I stumbled on this lecture, which is very timely find.
Gestalt therapy is an effective an efficacious form of psychotherapy (Roubal, 2016). Gestalt psychotherapy is practiced by certified psychotherapists trained and supervised in the modality. Anyone who is interested in having gestalt therapy as a treatment for psychological and psycho-somatic stress or pain, or for the treatment of systemic issues regarding relationships in families or organizations, should seek a gestalt therapist who is actually trained and licensed as one.
Gestalt therapy is often described as a humanistic and holistic form of therapy. What this means, is that when a client comes to a gestalt therapist, he/she can expect to be met with a trained person who has been treated with gestalt therapy him/herself. Here I emphasize the person as an instrument of treatment, as opposed to other instruments like medication, techniques, advise or exercises.
Established gestalt therapists have identified observable behaviors that one can expect of gestalt therapists at work. This is documented within the gestalt therapy fidelity scale, or GTFS (Fogarty et al., 2016).
So, what do Gestalt therapists really do in the session?
Developing awareness. It is said that “knowledge is power”. Awareness, however, takes the client way beyond empowerment. It leads towards self-agency and healing. When a client approaches therapy, he/she is really looking for healing answers. This knowledge is given to the client through newly acquired self-awareness. Gestalt therapy acknowledges awareness as encompassing 1) inner emotions feelings, 2) behavior, speech and actions, and 3) thoughts, judgements, beliefs. Developing awareness is not what the therapist does per se. Its intent is, however, central to the work.
Working relationally. Clients usually come for therapy with a target complaint. This complaint is very valid to the goal of the therapy. It is not unlike going to the doctor with a health complaint. Gestalt therapists, however, handle the complaint differently from doctors. The therapist pays attention to the client’s interaction with the therapist in the session and the therapist pays attention to his/her own resonance with the client in the session. The therapist has no pre-determined agenda. For example, a client comes in with complaints of insomnia. The therapist focusses on the client interaction with the therapist in the session. There is no judgement on part of the therapist. She allows the client to freely express himself. She pays attention to the differences between them. She notices how the client talks quickly with flat affect. She notices also how she feels “heavy in the head” as the client speaks. Giving attention to this dialogical interaction, the therapist and client gain awareness of the client’s mode of being in the world. The client learns of the psychological burdens that keeps him up at night.
Working in the here and now. The therapist asks the client about his immediate experience. If the client mentions a disappointing day at work, the therapist would notice his facial expressions and tone of voice as he recounts his experiences.
Phenomenological practice. The therapist would bring these feelings to awareness of the present moment, thereby helping the client to describe and deepen his sense of theses experiences and gain better understanding of the presenting issue.
Working with embodied awareness. The client is encouraged to observe his emotions and bodily sensations. The therapist may notice the client’s shallow breathing, for example, and mention it. Through this deep embodied understanding the client is encouraged to try new movements. He realizes that he has choices.
Observance of the resonance in the relationship. The therapist is sensitive to the context in which the dialogue takes shape. Themes emerge. Emotions emerge. The therapist shares with the client her experience of what emerges. The client is empowered, with this awareness which is otherwise unconscious to him. He is provided with the new learning of his role in his past, present and future relationships.
Working with client’s mode of relating. The therapist acknowledges the client’s relationship pattern as these emerge during the session. In gestalt therapy, both therapist and client co-create the space in which they reside. They explore how they impact each other in the relationship.
Adopting a spirit of experimentation. Like in a kaleidoscope, small changes in movements lead to complete change in form of the pattern. The therapy session is like a crucible of life. The client is encouraged to experiment with new ways of being: simple moves within a session like a movement of the hand or uttering a sentence to somebody on an empty chair. The therapist supports the client with these experiments. They explore ways in which he can integrate these experiences in the world outside the therapy session.
The client leaves therapy with new awareness and is armed with choice. In the case of the client who has had insomnia, work with a therapist in the gestalt modality can be effective. The client works on his self as a whole, rather than only with his sleeping problems. The client is not his illness. He is a person who has feelings and relationships. Working on his self-awareness, the client gains agency over himself. In therapy, he experiments with ways of being. He finds answers to questions that affect his life. He gains better understanding of his past, present and future. He gains self-compassion. He learns to let his body rest at night.
