Some of the biases psychiatrists have amaze me. I’ll grant you that some of them are useful, such as if you say to me a young woman has Borderline Personality Organization I know what you really mean is bitch (because psychiatrists certainly aren’t using the term analytically these days). A positive teddy bear sign is useful information. So is failing the elevator test. Still, one I wish would get a little more kindness are those poor bastard somaticizers. 

Psychosomatic. Somatizing. Somaticizing. It’s all the same word, and in common medical parlance it refers to someone who is overly emotional, needy, codependent, and has seven admissions for the same GI or neurological complaint that are all “in their head.”

That’s my problem with the stereotype, though- it isn’t in their head. It’s in their body. Somaticization is an immature (think adolescent, teenaged) defense which converts emotional pain into physical pain. That’s it. 

Every human being has access to this behavior and we all use it from time to time. Our defenses get activated for many reasons, but typically an intense affect, a powerful mood or emotional feeling, will trigger us into relying on an immature or primitive defense (rather than mature ones) to rescue us from the Bad Feeling that is causing us to suffer. 

We all have our favorite defenses, the ones we rely on more often than not. You can think of defenses as accomplishing the same effects as your vices do (relief from overpowering affect (emotional energy/intensity)). Defenses differ from vices in that they are internal and typically unconscious; your vices are external and require something outside you (bourbon, whores, money). Same end goal- don’t feel bad right now, damn the future. 

Somaticizing is unconscious. You won’t even know you’re in emotional pain at first- it’s a headache. It’s diarrhea. It’s tingling or pins and needles running down your extremities. Only a person who is emotionally self aware can connect the dots and discern the source. 

A rarely discussed (but incredibly useful) symptom of somatizing is misophonia- the experience of sudden, intense disgust connected with certain sounds. Some of the most common sounds are chewing or metal clanging against teeth, but there are plenty of others. I haven’t seen this in any of the literature but perhaps my buddy Bessel can study if there’s a correlation between misophonia and complex trauma. If there is, that’s somaticizing. 

Ultimately, we are all constantly rescuing ourselves from moods we don’t want to have. All of psychiatry, from the outpatient clinician working with the homeless schizophrenics to the Freudian psychoanalyst taking cash only payments four times a week, has in common that the physician is attempting to help their patient reconcile their fantasies with the objective reality.  

We are constantly lying to ourselves, or more correctly, we are constantly being lied to by ourselves. (The Last Psychiatrist: Illusionist)