EPILOGUE

The contributors to this issue have considered the psychosomatic patient from a variety of contemporary perspectives, but all of them recognize that the mind and the body constantly interact. It is clear to most psychoanalysts and dynamically oriented clinicians, explicitly or implicitly, that affect is a somatic event as well as a psychic one, however intertwined it may be with the internal fate of the loved and hated objects of infancy and childhood. It is less apparent to intuition that the complicated vicissitudes of developmental processes, relational issues, and internal conflicts are psychosomatic events, too. Yet they are being mediated through bodily experience, and a physical symptom may be as much a compromise formation as a phobia or an obsessional thought. This is why, for some patients—most familiarly, but not only, those who suffer from recognized psychosomatic disorders—it may not be possible to approach their emotional complaints until their bodily compromise formations have been at least partially understood and ameliorated. Sadly, because the initial phase of therapeutic work may take considerable time in patients who habitually express experience physically instead of in words, some analysts and therapists conclude that these patients are unanalyzable, too concrete to benefit from an analytic or dynamic treatment approach. This misapprehension is a loss for both the patient and the therapist, as many apparently refractory patients with psychosomatic issues can, indeed, benefit from treatment. Even in ordinary analytic patients, some psychological experiences are accessible to analysis only through attention to their bodily reflections.

As the cases presented here illustrate, psychosomatic illness is multiply determined, and its possible sources are many. Bodily symptoms may be expressions of relatively early affects, unsymbolized at the time of their occurrence, before language was available. Or they may express later affects that for one reason o