Fogarty, M., Bhar, S., Theiler, S., & O’Shea, L. (2016). What do Gestalt therapists do in the clinic? The expert consensus. British Gestalt Journal, 25(1), 32-41.
Roubal, J. (Ed.). (2016). Towards a research tradition in Gestalt therapy. Cambridge Scholars Publishing.
Contact for gestalt therapy in Singapore or recommendations internationally
Presenting a psychotherapy case study about how psychotherapy treatment heals.
The full potential of psychotherapy is healing. The healing work enabled through psychotherapy is holistic. This means that psychotherapeutic healing involves the biological, psychological and social aspect of the patient.
Psychotherapy is a complement to medical treatment
Unlike medical professionals who traditionally focus solely on the body while ignoring the social and mental state of the patient — that is now changing in, thankfully– psychotherapists pay attention to the entire person. Particularly true for chronic diseases like cardio-vascular heart disease, medicine and medical procedures only try to remove the symptoms. Psychotherapy helps the patient to work through stress that resulted in the symptoms in the first place, manage behavior to help maintain lifestyle changes, and work through coping with the depression and trauma of having been diagnosed.
Studies have been surfacing about the link between stress and chronic diseases. Read this article featuring a lecture by Gabor Maté : Denial of own emotional needs and its connection to chronic illness.
Psychotherapy is a more intensive form of counseling or psychiatry
Psychotherapy is a profession that is often confused with others, like counseling, psychology and even psychiatry. To really briefly describe the essential focus on each field of mental health I would say that counseling works on problems of daily existence, daily functioning at work and play, or problems created from behaviors that do not support daily function. Psychology is a broad field of work that researches human behavior and responses to situations. Psychiatry considers that which is emotional and behavioral to be biological, and deals with these issues with medicine or medical procedures.
The way to explain the gestalt therapy attitude towards healing is with this Chinese idiom:
“When cutting grass, the roots are not pulled out, when spring arrives, the grass grows back.”Chinese idiom
We can see this in ourselves and in others. Our emotional problems, issues with relationships, problems with work, health problems tend to show repeating patterns. Sometimes we even see these patterns in our parents or in our children. Oftentimes we try to fix the problems. Often another problem of a similar nature surfaces. This is the metaphorical grass mentioned in the above idiom.
If you do go for psychotherapy, your attitude as a patient is to work towards identifying and removing the roots. It is not always painless, but a therapist who is well versed in the work can walk you through it.
The tool of Psychotherapy is dialogue
The term “talking cure” was coined by a patient of Breuer, Anna O, the first recognized patient of psychotherapy. Talking is not the right word. Rather I would used the word, dialogue. Gestalt psychotherapists like myself work with verbal and non-verbal communication. We can work with persons who do not talk or are not able to.
Psychotherapy works through affects and unconscious activity through dialogue and expression of these thoughts and emotions. The goal is to relief stress from painful emotions, by working through traumatic memories, painful thoughts, and difficult emotional experiences. Through working with the unconscious, awareness is formed and stress is relieved.
Relief of stress from psychotherapeutic treatment and health consequences
The relief of stress creates a change in the neuro-chemical balance in the brain. In turn, the hormonal system is readjusted. This changes and strengthens the immune system and cardio-vascular system. Balance in the immune system reduces risk of cancer and even aids in healing cancer, while reduced stress to the cardio-vascular system reduces blood pressure and heart attack & stroke risk.
Psychotherapy heals the body by causing a readjustment of the neuro-chemicals and hormones in the organs. Patients can feel this effect after an effective session of psychotherapy.
What one gets from Psychotherapy is a holistic benefit: empowerment to build relationships, energy for work, study and play, and inner peace.
What is the consequence of this relief of stress? Let this interview of Bruce Lipton explain to you how relief of stress as a result of dealing with the unconscious leads to physical healing and prevention of serious diseases. Lipton explains how medical problems are influenced by epigenetics rather than genetics. Unlike genetics, which we cannot change, epigenetics describe the expression of genes. Expression of genes is determined by environmental and situational factors that we face in our daily lives.
Lipton explains that belief can determine outcome of treatment of illnesses, and how this translates to the concept that our consciousness affect if we get ill or get cured.
Healing in the psychotherapeutic session
I focus on the emotions and the connected thoughts that arise. The opposite is also important: memories and even fantasies are investigated to examine the underlying emotions. The integration of the person with his/her emotions and thoughts through dialogue and behavioral experimentation in the psychotherapeutic session leads to chemical change in the neurological system of the patient.
