Psychosomatic
To be well, we need to defang this word
Psychosomatic circled my brain. Bothering me. Calling me. It’s a thing that happens to me, where a word will poke at me. Psychosomatic started poking at me a few days before my annual gynecological exam. I was experiencing the sensation of the start of a bladder infection. I have pretty good protocols around sex to ensure I don’t get them, and I questioned myself… had I done all the things? Yes.
But having a bladder infection as a 5-year-old is one of my rape facts. It’s one of the details that stands out when I’m mentally rolling and tumbling those facts. I’m launching a book about this right now, so it’s all very top of mind.
What occurred to me as I was pondering psychosomatic and its definition sparked curiosity, though. I noticed the sensation of having a bladder infection and knew that I was going to the doctor, so I made a point of asking the doctor about the bladder infection, as I had done a few years earlier.
I did not have a bladder infection (and I had not had a bladder infection a few years earlier). My doctor said my urine specimen was perfect… and we talked. I had never told her about being raped as a child. She asked me questions about it and about the sensation.
I shared with her that I wanted to talk with her in detail so that I could absolutely rule out that I had an infection.
In my examination, she did a more extensive exploration of my bladder, and she reported that all felt right.
I wasn’t happy that I had had the sensation of a bladder infection, but I was quite happy to not actually have had one.
And then I got more curious. No infection. Nothing unusual physically. But I had the sensation of pain.
I am having psychosomatic pain.
OK. Now what?
I am not crazy. I am not hysterical. I am a proactive, pragmatic participant in my mental and physical health.
In my book, I talk about noticing where pain is and naming it. Noticing when it surfaces, investigating the physical and psychological nature of it, questioning whether or not it is surfacing as a deflector… to something that I really, really want to do.
In this instance, the sensation of a bladder infection inhibits my sexual activity. I really, really want to have sex with my husband. So… figuring this out is worth it.
I looked back over the years. I had a bladder infection when I was 5 and another in my early twenties. Other than that, I have been tested on a number of occasions and have had only the sensation of a bladder infection.
Looking at it with all of those facts in front of me, it was easy for me to say to myself, “Oh, this is part of the trail of the atom.” I’ll keep this as short as I can, I went on a field trip to the Linear Accelerator at Stanford University when I was a freshman in college. The idea of seeing atoms seemed insane to my 16-year-old mind. The reality is, of course, that you don’t actually see the atoms or the particles. You see the trail the atom leaves. That’s how I think of my incomplete story of being raped. I have my facts, and I have the trail of the atom.
The sensation of a bladder infection is part of my trail of the atom. With that in mind, I have choices in how to engage with it. I can be freaked out, or, I can be gentle with myself and do this: Notice it; Acknowledge it; Name it. Understand what the sensation is trying to protect. And play with it. Have a little fun with this marvelous mind of mine.
One way that I can have fun with it is by investigating what I think this sensation is trying to protect, turning it into what Joseph Campbell, who wrote extensively on myths and the hero’s journey, calls a threshold guardian or a monster at the gate.
I think this sensation is trying to protect me from unsafe sex that will hurt me.
Having sex with my husband is not unsafe, and it does not hurt me.
I say out loud, “Thank you, threshold guardian, I’m OK.”
I like to name threshold guardians. It makes it easier and quicker to access the whole story of what’s going on. This guardian needed a name.
Partly because I love the work of Joseph Campbell so much, and partly because I love the richness of the stories, I love turning to myths when it’s time to name a new monster. In my search for this monster’s name, I came upon the undine. An undine is a water nymph. The myth has it that the undine, to gain her human soul, needed to make love with a human. A water nymph that needs to make love with a human — this myth in all its forms has been needed by us mortals over the millennia. Marvelous.
The clincher for this being my monster’s name is that Seamus Heaney wrote a poem in her voice. He is a hero of mine and wrote what I think of as my call to adventure: “Hope is not optimism, which expects things to turn out well, but something rooted in the conviction that there is good worth working for.” As I said above, making love with my husband is good worth working for.
The following is his poem, written in the voice of the Undine.
Undine
By Seamus Heaney
He slashed the briars, shovelled up grey silt
To give me right-of-way in my own drains
And I ran quick for him, cleaned out my rust.
He halted, saw me finally disrobed,
Running clear, with apparent unconcern.
Then he walked by me. I rippled and I churned
Where ditches intersected near the river
Until he dug a spade deep in my flank
And took me to him. I swallowed his trench
Gratefully, dispersing myself for love
Down in his roots, climbing his brassy grain —
But once he knew my welcome, I alone
Could give him subtle increase and reflection.
