When the meaning gets lost in the body: psychosomatic disturbances as a failure of the transcendent function

The symbol in the body: the un-doing of a dissociation through Embodied Active Imagination in Jungian analysis

Jung understood dissociation as a natural state of the psyche, capable of turning defensive through development. Based on this premise, and its conception on the equivalence between psyche and matter, the present work describes the un-doing of a dissociation expressed through a chronic enterocolitis disorder. When the symbol remains closer to the body and its most instinctive manifestations, we need to descend to that level in order to let the vertical axis connection be gradually restored through the therapeutic relationship - the horizontal axis. In other words, this un-doing requires that patient and analyst follow the unconscious path proposed by symbolic expressions that gradually emerge through the patient's body and active imagination. Movement is our most primitive and fundamental experience. Many authors (Stern, Panksepp, Gallese) have agreed that, in addition to being first in terms of development, movement continues to have primacy over any other experience throughout life. This means that emotions, bodily concepts and, later, speech, evolve from a somatic basis. In the light of such neuroscientific findings, Jung's vision of the correspondence of psyche and matter will be revisited in order to portray how the analytic bond provides a context for the re-establishment of the linking/creative function of the archetype, and allows the restoring of the ego-Self axis connection by including non-verbal approaches, such as body-based active imagination, also known as Authentic Movement. Authentic Movement is an amplification of Jung's active imagination method that enables a dialogue between the ego and the diverse configurations of the unconscious. When such dialogue is grounded in the body, there is an easier access to the affective dimension stored in implicit memory. That which was relived through the body can gradually be remembered, and affects hitherto rejected, find other symbolic ways of being expressed and contained in the analytic vas.

Early trauma and affect: the importance of the body for the development of the capacity to symbolize

In this paper I aim to outline the importance of working clinically with affect when treating severely traumatized patients who have a limited capacity to symbolize. These patients, who suffer the loss of maternal care early in life, require the analyst to be closely attuned to the patient's distress through use of the countertransference and with significantly less attention paid to the transference. It is questionable whether we can speak of transference when there is limited capacity to form internal representations. The analyst's relationship with the patient is not necessarily used to make interpretations but, instead, the analyst's reverie functions therapeutically to develop awareness and containment of affect, first in the analyst's mind and, later, in the patient's, so that, in time, a relationship between the patient's mind and the body, as the first object, is made. In contrast to general object-relations theories, in which the first object is considered to be the breast or the mother, Ferrari (2004) proposes that the body is the first object in the emerging mind. Once a relationship between mind and body is established, symbolization becomes possible following the formation of internal representations of affective states in the mind, where previously there were few. Using Ferrari's body-mind model, two clinical case vignettes underline the need to use the countertransference with patients who suffered chronic developmental trauma in early childhood.

How the mind understands other minds: cognitive psychology, attachment and reflective function

Jung's epistemological relativistic attitude was very advanced for his time and very much in line with the contemporary philosophy of science. Further, Jung states that the patient's unconscious has the capacity to represent itself by creating metaphors which give the therapist all the help he might need in treating his patient. As such, Jungian analysts have not been encouraged to embark on theoretical work and as a result, the Jungian movement has been lacking those theories that connect general psychological principles with clinical practices. In an attempt to enlarge our 'middle-range theories', we shall discuss Peter Fonagy's concept of reflective function. In our opinion, the theoretical hypothesis regarding the instinct of reading the mind (Baron-Cohen 1995) and Fonagy's idea of reflective function are extremely useful in our Jungian clinical practice and these concepts are utilizable because they are not at odds with analytical psychology's general epistemological and theoretical framework.

An under-active or over-active internal world?

This paper explores the dynamics brought into analytic work when there is a symmetric fusion between psyche and soma within the patient. It will consider how such a fusion may emerge from reverberations between physical constitution and a lack of maternal attunement, containment and reflective function. I will describe the work with a patient, Jane, who was diagnosed with Myalgic Encephalomyelitis (ME) during the course of her analysis. The dynamic of her physical symptoms within the analytic work, and the impact of her internal affects and internal 'objects' within the transference and countertransference, indicated a difficulty in finding an homeostatic balance resulting in overactivity and underactivity at both somatic and psychological levels. Using the clinical work with Jane this paper will also examine the interrelationship between mother-infant attachment, an inadequate internalized maternal reflective function, affect dysregulation, unconscious fusion, the lack of psyche-soma differentiation and the impact of the latter in relation to internal regulation systems, or lack of, in patients with Chronic Fatigue Syndrome (CFS) and Myalgic Encephalomyelitis (ME). I will draw on similar work carried out by Holland (1997), Simpson (1997) and Simpson et al. (1997). The paper will also employ the concept of the reflective function (Fonagy 2001; Knox 2003), and consider Matte-Blanco's (1999) concepts of generalization and unconscious symmetry in relation to the patient's internal world. I go on to consider how analysis provides a point outside the 'fusion' that can enable the 'deadlock' to be broken.