This is a case study of a patient who came to therapy because of experiencing stress at his workplace. He was often on sick leave for chronic migraine, hemorrhoids and even un-explainable occasional hearing loss. Close to losing his job, he attends therapy. Only after weeks of treatment, did he realize how he, as a young child, was affected by traumatic situations at kindergarten and later elementary school. His home country was governed by a communist regime during the time of his childhood in the 80s. He had survived his childhood years by forgetting how frightening and lonely the situation was, while secretly hoping that he would be sick so that he could skip school.
This client’s psychotherapy treatment was about working through the trauma. With time, we worked together integrating his memories with awareness of which emotions belonged to the past, and what is no longer needed in the present. One of these was the realization that he no longer needed to “get sick” to skip work. He took breaks, sometimes weeks of non-paid vacation. He learned to regulate his spending, so that he could breathe easy when he took those breaks. Talking about and expressing painful emotions allowed him to release energy that he had bottled up and forgotten all his young life. He became more aware of tension in his body, and started doing yoga. Soon after, he stopped taking medication for migraine. The patient realizes that his path to healing is life-long. Along the way, he was able to find love as well.
The Lasting Effect of Psychotherapy
Unlike taking a pill to regulate emotions, neurological changes brought about by psychotherapy are subtle and lasts the lifetime. With regular sessions, these changes snowball into observable physical improvement. Unlike medication, treatment with psychotherapy does not leave behind negative physical side-effects, as can be seen with antidepressants.
For reasons that Psychotherapy is chemical-free, it is a treatment much needed for children, teens, young adults, and people hoping to be parents.
Through working with the psyche, psychotherapy enables the patient to better function in work, play, sex and relationships. As the patient becomes more self aware, he/she also becomes more aware of his/her relationships. He/she ultimately functions better in life. The effect of psychotherapy achieves what one looks for in counseling, with the added benefit somatic healing.
Just as there exists many schools of psychotherapists, there are, of course, different opinions on this subject of healing. The article written reflects my own work.
I mentioned in the first page of my website that clients can expect motivating, fun and experiential psychotherapy sessions. While it is for most clients the road to therapy is wrought with painful experiences and difficulties, being in therapy is about learning. The learning one gets from gestalt psychotherapy is not the kind of cognitive learning one expects to get at school. Rather, in experiential sessions, one learns procedurally. The experiments and role playing enables the clients to embody new ways of being. This kind of learning takes no effort. This kind of learning is integrated and permanent. The road to this kind of learning is also playful, touching and motivating.
Scapegoating is a phenomenon that happens in almost all human groups. A. Colman (video below), begins the above talk by saying that it is the root of evil in humanity. Is he exaggerating this? Or are there truths in his remark?
What makes a group?
A group is made up of a bunch of individuals (and we are referring to human individuals here), who have to be together because of a certain task or function. A company of workers is a group. There are social groups, church groups, political groups, hobby groups, support groups and the like. Families are also groups.
In my article Bion: The Function of Myths in Groups, I explain that a group is a body that has a mental state and creates a phantasy. The group becomes more than the sum of people that come together to form it. The group has its own dynamics and it is its own organism.
Groups are like organisms, and they strive to keep themselves intact
The group connects the inner worlds of people. Narcissistic tendencies and psychological traumas get played out in groups. Like a living organism, the group strives to keep itself intact.
In order to do so, any form of aggression that naturally and unconsciously arises from the group becomes a threat to the status quo of the group. There is a tendency then for the group to move towards “doing something” to maintain harmony and equilibrium. The individuals then strive to retain their own idea of their “good self” and deny their part in the aggression that threatens the group.
Groups need scapegoats so that the members can disown their responsibility for the group’s destruction
The aggression that is latent in the group becomes disowned by the individuals (who do not want to be blamed for their group’s destruction), and transferred on to an external object of blame. This object of blame is the scapegoat.
Oftentimes the scapegoat is a member of the group. Sometimes it appears in the form of someone from outside the group– people from another culture, immigrants, women, etc.
Scapegoating in Groups
Scapegoating is the most ancient human rituals. It used to come in the form of practices such as child & animal sacrifice, adult sacrifice, witch hunting. Large groups of people can also become scapegoats, as we have witnessed during the Holocaust, Apartheid, and other genocides.
