The Structure of Psychosomatic Symptoms

This article presents an outline of the research that has been carried out at the Institute of Psychotherapy in Milan, Italy, under my supervision.1 Our research is founded on the psychotherapeutic treatment of 14 psychosomatic patients by 10 physicians and psychologists for an average of 3 years. Our main research goals were to learn whether there is a specific psychosomatic structure, as has been discussed in recent years by many authors, and to learn what its clinical and metapsychological features are when compared with those of psychoneurosis.

The concept of alexithymia was introduced to modern psychiatry by Nemiah and Sifneos.2 It is rooted in the observation that psychosomatic patients are not able adequately to perceive and to express their own feelings. Nemiah and Sifneos presented two hypothetical alternatives to explain the genesis of psychosomatic diseases: either alexithymia is the consequence of some biological fault, corresponding to a primary emotional defect, or it is the expression of a neurotic denial. Particularly Nemiah is of the opinion that psychosomatic illness may somehow be rooted in malfunctioning neural connections between the limbic system, where somatic feelings are organized, and the neocortex, where they are consciously represented.

The work of these American authors has been paralleled in Europe by three French authors, Marty, M'Uzan and David,3 who in 1963 stressed the “economic level,” the “structural and the progressive disorganizations,” and the “partial and global regressions” of such patients. On the clinical level, they were also impressed by the patients’ lack of fantasy, of symbolization, and of insights. They spoke of a “psychosomatic structure,” which would be resistant to psychoanalysis. These authors presented a group of psychosomatic patients who resisted psychological analysis. Marty, M'Uzan, and David proposed an alternative model to that of neurosis, as known in classic psychoanalysis. They termed their model psychosom