‘Grief that has no vent in tears, makes other organs weep.’¹ Seeking refuge from trauma in the medical setting

Abstract

This paper will look at work carried out with asylum-seeking families and children within a hospital paediatric setting, exploring theories that can help us to understand how highly traumatic experiences, emotionally and cognitively unprocessed, may become expressed bodily. The case examples will show how these shattered and dislocated patients experience a range of physical symptoms from symbolic conversion manifestations to foreclosure of unthinkable and terrorising experiences displaced into the body. In the latter cases, there are particularly powerful and intergenerational effects upon the family as a whole, as the family becomes organised around physical symptomatology that covers ‘holes’ created by the trauma in their sense of ‘going on being’ as both individuals and as a family. These families can become over invested or hypercathect the physical fragility of children born into this matrix of trauma. The aim of this paper will be to draw upon psychoanalytic ideas in relation to psychosomatic symptoms, including Freud, Winnicott and Joyce McDougall amongst others and to try and integrate these ideas to some extent with both neurobiological understanding of the bodily aspects of feeling and emotion, as well as important anthropological understanding of identity in a cultural context.

Keywords:

• Psychosomatic symptoms
• post-traumatic stress disorder
• holes
• going-on-being
• trauma
• refugee
• asylum seeker
• anthropology

Notes

1. This quote comes from Joyce McDougall (1989) but has been variously attributed much earlier to the nineteenth-century anatomist and physician, Henry Maudsley as ‘The sorrow that has no vent in tears may make other organs weep’ (Maudsley, 1867). Maudsley was particularly interested in the link between body and mind and considered an authority in his day.

2. Whilst negation clearly plays a role in many psychosomatic manifestations which may therefore have a symbolic content, in this paper I am arguing that there may also be experiences in the body that fail to be represented in the first instance in any way; neither taken in nor ‘spat out’. These bodily experiences nevertheless may subsequently be subject to secondary revision as the mind seeks to represent a gap or ‘hole’ in mental experience; our understanding of disorganised attachment supports the idea of the importance of an organising narrative around experience and the impact of trauma upon this.

3. One can think of how a pre-pubescent child (and even older) can deny an act when all the evidence is against them and visible to all to see; whilst this implies yet primitive ‘theory of mind’ development, it is notable how a child in this position can end up believing their own denial to the extent of becoming genuinely filled with a sense of injustice at being ‘wrongly’ ascribed responsibility.