The Psychosomatic Symptom: When the Body Speaks Where Words Fall Silent

Introductory statement

A man in his forties comes to the doctor's office with a five-year history of chronic headaches. He has been to neurologists, x-rays, MRIs, multiple treatments. The findings are negative. He is not just tired of the pain — he is tired of the inability to place it anywhere.

Public perception often treats the psychosomatic symptom as "imaginary," something less real than "normal" pain. Clinical experience shows the opposite. The pain is absolutely real. What is missing is not the intensity, but the context within which it can be understood.

And then a question opens that is not rhetorical: what happens when a mental experience does not find its way into words and thought — where does it go?

From symbolic conversion to psychic desolation

The observation that the body absorbs psychic vibration was at the center of theory as early as the late 19th century. In Studies on Hysteria (1895), Freud described the mechanism of conversion: the repressed psychic conflict is transferred to the body and manifests itself as paralysis, loss of voice, blindness without an organic basis. The symptom, for Freud, was symbolic — it hid and at the same time revealed a forbidden desire, waiting for the analyst to decipher the meaning.

This approach, radical as it was for its time, soon seemed to leave a large clinical field uncovered. In the 1960s, the French Psychosomatic School in Paris, through the work of Pierre Marty, turned the tables. Psychoanalysts began to observe patients with serious, chronic illnesses who did not present any hidden symbolic depth. On the contrary, they radiated a sense of psychic desolation.

Marty described “operational thinking” (pensée opératoire), a mode of functioning in which patients narrate their own lives — a divorce, a loss, a dismissal — in a flat and transactional tone, attached to the material reality of events. Within the clinic, the so-called “white relationship” (relation blanche) is established: their speech is stripped of dreams, fantasies, ambivalences. In these cases, the symptom does not symbolize any repressed desire. It is the consequence of a psychic weakness: when the mind cannot bind the stimulus and give it meaning, the body directly receives the load.

The difference between Freud's hysterical patient and Marty's "operational" patient is not a detail. They are two different ways in which the body becomes the vehicle of psychic life.

The theater of the body and the beta-elements

Joyce McDougall called this process "the theater of the body." When the soul cannot find words for what is pressing on it, it uses the body as a stage. Pain, excluded from thought, pantomimes its anguish through illness.

Wilfred Bion gave a parallel image through the concept of beta-elements. These are raw sensory and emotional impressions — something that is experienced, but has not yet been transformed into meaning. For this transformation to take place, a psychic function is needed that Bion associated with the mother’s “reverie”: the mother receives the infant’s raw anxiety, processes it, and returns it in a tolerable and processable form, as the a-element — the basis of thought.

When this function fails, or when later in life a trauma overcomes the psychic defenses, the b-elements remain undigested. They cannot become a dream, a memory, a word. They are exiled to the body.

Donald Winnicott, observing this same fragility from another angle, spoke of psyche-soma indwelling. When the early environment is inadequate, the psyche becomes detached from its physical roots. A False Self develops that functions mechanically and adaptively, while the body remains alone, a carrier of the unprocessed. John Bowlby's attachment theory illuminates a parallel path: the infant who has not found reliable regulation in the arms of the caregiver, as he grows up, is unable to regulate his own physiological arousal.

Alexithymia: When Emotion Has No Name

A client in the early months of motherhood describes bouts of severe eczema covering her hands. When I ask her how she feels about the sweeping changes of her new life, she looks at me with sincere wonder. “I don’t feel anything strange. Everything is as it should be. My skin is just inflamed.”

This scene gets to the heart of what Peter Sifneos (1973) called alexithymia — etymologically, the lack of words for emotion. Alexithymia does not mean that the person is hiding what they are feeling. It means that he has never developed — or has lost — the ability to recognize them as emotions. Anger, sadness, terror are not registered in consciousness by their name. They are experienced exclusively as physiological arousal: a tight neck, a sore muscle, burning skin.

At the same time, a disturbance in mentalization appears — the ability described by Peter Fonagy to perceive the internal states, intentions, and desires behind one’s own behavior and that of others. In periods of prolonged stress, this ability shrinks. Thought becomes extremely concrete and material. The metaphorical, the symbolic, the emotional shut down — and the body is left to speak for itself.

The neurobiological imprint

Psychodynamic understanding does not oppose biology. It gives it a context.

Bessel van der Kolk, in The Body Keeps the Score, has documented that the memory of trauma is not stored as an organized narrative. When an event exceeds the capacity of the mind, the brain is unable to translate it into words. The experience is recorded viscerally, in muscle tone, in breathing, in the autonomic nervous system. The body remains in a state of permanent alert, reacting to past dangers as if they were unfolding now.

