When Symptoms Become Questions

                                                        

  Image by Yara Amaral | Unsplash

Exploring the relationship between the body, the psyche and meaning

When we talk about illness, it is important to recognise that it is not just about the body. Historically, the relationship between mind (or soul) and body has been debated since ancient Greek philosophy. Plato distinguished between the soul and the body, while Aristotle viewed them as inseparable aspects of a living organism. Later, René Descartes famously distinguished the mind from the body while still recognising that they interact. Contemporary approaches move beyond a simple mind–body framework by recognising that health and illness are influenced by biological, psychological and social factors, which interact with one another.

From a psychoanalytic view, illness can mean losing the sense of meaning that holds life together. What is unwell can be our very sense of self. Illness can begin when our desires are silenced, when we forget who we are, and when the unspoken starts to speak through symptoms.

Picture a woman who has spent years caring for her children, husband, the family business, and her elderly parents. One day, she starts to feel dizzy. She has always been strong and resilient, but suddenly she cannot get out of bed. She is exhausted, paralysed. Medicine might ask, “What is the diagnosis?” A psychoanalyst might ask, “What collapsed inside her? What role did she play, and what role does she truly want?”

In this way, illness can be the breaking of a mask, when an identity built on others’ expectations starts to fall apart. The body reveals what the soul has been trying to say: I cannot take this anymore. Illness is a way of communicating without words. A symptom is the unconscious sending a coded message. And as Freud said, every symptom has meaning.

  Image by Vilkasss | Pixabay

In psychoanalytic thinking, symptoms can be understood as meaningful expressions of unconscious conflict. One of the central aims of psychoanalysis is to transform the body that speaks through symptoms into a subject who can speak through words. 

Illness is a form of self-defence. Although this may seem strange, many illnesses serve a defensive function. The obsessive who loses themselves in rituals is, unconsciously, protecting themselves from chaos. The person who develops a phobia is setting boundaries for a territory where they can exist in safety. The psychotic who constructs a delusion is attempting to organise a world that has become intolerable. A symptom is not a punishment. It is an attempt. Of course, it is a dysfunctional attempt, one that brings suffering. The body wants to scream, but when it cannot do so through words, it creates dysfunctional symptoms instead. Treating an illness or symptom without addressing its emotional cause is like mopping up water from a leaking roof without repairing the hole above.

The social position one occupies can also be a source of illness. Contemporary society is built on performance. How many people, after receiving a promotion at work, fall ill because their exhausted body refuses to continue, yet they do not know how to ask to slow down? 

For some young people, self-harm may become a way of regulating overwhelming emotions, communicating distress, or temporarily converting psychological pain into something physically tangible. Therapy can provide alternative ways of recognising, expressing and regulating that distress.

The therapist’s role is not to erase the symptom, but to ensure that the person is heard and can reclaim their own story. Healing in therapy is not the same as the cure found in medical manuals; it is the re-inscription of the person into their own narrative, giving new meaning to what once seemed meaningless. This requires time, trust, and ethics. 

From personal experience, as far as I can remember, I have always been quite somatically oriented. During adolescence, I experienced rashes on my legs and scalp, facial paralysis, and later endometriosis and episodes of fever without an identifiable cause. While there are biological explanations for some of these experiences, the underlying causes have not always been clear to me. What I do remember is that some of these periods coincided with significant stress, which makes me wonder about the relationship between my psychological experiences and my physical symptoms. Of course, this does not mean that stress was necessarily the cause.

As women grow older, the picture can become even more complicated, as physical changes may be attributed to perimenopause or other biological processes. When we cannot identify a clear cause, there can also be a temptation to look for explanations that are invisible, such as spiritual causes. However, this can sometimes become a form of new age spiritual bypassing, where spiritual explanations replace the deeper self-reflection that might otherwise take place.

At the same time, I think we need to be careful not to fall into the opposite trap. We cannot simply attribute everything to perimenopause or another biological explanation and stop looking at the psychological dimension. Perhaps we need to avoid both spiritual bypassing and what we might call biological bypassing.

There are, of course, many biological factors in the equation, and these should not be ignored. But neither should we ignore the potential clues offered by our psyche. Rather than assuming that a physical symptom is caused by the psyche, we can remain curious about what the symptom might be telling us about our experience as a whole.

We don't have to assume that the psyche caused the symptom to become curious about what the symptom might reveal.

In therapy, there is space to discuss things that we may never be able to answer with certainty. The value lies in reflecting on our personal experiences and the patterns we observe. The ways in which our experiences affect our bodies can become clues that point us towards new directions and new learning. In this sense, self-reflection is like a psychological muscle that we can develop, allowing us to explore our symptoms with curiosity without needing to immediately find an answer.

