Symptoms as Disguised Messages

Many people enter therapy because their day-to-day lives have become disrupted by symptoms such as compulsions, anxiety, depression, feeling stuck, a lack of desire, or painful reminiscences.

What Is a Therapy Symptom?

We are all familiar with medical symptoms—visible signs like a rash or fever that indicate an underlying illness.

 

 

For example, a high fever, cough, runny nose, red and watery eyes, and a rash are classic symptoms of the measles virus.

In medicine, there’s a clear cause-and-effect relationship:

 

However, the symptoms therapists work with belong to a different register – this is why becoming a therapist does not require a medical training.

Rather than indicating a physical illness, many therapy symptoms represent a compromise between powerful, opposing forces within us.

 

 
So therapy symptoms can be thought of as protective or defensive formations—signs that we are somehow ‘out of sync’ with ourselves.

 

Symptoms as Compromises

Imagine a situation where Force 1 and Force 2 are in conflict, equally matched, and cancel each other out.

The result might be a lack of energy, difficulty getting out of bed, loss of concentration, or a depressed state.

symptoms in therapy represent not an illness but a compromise

Alternatively, one force might dominate the compromise, leading to behaviors like forgetting your wedding anniversary, repeating the same argument, or compulsively checking if the door is locked.

All these may be symptoms in the therapy sense.

People often turn to therapy not because they have a symptom, but because the symptom has become too disruptive or costly to maintain.

The first task of therapy isn’t to remove the symptom but to approach it as a protective formation and understand its purpose.

 

A Portrait With the Subject Missing

A work by British artist David Hockney offers a unique way to think about therapy symptoms.

Hockney’s Panama Hat emerged from a conversation between Hockney and his friend Henry Geldzahler, who was fundraising for the charity Phoenix House. Geldzahler recalls:

Hockney said, “Let me do a portrait of you” and I said “You really can’t because I am fund-raising for them. It would look a little funny.” So Hockney said, “Well”, and just sat down… and in about an hour, he did my jacket, my hat, my pipe and my iced coffee. I like that picture because it’s a portrait of a subject with the subject missing.

The painting represents a compromise between two opposing forces: Hockney’s desire to create a portrait and Geldzahler’s reluctance to be the subject.

The result is a portrait with the subject missing—a visual metaphor for how therapy symptoms often disguise or obscure their true meaning.

This alerts us to another aspect of symptoms in therapy.

symptoms in therapy often seem nonsensical

 

Symptoms as Disguised Messages

Like Hockney’s painting, therapy symptoms often seem nonsensical: compulsively checking a locked door, flying into a rage over a trivial matter, or feeling stuck despite wanting to move forward.

It’s as though the real subject—the underlying issue—is missing or disguised.

As a therapist, I am trained to understand your symptom—your suffering or complaint—as a compromise that represents something intimate and important, half-expressed or hidden.

 

A Final Question

To end, let’s consider another work by Hockney: his large (183x183cm, 6ftx6ft) painting Chair and Shirt.

Has the ‘language’ of the earlier work, Panama Hat, been continued or carried across to this painting? If so, what might the missing or disguised subject be?

 

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Notes

The measles infographic is taken from the Centers for Disease Control and Prevention (accessed June 2019)
https://www.cdc.gov/measles/parent-infographic.html

The idea of using opposing arrows as a way of making sense of symptoms is taken from the first chapter of Bruce Fink’s clear and accessible book, A Clinical Introduction to Freud, 2019.

Henry Geldzahler recalls his conversation with Hockney in the periodical Art in America, February 1981. For further reading on Hockney’s use of metonymy see chapter four of my book co-authored with Ulrich Luckhardt, David Hockney Paintings, Prestel 1994.