A body with chronic fatigue syndrome as a battleground for the fight to separate from the mother

I describe the therapy of a 20-year-old women who believed that her difficulties in concentrating and remembering were caused by her "ME' (Myalgic encephalomyelitis, Chronic fatigue syndrome, or CFS). She had been fathered by a man who never left his own wife. Work with her dreams revealed a within-body drama in which she was locked in an unspeakable fight to the death with her mother. Her symptoms improved after parallels between a dream and an accident showed her own self-destructive hand in her story. Another dream, reflecting her first 'incestuous' affair, showed her search for her original father-self as someone separate from mother, and a later affair provided a between-body drama, helping her to own the arrogant and abject traits she had before seen only as her mother's. I show how we worked in the area of Winnicott's first 'primitive agony' as experienced by a somatizing patient, stuck in a too-close destructive relationship with her mother-body. I discuss how analytical work can be done with the primitive affects and conflicts against which the ME symptoms may be defending.

Coniunctio--in bodily and psychic modes: dissociation, devitalization and integration in a case of chronic fatigue syndrome

Three years of analytical psychotherapy with a professional woman in mid-life, suffering from chronic fatigue syndrome (CFS), is described. Gradual recovery merged into mid-life changes; marriage, along with a new balance of maternal and paternal imagos, enabled her to trust enough to become pregnant-coniunctio in the most primal bodily and psychic modes. Her life-long, schizoid type pattern, "the pendulum of closeness and isolation', with its extreme of psycho-physical collapse and devitalization, was replayed in therapy. The analyst's symbolic attitude is emphasized, containing the patient's initial affective explosion and validating the physicality of her condition. Mirroring and steady rhythmic attunement became a new, pre-verbal, source of trust-vitalization; differentiation and separation replaced defensive splitting and dissociation. Then the overwhelmingly powerful bodily/maternal could be counterbalanced by the masculine, and a transitional space emerged for symbolic work. Both the regressive and the dynamic aspects of CFS are located in the earliest undifferentiated, archetypal, bodily/psychic modes, when the frustration of primary needs evokes the defences of the self. It is argued that our psychodynamic understanding can contribute to the stalemate in seeing chronic fatigue syndrome as either an organic illness or depression, and that a new linking of the somatic and psychic calls for a new professional collaboration.

Looking out and looking in: some reflections on 'body talk' in the consulting room

In this paper, I use illustrations from analytic work with one patient to suggest that we reconsider and extend the meaning which we give to the term 'psychosomatic'. It should include patients who come for analysis with severe anxieties about their bodies which may not necessarily take the form of an actual organic bodily illness. Using contemporary analytic thinking in this field, I have tried to look at what we mean by the term 'psychosomatic' and to make some attempt to differentiate it from the term 'hysteria'. Hysterical symptoms may sometimes mask earlier and more profound psychosomatic troubles, but may need to be analysed before the core split between psyche and soma may be approached. A useful way of bypassing difficult overlaps in diagnostic terminology when thinking about the way in which patients use the body in the consulting room, can be to make a distinction between body talk and body language. Body talk I have described as a primitive mode of communication which is a precursor to actual talking and which for some patients can come to be a substitute for talking, thinking and reflecting. When this happens, it suggests a very early fundamental rupture between body and mind where certain deintegration/reintegration experiences have inhibited growth and the body continues to function in an archetypal fashion. I hypothesize that body talk is a consequence of the kind of preverbal communication between mother and baby where there may have been a bad fit in terms of vitality affects. In later life, this can manifest itself in the form of 'body' or psychosomatic problems which cannot be put into words but are often recognizable through the quality of the interpersonal transference dynamics. Body language, on the other hand, is an essential and unique component in every patient's communication about him or herself. Our sense impressions of a patient can teach us much about the psychic meaning of body-based responses through observing with our eyes, our nose, as well as through our ears. Whilst we may all regress into body talk when under stress, body language may be said to be more integrated at all points with verbal communications and therefore it suggests some capacity to symbolize. In the transference/countertransference dynamics, there is less evidence of discomfort or dissonance between what the patient is 'saying' and what they seem to be 'doing', than there was in the earlier body talk.