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A Jungian approach to somatization (bodily symptoms) through the use of dream analysis (2001) by Robert Winer, M.D. |
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Neurocare president is Philadelphia and Delaware valley neurologist, psychiatrist, psychopharmacologist, neuropsychiatrist, and psychotherapist Robert I. Winer, M.D., a medical doctor specialist in neurology, psychiatry, psychopharmacology, psychotherapy. Dr. Winer's psychotherapy is Jungian-oriented (using the approach of psychiatrist Carl Jung ) making use of dreams (dream interpretation) to work with the unconscious. In his psychotherapy practice he performs therapy, psychotherapy, analysis, and psychoanalysis. Dr. Winer is the president of the C.G. Center of Philadelphia. He is also the president of the Winer Foundation which has been doing humanitarian and medical education in Ethiopia since 1994.
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Table of Contents Dreams: Conscious or Unconscious
Jung's observation is undoubtedly true. Any clinician whose has been working in the psychiatric / psychological field for some time couldn't dispute this. I explain this by the idea that there are subconscious processes that become manifested in dreams. Before we get into a dispute about whether dream material "proves" the existence of the subconscious, let's look at it another way: Does it matter? If a phenomenum is clinically usueful, does it matter what how others explain it, even if two sides explain it in opposite and incompatible ways? Being a neurologist, I daily use clinically useful bedside neurolgical testing that are not fully supported by scientific data. When attempting to diagnosis a patient who comes to you with a motor function problem (for example, the inability to use a limb normally), it's important to look specifically for the clinical signs on examination of what a neurologist calls "upper motor neuron" pathology. Here's what we may find on physical examination:
When some or all of these clinical signs exist in a patient, we can be confident that some central nervous system pathology exists, probably in the brain and / or spinal cord rather than in the peripheral nerves or muscle. When these signs were first observed in the 1800's and correlated with structural damage by human autopsy findings, the brunt of the damage was found in the pyramidal tracts (areas of the brain and spinal cord that can be differentiated from other areas of the brain by their distinct appearance). Later scientific research has found that this explanation is an oversimplification of situation, nevertheless the finding of the above three abnormalities on examination in real patients is clinically useful. As has been conclusively documented for over one hundred years, if one makes medical decisions based upon these signs (like order a scan of the brain, or some blood studies) more often than not, your opinion that there is something physical wrong in the brain or spinal cord will be verified objectively and subsequent treatment that helps the patient can be instituted. So, too, whether one wants to argue for or against dream material "proving" the existence of an unconscious, years of clinical observation and treatment, using dream material has conclusively proved its usefulness. To me, this is the vital and most important issue. If what one is doing can help people, then by all means use it. If you find it unhelpful, even though it may be theoretically accurate, than discard it, but by all keep an open mind toward others who practice medicine differently. This is what I call being flexible or having a "teachable spirit." I believe that when a physician has the attitude of having arrived at a mastery of their field and perceive that they are no longer in need of education and growth, then it is a good bet that they are generally in a state of intellectual stagnation and perhaps even deterioration. Their lack of openness, curiosity, and perhaps pride, has, in effect, caused them to be paddling impotently against the current. Instead of proceding forward toward a destination, without even realizing it, they are being propelled backwards -- a frightening thought. Let's not forget that medicine must still practiced as an art. Even among your own patients, what may have worked for one, is not necessarily a guarantee that it will be particularly helpful in another. "The dream ... is a content of the consciousness, otherwise it could not be an object of immediate experience." For us to become aware of a dream, its memory trace must become conscious so that it can be perceived and remembered. That is, at the time of wakening, the conscious awareness of the dream now exists. This is a fact, not a theory. Therefore interpretation of the dreams confronts us with facts derived from the dreamer's life. That these dream contents are psychic facts cannot be reasonably disputed though many try to explain them away by this or that theory. Furthermore, it can be shown clinically that the dream expresses thoughts, emotions, and desires that the dreamer was not aware of having. Also clinical practice has proven that working with dreams is clinically helpful. Bodily symptoms and dreams: a possible healer.
