Epilogue

It is our view that the experienced linking of mind and body may only be understood in the context of human relatedness in which it is embedded. Chronic failures of attunement during development interfere with the ability to link and integrate somatic, sensory, motoric, and cognitive aspects of experience with symbolic, affectively toned self and object images. The result is an inner world characterized by severe dissociations reflecting the fragmenting effect of interactions with invalidating and abusive caregivers.

While we agree that somatization may be a symptom of defensive or structural regression, our clinical observations suggest an additional possibility, namely, that somatization may also represent the first perceivable registering of actual subjective experience. In this context, we see dissociated bodily states as attempts at schematization of traumatically invalidated subjective worlds. In this instance, somatization occurs in a context of validating acceptance and responsiveness. It constitutes a developmental achievement in the process of self-integration.

When a patient appears in our consulting room with somatic symptoms or develops them during the analysis, we may very well be seeing a desperate attempt to communicate a “personal holocaust.” Hopefully, we now can use a new lexicon for an expanded repertoire of registering their meanings. All too often, instances of somatization that do not yield to a particular theoretical formulation are considered unanalyzable and relegated to the internist. We underscore the need for studying alternative possibilities for those bodily states not yet understood in theory. These should not be considered unanalyzable and/or dismissed as a negative therapeutic reaction, thus blaming the patient for the limitations of our knowledge. We hope that this volume of Psychoanalytic Inquiry brings us further toward accomplishing that goal.