Affect, Somatisation and Symbolisation

Joyce McDougall conveyed the optimistic attitude that the unfolding of transference during analysis helps to dissolve psychosomatic symptoms, replacing them with transference affects, once the patient becomes able to bear her feelings. The clinical presentations did indeed convey this optimistic potential that analytic engagement usually succeeds in overcoming the previous affect intolerance of many psychosomatic patients. That intense analytic engagement generates new, strong feelings in psychosomatic analysands seemed much clearer at the end of this panel than did our usage of the terms ‘somatisation’ and ‘desomatisation’. Distance between analytic material and theoretical assumptions tended to hinder understanding, at least for this reporter, of why some of these patients needed their somatic symptoms and of how these symptoms functioned psychologically. In a nutshell, our presenting analysts were highly effective at treating patients’ somatic concerns, far more effective than at being able to explain why and how the body was being used to defend against and to express conflict. But it should not be surprising than we can analyse far better than we can explain causes and mechanisms, especially about the leap from a mental process to a somatic innervation, which Freud (1909) warned that we would not understand.

Dieter Bürgin presented a video from a research project to show steps in the development of children's pretend play and its links to symbol formation. Bürgin suggested that symbol formation allows for somatisation, although he did not otherwise discuss somatisation. So, of course, he could not consider the opposite possibility, as McDougall (1980, 1989) has proposed and as the other panellists noted, that what is expressed bodily includes some of what has not yet been encoded symbolically. What has not yet been encoded symbolically may include the effects of early trauma. Then, traumatic affects that cannot be encoded in words, so that they cannot be express