"We [must] remember the fundamental principle that the symptomatology of an illness is at the same time a natural attempt at healing." Personally I like Jung's constructive approach to the symbolism of a particular neurotic somatization or dream content. Though I'm certain that this is not true in all cases, I find principles like this promote a positive orientation. And to me, a positive outlook, orientation, a so-called "will to improve, live, or to be healthy," seems to be very beneficial in both the healing of physical and emotional (psychological) illness or problems. My experience for nearly twenty years with patients having a variety of chronic neurological disease, and right now I'm thinking in particular of Multiple Sclerosis, has proved this out. Positive people generally do the best. The "will to die" or a negative, do-nothing sentiment seems to me to promote what the patient believes will happen. Life seems to produce life and death thoughts produce death or a slow death of worsening health. The old adage, "you reap what you sow," seems quite fitting here. A case of somatization: its explanation and cure
"The case is that of an officer, 27 years of age. He was suffering from severe attacks of pain in the region of the heart and from a choking sensation in the throat, as though a lump were stuck there. He also had piercing pains in the left heel." Jung goes on to explain that absolutely no physical cause for this patient's symptoms was found. Later, with therapy and dream analysis, there was a cure of all his symptoms, which proved their origin to be psychological. Let's take the time to go through this fascinating case of emotional distress resulting in bodily symptoms. There were three bodily symptoms: 1. Chest pain Jung was not helped much through taking a complete medical and psychiatric history. So he turned to the patient's dreams for help: "I felt almost hopeless -- the man was Swiss and perfectly innocent of any psychological complications -- but thought as a last resort that there might be dreams from which to catch something. Dreams leak out, they are not under control. No matter how innocent and simple a person is, there are dreams from which to get something if one only catch any little tail that may be sticking out. I was sure the trouble must be due to some emotional conflict or he would not have had such symptoms all at once. So I said to him: I don't know what is the reason for your symptoms, but you might tell me your dreams. By doing so I ran the risk of being taken for a sorcerer with such a simple-minded man, to ask about dreams is almost obscene, so I had to explain very carefully why I did so. He had great difficulty in remembering his dreams but produced some scraps and finally brought one that struck him as very peculiar and had evidently made an impression on him."¹
"I was walking in the open somewhere and stepped on a snake that it me on the heel, and I felt poisoned. I woke up frightened."² From this dream and its associations, Jung suggested that the snake in the dream was a metaphor from the Bible. To this, the man said, "Oh, you mean a woman" and he showed emotion (emotions are defined as a feeling-tone plus bodily symptoms. In this case, it was probably tears though Jung doesn't specify what the emotions were. ). Jung then asked, "Is there perhaps something of that kind [in your case]?" At first the man denied it, but then admitted that about three months ago he had almost been engaged, He returned for a furlough and found that the woman he was recently seeing rejected him and was engaged to another man. The symptoms began shortly after the rejection. Let's look at the man's description of the rejection by his girlfriend: "[This whole issue is irrelevant to my condition. She was just] a stupid girl. If she doesn't want me it's easy enough to get another one. A man like me isn't upset by a thing like that." Understanding the Somatization Symptoms
The truth was that the rejection caused
the man very real grief and disappointment, but his temperament
(personality and past experience) and general emotional health
would not allow him to consciously admit or feel the emotional
hurt. He had conclusively decided, whether he was aware of it
or not, that men should not grieve over these type of things.
And, more importantly, if he was to grieve, it would be a sign
of weakness or lack of manhood. He repressed his feelings about
her and his emotion at being rejected by her. This was clearly
a distorted outloook that eventually proved to be the source
of his bodily symptoms. "Heartache is a poeticism, but here it became an actual fact because his pride would not allow him to suffer the pain in his soul. The lump in the throat, the so-called globus hystericus, comes, as everyone knows, from swallowed tears. His consciousness had simply withdrawn from contents that were too painful to him, and these, left to themselves, could reach the consciousness only indirectly, as symptoms." The resolution of the heel pain awaited the uncovering of the relationship of the women who rejected him to his own mother. This led to the examination of deep wounds from his past regarding the relationship between son and mother which was accompanied by symptom resolultion. Jung describes the results of analysis: "He had been the darling of a somewhat hysterical mother. She had pitied him, admired him, pampered him so much that he never got along properly at school because he was too girlish. Later he suddenly swung over to the masculine side and went into the army, where he was able to hide his inner weakness by a display of toughness. Thus, in a sense, his mother too had lamed him.
Jung holds it to be fundamental that one should look at a psychiatric, and in particular, a neurotic illness, as compensatory. He calls this a "natural attempt at healing." In this case, the chest pain and throat symptoms are the body's attempt to produce an emotional outburst. The "heel" symptoms would stop him from walking away from his problems -- that is, continuing the repression of emotional hurt from childhood. The "heel pain" was the body's way of stoppoing him so that he could "go no further" unless he dealt with his unconscious issues.
(All references from Jung's "Structure and Dynamics of the Psyche," Collected Works, Vol. 8, pars. 283-342, unless otherwise indicated.) 1. Jung, CG. "Dream Analysis: Notes of the Seminar ..." Princeton University Press. 1984 (p. 17). 2. Op cit., p.17
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