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The mind/body duality has been with us in many forms: mind/brain, organic/functional, feelings/behavior. In psychoanalytic thinking the
actual body is often not quite present, with attention directed instead to fantasies and concepts about the body and its symbolic meanings. Relational perspectives consider the “embodied self,” for instance, but not the real three-dimensional body. In Unmasking Psychological Symptoms, Barbara Schildkrout approaches the mind/body duality with a particular focus. She asks us to consider the body as possibly an unrecognized contributor to our patients' emotional symptoms and complaints. Her emphasis is on finding any underlying somatic pathology that may play a role in problems that present as psychological. Fully aware of the complexity of syndromes, she avoids the dichotomous thinking that would reductively identify symptoms as either functional or organically based, to the exclusion of the other. Her thesis is that some somatic disorders can mimic psychological conditions, or produce psychological symptoms. For example, depression can accompany pancreatic cancer or thyroid malfunction. The depression is not the patient's reaction to the illness but rather is based on neuronal or hormonal changes attendant on the condition. If the therapist treats only the depression, the somatic problem can be missed. Schildkrout wants therapists to keep in mind the possibility that organic pathology may be present—say, a brain tumor, a seizure disorder, a thyroid malfunction—and to look for clues that arouse suspicion about the presence of covert organic illness. One needs to “unmask” psychological symptoms caused by a medical disorder in order to find that disorder. This point seems to me extremely important, and we as analysts and therapists can easily miss it, particularly when a patient's symptoms fit a specific psychiatric picture. The tendency then is to develop a dynamic formulation and look no further. This is particularly likely when the