosomatic Symptoms - The Allergic Object Relationship

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P. Marty elaborated on his theory of psychosomatic symptoms in his 1958 article called “The allergic object relationship”. In this article he suggested that psychosomatic patients suffering from allergies, especially asthma and eczema, display a special relationship pattern. This pattern is characterized by their need to merge with other people and identify with their characteristics.

According to Marty this process of merging has two phases. Firstly, psychosomatic patients project their own qualities to the other person and secondly identify themselves with the qualities that they have projected. Through this two-fold process of projection and identification they have the delusion of becoming one with the others.

The merging of the subject with the other person is at the beginning forceful and violent but later becomes smoother. The psychosomatic patient is very eager to find people who are susceptible to this kind of control and are willing to be “objectified”. This usually happens because they have a very weak and inconsistent ego structure and they try to control other people in order to overcome this vulnerability.

This way of relating of the psychosomatic patient originates from early infancy. At that age the mother – child relationship is built mainly on touching and holding. If this relationship is not safe, the infant cannot create a stable initial representation of the self. This makes it difficult for the baby to make sense of their internal feelings. In these cases the infant creates a shell that protects but also hinders the self from connecting to other people. The somatic symptoms developed in adulthood reflect this poor self- organization.

Marty showed the validity of his theory by bringing up clinical material from his work with psychosomatic patients. Some of them said: “I am so dependent on you…I am you”, “I cannot live within myself but only united with another person”. Even in the first psychoanalytic interviews patients made slips of tongue like “I am here because you suffer from eczema” or “You certainly wish me to tell you about your mother'”, which reflected their lack of boundaries in the therapeutic relationship and their instant identification with the therapist.

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Psychosomatic Symptoms - Mechanical Thinking

The Thinker, Auguste Rodin

In the 1940s and 1950s new interest arose in the field of psychosomatics. In USA the main representatives were Helen Dunbar and Franz Alexander whereas in Europe was P. Marty. Marty was a psychiatrist, psychoanalyst and psychosomatician and he was at the heart of the French psychoanalytic movement when he formed the Paris School in 1963.Marty discovered that his psychosomatic patients had an overly rational and pragmatic way of thinking that he named “mechanical thinking”.

These patients lacked in their ability to fantasize, symbolize and bring their emotions into words. They also seemed to have a flattened affect and an impression of detachment from external relationships. They could not exhibit variety and richness of emotions and couldn’t elaborate on their feelings. The inability to fantasize and symbolize resulted in internal disorganization. The somatic symptom was an effort of the body to stop this internal disorganization and at the same time its expression on a somatic level. Marty’s theory was put into practice at the Poterne des Peupliers Hospital, a world recognized institution, where the Paris school applied their ideas for therapy, research and training.

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Introduction to Psychosomatic Symptoms

What are the psychosomatic symptoms?

Sorrowing Old Man, Vincent Van Gogh

Psychosomatic symptoms are physical diseases that are caused by psychological factors. Chronic stress, unresolved conflict, depression, loss of important people in our lives and other psychological difficulties can trigger the emergence of psychosomatic symptoms, which if not taken care of can become real health problems. This is why psychologists have turned their efforts on understanding the nature of psychosomatic symptoms.

Background

Freud was the first to underline the psychological dimension of physical diseases saying in 1923 that “the psychoanalytic treatment of obvious organic disturbances is not without a future, since it is not unusual for a psychic factor to play a role in the genesis and persistence of these affections". In the 1940s Franz Alexander expanded on Freud’s theory saying that emotional conflict and the buildup of negative feelings could result in somatic symptoms. Alexander also spoke about “organ neurosis”. This term meant that when energy stagnated in a bodily organ for too long, this organ would get ill. During the same period Helen Dunbar, main representative of the School of New York, introduced the idea of “personality types” that were linked to specific diseases. This school of thought suggested that the personality structure of each patient made them vulnerable to specific illnesses and laid the ground for the development of somatic symptoms.  

Which are the most common psychosomatic symptoms?

The most common psychosomatic symptoms are: stomach ulcer, irritable bowel syndrome, arthritis, skin problems, allergies, high blood pressure and heart disease. Also a few scientists regard as psychosomatic symptoms pains that are caused by psychological factors but do not lead to physical diseases. For example, people may feel headache, backache or high blood pressure after a period of great stress.

Which are the causes? 

The brain affects the body in many ways. When we feel extreme fear or anxiety our pulse rate increases, we sweat, we feel dizzy or we start breathing very fast which proves how our perception of the world can influence our bodily functions. Furthermore, stress may affect the function of the immune system and make the body vulnerable to illness. Nevertheless, the exact way in which our central nervous system acts upon our body to create symptoms is still unknown.

Treatment

According to some psychoanalysts at the heart of every psychosomatic symptom lies a person who seeks understanding. The psychosomatic symptom is a sign that something is wrong in the person’s life. The development of the personality is hindered and symptoms are created. Through psychotherapy the patient can start a deeper dialogue with their self and process their relationships with other people in order to find the dysfunctional patterns of communication. In the cases of successful psychotherapy chronic emotions of pain, sorrow and anger that remained buried in the unconscious usually come to surface. With the gradual understanding of these emotions the psychosomatic symptom can restore its initial meaning, find its place in the history of the person and in some cases disappear. 

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