Carol-Ann Farkas, Reading the Psychosomatic in Medical and Popular Culture. Routledge, London and New York, 2018. 160 pp. Contents, Index. No price available. ISBN: 978-1-138-69997-7
Psychosomatic illness - a disorder that develops at the intersection of mind and body - is the central theme of this thought-provoking and immensely engaging book. The contributing authors investigate whether the psychosomatic refers to physical or mental illness, narrative or discursive construction, biopsychosocial disorder or a cultural phenomenon. They all acknowledge that the body's condition affects the mind and vice versa, which produces medically unexplainable symptoms often disregarded or not taken seriously by doctors, but all of the authors approach this sensitive topic from different angles. Reading the Psychosomatic in Medical and Popular Culture attempts to bridge core knowledge gaps which frustrate successful communication between experts and laypeople. Nonetheless, the chapters do not aim to provide a clinical explanation of what the psychosomatic is, rather, what it does. Psychosomatic illness, as it is proven in this anthology, is not only capable of generating suffering, turmoil and disorder, but it also creates meaning amidst the chaos.
The biomedical model suggests that illnesses work and signify very differently in the body and the mind. Our assumption tends to be dualistic: we have been taught to think that we are made up of two parts which function cooperatively and complementarily, but which are also capable of working against one another. Accordingly, we take charge of the more submissive part as a way of rehabilitating the other. We adhere to this dualistic model in a quite obsessive way, even subconsciously, simply because we cannot surrender to the idea of not having a concrete, convincing explanation for our perceived pain. The desire for certainty renders ambiguity intolerable - and the psychosomatic embodies exactly that. Psychosomatic illnesses are therefore heavily stigmatized; patients are labelled 'difficult' and their symptoms are referred to as 'hysteria', 'hypochondria', 'functional illness', etc. The associated syndromes generate controversy and antipathy in the provider-patient relationship. Correspondingly, the essays in this volume have a clear joint message to challenge such tensions: the uncontrollable nature of psychosomatic disability should not be doubted but embraced as is.
In Chapter 1, Caryn Rubanovich examines the conflict in the provider-patient relationship, which derives from the difference in the interpretation of the psychosomatic. The author offers a model of applied medical humanities where the practices of creating, telling, reading and analysing stories may lead to the construction of more compassionate narratives of healing by patients and providers alike. Chapter 2 concentrates on direct clinical practice by studying cases of fibromyalgia. The group of authors - including Maria Giulia Marini, Daniele De Nardo, Paola Chesi and Luigi Reale - observe that improved communication, achieved by a structured sharing of narratives, might help sufferers and medical professionals as well. In their study, they asked patients and doctors to keep journals and articulate their experience of being ill and undergoing treatment. This type of reflective writing had a therapeutic effect. The findings underlined that both parties agreed there was definitely something wrong. The validity of psychosomatic illnesses, therefore, cannot be denied. As opposed to this, in Chapter 3 Louise Stone and Claire Hooker investigate what happens when doctors insist that there is nothing wrong. The authors rightly point out that the discursive construction of diagnostic categories depends on who controls the concepts of "health" and "illness". In a view of that, the psychosomatic is triggered not only by the body and/or the mind but by society as well. The ideologies of late capitalism imposed on individuals indicate "good health" as the marker of the neoliberal subject's ability to succeed, whereas "ill-health" (including stress, anxiety, depression) is a marker of failure. The psychosomatic, which yearns for a medical explanation yet very rarely finds medical understanding or treatment, must be displaced to the responsibility of the sufferer.
Jessica Parr in Chapter 4 provides the reader with a recognised problem in 20th-century American culture: emotional eating and the medico-moral judgement of fatness. Obesity is considered a psychosomatic symbol for unresolved problems of identity and emotion. According to the research conducted by Parr, psychoanalytic assumptions about overeating are far more acceptable in American culture than the explanations related to physiology or metabolism. Chapter 5 deals with cultural matters, too. Amba J. Sepie scrutinises how biomedicine facilitates the diffusion of knowledge and power in societies. She argues that biomedical practices have had a colonising effect on the discourses of "health", which signifies what is knowable. The psychosomatic defies knowability, therefore it is not privileged in cultures. Chapter 6 conducts a deep rhetorical and narratological analysis. Seamus L. Barker and G. Lorimer Moseley study the notion of pain, and they emphasise that dualistic biomedical readings are doomed to failure. Narratives of the psychosomatic might be about sufferers but not by them because the power of knowledge belongs to doctors who explain diseases through narratives of coherence. The story of the psychosomatic as individuals live it is sidelined. Maria Tutorskaya in Chapter 7 carries the thought of analysing medical professionals further. Using autobiographical memoir and fiction as primary sources, she offers an interpretation of so-called "medicalstudentitis". She explains the distress medical students experience as a side-effect of cognitive overload, which results in explicit signs of psychosomatic illness. Olaug S. Lian, Catherine Robson and Hilde Bondevik in Chapter 8 focus on another group of individuals affected by the psychosomatic as metaphor in narratives of conflicted identity. The stigmatization of females and femininity as non-adherent to what patriarchy prescribes and codifies for society forms the central argument of their essay. The authors explore the medico-moral assumptions about hysteria and neurasthenia, and they argue that what is read as "hysterical" (for example, fatigue, inability to control one's emotions, lack of engagement with one's social obligations) is only a way of individuals' rejection of performing their gender in a valid manner. Chapter 9 returns to the importance of bibliotherapy. Camelia Raghinaru claims that where the concepts of wellness lock out mysterious symptoms and unresolved conflicts of identity (within and between body, mind and social roles), the psychosomatic offers a narrative way out. Nonconformist identities labelled to have "hysterical" symptoms find an outlet in the inexplicable nature of the psychosomatic as well as the narratives thereof. The problem of uncertainty plays the central role in Chapter 10, too. Hannah Tweed explores postmodern extremes where the narrative itself becomes psychosomatic. All markers of wellness and wholeness become the subject of destabilising parody. In the texts under review, not everything is ill or broken, of course, but nothing seems to be whole or repaired either. According to Tweed, it is the manifestation of our identities, relationships and social lives shifting towards gradual decline into disorder and uncertainty.
Reading the Psychosomatic in Medical and Popular Culture is an invaluable resource for anyone engaged with medical humanities. It is a comprehensive collection of diverse ideas on a condition that has been largely overlooked and discriminated despite the fact that medically unexplained symptoms account for a significant proportion of patient visits. The book is well-structured, it has Contents and Index pages as well.
Teodora Domotor, Karoli Gaspar University, Budapest