INTRODUCTION

This presentation has arisen out of separate work which we have both done. We are interested in the interface
between psychological therapy and metaphor. We have also developed some ways of working with metaphor
and symbol so that the client’s archetypal material is uncovered and made available to their conscious minds.
All of these approaches are grounded in the physical and in a language which is meaningful to the client. Today
we will present Client’s somatised distress, linking their words with landscape metaphor, and relating metaphor
to symbol with reference to art and poetry and the concepts of the long-distant past of our ancestors.

PSYCHE AND SOMA

The body enters into the psychological picture when the client somatises their distress. This is when the pain is
etched into the body as if it were the topography of a landscape - when the client says:-

I have no face

or

I am numb - nothing means nothing

or

I’ve got pressure in my head

The body reacts to psychological stress as though it were a physical one, and then uses a language which is an
archaic form of psychic functioning and which cannot be expressed in words. It only has the physical as its form
of encoding and therefore as its mode of expression.

The challenge to us is how to include the body within a truly psychological psychology.

Maria Cardinal, in her autobiography ‘The Words to Say it’ says:-

"The mind picks up everything, files it, classifies it, and keeps it all. It has meaning, every event, no matter how
minuscule, no matter how ordinary is catalogued, labeled and locked away in oblivion, but marked in consciousness
by a signal which is often microscopic:a scented sprig, a flash of colour, a blinking light, a fragment of sensation,
a shattering word. And less even than that; a rustling, an echo. And still less, even: a nothing that is nevertheless
something".

                                                                                                                                           Maria Cardinal 1975

Louise collected together the transcripts of conversations with women at Rampton who had a history of abuse.
She will present their testimony today, in particular the way in which they have taught us to listen to their language
and the way in which it tells us far more than the words, if we hear the rich meanings in the metaphors.

William James:

"The body is the storm centre, the origin of co-ordinates, the constant place of stress in all that experience-train.
Everything circles around it, and it is felt from its point of view".

Van-Egeren stressed that "anxiety is usually regarded as a state of a complex system having three major
components: a) experiential, b) biological, c) behavioural".

Abuse work forces us to move beyond the purely physiological to a level where the manifestations of abuse appear
on all three parts of the system. These effects may be somatisation, sensory flashbacks, self-harm or intrusive surgery.
They may be subjective experiences of strange sensations or metaphorical deadness.

We are using this definition of somatisation:

The expression of emotional discomfort and psycho-social distress in the physical language of bodily symptoms.
(Barsky & Klerman, 1983)

Briere & Runtz (1988) concluded that the two forms of symptomatology most predictive of abuse history were
dissociation and somatisation, both symptoms relatively neglected in abuse research.

As therapists we need to hear and pay attention to the language of the body. When a client describes physical
symptoms, they are often speaking metaphorically, and if we are only programmed to hear the words literally,
and if we then dismiss them on medical grounds, we completely miss the important information which may be encoded.

Emily Dickinson

                                        Heavenly hurt it gives us
                                        we can find no scar
                                        but internal difference
                                        where the meanings are
                                                         Selected Poems, 1959

Using transcribed recordings and written comments from interviews with women patients at Rampton Hospital, Louise
used a qualitative content analysis regarding women’s explanations and perceptions of their physical health. Combining
these responses with the file information and comments it was possible to categorise the information under the following
headings and themes:

INTERNALISATION OF DISTRESS

Four women with histories of abuse commented on their experiences of their illnesses or health problems as being a
result of some internal problem. Their experience of trauma could only be spoken as though it were a disease process.
One woman commented that

"I think I’ve got some diseases inside"

another said:

"My insides are old"

while one woman explained:

"All my illness went within me, I didn’t feel it on the outside".

Finally another woman attributed her bad feelings to something being wrong physically:

"There must be something wrong with me if I feel like this".

A woman who was unable to respond particularly well verbally during the interview, wrote four times around the picture
(used to represent a woman’s experience of pain and health problems) the word "sore", as if to highlight the intensity
of these problems she experienced on an internal level.

THE SECOND THEME WAS - THE PAST HAS CAUGHT UP WITH ME

Two women gave examples in their interviews suggesting their present health problems stemmed from their experiences
in the past (namely their abuse histories). These women made the conscious link between their abusive past and their
present symptoms:

"past has caught up on me, haunted me".

And:

"I know I’ve got a lot of ‘why’s’ in me, what I’ve done years ago, and keep thinking one of them are coming to the surface,
but it’s like the pain under me bust . . .".

THE THIRD THEME - JUST BECAUSE I LOOK ALL RIGHT ON THE OUTSIDE DOESN’T MEAN I’M ALRIGHT ON THE
INSIDE

Responses from the women interviewed and information written in the files indicated that 13 of the women complained
about physical problems and difficulties for which no physical cause could be found upon investigation. For example
file comments include:

"Frequent complaints of physical ailments which upon investigation indicates nothing detected"

Another file comment was:

"Complained of gynaecological problems though nothing abnormal found on investigation".

Four of the women were able to talk about their experience of believing they had something wrong physically, but that
no physical cause could be found. For example, one woman who had been sexually and physically abused by family
members commented:

"I know they think I’m alright but you can look alright and die can’t you?"

Another woman who had been physically and emotionally abused by family members spoke about her wish to find
something wrong:

"Dr . . . said she couldn’t find anything, I want there to be something"

A woman also talked about professionals being unable to find something wrong:

"They couldn’t find nowt wrong . . . I don’t look poorly on the outside, but that doesn’t mean I’m not ill".

One woman who had been physically abused was able to make the connection herself between health and body:

"Physical belief affects mental health".

THE FOURTH THEME - MY BODY DOES NOT EXIST

One woman used very eloquent descriptions regarding her depersonalised body image. Nursing reports and
Consultant Psychiatric reports list some of her perceptions:

"My heads away", "I feel as if I have no blood", "My brain has snapped", "My rib cage is floating up and down and
swinging free from my body", and "All my body is dead. It’s living but not there".

Similarly, in another woman’s file staff write about a woman’s ideas about people - "taking her body away". This
woman had been physically abused in childhood.

In an interview with the researcher a woman who had been physically abused by a family member attributed her
health problems to Martians, who she believed were "picking on her" and thus affecting her health.

Some of these client quotes could be interpreted physically and medically, but many of them are incomprehensible
within literal parameters. As soon as one makes the switch from being literal to being metaphorical, certain fundamental
changes occur:

Symptoms Perceived Literally                                       Symptoms Perceived Metaphorically

Body as mechanism                                                         Body as artist’s canvass/landscape

Need for systemic intervention                                             Need for image exploration

Intellectual distancing                                                       Empathic feeling

Professional ‘righting’ response                                         Professional ‘honouring’ response

Evaluation of objectivity                                                    Respect for subjectivity

Phrases such as "all my illnesses went within me" or "my rib cage is floating up and down and swinging free from
my body" - do not allow us the luxury of a literal interpretation. They are visual and poetic and they plunge us into
an imaginative territory which needs some anchoring in a dimension to which we can relate.

Clarissa Pinkola Estes (1991) has been very influential in the last five years both in teaching us to value the mythical
stories of our ancestors but also in reconnecting us to the language of the body. She says: