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The New Therapist
with Anthony D. Smith, LMHC

What Remains of Psychoanalysis: Psychosomatic Illness, 1

“Is it all in my head?” pleaded Nancy.

She laid on the bed, one hand clutching her stomach, the other draped across her forehead. “I’ve really lost it now!,” she dramatically announced, reaching for the doctor’s hand. Two neurologists, independent of each other, found no reason for Nancy’s fainting spells or bouts of deafness. The internists also gave her a clean bill of health, yet her stomach cramping persisted.

No stranger to strong emotions, Nancy grew up in chaos, her anxiety running amok. She rarely saw her parents, who were more like roommates. Eve, her mother, preferred socializing to mothering and was cold towards Nancy’s needs. Her father, Alton, would be gone working for weeks and rarely saw her. Unless, that is, when he was home, and had to pick her up from the nurses’ office at school.

You see, Separation Anxiety in children often includes very real upset stomachs and headaches. It is not faking. It is likely corollary to the musculoskeletal tension from the intense anxiety. Subconsciously, though, the child learns that, while it’s discomforting, it’s useful: the rendered complaints are a ticket home to the attachment.

Alton showed a loving demeanor towards Nancy. He and Eve often argued about Eve’s neglect while he was away. Nancy indeed had an ally but seemed to not be able to maintain his full attention- his job was calling. She hated it when he left and fantasized about running away with him; dealing with Eve, she could understand why he wanted to be away, but what about Nancy!? Her greatest fear was that something would happen to him while away, permanently robbing her of him. Then again, him being gone allowed her something to look forward to: his return.

Desperate for Alton’s attention when he was available, Nancy learned early on that, with a little drama, she could turn up the volume of the effects of her physical discomforts. Out of guilt for not being home enough for her, Alton invariably came running.

As she aged, Nancy honed her dramatic craft; if it worked with one person she wanted attention from, why not another? In high school she developed romantic relationships with boys, who naturally became more interesting than her father, who continued to be missing in action. Though seemingly a cheery kid, under the surface, years of anger towards her parents stewed, and anxiety about her image and worthiness festered. No attention was too much attention.

Then came college. Though excited to move away, it proved too much to bear. Nancy would have to find new attention-givers. The pressure to do well also ran high; she wasn’t only theatrical and seductive, she also received plenty of attention for being top of her class. In college there was a lot of competition she needed to deal with. Then the bomb dropped- her parents were officially divorcing. Empty nest was the straw breaking the camel’s back; there was no need to stay together. Deep down, Nancy always had a fantasy of her parents rekindling a good relationship and somehow gaining the childhood she never had. Now, it would be permanent unfinished business, and her guilt ran high- if only she hadn’t moved out!…

Within days, an old, familiar discomfort crept up in her stomach. Nancy began asking people to repeat themselves, and she was soon deaf in her right ear. One day she fainted in her advisors’ office and a day later in the nurse’s office. A third fainting spell led to the emergency room. After considerable evaluation, no medical causes were found. Alton demanded a second opinion. His daughter was no liar! Similar results in the second opinions spurred a referral to the University Medical School Psychiatry Department, where Nancy was evaluated by Dr. H.

Getting to know Nancy, and taking a very detailed history, Dr. H began making sense of the “unexplainable” medical complications. First, psychological testing and interviews pointed sharply towards traits of Histrionic Personality Disorder, or, what was known in Freudian times as Hysteria. Eventually deemed a sexist term, given the prefix “hys” implies the uterus and thus implied inherent feminine flaws, the condition was renamed. Regardless, it is a personality with core features of theatrical, attention-seeking behavior; displays of often fleeting, strong emotions that can appear superficial; and a tendency to perceive relationships as much more intimate than they are. It is easy to see how Nancy’s early experience at home spurred her pervasive interpersonal style of adulthood.

Adding to the Hysterical (Histrionic) Personality peculiarities, as Freud and contemporaries puzzled over, there was often a collection of neurological and somatic illness symptoms with no physiological cause. A neurologist in training, Freud wrestled with the phenomenon and perceived a meeting of the waters of neurology and psychiatry. It is with this interest that Freud’s career shifted, and out blossomed understandings of psychosomatic illness that still hold water today. Stay tuned for the rest of the story on Sunday, 8/23/20!

What Remains of Psychoanalysis: Psychosomatic Illness, 1

Anthony Smith, LMHC

Anthony Smith is a licensed mental health counselor in Massachusetts with 20 years of experience. He has worked in facilities and in private practice performing therapy and diagnostic evaluations across a wide array of populations both demographically and clinically. This includes 17 years in the forensic arena, where he currently provides assessments for the juvenile courts. Aside from interest in the intersection of psychology and law, Anthony is particularly in interested differential diagnosis and supervision of new practitioners. He regularly teaches abnormal psychology and creates courses on the lived experience of people with mental illness, along with supervising graduate student counselling practicums at a local university. When not providing clinical services, teaching or blogging, Anthony can be found hiking and fly-fishing around the Northeast and American West.


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APA Reference
Smith, A. (2020). What Remains of Psychoanalysis: Psychosomatic Illness, 1. Psych Central. Retrieved on December 4, 2020, from