Many people enter therapy because their day-to-day life has become disrupted by symptoms: obsessions, compulsions, anxiety, depression, problematic relationships – for instance, to people or to food – as well as chronic states of confusion, resentment, rage and despair.
But what is a symptom?
We are probably all familiar with medical symptoms. They usually appear on the surface of our body and are a sign of an infection or some other illness.
For example, a high fever, cough, runny nose, red and watery eyes, along with a rash are probably symptoms we have the measles virus.
There’s a cause-and-effect relationship which we can picture as follows
measles virus in body ⟹ symptoms on surface of body
The symptoms with which therapists work are different, however. We can think of many therapy symptoms as representing a compromise between powerful internal forces pushing in different directions at the same time.
Force 1 ⟹ symptom forms as a compromise ⟸ Force 2
We can imagine a situation in which the forces can be equally matched and somehow cancel each other out.
The symptom – the compromise – might be we are left then with very little or no energy, as all our energy is tied up in this struggle.
Specific symptoms might include our finding it hard to get out of bed in the morning, or a loss of concentration and purpose, or a loss of sex drive or a depressed feeling.
therapy symptoms often represent a compromise
Of course, the forces may not be equally matched and one may gain the upper hand in the compromise.
So always forgetting your wedding anniversary despite your best intentions, or getting into the same tired old argument over and over again, or needing to check repeatedly your front door is locked before leaving home. All these may be symptoms in the therapy sense.
People often turn to therapy not because they have a symptom but because their symptom has become too disruptive, or has come to be maintained at too high a price.
But symptoms cannot just be removed, be made to disappear. If one is, another usually forms to take its place so as to re-establish the defensive compromise.
So symptoms in therapy are often a sign that we are somehow ‘out of sync’ with ourselves.
A picture by the British artist David Hockney can help us to think a bit more about symptoms in therapy.
This picture came about after a friend, Henry Geldzahler, approached Hockney to make an original art work for him to sell for charity. Geldzahler recalled their conversation,
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 he 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.
We can think of the picture as a compromise between two forces: Hockney wishing to produce a portrait of Geldzahler but not being allowed to because Geldzahler was the fund-raiser.
So a compromise was reached: the picture is a portrait though one with the subject missing!
therapy symptoms often seem nonsensical
This alerts us to another aspect of symptoms in therapy.
Symptoms often seem to be nonsensical: like having to check the door is locked not once but many times, or flying into a rage over what seem in retrospect to be trivial matters.
It is as though the real subject is missing or disguised, just as the real subject in Hockney’s picture is disguised.
A psychotherapist is trained to understand symptoms – your suffering, your complaint – as a compromise that represents something intimate, important and only half-expressed.
The measles infographic is taken from the Centers for Disease Control and Prevention (accessed June 2019)
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, ‘Hockney Abroad: A Slideshow,’ an article published in the periodical Art in America, February 1981. For further reading on Hockney’s use of metonymy see chapter four of my book written with Ulrich Luckhardt, David Hockney Paintings, Prestel 1994.