To Know Another Inside and Out: Linking Psychic and Somatic Experience in Eating Disorders

ABSTRACT

This article explores the role of the body in the psychoanalytic treatment of eating disorders from a relational and developmental perspective. Many who struggle with eating disorders and related issues have had early experiences that adversely affected the development of flexible, adaptive self-regulation, including the ability to experience affects as psychic states that can be safely shared in the context of a relationship. Because of their difficulty symbolizing and expressing feelings, patients with eating disorders often experience affects as somatic problems, for which they seek somatic solutions. Tuning in to patients’ bodily experience can open up pathways for accessing and, eventually, verbalizing and reflecting on internal states in the therapeutic relationship. As shown through a detailed case illustration, the therapist can discover and engage aspects of the intersubjective matrix that may not meet the eye by attending to his or her own bodily experiences and associations in and out of sessions.     

Repercussions of transition out of elite sport on body image

The purpose of this study was to evaluate the psychological repercussions of transition out of elite sport from a bodily point of view. We hypothesized that the passage from a bodily over-investment to a more sedentary state would have an effect on body satisfaction. 16 Transitioning Athletes following the Sydney Olympic Games were compared with 16 Active Athletes two times during the transition period using the Body-Image Questionnaire of Bruchon-Schweitzer. Qualitative data in the form of interviews provided a complement to the quantitative data. Analysis yielded no significant differences 1 1/2 mo. after career termination between the two groups but showed a decrease in body satisfaction between 1 1/2 and 5 mo. after career termination for Transitioning Athletes, with a significant between-group difference at 5 mo. The Transitioning Athletes initially reported weight gain and uncertainty about their real physical capacities but also a continued social recognition that maintained body satisfaction. Over time, however, they were increasingly aware of this bodily deterioration, as ongoing exercise served as a reality test. Added to this were perceived decreases in social value as well as disturbing somatic manifestations. The result was a substantial effect on body satisfaction.     

The body in analysis: authentic movement and witnessing in analytic practice

This paper will describe a form of active imagination called authentic movement, in which attention is given to the somatic unconscious. In authentic movement, patients are encouraged to focus inward and attend to any bodily sensations, images and feelings which may arise. In the process of focusing inward on one's bodily-felt experience, images, somatic memory and the accompanying feelings which arise are then available to be explored as a communication from the patient's unconscious. Authentic movement supports the individual in linking image with affect in that the individual re-experiences the somatic aspect of symbolization. What was previously conserved on the somatic level as unmentalized experience, can now begin to be taken up into the mind, thought about, and made available for analysis. In authentic movement, the analyst acts as a silent witness to the patient's explorations. The quiet focused attention of the witness helps to create a secure containing environment in which the person moving can experience a sense of feeling held and seen. The function of the witness is to hold the patient's experience in his own mind, particularly what is not yet mentalized. The witness utilizes his somatic countertransference, including any images, feelings and bodily responses which are generated by what is being communicated non-verbally, as a means of understanding and responding to the patient's material.     

“[G]azing into the synaptic chasm”: the Brain in Beckett’s Writing

This paper argues that Samuel Beckett’s interest in functions of the brain is not only evidenced in his notebooks, taken from a number of psychology and psycho-physiognomy texts in the early 1930s, but is also explored and expanded in his fiction and drama. This paper investigates Beckett’s fascination with the limits of “cerebral consciousness” and the brain’s failure to consciously perceive certain bodily modifications especially when processing emotion. Like Antonio Damasio’s definition of emotion as essentially the bodily modifications that include chemical changes, Beckett often exploits the idea of emotion as sorely a bodily phenomenon by creating characters who are unable to consciously perceive and process their emotion. For example, when talking about his own weeping, the narrator of The Unnamable attributes the tears to the malfunctioning of the brain, “liquefied brain”, denying, displacing or making physical the feeling of sadness. By examining the ways in which Beckett emphasizes a somatic dimension of emotion and its relation to the brain function and perception in his writing, this paper reveals how he explores the idea of the self and extends the idea to what he calls the “impenetrable self” that cannot be consciously recognized. I argue that if, for Joseph LeDoux, the “notion of synapses as points of communication between cells is […] essential to our efforts to understand who we are in terms of brain mechanisms”, for Beckett to expose such unconscious biological mechanisms and “gaps” becomes his own artistic challenge.     

Increased interoceptive awareness in fear of flying: sensitivity to suffocation signals

In flight phobia, particular environmental factors can facilitate a fear response. The current study aimed to explore the relationship between respiratory sensations and fear of flying: individuals with fear of flying may be more sensitive to suffocation signals and could experience more bodily sensations as a consequence of an added resistive respiratory load. The sample included 19 subjects with fear of flying and 19 controls. Each subject wore a mask to which a respiratory load could be added. First, an interference paradigm was used: respiratory loads were presented during a tone detection task. Next, subjects were asked to detect the loads. After each task, subjects reported their somatic sensations. All subjects showed interference of the respiratory loads. However, subjects with fear of flying were more accurate in detecting the loads, thereby indicating higher interoceptive awareness. Moreover, their superior accuracy was related to increased bodily sensations: a higher interoceptive awareness resulted in increased symptom reporting. It follows that treatment interventions for fear of flying should be supplemented with interventions that target internal stimuli.     

