A 24-year-old woman named Rose was referred to therapy by a doctor at a Los Angeles hospital. Rose had a history of frequent vomiting when she woke up in the morning. The vomiting brought on severe anxiety and panic attacks. Sometimes Rose’s vomiting and anxiety were so severe that her husband had to rush her to the emergency room.
Numerous physical examinations and tests at various hospitals and in doctors’ offices revealed no medical cause for Rosa’s vomiting. Finally, a specialist suggested that her symptoms might have an emotional cause. He referred Rose to therapy. At first, she was reluctant to go to therapy, but all medical options had been exhausted, so she felt like she had no choice.
Treating physical symptoms for which there is no medical explanation poses an interesting and sometimes challenging task for the therapist. This type of situation is called “psychosomatic illness,” an illness in which the unconscious mind produces physical symptoms in the absence of disease.
Although the term “psychosomatic” was not coined until the 20th century, these sorts of symptoms played a pivotal role in the earliest origins of psychoanalysis. The famous case of Anna O, a patient treated by Freud’s medical colleague Josef Breuer, played a crucial role in the development of Freud’s thought. Anna O has been frequently described as the first psychoanalytic patient. Breuer cured her symptoms—which included paralysis of the extremities on the right side of her body and disturbances of vision and hearing—by talking with her and using hypnosis. Anna O described her treatment as the “talking cure,” a term by which Freudian psychoanalysis famously became known.
I started by asking Rose to give me a history of her symptoms. She said that previously she had had a brief episode of vomiting and anxiety when she was 13. At the time, she was living with her family in Buenos Aires. Subsequently, she had experienced the symptoms on a few occasions, but nothing like she was having now. Nine months ago, Rose had moved to the United States to marry her husband, Seth. For no apparent reason, her vomiting and panic attacks became more frequent and severe.
Rose was happy in her marriage and happy to be living in the United States. She was working on her master’s degree in sociology at a local university. She had made a few friends here and was generally content.
As a family systems therapist, I find that many symptoms—whether physical or psychological—are rooted in family problems. Since Rose and Seth seemed happy together and expressed no marital distress, I turned my attention to Rose’s extended family. When I asked her if she missed her family in Buenos Aires, Rose began to cry.
“It’s OK,” Seth told her. “Tell her about your mother.”
Through her tears, Rose told me that she was worried about her mother, who was very ill. She was going to have heart surgery next month, and Rose felt guilty that she wasn’t going to be with her mother to nurse her. Her older sister was a nurse who lived close by her mother, and she and her father would care for her, but Rose still felt guilty.
I asked Rose if there were any problems in her family when she was 13, the time when her vomiting and panic attacks had first begun. Again Rose started crying. Her mother had been very ill at that time. She had to have surgery for a benign tumor in her brain. The surgery was successful, and her mother was fine, but Rose had been very worried. In fact, at the time, her father, a college professor, told her that her vomiting was probably caused by her worry about her mother. Even though psychology wasn’t his field, he had hit the nail on the head.
Instantly, the connection between Rose’s vomiting and panic attacks and her worry about her mother, both in the past and the present, became clear to me. Her father had come up with the same answer. Rose’s unconscious mind was turning her fears about her mother’s health into physical symptoms, by way of a process called somatization.
My therapy with Rose turned on helping her realize that her mother had every chance of a full recovery. She had an excellent surgeon at a prestigious hospital in Buenos Aires. Her father had told Rose that doctors had confidence that her mother would be fine. She would have good care from her father and sister, and there was no reason for Rose to interrupt her studies and her new marriage to travel to Buenos Aires. I used light hypnosis to help Rose relax, planting a hypnotic suggestion of her mother’s healthy recovery.
After a few conversations with her parents and two therapy sessions during the following weeks, Rose no longer felt conflicted about interrupting her life to travel. She and Seth planned a trip to see her mother in June after her school semester ended. By the fourth session, Rose was no longer vomiting and having panic attacks.
Of course, not all cases of psychosomatic symptoms are so easily cured. Rose was very intelligent. Her father had previously made the connection between her symptoms and her worry about her ill mother. My work was reinforced by her father’s earlier insight. Once the unconscious roots of Rose’s symptoms came to light, she was able to consciously express her worries and conflicts about her mother and deal with them rationally.
Interestingly, the symptoms of Anna O also involved worry about an ill family member. Anna O was a 21-year-old woman who had developed symptoms while nursing her father, who eventually died of a tubercular abscess. As it turns out, the “talking cure” was not merely the analysis of the individual’s psyche. The role of the family system played a part from the very beginning.