A Scapegoat is a person, subgroup, collective idea … who is made to take the anxious blame for the other people in their place.
The process of scapegoating is done in order for the rest to feel more comfortable, or to be more efficient, and whole.
The scapegoat embodies the transformational, creative and/or destructive potential within the group.
The scapegoat has often creative potential, and is often different from the others in the group. Sometimes this person has the potential to make changes in society.
Scapegoating is victimization of the other
Many who have been young victims of bullying in school or in the family have experienced from a young age, what it is like to be in the position of the scapegoat.
The scapegoat is usually the different / outsider. Not being able to bear the difference. Potential scapegoats are usually people who are racially different.
In order to survive being scapegoated, the person either turns into the
- victim /patient (as in children who develop illnesses or develop behavioral problems in school).
- avenger (someone who takes revenge)
- the messiah / prophet (someone who saves the group)
09:10 Colman, in the video above provides us with literary examples of some of these scapegoat transformations.
In Families, the child who becomes the Scapegoat is also the Symptom Bearer
Scapegoating happen in almost all families. Most of the time a child in the families bears the brunt of the scapegoating. If the family is relatively harmonious, the scapegoat feels simply like a “black sheep”, and grows up to be an adult who can function well.
In families that are dysfunctional, or in families where mental disorders and/or addictions or illnesses exist, the scapegoat child develops symptoms or syndromes that affect his/her ability to function emotionally as an adult. Some of these scapegoated children develop psychological issues like depression, anxiety, eating disorders. Some also develop the tendency to self harm.
This is usually seen (which I witness in practice) in a families where parents strive to stay together, despite the fact that one or both parents are abusive or psychologically unstable. What would have been a natural course of action, a break up, is avoided by members of the family at all costs. A superficial picture of stability is often seen in these families.
The “only” problem this family seem to have is a problem child — a child who is doing poorly at school, has behavioral problems, has eating disorder, self harms or has other emotional difficulties. When as therapists we see such children, we understand them to be symptom-bearers.
The experience of being a child scapegoat is one of Childhood trauma. There is immense feeling of loneliness because his/her feelings towards the family are negated by their own parents and siblings. These are the children who’d take the blame for their parents’ worries. Many grow up believing that they are flawed. Many introject the blame. Self blame lead to self hatred, self harm and sometimes suicide.
Psychotherapy for Child Symptom Bearers
Usually families bring themselves into therapy because of a “problem” or “sick” child. In successful family therapies, the therapeutic work centers around the relational dynamics between the family members, and not focussed on the “problem child”. Helping the parents and other members become aware of their roles in the family system releases the afflicted child of having to bear the intrinsic problems that exist in the family.
Psychotherapy for Adult sufferers of Scapegoating
One does not always know that one is being made a scapegoat. In the working environment, the scapegoat may simply find work in the office stressful with conflicts.
Sometimes, of course, in the course of therapy the client realizes that he/she was his/her family’s symptom bearer, or that he/she was a scapegoat in a group.
Being a scapegoat brings with it feelings of loneliness. You are being targeted as the cause of problems. Because of this, there’ll also be feelings of having done something wrong, or being flawed. This progresses to self blame. Psychotherapy involves
- addressing these feelings of loneliness, shame, fear and betrayal
- re-aligning oneself by being awareness of the group reality,
- finding oneself again being independent of the group,
- finding resources outside the group
- getting support from others
This article explores the mutual, interactive influence between cardiovascular disease and mental health. The psychological issues present among patients of cardiac health issues are mainly that of anxiety and mood disorders. Often termed “psychocardiology”, this field integrates both medical aspects of cardiology and psychotherapy.
The interactions between the mind and body are pronounced and evident. When we feel anxious, our heart pumps faster and we feel breathless. The interaction between psycho and soma is also complex and multifaceted.
Cardiological and psychiatric disorders are closely interrelated and have a bi-directional relationship. This is what we understand as a psycho-somatic interaction.
Mind and Body Connection in Cardiology
Cardiovascular disease is among the leading cause of morbidity and mortality in the industrialized world. While psychiatric disorders have a prevalence rate close to 20% of the population, depressive illness is one of the leading cause of disability worldwide (Murray & Lopez, 1997).
Put together, depression and anxiety related to depressoin is identified as a significant risk factor for mortality in patients with coronary heart disease (Barth et. al. 2004).