Innerdeutsche Migration und psychisches Befinden

In a representative study German migrants within Germany were assigned to two different groups depending on their answers to the following two questions (?Where did you mainly grow up – Eastern Germany or Western Germany?“ and ?Where do you live now?“). The migrants (54 West-East and 68 East-West migrants) were compared with non-migrants (1,136 Western and 294 Eastern Germans) concerning different variables of their psychic condition. Migrants suffered from higher stress, less bodily well-being and more somatic symptoms than non-migrants. Probands migrating from Western to Eastern Germany reported the lowest levels of quality of life.     

The Role of Bodily Perception in Emotion: In Defense of an Impure Somatic Theory

In this paper, we develop an impure somatic theory of emotion, according to which emotions are constituted by the integration of bodily perceptions with representations of external objects, events, or states of affairs. We put forward our theory by contrasting it with Prinz's (2004) pure somatic theory, according to which emotions are entirely constituted by bodily perceptions. After illustrating Prinz's theory and discussing the evidence in its favor, we show that it is beset by serious problems—i.e., it gets the neural correlates of emotion wrong, it isn't able to distinguish emotions from bodily perceptions that aren't emotions, it cannot account for emotions being directed towards particular objects, and it mischaracterizes emotion phenomenology. We argue that our theory accounts for the empirical evidence considered by Prinz and solves the problems faced by his theory. In particular, we maintain that our theory gives a unified and principled account of the relation between emotions and bodily perceptions, the intentionality of emotions, and emotion phenomenology.     

The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression

The objective of this study was to examine if emotion awareness in children and adolescents (age 7-18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N?=?617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.     

The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression

The objective of this study was to examine if emotion awareness in children and adolescents (age 7–18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N?=?617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.     

Pain, dissociation and subliminal self-representations

According to recent evidence, neurophysiological processes coupled to pain are closely related to the mechanisms of consciousness. This evidence is in accordance with findings that changes in states of consciousness during hypnosis or traumatic dissociation strongly affect conscious perception and experience of pain, and markedly influence brain functions. Past research indicates that painful experience may induce dissociated state and information about the experience may be stored or processed unconsciously. Reported findings suggest common neurophysiological mechanisms of pain and dissociation and point to a hypothesis of dissociation as a defense mechanism against psychological and physical pain that substantially influences functions of consciousness. The hypothesis is also supported by findings that information can be represented in the mind/brain without the subject's awareness. The findings of unconsciously present information suggest possible binding between conscious contents and self-functions that constitute self-representational dimensions of consciousness. The self-representation means that certain inner states of own body are interpreted as mental and somatic identity, while other bodily signals, currently not accessible to the dominant interpreter's access are dissociated and may be defined as subliminal self-representations. In conclusion, the neurophysiological aspects of consciousness and its integrative role in the therapy of painful traumatic memories are discussed.     

Bodily Integrity and Conceptions of Subjectivity

This paper examines two different ways of understanding the concept of bodily integrity and their political implications. In Drucilla Cornell's use of the concept, the body cannot be separated from the mind. Protecting bodily integrity means protecting possibilities of imagining the self as whole. Martha Nussbaum's theorizing is based on a liberal way of conceptualizing subjectivity, in which the mind and the body are separate, and bodily integrity is used to refer to physical inviolability.     

Emotion understanding in children with frequent somatic complaints

The assumption that an impaired ability to identify and express emotions (“alexithymia”) is related to a lack of physical well-being in children was investigated. Two groups of children (mean age 10 years), who differed in their reported frequency of somatic complaints, were asked to fill out a mood questionnaire and respond to emotion-evoking situations. The findings showed that the number of somatic complaints in children was unrelated to their ability to identify their own emotions when asked about hypothetical conflicting situations. Yet, both groups identified different emotions. Children with more somatic complaints reported more fear and fewer anger reactions. They also reported experiencing more negative emotion-evoking situations with peers.

Fear suggests a stronger tendency for withdrawal, whereas the anger reaction of the healthier group implies a stronger tendency to approach (negative) emotion evoking situations. Consequently, the conflicting situation continues for the first group, whereas the second group will be more likely to solve it. Strong or long-lasting arousal has a negative effect on bodily functioning: it can disturb biological subsystems and bring about organic changes. The possibility that fewer social skills, for expressing emotions in a socially constructive way, or fewer coping strategies in the group who reported more somatic complaints also influence the intensity and duration of negative emotions is discussed.     

Interoception and gender: What aspects should we pay attention to?

Interoception is involved in both somatic and mental disorders with different prevalence between genders; however, gender differences are often neglected. To examine the potential gender differences in interoceptive awareness, we recruited 376 healthy subjects (51% males, aged 17–30 years), to fill in the Multidimensional Assessment of Interoceptive Awareness (MAIA). Of that sample, in a subgroup of 40 subjects (50% males), interoceptive accuracy was assessed by heartbeat counting task (HCT).The results on interroceptive awareness suggest that females tend to notice bodily sensations more often, better understand relations between bodily sensations and emotional states, worry or experience more emotional distress with sensations of pain or discomfort and see body as less safe. The results of interoceptive accuracy further suggest that females are less efficient in consciously detecting heartbeats. Therefore, gender should be considered when interoceptive evaluation is performed in disorders associated to bodily sensations and to the emotional/mood states.     

