Stimulus Entrapment: On a Common Basis of Somatization

Somatization is often conceived as if it were a form of language in which bodily symptoms are symbols, expressive of states that, for some reason, cannot be communicated directly. Can we be confident in this? Consider, for example, the following clinical presentation.

Session after session, the patient tells the therapist of a multitude of physical complaints. Pain is prominent. There is a preoccupation with sensation coming from viscera, joints, skin, and other parts of the body. The patient speaks in a monotonous way, as if the therapist were not in the room. Indeed, the patient barely looks towards the therapist and appears to expect no responses. The descriptions of symptoms are accompanied by a catalogue of events concerning such matters as problems with work and family. The patient seems unable to imagine. Rather, he or she appears to be inextricably caught up in the experience of sensation and immediate events. Is this presentation a form of symbolic communication or is it a literal representation of the patient's experience at the time? The main thesis of this paper develops the latter view. The individual is seen as enmeshed in a system of “stimulus entrapment” (Meares, 1993). This clinical phenomenon is perhaps the commonest form of somatization confronting a psychotherapist. It can be conceived as a manifestation of a disruption in the sense of going on being, or self. When the sense of self is lost through lack of connectedness with the other as selfobject, the