The Problem of Psychosomatic Medicine

Regarding the problem of Psychosomatic Medicine, there is currently no doctrine accepted by all authors who attempt this orientation of Medicine. If we tried to generalize, the only thing they have in common is the attempt to introduce the psychological aspect into pathology as an essential factor. We could affirm that it is more of a point of view than a grouping of diseases.

Viewing the issue in this way, we will begin by explaining that in the development of personality, a series of events give rise to certain traits with a common denominator which is insecurity, infantilism and anxiety. But the disease appears precisely at the moment when the person must make use of their freedom and face problems that, due to their special nature, they cannot solve.

They do not fall, so to speak, into neurosis – a term that is currently obsolete in the ICD-11 and that in the ICD-10 (F40-F49) included, F40: agoraphobia, social and specific phobias. F41: panic, generalized anxiety, anxious-depressive. F42: obsessive: with thoughts or ruminations; with a predominance of compulsive acts. F43: acute stress, post-traumatic stress, adaptation. F44: dissociative (conversion). F45: Somatization, hypochondria, somatoform vegetative dysfunction, persistent pain. F48: Neurasthenia, depersonalization-derealization-.

As we said, they do not reach high levels of neuroticism, despite everything, because they have strong defense mechanisms of the “I” – a psychoanalytic concept that in the nomenclature of the Scale “C” of Cattell’s 16 PF-5 is considered the ability of coping with life’s problems and its challenges-; But the anguish must “come out” and it does so by somantizing itself in those organs that are most significant, that is, those that have been most vulnerable since childhood or adolescence.

What do we mean by “somatize”?

When the personality’s immune system does not function properly and existential anguish – in Kirkegaard’s sense – must “come out”, it does so by somatizing in those organs that are most significant. The interesting thing is that the significance lies in the fact that psychosomatic illness is not a mere consequence of poor personality functioning, it is the “discovery” of a new way of facing life’s problems.

The patient discovers that something has happened in his life that helps him solve his problems – or at least the responsibility that he must show towards them -: this something is the illness. What is important to highlight here is that the disease “communicates” something patient. The availability of your body is limited, but so is your freedom – understanding freedom as the ability to choose or decide.

It is precisely this fear of freedom or decision – in short, of failing in the commitments that are to come – that produces anguish, or at least, one of its roots. When we become aware of what “living” entails, of the frustrations of life. Seen this way, “conscience makes us all cowards” – we read in Hamlet. And we define this precisely as a “biographical crisis.”

The biographical crisis is not a sequel, but a cause of the disease. What this means is that every disease can only be understood from the biography of the person who suffers from it, that is, somatic events – the pathological – are not mere isolated or sporadic events that occur in the patient’s life; They are events that modify the course of a life, because they are vital experiences, sometimes unconscious – not in the sense of psychoanalysis – but simply may not have been made aware of by the patient.

The person – through his illness – discovers a new path of expression, he has another experience of his corporality. It is not that he makes a “profit from his illness”, it is not exactly what decades ago we called “income neurosis” – although there are similar roots. It is simply the solution that the person finds to avoid facing their responsibility.

Responsibility, painful or impossible, to assume or decide, and that due to its particular difficulty you cannot or do not know how to manage (for example: loss, separation, divorce, job change, entrepreneurship, and a long list of “limit situations” – a notion introduced by Karl Jaspers in his work Psychology of World Configurations of 1925 – among which are: facing the truth, admitting one’s own limits, facing old age, illness, the loss of incentives, checking the personal capacities and vulnerabilities, strengths and resolutions never seen and even unthinkable, being led to uncertainty, to the darkness of the encounter with the “other”, be it a friend, girlfriend, partner, boss, when we abandon family security, where everything was clear, as often happens in adolescence).

Extreme situations produce such unrest that we should not be surprised that psychosomatic illness appears as a solution to a “biographical crisis” since we put in the hands of others what only one is responsible for deciding or resolving.

Psychosomatic illness is more significant than mere anxiety or depression, which are also revealing experiences of biographically chronicled extreme situations – such as dissociative disorders related to trauma -; And for this reason, psychosomatic diseases also pass from one disease to another as the demands of the patient’s life also change.

Why not continue with the same clinical syndrome?

Firstly, because somatic therapy prevents, to the extent possible, the biological response. But also because an illness can solve certain problems, but not all. The purpose of the work brought here is to try to understand this phenomenon and at the same time develop a hypothesis that helps to understand some aspects of psychosomatic pathology.

The author believes that the reality of poor personality functioning (in the areas involved: “Identity”, “self-direction”, “empathy” and “intimacy”) associated with a disease or group of diseases cannot be discussed, and that This fact alone does not serve to understand psychosomatic illness and the latter can only be achieved if we understand that mental illness is an event that occurs in a person.

In the midst of the rise of technologies, we know many things about mental illness but few about the person who suffers from it and their relationship with a “biographical crisis.” Since 1970, current psychiatry has been leaning towards biology, trying to find in brain biochemistry – and by extension in psychotropic drugs – the most effective remedies for the diseases it treats. But the person does not allow himself to be caught and the etiopathogenesis of most mental illnesses – read psychoses or the common “panic attacks” – remains insufficient to explain the things that happen to us and how, why and in what way they occur.

There is not the slightest doubt, we must continue to base our work on scientific knowledge because although in many aspects the future is still uncertain – in the field of mental health – not asking the right questions is going off the path – let us remember a phrase by M. Heidegger: “To ask is to build a path”-; But the practice of that exercise and its knowledge cannot only be a practice accompanied by knowledge, but it is a way of knowledge.

Building paths and bridges together – patients and psychotherapists – in the 21st century should not be seen as the scientific work of geniuses, it is a work of people for people, of ordinary men and women that Unamuno wanted. We consider Science, that which each one silently builds inside as a life experience, always as a personal event. In this way we will gather, each one and separately, in our “biography”, in our “School of Life” – and by extension the entire world – examples of how to become “being”, be aware of our “I”, and of our “surrounding world (Umwelt)” with courage and bravery.

We have to act with empathy and intimacy, patients, clients, users and professionals (psychiatrists, psychologists and social workers), to reach deeper knowledge. For this reason, Jasper says that “Psychotherapy texts are partly Psychopathology texts.” Each person can build their personal world with what they think, but what they think can only be understood taking into account the world to which it refers.

That seemingly simple thing called living is, as Rof Carballo once pointed out, “as biological, as elementally biological, as the regulation of blood glucose or the existence of adrenals.” And it is precisely what helps us understand why the lack of readjustment between the ideal of the “self” (frustration, lack of decision, fear of failure) is expressed in psychosomatic patients due to neurovegetative disorders.

Our personal life and the world to which it refers does not rely solely on the conscious, but the unconscious must be considered as a reality. Therefore, achieving harmony between “who am I?” and “how would I like to be?” It is healthy to know psychosomatic pathology.