The article cites a meta-analysis of research papers and have found that depression and anxiety contributes to the mortality of patients of coronary heart disease. Cardiac patients who suffer depression are 2x more likely to die than cardiac patients who do not suffer depression in the 2 years of initial assessment of the disease.
Halaris (2013) highlights links underlying recognized cardiovascular disease and mood disorders. Genetic and epigenetic factors affect how an individual reacts to mental and biological stress. Psychosocial and environmental stressors together with lifestyle choices also determines susceptibility to level of disease states.
Among patients with Congenital Heart Disease, for example, it is found that illness perception of the patient is a significant predictor of patients’ quality of life, cardiac anxiety and depression one year after the heart intervention (O’Donovan et.al. 2016). It indicates that how the patient see his/her illness and the self in this situation affects his/her health development and quality of life.
Psychological effect of Diagnosis of Heart Defects on Patients
Being diagnosed with heart complications, whether it is congenital heart disorder or coronary heart disease leads to years of continuous physical, psychological and/or social burdens for the patient and family.
Patients with early-recognized congenital heart defect live with the condition throughout life. This is especially so in the case of babies / children diagnosed with congenital heart defect. The psychological state of these patients is deep rooted becomes embedded in identity.
Encased in the anxiety of other types of patients whose heart disease emerge later in life is the shock/abruptness of the heart failure due to a previously unknown / undetected defect. This further stir associations regarding health in general (loss of former self-identity, increase of insecurities etc.).
Psychotherapy needs of Cardiac Patients in Cardiology
Medical professionals in countries like Austria realize the need for an integrated-method of treatment of cardiac patients. Medical treatment is more focused upon when the symptoms are acute, and with chronic ailments the psychological work take precedence. Many fields of mental sciences work together with the doctors for after-care of the patients.
Psychotherapists, as per the studies cited in this article have un-covered the major psychological issues patients face: Clinical anxiety coupled with depression. These have also been shown to have adverse affect on the health development of the patients.
Anxiety is an increase in the awareness of psychic or physical sensations to a degree that makes it impossible for the real or imagined danger to be avoided; there is a constant danger signal together with the incapacity for active coping (Waelder, 1960). Relaxation in the tensions of anxiety seeks the experience not of satisfaction but of security (Sullivan, 1953).
Patients come to psychotherapy with existential anxiety because of their life-death situation. Illness perception is linked to these feelings. Along with it comes the perception of oneself in relation to a defect. Patients talk about the feeling of being vulnerable, ‘damaged’, ‘weak’. For adult patients (especially those who are independent in life), these experiences are often concealed from relevant others.
In therapy, these themes are worked through in the confidentiality and security of the session. The psychotherapist for such patients has to possess the resources to contain the very strong emotions of the clients, approaching the sessions with empathy and patience. Patience is normally understated, but important. Many patients take time to trust the therapeutic process, and may discourage the therapists from helping them. Feelings of hopelessness /helplessness do become projective identification.
“.. the therapist should function as a container of the patients’ anxieties. The fundamental therapeutic task at this stage is the analyst’s containment and interpretation of the patient’s anxiety. To the extent that this process is carried out, if the patient deposits—or rather evacuates — his anxiety and the analyst is able to bear it, a type of relationship is established in which the patient feels the analyst is an object who’s function is to contain him … As this process repeats itself, the patient develops a growing confidence in the relationship and gradually introjects ‘it’. It can be said theoretically, that from the moment there has been sufficient introjection, the patient has (achieves) within him an object where he (from now on) can deposit his anxieties … “
(Etchegoyen, 2005, p. 620).
The therapists who is able to see through the difficulties of the therapeutic sessions eventually builds the sound alliance. He/she is then able to support the client through the worst of feelings (especially that of loss), thus alleviating existential loneliness and isolation that is part of the depression.
Psychotherapy for Parents and Siblings of Children with Congenital Heart Defect
Psychotherapy cannot ignore that alongside a patient is his/her social system. Parents and siblings of child patients bear a big burden. Work with the family on a long term basis helps alleviate chronic stress faced by parents and supports the family. We can take heart from the research mentioned by Re et.al. (2013).
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Drawing much inspiration from a lecture given by Sapolsky (2011), an expert in the neuro- and biological field, I would like to discuss the use of language, or — more accurately put– communication, as a cure for psychological pain.
