Abstract
In this chapter, the phenomenological theory of psychosomatics is presented. The solution to the mind–body problematic is shown to be found in the concept of the lived body and the relationship between body—world as flesh. The psychosomatic condition is understood as a disarticulation of self and world, which is the result of a collapsed meaning-constitution at the higher (psychosocial) levels. The body takes over the task of expression (meaning-constitution at the level of the body), attempting to manage a life situation by using bodily structures which are not adapted to this level of meaning. Merleau-Pontian concepts are used in order to understand psychosomatics as a specific way of being-in-the-world. The consequences of this understanding of psychosomatics for the clinical encounter are drawn out. Teaching psychosomatics and supervision of psychosomatic case work is also discussed from this perspective. The theory is illustrated with patient examples.
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Notes
- 1.
I should make clear that Merleau-Ponty himself never wrote about psychosomatics. It is my own application of his concepts and insights to the phenomenon of psychosomatics which constitutes the phenomenological psychological theory presented in the following chapters.
- 2.
I will in the following sometimes use the terms mind and body, but these should be understood as levels of the lived body , not as separate dualistic categories.
- 3.
This is somewhat reminiscent of Piaget’s concepts of accommodation and assimilation, although here this transformation occurs on all levels, not only in terms of cognitive development.
- 4.
“Man taken as a concrete being is not just a psyche joined to an organism, but the movement to and fro of existence which at one time allows itself to take corporeal form and at others moves towards personal acts. Psychological motives and bodily occasions may overlap because there is not a single impulse in a living body which is entirely fortuitous in relation to psychic intentions, and not a single mental act which has not found at least its germ or its general outline in physiological tendencies” (1945/1962, p. 88).
- 5.
It is interesting that we say “fall” asleep in English, as the image of falling brings to mind plunging into a depth or at least losing the upright position, which is characteristic for images of personhood, such as “stand up for yourself” “to take a stand on X” “she is an upright person” etc. To lose oneself to sleep is nothing more that relinquishing the level of mind/personhood on the mind body continuum. The same metaphor of falling into sleep is used in a variety of languages, such as Swedish (falla i sömn), Spanish (caer dormindo) and Ibo in Nigeria (mmadu na- arahu ura).
- 6.
According to this theory, no distinction is made between symptoms without material causes and symptoms with material causes. What is important is how this body symptom is used as a substitute for meaning-constitution on a higher level. Whether the symptom arose due to organic or psychological processes is irrelevant. Psychosomatic pathology is a way of being-in-the-world , and as such, it is how the world appears and is lived that is important.
- 7.
Sartre used the image of making oneself into a thing in his example of bad faith (mauvais fois) but it is not in relation to freedom that this move is made on the part of the subject according to my theory. Rather, it is the result of the breakdown of meaning constitution (structure transformation) in relation to a specific situation. The person is able to carry out habitual life activities to various degrees, but in their relation to the world as an upsurge of horizons of meaning, they have retreated from the level of self and found a “home” as an objective body. Unfortunately, health care practice often reinforced the objective body, thus sedimenting even further the experience of being a thing-to-be-repaired.
- 8.
All names are changed as well as non-relevant empirical data in order to protect the identity of the persons described. The cases are from my own clinical practice, my research with staff focus groups working with psychosomatic patients, or my supervision of psychosomatic casework. Illustrative cases in this chapter are taken from Bullington et al. (2003, 2005).
- 9.
Medard Boss has used insights from Heidegger to form his own existential form of psychoanalysis called Dasein analytic. This therapy is based on the Heideggerian notions of Dasein (being-there), being-towards-death, anticipatory resoluteness and so on. Although Boss criticizes both Freudian theory and psychosomatic medicine for reasons similar to my own, his alternative is different from mine. We are both concerned with being-in-the-world and the body, but the concepts and categories of understanding used by Boss diverge from the understanding presented here. See Bingswanger (1975), Boss (1979) and van Deurzen and Kenward (2005) for literature from this tradition.
- 10.
- 11.
See Ahlzéns doctoral dissertation, Why should physicians read: Understanding clinical judgment and its relation to literary experience (2010).
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Bullington, J. (2013). The Phenomenological Psychosomatic Theory. In: The Expression of the Psychosomatic Body from a Phenomenological Perspective. SpringerBriefs in Philosophy. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6498-9_5
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