ABSTRACT
This chapter considers the role of difficulties in symbolisation in psychosomatic patients. The two authors present contrasting but closely related views on symbolisation. Luigi Solano believes that symbolisation has not been developed and must be constructed during the analytic work. In his view, somatic symptoms occur when symbolic operations have failed to take place, which is different to the mind finding expression in the body as in hysterical conversion states. Instead, in somatic symptoms the body reacts to an internal conflict which is not symbolised. In contrast, following Green, Fotis Bobos suggests that psychosomatic acting in is a defensive step, which functions to expel symbolic representations of psychic reality, just as acting out does. Fotis also makes an important differentiation between primary symbolic processes related to the body and secondary symbolisation based on language used in classical psychoanalytical work. He refers to Roussillon’s discussion of how the analyst facilitates the patient’s move towards secondary symbolisation by his verbal interpretations that stem from his countertransference. Both authors agree that the relationship with the analyst plays a key part in developing the patient’s capacity for symbolisation, moving away from somatic symptoms towards emotionally meaningful expressions.