The profession of Psychotherapy, at its formation, was termed the “talking cure” (Freud & Breuer, 1895). This literally means talk as a means of relieving one of symptoms or psychical and often also somatic nature. What the term “talking” does not describe is the “listening” from the other person. In psychotherapy it is the talking to someone who is actively listening that cures. Read also: The Psychotherapeutic Alliance.
Language is in verbal and non-verbal communication
Talking and listening is communication. When we think of communication, we think of dialogue, and language. Language, according to Sapolsky is more than speaking or writing verbally. Neuroscience has indicated, especially through studying the neurobiology of sign language learning of completely deaf individuals, that whether it is verbal or non-verbal, the communication process is the same. This means that language is not merely a motoric process (i.e. about moving lips and tongue), but rather a cognitive process.
Language is unique to humans
Human communication has universal qualities. All forms of human languages have semanticity, embedded clauses, all human language can “talk about things”, can talk strategy. There is arbitrariness of language, in which words are not tied to meaning. People are able to tell lies, and say one thing and mean/feel another. Language is also invented and re-invented. Human children have innate ability to coin phrases and say things they have never heard before (N. Chompsky).
Unlike animals that have specific vocals for specific emotions, human language is not tied to specific emotions. This explains why in therapy we notice a quality of communication in which there is a “content-affect split”.
Non-verbal aspect of language
We do not communicate with words alone, there is also verbal tone, sounds, body movement, hand gestures, facial expression. Gestalt therapists look out for these during therapy as well, since the non-verbal language reveal often much of the emotional content of the communication. Certainly emailing does not allow for non-verbal communication. Perhaps that is why many of us feel more secure communication over messenger apps to even talking on the phone.
Neuro-centers of the brain that affect language
Ninety percent of humans process verbal language in the left hemisphere of the brain. The other (right) hemisphere, process the non-verbal and emotional content of the communication. The Broca’s area is connected to the motoric nature of language production. The Wernicke’s center is responsible for language comprehensibility. The connection between these two centers connect the two functions.
Through studies of biological brain disfunction due to disease, degeneration or injury, scientists have managed to identify which part of the brain is utilized for which function. Through neuro-imaging, we know that in tourettes syndrome, for example, where the sufferer curses uncontrollably, the limbic system is hyperactive. The limbic system is not known to be responsible for emotions and not language production, but language is connected to the formation of emotions.
Many have also proven that singing is a way for people who suffer damage to the Broca’s area (and hence have problems talking). Singing activates the right hemisphere and emotional centers of the brain.
Hence the phenomenon of the talking cure; an emotional weight off the shoulders when on talks emotionally to someone who is willing to listen. One can also see how verbal language is only a part of communication. Clients who have problems with speech (in particular in Alzheimers patients) respond to communication with music.
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This is my presentation on this topic, “Psychedelics and Psychotherapy”. ONe can also download a pdf version of this assignment here.
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What is Psychosomatics?
Psychosomatics is a scholarly discipline of medicine with a rich history. The term psychosomatic was coined in 1818 by Johan Heinroth, and the words psychosomatic medicine is known to be used around 1912; the term being a combination of psychological and body function. Contributing to the development of psychosomatic medicine are the fields of psychoanalysis and psycho-physiologists that work with the mind-body interaction (Levenson, 2005).
As one looks towards the other non-medical and non-therapeutic fields, one also stumbles upon the philosophers like Maurice Merleau-Ponty, who had taken the non-dualistic view that that the ideological separation of mind and body is erroneous. In Phenomenology of Perception originally published in 1945, Merleau-Ponty explains that the body is consciousness, and not separate from the mind: “Bodily experience forces us to acknowledge an imposition of meaning, which is not the work of a universal-constituting consciousness, a meaning which clings to certain contents. My body is the meaningful core which behaves like a general function, and which, nevertheless, exists and is susceptible to disease” (Merleau-Ponty, 2004).
Levenson (2005), in citing three general groups of patients— i.e. “those with comorbid psychiatric and general medical illnesses complicating each other’s management, those with somatoform and functional disorders, and those with psychiatric disorders that are the direct consequence of a primary medical condition or treatment”— gives us an idea of how psychosomatic disorder is considered by the medical profession; that medical and psychological are linked in a way that one is a cause of the other. The perspective of Merleau-Ponty’s writings—and psychotherapists from modalities that are founded on the phenomenological experience— begs to differ from this point-of-view. They consider both medical and psychological ailments are one and the same thing.