He explored me so completely, each limb
Lost its cold freedom. Human, warmed to him.
The sensation of my having a bladder infection is literally psychosomatic. My mind and body are working together, but at this point in my life, they are not working together in my best interest. With Undine, I can remind myself that I am safe, I don’t need her protection right now. Thank you, Undine. (And thank you, Seamus, for “giving me right of way in my own drains.”)
As I said, I am not crazy. I am not hysterical. I am a proactive, pragmatic participant in my mental and physical health. I have psychosomatic pain, which means that working with both my mind and body to address it is sane. Yet the term psychosomatic has been weaponized against women for centuries. It’s right up there with hysteria and hysterical.
The misuse of psychosomatic as a dismissive term reflects broader issues of gender bias in healthcare, where women’s health concerns are often taken less seriously than men’s. This has real consequences for diagnosis, treatment, and overall health outcomes for women.
In the 19th century, the concept of psychosomatic illness emerged alongside the development of psychology. It was often linked to hysteria, a diagnosis almost exclusively applied to women. Sigmund Freud’s theories popularized the idea that physical symptoms could have psychological origins. This sometimes led to dismissing women’s physical complaints as “all in their head.” (maybe this should sound like Freud. IE: “merely a manifestation of the patient’s psyche”
By the mid-20th Century, the term became more widely used in medical contexts. It often carried negative connotations, especially for poorly understood conditions. In the 1980s-1990s, there was increased recognition of conditions like chronic fatigue syndrome and fibromyalgia, which were often labeled as psychosomatic, particularly when affecting women.
Currently, medical gaslighting is a phrase being used by women who report having their symptoms dismissed as psychosomatic, again, especially for conditions that are difficult to diagnose or poorly understood. Many autoimmune conditions, which disproportionately affect women, are often initially misdiagnosed as psychosomatic.
Women with chronic pain conditions are more likely to have their pain attributed to psychological factors than men with similar symptoms. Endometriosis was long dismissed as psychosomatic or “normal” menstrual pain. Women’s heart attack symptoms are sometimes misdiagnosed as anxiety or stress-related, reflecting a persistent bias. There is strong evidence of correlation between childhood sexual abuse and women’s heart health, I have AFib, it is exacerbated by anxiety and stress, and it is a 100% real physical condition that I engage with as such.
It’s unsurprising that psychosomatic is misattributed to so many situations, given the historical lack of inclusion of women in medical research, which has led to a poorer understanding of how diseases manifest in women, sometimes leading to psychosomatic labels for unexplained symptoms implying that the condition is somehow less real or important if it has a psychological component. (Well+Good recently published a terrific article on how women are still not included in clinical trials.)
A positive approach to discussing psychosomatic conditions would emphasize the mind-body connection and treat it as valuable insight into a patient’s health rather than as a way to dismiss the symptoms.
Instead, let’s be transparent with our doctors. I have been seeing this gynecologist for a decade and had never shared with her that I had been raped. I don’t know why.
Let’s query our medical doctors and interview them to determine if they will see all of us. If they are unwilling, let’s look for a new one.
Let’s ask for — and be open-minded to — a productive conversation that could well have this kind of opening statement: “Your symptoms appear to have both physical and psychological components. This mind-body connection is complex and very real. Understanding this connection can be key to managing your condition effectively.”
Great doctors would explain the Mind-Body Connection by saying something like, “Our minds and bodies are intimately connected. Past experiences, stress, emotions, and thought patterns can influence physical symptoms, and physical symptoms can affect our mental state. This doesn’t make your symptoms any less real or important.”
A great doctor would go on to validate an experience with statements like “What you’re experiencing is genuine and significant. Recognizing the psychosomatic, literally meaning the mind/body, nature of your symptoms doesn’t minimize them; it gives us more tools to address them. We’ll approach your treatment holistically, addressing both the physical symptoms and the psychological factors that may be contributing to, exacerbating, or the root of them.”
In this approach, the term psychosomatic is not used as a label to dismiss symptoms, but as a starting point for a more comprehensive, patient-centered approach to healthcare. It acknowledges the complexity of the human body and mind and the importance of us participating with our doctors as a whole person rather than just isolated symptoms.
This essay is part of a series for National Wellness Month. I’d love to hear your thoughts, I’m curious about any monsters you may have (you can private message me if you’re interested in chatting), and claps are nice, too.
The upcoming book I mention is Buried Treasure: A Field Guide to the Life-Changing Magic of Revealing Yourself. It is part memoir, part science-based action to bring play, imagination, wonder, and hope back online in our trauma-addled brains. It will be available for pre-order soon, and you can listen to an interview with me about it on the podcast The Alternative.
