Responding to Incomprehensibility: On the Clinical Role of Anonymity in Bodily Symptoms

We are grateful to René Rosfort for his comment on our target paper Clinical Response to Bodily Symptoms in Psychopathology. Rosfort’s remarks lead us here to specify an important point which our initial proposal may have left too implicit. Within the realm of clinical practice in psychopathology, we argue that bodily manifestations can be offered an expressive space and that they can be listened to in the clinical encounter as being part of the patient’s speech whereby she, by way of her bodily symptoms, addresses a demand to be attended to as a subject of communication. We detail the circumstances under which bodily manifestations may or may not be addressed to a person who is expected to respond, especially in a clinical encounter where this responsive stance may be reinforced. We also propose that bodily symptoms can be meaningful, under certain conditions, provided that they are considered as part of a meaningful situation, which includes another subject who may receive these bodily manifestations as expressive or to whom these bodily manifestations may be addressed: considered in and of themselves, out of the situation in which they occur, bodily manifestations do not have any meaningfulness. Moreover, we affirm that, defined as such, being meaningful is irreducible to having a meaning: by considering it in isolation, independently of the situation in which it occurs, one may attribute a meaning to a given bodily symptom, but the latter would have lost its situated meaningfulness; inversely, by considering it in the situation in which it occurs, one may fail to attribute a meaning to a given bodily symptom, but the latter would not have lost its situated meaningfulness.

On this basis, and confronted with Rosfort’s comments, we must now specify explicitly that the responsive stance is not an epistemic stance: by holding a responsive stance, one may recognize the singular meaningfulness a bodily symptom may have insofar as it is addressed to someone; by holding an epistemic stance, one may search for the generic meaning a bodily symptom may have independently of whether it is addressed or not. Whereas Rosfort holds an epistemic stance, we hold a responsive stance, and it is important to avoid conflating these two stances. Here, we elaborate on this distinction, and following Rosfort’s invitation, we consider in particular the fragility we are confronted to when facing bodily symptoms in psychopathology.

In our target paper, we stated that, practically, any clinical encounter may confront us to the limit of what we may understand, thereby confronting us to what, beyond this limit, remains foreign to us. Now, with his comments, Rosfort invites us to ask: what is this foreignness? Is it what he names: anonymity? Rosfort intends to contrast, on the one hand, the personal meaningfulness that arises when one holds a responsive stance, with, on the other hand, the idea that there could be anonymous meanings, including in particular factors of our functional biology, which would lack any personal meaningfulness but would nonetheless participate to the determination of bodily symptoms and should thus be considered in psychopathology. Our understanding is ‘fragile,’ he adds, because personal meaningfulness and anonymous meanings are inextricably intermingled, while not being possibly integrated with each other. We agree with Rosfort that the anonymity of bodily manifestations is indeed important to be considered carefully, but we would like to ask: in which sense are bodily symptoms anonymous, and what is the clinical role of anonymity in bodily symptoms?

Rosfort considers that the anonymity of bodily symptoms corresponds to the biological functioning of the body and argues that this anonymity stops our understanding, thereby confronting us to an ‘incomprehensible pain.’ Here, we would like to underline that, on the one hand, there is a certain anonymity which confronts us to a fundamental incomprehensibility, an incomprehensibility that is canceled out neither by holding an epistemic stance and attributing generic meanings, nor by holding a responsive stance and participating to the meaningfulness of the situation in which bodily symptoms occur. Nonetheless, this incomprehensibility does...