Looking Out and Looking In:

In this paper, I use illustrations from analytic work with one patient to suggest that we reconsider and extend the meaning which we give to the term 'psychosomatic'. It should include patients who come for analysis with severe anxieties about their bodies which may not necessarily take the form of an actual organic bodily illness. Using contemporary analytic thinking in this field, I have tried to look at what we mean by the term 'psychosomatic' and to make some attempt to differentiate it from the term 'hysteria'. Hysterical symptoms may sometimes mask earlier and more profound psychosomatic troubles, but may need to be analysed before the core split between psyche and soma may be approached. A useful way of bypassing difficult overlaps in diagnostic terminology when thinking about the way in which patients use the body in the consulting room, can be to make a distinction between body talk and body language. Body talk I have described as a primitive mode of communication which is a precursor to actual talking and which for some patients can come to be a substitute for talking, thinking and reflecting. When this happens, it suggests a very early fundamental rupture between body and mind where certain deintegration/reintegration experiences have inhibited growth and the body continues to function in an archetypal fashion. I hypothesize that body talk is a consequence of the kind of preverbal communication between mother and baby where there may have been a bad fit in terms of vitality affects. In later life, this can manifest itself in the form of 'body' or psychosomatic problems which cannot be put into words but are often recognizable through the quality of the interpersonal transference dynamics. Body language, on the other hand, is an essential and unique component in every patient's communication about him or herself. Our sense impressions of a patient can teach us much about the psychic meaning of body-based responses through observing with our eyes, our nose, as well as through our ears. Whilst we may all regress into body talk when under stress, body language may be said to be more integrated at all points with verbal communications and therefore it suggests some capacity to symbolize. In the transference/countertransference dynamics, there is less evidence of discomfort or dissonance between what the patient is 'saying' and what they seem to be 'doing', than there was in the earlier body talk.