A Holistic Point of View
This phenomenological viewpoint marks the movement towards holistic recognition of the connection between what we perceive as mental and physical cause-and-effects of illnesses and the respective treatment of symptoms. This attitude makes psychosomatics stand out from other disciplines of medicine. There is also the implicit recognition that patients suffering from organic diseases recover better with integration of medial and psychological therapy than with just medicine alone.
That psychosomatic medicine is considered a new discipline in the medical profession is paradoxical to the history of medicine itself. Millennia before construct of physics, primitive man understood phenomenologically how his own psyche affected his physical actions, in so doing, attributed the forces of nature to human-like emotional states as well (Alexander, 1962). This natural sensitivity of human beings to perceive mind and body as inseparable concepts is evident in traditional and folk medicine. Traditional Chinese medicine (TCM) is a good example since it developed independently and possesses written records dating back to 1500 BC (Tseng, 1973).
TCM is based primarily on the idea of correspondence between organism (microcosm) and its environment (macrocosm). Like the “primitive man” idea described by Alexander (1962), this is a belief in the conceptual connection between the body and nature. TCM considers human emotions the “vital air” in the body, which has its equivalence in nature. The body is characterized by its visceral organs. Patients frequently describe their psychiatric problems in terms of organs, like “exercised heart” to give meaning to apprehension, “injured heart” to mean sadness, and “elevated liver fire” to mean agitation and tension (Tseng, 1973). Since psychological problems are deemed somatic and organ-based, ancient Chinese did not separate psychiatric disorders from other medical illness.
Attempts at explanation of natural phenomena is a preoccupation of western civilization, commonly traced to Greek cosmologists of the pre-Socratic era at around 600 BC- 400 BC. Substances like water, air and fire were used – almost metaphorically— to give material foundation for explaining illnesses. Similar ideas were also seen in the medicine of other cultures like those in the Islamic world, Tibet and India (Sabernig, 2016). This materialist way of understanding disease afflictions can be extrapolated to the modern-day reductionist scientific thinking. The milestone of this idea is popularly traced to Hippocrates in 400 BC, who declared the cause of epilepsy to be material in nature with nothing to do with the “sacred” (Alexander, 1962).
Interestingly enough, when one traces the roots of dynamic psychiatry, one is led to the very concept that Hippocrates disproved in the early days: the idea that demonology has anything to do with the physical condition. In almost every culture, there existed faith healing. Medical anthropologists like Forest E. Clement and Erwin H. Ackerknecht in his early 20th century attempted to systematize primitive medical beliefs and practices. Clement categorized disease theory of the ancient healers into 5 main forms: disease-object intrusion, loss of the soul, spirit intrusion, breach of taboo, and sorcery. For each of these theory there existed corresponding therapeutic methods. These methods included extraction of diseased object, to resort lost soul, exorcism, transference of the foreign spirit to another living being, confession and counter magic.
Ackerknecht showed that the true ancestors of the modern physician are the lay healers, that is, those men to whom the medicine man left the empirical and physical care of the patients), whereas “the medicine man is rather the ancestor of the priest, the physician’s antagonist for centuries” (Ellenberger, 2008, S. 5-48). By taking us through the the era of faith healing to the discovery of the unconscious Ellenberger can help us make sense of how the idea of demonology could have existed as explanation for psychological afflictions during the period of the Dark Ages. The psyche— and consciousness in itself— is, after all, a concept that has been illusive to human awareness, until the 18th Century.
The 20th century saw the movement towards re-integration of this medical field through the development of psychoanalysis and the use of psychotherapeutic methods including hypnosis in dealing with physical healing, as well as the work on the body to aid psychological problems. With the advancement of new technology like neuroscience, we can expect to see the move towards integration and separation of handling of what is deemed psychological and what is deemed somatic issues again and again; this happens as long as mind and body cannot be understood or accepted as one whole which is more than the sum of its parts. Holism, as with phenomenology, are philosophical foundation in some psychotherapeutic methods that deals with symptoms suffered by individuals in an integrated manner.
