Concreteness, Metaphor, and Psychosomatic Disorders: Bridging the Gap

Use of metaphors when treating unexplained medical symptoms

The words one chooses to describe personal pain mirror current usage, but may also hold echoes of an individual’s lived experience. They may provide clues to the origin of physical symptoms that are medically hard to explain. The aim of this commentary is to propose, on the basis of the available literature, that verbal metaphors can prove effective in the psychotherapy of such conditions. I provide a case history of a 45 year old woman referred to psychiatry because of extreme ‘burning’ pain in her mouth and tongue. She had been to numerous doctors, had undergone a variety of tests, had tried many medical treatments, and had been prescribed a number of different pharmaceutical agents. She had changed her diet, done her daily dental mouth exercises, drunk a lot of water, but the burning continued and interfered, with her job (she was a teacher), her friendships, and her everyday life. This made her angry and recalcitrant to therapy, but the metaphor ‘burning with rage,’ as applicable to her pain, worked to establish a good alliance that led to a decrease of symptoms. Burning Mouth Syndrome is a medically unexplained condition of complex etiology that psychotherapy alone cannot reverse. The literature bears out, however, that the use of metaphors can help to open avenues of psychological exploration that accelerate adaptation to pain and improve quality life.

Psychosomatics today: a review of contemporary theory and practice

In the past few years there has been a dramatic increase in the number of psychoanalytic publications on the topic of psychosomatic illness, including edited collections and special editions of psychoanalytic journals. This paper is a critical conceptual review of the topic of psychosomatic illness using the material contained in a number of these recent publications as a basis, but also drawing on other works by the key authors of the publications discussed herein. This paper proposes that currently there appear to be two schools of thought around the origin, development, and treatment of psychosomatic symptoms. The first of these is the well-established "Paris School of Psychosomatics." The second approach does not formally exist, but is referred to in this paper as the "Attachment approach" since there are a number of authors who theorize about the treatment of psychosomatic symptoms in a similar and important way. The paper will compare and contrast the two approaches with respect to their underlying theories, treatment approaches, and conceptualization of the mind-body problem, with particular attention paid to how this is related to mentalization. The understanding of how problems in mentalization may be linked to psychosomatic illness can be conceptualized as the "speechless mind" from the perspective of the Paris School and as the "speaking body" by the Attachment approach. The paper concludes by engaging with these two conceptualizations and suggests that in order for an individual to achieve both psychological and physical health, the work of sensation must be located primarily in the logic and function of the body, while the work of making sense of these sensations and interpreting them must be located in the mind.