Psychosomatic Medicine 19:11-16 (1957)
© 1957 American Psychosomatic Society

The Psychology of Bodily Feelings in Schizophrenia (Special Article)

¹ Department of Psychiatry of the State University of New York, Upstate Medical Center, Syracuse 10, N. Y.

This essay aims at elucidating the psychology of bodily feelings in schizophrenia. Its subject matter is, therefore, hypochondriasis and so-called somatic delusions.

Previous workers concerned with these phenomena have either emphasized the role of the alleged perception of minimal somatic stimuli which ordinarily remain unconscious, or have stressed the psychological meaning of the symptoms in terms of the symbolic meaning of their content (i.e., words, images). The present study focuses on an interpretation of this type of behavior in terms of its formal characteristics, that is, as a particular mode of ego-body integration.

A mechanism of the genesis of bodily feelings in schizophrenia is presented. This mechanism utilizes the concept of the body as an object vis-à-vis the ego. The notion of transferences to the body is implicit in this scheme. Bodily preoccupations pertain to the fear of body loss and function as a warning of this danger as well as a reassurance against it. So-called loss of body feelings relates to a stage of ego-body integration in which further progression of body loss has occurred. Such affects (experiences) function both as a solution of the dreaded body loss and as an expression of a new (psychically amputated) ego-body integration. This state may lead to painless self-mutilations which are viewed as attempts on the part of the ego to bring the body up to date.

Schreber's illness is cited as a well-known example of the sort of phenomena with which this essay deals. The similarities between his prepsychotic and postpsychotic hypochondriacal preoccupations have been noted by previous workers. It is important, however, that before his overt psychosis Schreber had doubts about whether he was turning into a woman, while during the phase of recovery he was certain that he was a woman. The implications of this difference for the problem of the nature of schizophrenia--and the related question of what constitutes recovery in this syndrome-are briefly discussed.

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