Given the broad understanding of psychosomatics, one may create categorization of the specific disorders in a number of ways (Mörtl, 2016). In the medical profession, the categorization may be done according to the anatomical location, i.e. the skin, the musculoskeletal, cardiovascular, lymphatic, gastrointestinal genito-urinary, endocrine and nervous systems and specific organ reactions. Another classification system is one based upon the dynamic in which the disorders evolve. They could be:
- psychological afflictions caused by bodily symptoms, otherwise known as psychophysiologic, psychosomatic or somatoform disorders. These disorders do not present in itself organic causes, which often lead the sufferer to seek multiple medical consultations without result. These symptoms can be observed physiologically on the patient, and a description of the affliction can be made. The nosology— that which describes the underlying psychological causes of the condition— is much more complicated, and would require deeper understanding of the patient’s psychosocial situation as well. This category encompasses an array of somatic syndromes, those which maybe related to mood (affective) disorders, neurotic and stress-related disorders, behavioral syndromes, personality disorders, mental retardation and disorders in psychological development.
- Physiological problems that cause psychological disturbances, otherwise known as somatopsychic disorders. These disorders have organic causes, and include (but not exclusively) degenerative brain disorders like Dementia, disorders caused by lesions to the brain either caused by disease, damage or dysfunction. The causes of brain dysfunction may be also attributed to intoxication. Symptoms that afflict other parts of the body that also lead to the need for psychological care would be psychosocial influences that affect physical health. These broadly include addictions, poor nutrition and aging. Many physical diseases cause psychological stress, like chronic ailments and terminal conditions. Psychological help is needed to help patients cope with their symptoms, and the consequences of disease.
Classification of psychosomatic symptoms
Contemporary textbooks and diagnostic manuals commonly classify psychosomatic disorders as:
- Somatoform: Physical disturbances caused by somatization of psychological problems. This includes somatoform-autonomous symptoms— like tinnitus, irritable bowel syndrome, and cardiovascular heart disease— non-organic sleep disorder, non-organic sexual disorders, conversion disorder and non-organic migraine.
- Eating disorders: Behavioral conditions as result of psycho-social problems resulting in Anorexia Nervosa, Bulimia Nervosa and Binge Eating disorder.
- Potential psychosocial factors in organic disorders in organic disorders like Hypertonia, bronchial Asthma, Colitis Ulcerosa, and Neurodermatitis.
- Somatopsychic disorders: characterized by psychological symptoms with organic origins like brain lesions, strokes and tumors that cause structural damage and/or biochemical, dysfunction, adversely affecting normal brain activity. This also includes psychological problems in dealing with pain, chronic illnesses, and consequences of surgeries and injuries.
When we consider Merleau-Ponty and the holistic philosophers, it should be a given that the condition of the physical body is one and the same with the mind. In the western world of knowledge politics, this basic wisdom is somewhat put aside in favor of reductionist thinking. The idea that “psychosomatics” be a discipline rather than a standard form of looking at symptoms is proof of this. The classification in psychosomatic medicine is helpful for practitioners and patients alike to discover which came first— the psychological problems or the physical ones. That, however, cannot really tell much else, since every single client is a unique case study in him/herself in relation to his/her own environment. Non-holistic observing of the client could be the reason that many in the medical and psychotherapeutic professions alike find difficulty working with psychosomatic problems and keeping the clients in therapy.
Development in psychosomatics and psychotherapy may lead to greater arguments among psychotherapy modalities as well as fields of medicine. These studies may also bring the modalities in a common agreement as well. It would be interesting to realize, perhaps, how almost every person suffers from some kind of psychosomatic issue, and how their personality, muscularity, adiposity or aging are linked. The term “psychosomatics” alone conjures a whole philosophical understanding of what it means to have mind and body.
Alexander, F. (1962). The development of psychosomatic medicine. Psychosomatic medicine, 24(1), 13-24.
Ellenberger, H. F. (2008). The discovery of the unconscious: The history and evolution of dynamic psychiatry. Basic Books.
Levenson, J. L. (2005). Textbook of psychosomatic medicine. (J. L. Levenson, Ed.) VA: The American Psychiatric Publishing.
Merleau-Ponty, M. (2004). Maurice Merleau-Ponty: Basic writings. (T. Baldwin, Ed.) NY: Psychology Press.
Tseng, W. S. (1973). The development of psychiatric concepts in traditional medicine. Archives of General Psychiatry, 29, 569-575.