The Opacity of Bodily Symptoms: Anonymous Meaning in Psychopathology

Through an original combination of phenomenology and psychoanalysis, Ingerslev and Legrand (2016) argue convincingly for a complex theoretical framework for making sense of bodily symptoms in psychopathology. The argument is particularly interesting because it manages to show how the theoretical efforts to arrive at a better understanding of bodily symptoms are connected closely with the ethical demand involved in the dialogical situation of therapy. The framework thus operates on two interconnected levels, on the one hand ensuring a more careful clinical differentiation of bodily symptoms and, on the other, encouraging the clinician to adopt a responsive stance that allows for those symptoms to be recognized as subjects of communication. This is a much welcomed contribution to the understanding of the vital role of the body in mental suffering, and to the ethical problem involved in not being attentive to the complexity of bodily communication in therapy. It is, of course, not possible to address all the subtle aspects of this rich article, so I will focus on the distinction between the ‘meaning’ and the ‘meaningfulness’ of bodily manifestations that is fundamental to the argument, but—in my view—not sufficiently articulated. I argue that the phenomenological approach to the ‘meaningful’ body advocated in the article needs to deal more carefully with the question of the ontology of the body.

A phenomenological approach to the body is an appropriate methodological choice for a psychopathological investigation of bodily symptoms. Phenomenology focusses on and articulates the subjective, experiential features of bodily symptoms, whereas a biological approach to bodily symptoms normally employs an instrumental use of the experiential aspect to arrive at the objective, ontological features of those symptoms (what they are rather than how they are experienced). In this sense, phenomenology serves the important purpose of making us aware that bodily symptoms are expressions of a self-aware human being who experiences and acts as “a bodily-subject-in-the-world” (Legrand, 2011, p. 209; Zahavi, 1999, pp. 92–97), and as such these symptoms cannot be interpreted on a par with the biological manifestations of nonhuman organisms. The biology of the human body is complicated by the fact that humans are aware of their bodily functioning, and this awareness is part of the constitution and dynamics of the body. This complexity is at the heart of the phenomenological critique of the ontological (pre)conceptions of the body at work in biological explanations of bodily symptoms (Ratcliffe, 2009, pp. 225–228; Zahavi, 2010, pp. 5–7). We cannot simply adopt an observational stance that cuts through the personal character of bodily symptoms, that is, the experiential features, to arrive at a (preconceived) ontological explanation of the anonymous functions of those symptoms. This is what the authors convincingly argue for when insisting on the expressive and communicative features of bodily symptoms rather than operating with ‘an identified meaning,’ for example, a biological meaning of these symptoms in terms of distant evolutionary or proximate neuroscientific explanations (e.g., Murphy, 2008; Wakefield, 2007). And in a time dominated by naturalistic ambitions in psychiatry in the form of neuroscientific and evolutionary investigations into mental suffering, this insistence on a phenomenological approach to psychopathology that allows us to systematically take into account the (phenomenologically) ‘meaningful’ experience of symptoms, rather than merely focusing on the (ontological) ‘meaning’ of the symptoms, is more necessary than ever.

The insistence on phenomenology comes at a cost, however. The phenomenological perspective advocated in the article enables us to interpret bodily symptoms as meaningful. This meaningfulness is then further differentiated by distinguishing impersonal expressive bodily manifestations from the more personal, intersubjective character of communicative body language. This latter distinction between impersonal and personal aspects of bodily manifestations is an important recognition of the limits to the idea of bodily familiarity (i.e., my bodily experience is that which makes the world familiar to me) at work in some phenomenological accounts of the body (Ingerslev, 2013). The problem is, however, that the phenomenological notion of meaningfulness is not able to assess, let alone provide us with theoretical tools to explore, the complexity...