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Freud's declaration that ‘the ego is first and foremost a bodily ego’ (1923, p. 26) was long preceded by his interest in the psychodynamic foundations of the somatic symptoms of hysteria (Breuer & Freud, 1895) and his astute observations of patients’ non-verbal communications in the clinical situation (Freud, 1909). Wilhelm Reich developed this line of thinking with great fervor. Before his descent into paranoid grandiosity, Reich made highly significant contributions to psychoanalysis, especially in the realm of character pathology and its treatment. More than any other analyst, he investigated and worked with embodied expression of affect and fantasy. Note the following remarks.
‘Alongside the “what” of the old Freudian technique, I placed the “how.” I already knew that the “how”, i.e. the form of the behavior and communications, was far more important than what the patient told the analyst. Words can lie. The expression never lies’ (1942, p. 152).
‘ … the patient's behaviour (manner, look, language, countenance, dress, handshake, etc.) not only is vastly underestimated in terms of its analytic importance but is usually completely overlooked' (1949/1972, p. 81).
‘The patient's expressive movements involuntarily bring about an imitation in our own organism. By imitating these movements, we “sense” and understand the expression in ourselves and, consequently, in the patient’ (1949/1972, p. 362).
Reich's work inspired psychoanalytic interest in non-verbal, postural, and somatic communications during the clinical hour. It also led to therapeutic techniques that included actual involvement with patients’ bodies. Reich himself began practicing ‘vegetotherapy’ and, later, ‘orgone therapy’. Many forms of Reichian body work subsequently emerged, including Character Analytic Vegetotherapy which, at times, went in shocking directions whereby ‘patients were treated in their underwear and sometimes completely naked’ (p. 47). Among the methods that stayed close to conventional prac