Modes of Communication—The Differentiation of Somatic and Verbal Expression

PSYCHOANALYSTS HAVE BEEN INTERESTED IN THE COMMUnicative aspects of somatic manifestations ever since Breuer and Freud (1893–95) defined hysterical conversion as "the transformation of psychical excitation into chronic somatic symptoms" (p. 86), and discovered that such symptoms disappeared when the traumatic events which had provoked the excitation were remembered, and when the accompanying affect was aroused and put into words. In their abreaction technique talking served as a substitute for action. Psychoanalysts are sometimes accused (rightly) of taking an oversimplistic view of somatic symptoms and of psychosomatic disease in that they concentrate on interpretation of unconscious conflict and ignore other factors. Freud himself certainly did not take such a simplistic view. He distinguished between "actual" neuroses with a physical cause and psychoneuroses with functional symptoms (1896), (1898). He further distinguished between symptoms which begin as symbolic somatic expressions of psychic states of mind and those which may be originally unrelated to the trauma and only fortuitously