If we begin with the assumption that there is no connection between our psychological experience and our physical symptoms, we may limit the exploration. But the opposite is also true: if we become convinced that we have discovered a particular root cause, the exploration can stop there too. When we are too certain, we may stop being curious.

Perhaps the more we try to control the meaning of our experiences, the less space we leave for learning from them.

I am experiencing neck pain at the moment. It has been present for a long time, and I have tried many things to address it. In my own exploration in therapy, however, I often use the pain as a starting point for reflection. My pain and my bodily state become a kind of sensor, helping me notice the contrast between different experiences and what it feels like to be in each of those states.

How does anxiety affect my body? What happens to my body when I feel safe, relaxed or connected? What changes when I experience stress or anxiety? The more I talk about these experiences in therapy, the more aware I become of the connections between my body, my emotions and my sense of self. As a result, I feel less anxious, and simply by understanding it, I can improve my life well-being. 

Different therapeutic approaches offer different ways of exploring the relationship between mind and body. Although they overlap, somatic approaches, Gestalt therapy, Focusing and mindfulness approach bodily experience from different perspectives. They can all help us become more aware of the body without assuming that every physical symptom has a hidden psychological cause.

Somatic approaches have roots in the work of Wilhelm Reich, who developed the idea of “character armour” to describe patterns of muscular tension associated with emotional experience. Later practitioners developed different forms of body-oriented psychotherapy. Alexander Lowen, for example, developed Bioenergetic Analysis, while Peter Levine developed Somatic Experiencing and Pat Ogden developed Sensorimotor Psychotherapy. These approaches place bodily experience more explicitly at the centre of therapeutic exploration. A therapist may invite a client to notice sensations such as muscle tension, changes in breathing, pressure, movement or feelings of activation and relaxation. For example, a client might notice that their shoulders become tense whenever they talk about a particular relationship. Rather than immediately interpreting this tension, the therapist may invite the client to slow down and explore the sensation: “What are you noticing in your shoulders right now?” The bodily experience becomes a doorway into greater self-awareness.

Gestalt therapy, developed by Fritz Perls, Laura Perls and Paul Goodman, also pays attention to the body, but places particular emphasis on awareness and immediacy. What is happening in the person's experience right now, including what happens between the client and therapist. Instead of only discussing an event from the past, the therapist may ask, “What are you experiencing as you tell me this?” For example, imagine a client saying, “My boss always makes me feel powerless.” As they speak, the therapist notices that the client looks down, becomes quiet and clenches their hands. Rather than analysing what this behaviour means, the therapist might say, “As you talk about your boss, I notice you are looking down, and your hands are tightened. What are you experiencing right now?” The client might respond, “I'm angry, but I don't feel allowed to be angry.” The therapist can then explore what is happening in that moment. The focus is therefore not simply on the body, but on the whole experience as it unfolds in the present moment and within the therapeutic relationship.

Focusing, developed by philosopher and psychotherapist Eugene Gendlin, offers another particularly interesting way of working with bodily experience. Gendlin described the felt sense as a bodily sense of a situation that is often difficult to put into words. For example, a client may say, “I don't know what's wrong, but I feel something here,” while pointing to their chest or stomach. Rather than immediately interpreting the sensation, the therapist can invite the client to stay with it gently and notice what words, images or meanings emerge. The process moves from bodily sensation towards language and meaning. Importantly, the meaning is not imposed by the therapist; it emerges through the client's own experiencing.

Mindfulness, associated with contemporary clinical approaches and influenced by contemplative traditions, offers yet another way of approaching bodily experience. Rather than immediately asking why a sensation is present or what it means, mindfulness encourages the person to observe thoughts, emotions and bodily sensations with curiosity and without judgment. A person experiencing pain might notice its location, intensity and changing qualities without immediately creating a story about it. This creates a space between sensation and interpretation.

These approaches therefore offer different ways of bringing the body into therapy. Somatic approaches may use bodily sensation as a primary doorway into therapeutic work; Gestalt therapy explores bodily, emotional and relational experience as it unfolds in the present moment; Focusing explores the felt sense and allows meaning to emerge from bodily experience; and mindfulness develops the capacity to observe experience without immediately needing to explain or change it. Despite their differences, they share an important possibility: the body can become a starting point for inquiry rather than a source of certainty. We do not necessarily need to decide what a symptom means before we can become curious about our experience of it.

What if your symptoms are not only asking to be treated, but also asking to be heard?

Take a moment to listen inward. What might your body be trying to tell you? What has remained unspoken? And what meaning might be waiting to emerge?

Perhaps the question is not only, “What is wrong with me?” but also, “What is asking to be understood?”

What do you think? Have you ever experienced a moment when your body seemed to express something you could not put into words? Share your reflections in the comments.