Life of the mind

My patient came into the room and threw herself into the seat by the customary box of tissues. “I think there’s something wrong with my legs,” she said. She stretched her legs out in front of her so I had to look at them. “There isn’t,” I wanted to say, but didn’t. “Sometimes they feel tingly and numb. But it might be in my head,” she said.

I have been seeing her for more than a year now as part of my two-year training to become a psychotherapist. In our early sessions she used to stamp her feet up and down, as though desperately trying to run away but unfortunately finding herself tied to the chair. Later she began to cross her legs and twist one foot behind the other. “She is tying herself in knots,” my supervisor said when I presented her to the clinical seminar. (Every session with a patient is written up and discussed).

Most of us are aware that we pick at our fingers, chew our lips or eat too much or too little when we are anxious or unhappy; that we fidget when uncomfortable and need to leave the room when the tension is unbearable, but it is always surprising in therapy just how literally problems are expressed by the body.

When I lie down on the couch myself, as I do for 50 minutes every weekday morning, I find myself suddenly unable to breathe until I start talking. I’ve wondered if it’s the climb up the stairs, too much coffee, anxiety about what I want to say today.

But, really, it is because I am terrified of lying on a bed with an unseen man behind me. Rationally, I know I am safe, but my body is screaming at me to run. “Once you start speaking you are back in the adult world,” my analyst says. This is true. The acts of thinking and talking squash the infantile anxieties expressed by my body. Keep talking and it might be OK.

Early on in her treatment, my patient arrived with a livid gash across her forehead. She’d been taking drugs with friends, and had fallen in the kitchen and needed stitches. It was a violent and explicit demonstration of how chaotic and dangerous she felt, but also how obviously injured she is. “Look!” she was saying. “Can’t you see how bad it is? It’s right in the middle of my face!”

A member of my family has been mentally ill for years and everyone has struggled to cope, not least himself. Recently he was in a car accident and was seriously injured in a clearly visible way. “Finally people are sending me get well cards,” he said, wistfully.

We know how to react to a physical manifestation of injury—it gives a clarity that everyone, including psychotherapists, find useful. It might be obvious that a patient finds it excruciating to sit in the room with me, but actually moving her legs in a running motion allows me to point it out.

Freud famously noted that shell shock was more prevalent in the returning First World War soldiers who had not suffered highly visible wounds. It seems important that our bodies communicate what we cannot. If we are agonisingly injured emotionally, we might express this by doing ourselves violence (unconsciously on purpose) as a way of communicating that, of making sense of it.

I first saw a therapist after my father was killed when I was 19. I told her I just wanted to go to some sanatorium and lie still in a white hospital room.

“Be careful,” she said, understanding that I might effect it. I didn’t do it. I bit my fingers and drank wine instead.