Stephen Porges’ Polyvagical Theory provides a useful mapping. The body constantly scans the environment for signs of safety or threat. When the threat is prolonged and the social engagement system is not sufficient for regulation, the body resorts to more primitive defenses — either sympathetic hyperstimulation (tachycardia, insomnia, muscle tension) or collapse into frozen stillness (exhaustion, disconnection).

On a chronic basis, this dysrhythmia affects the hypothalamic-pituitary-adrenal (HPA) axis. The cortisol curve is reversed, receptors are desensitized, and a silent, chronic inflammatory state (low-grade inflammation) is established. It is on this soil that the psychosomatic symptom often takes root.

Here I owe a clinical clarification: things are more complex than they often present. The relationship of a particular emotion to a particular symptom is neither causal nor linear. Popular psychology resorts to dangerous simplifications—“organ-emotion” mappings that do not withstand scientific scrutiny. Where a symptom manifests depends on a complex matrix of genetic predisposition, early experiences, environmental factors, and personal history.

A clinical mapping

In clinical practice, each system of the body can become the narrator of a different story.

Chronic headaches and migraines often occur in people who carry an excessive load without allowing themselves any falls. Migraine, in many cases, forcibly imposes the darkness and immobility that the person does not consciously give themselves.

Irritable bowel syndrome highlights the close gut-brain axis. An unresolved visceral fear or an indigestible experience directly affects the motility and microflora of the gastrointestinal tract.

Skin manifestations — eczema, psoriasis — often intensify in periods when personal boundaries are tested. The skin is not a simple tissue; it is the interface surface with the Other. When the sense of security is disturbed, the skin reacts.

Chronic musculoskeletal pain — a stiff neck, a persistent backache — reflects a constant physical alertness. The muscles tighten to contain what is mentally experienced as a risk of collapse.

Functional cardiovascular symptoms — tachycardia, palpitations, chest pressure without a cardiac finding — often confront the person with anxieties that touch the very coherence of existence, as described in the article on collapse anxiety.

An essential reminder: psychosomatic interpretation always presupposes medical exclusion of organic etiology. It does not replace medical examination — it comes to complement it when it has been exhausted.

The therapeutic work

Psychotherapy does not aim to immediately “eliminate” the symptom. That would be both premature and ineffective. The work focuses elsewhere: on creating a space where the experience can gradually take on the form of thought.

As a psychotherapist, I observe that change is not linear. There are periods when the symptom subsides, and others when it returns with intensity — sometimes within the therapy itself. This return is not a failure. It is often a sign that something is starting to move.

The process involves the gradual recognition of emotional states that until then were only expressed physically, the connection of experiences that seemed fragmentary, and the development of a tolerance to endure the emotion without immediately discharging it into the body. The therapeutic relationship functions, in Bion’s terms, as a container — a space where unprocessed elements can meet the mind of another soul and, through this encounter, be transformed.

As discussed in the article on childhood trauma, what did not find words early on often returns in physical form. The therapeutic process does not erase this history — it finally gives it language.

There is no guarantee that every psychosomatic symptom will be “solved.” But there is the possibility of understanding it differently. This shift — from “my body is betraying me” to “my body was trying to tell me something” — can radically change the person’s relationship with themselves.

Simply put

Pain is real, even when there is no organic finding. The body can express experiences that have not yet been thought about. There is no single cause, nor a specific emotion, for every symptom. The mind-body relationship is multifactorial, not linear. Understanding often precedes change.

To the point

The psychosomatic symptom is not “imaginary” or pretense. When mental processing fails, tension finds an outlet in the body. Alexithymia and reduced mentalization limit access to experience. Chronic dysrhythmia of the HPA axis and the autonomic nervous system create a biological ground for physical manifestation. Treatment does not aim to eliminate the symptom, but to search for the meaning it carries. The body, in this perspective, is not an enemy — it is an informant.

Conclusion

There is a fine line between seeing the body as a machine and loading it with symbolism that it cannot bear. Clinical reality moves somewhere in between. The symptom is neither purely biological nor purely mental — it is a meeting point of the two.

Perhaps the essential question is not “what does this symptom mean”, but “what has not yet found a way to be said”. The answer is not given quickly. It takes time, relationship, and a tolerance for not knowing from the beginning. This is perhaps the greatest difficulty of the process: to endure not knowing enough so that something new can be said.