Illusory own body perceptions: Case reports and relevance for bodily self-consciousness

Neurological disorders of body representation have for a long time suggested the importance of multisensory processing of bodily signals for self-consciousness. One such group of disorders – illusory own body perceptions affecting the entire body – has been proposed to be especially relevant in this respect, based on neurological data as well as philosophical considerations. This has recently been tested experimentally in healthy subjects showing that integration of multisensory bodily signals from the entire body with respect to the three aspects: self-location, first-person perspective, and self-location, is crucial for bodily self-consciousness. Here we present clinical and neuroanatomical data of two neurological patients with paroxysmal disorders of full body representation in whom only one of these aspects, self-identification, was abnormal. We distinguish such disorders of global body representation from related but distinct disorders and discuss their relevance for the neurobiology of bodily self-consciousness.     

Effects of Bodily Contact on Reactions to Crowding1

The present study examined the effects of bodily contact in a crowded environment. Initially, the skin conductance levels (SCL) of 160 males and females were obtained during rest and while bursting a balloon. In a subsequent session, subjects in same-sex groups of four were seated for 30 minutes in either (a) a large room, (b) a small room subjected to unavoidable bodily contact, or (c) a small room which was partitioned to either reduce or prevent bodily contact while allowing visual access. Measures of mood, tolerance for frustration, cognitive task performance, and self reports of annoyance and somatic distress were then taken. Results showed that crowding is stressful and that bodily contact makes a significant contribution to the amount of stress experienced for both men and women. In general, crowded subjects forced to touch showed the greatest increases in SCL, felt most annoyed, were most bothered by spatial intrusion during crowding, and had the lowest tolerance for frustration following crowding. Sex differences in mood following crowding and in reaction to the noncrowded environment were observed and appeared to be mediated by differential social concerns.     

Becoming Paladin: The Bodily Ground of World Becoming

In this article I will suggest that futures are made as embodied enactments of individuals and collectives. Values and identities are shaped as postures, gestures, movements, and expressions that are in themselves sites of personal and communal meaning. Bodily organizations are ground for senses of self, and the recognition, and reaction to, the otherness of others. Bodily organizations are shaped in encounters in families and social and cultural institutions that they in turn shape. Kinds of bodies and kinds of bodily enactments are cultivated in different communities. They can be sources of conflict or sources of transindividual and transcultural becoming. In this article I look at some ways bodily meanings are developed in both families and communities. I use the image of Paladin, a fictional television gunslinger character in the 1950s, among others, to describe processes of embodied self-formation that are derived from the media and other extra-familial sources. I look at the polycultural organization of individual psyches in our era, as well as somatically based community conflict and collaboration. I briefly describe how practiced experiences of somatic organization can be used as tools for personal and communal exploration of new possibility.     

Cognitive-emotional sensitization and somatic health complaints

Sensitization is conceptually related to cognitive bias in experimental psychopathology, and they share the basic mechanism of neuronal sensitization. Every strongly relevant individual concern, like fears, can yield cognitive bias or "cognitive-emotional sensitization". It might also be present for bodily and environmental information related to illness, and could be an etiological factor in medically unexplained complaints. Physiological and cognitive sensitization are theoretically compared. There is evidence for cognitive-emotional sensitization in some medically unexplained somatic complaints, and negative affect is suggested as a catalyst. Prolonged cognitive-emotional sensitization ("perseverative negative cognition" or worry, rumination) might even have demonstrable somatic pathological effects. It is concluded that sensitization may be organized at different levels, both in the organism and in the larger living system within which the organism is subsumed. This view might not only help to clarify medically unexplained pain syndromes, but virtually every subjective complaint, both with and without recognized physiopathology.     

Listening to Somatosensory States in Psychoanalysis: Body,Trauma, and Poetry

ABSTRACT

The author starts from the apparently outdated James-Lange theory of emotion to rediscover elements of modernity for contemporary psychoanalysis: from James’ bodily-sensory dimension to Damasio’s “feeling of what happens,” to Bucci’s attention to the patient’s visceral narrative in session. William James stated that bodily sensations are the first elements on the path toward consciousness. Damasio emphasizes that “Consciousness is rooted in the representation of the body”. Bucci presents a framework for identifying linkages between bodily and symbolic states and to observe the various degrees of patients’ “visceral speech” in session. These parallels support a sensibility to listen to language as the voice of the body: the relationship between the patient’s narrative and the bodily-sensory dimension can be grasped through the patient’s “imagery” which may reference earlier somatic experience. Particular emphasis is given to the story-telling of trauma.     

How passive is passive listening? Toward a sensorimotor theory of auditory perception

Phenomenology and the Cognitive Sciences - According to sensorimotor theory perceiving is a bodily skill involving exercise of an implicit know-how of the systematic ways that sensations change as...