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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