[The mystical physician to the King of Thrace] said the soul was treated with certain charms, my dear Charmides, and that these charms were beautiful words.

Somatisation involves the transformation or conversion of psychological distress into more tolerable physical symptoms. This might involve a loss of motor function in a particular group of muscles, resulting, for example, in the weakness or paralysis of a limb or a side of the body. This loss of motor function might be accompanied by a corresponding sensory loss. In some cases, sensory loss might be the presenting problem, particularly if it is independent of a motor loss or if it involves one of the special senses such as sight or smell. In other cases, the psychic material is converted into an unusual pattern of motor activity such as a tic or even a seizure (sometimes called a ‘pseudoseizure’ to differentiate it from seizures that have a physical or organic basis, for example, epilepsy or a brain tumour). Pseudoseizures can be very difficult to distinguish from organic seizures. One method is to take a blood sample 10-20 minutes after the event and to measure the serum level of the hormone prolactin, which tends to be raised by an organic seizure but unaffected by a pseudoseizure. More invasive but more reliable is video telemetry, which involves continuous monitoring over a period of several days with both a video camera and an electroencephalograph to record the electrical activity along the skull.

Given that all these different types of somatised symptoms are psychological in origin, are they any less ‘real’? It is quite common for the person with somatised symptoms to deny the impact of any traumatic event and even to display a striking lack of concern for his disability (a phenomenon referred to in the psychiatric jargon as la belle indifference), thereby reinforcing any impression that the somatised symptoms are not quite kosher. Ego defences are by definition subconscious, such that the somatising person is not conscious or, at least, not entirely conscious, of the psychological origins of his physical symptoms. To him, the symptoms are entirely real, and they are also entirely real in the sense that they do in fact exist, that is, the limb cannot move, the eye cannot see, and so on. In fact, some authorities advocate replacing older terms such as ‘pseudoseizures’ or ‘hysterical seizures’ with more neutral terms such as ‘psychogenic non-epileptic seizures’ that do not imply that the somatised symptoms are in some sense false or fraudulent. The reader may recall from the discussion on depression that many people from traditional societies with what may be construed as depression present not with psychological complaints but with physical complaints such as headache or chest pain; like many ego defences, this tendency to somatise or physicalize psychic pain is deeply ingrained in our human nature, and should not be mistaken or misunderstood for a factitious disorder or malingering.

A factitious disorder is defined by physical and psychological symptoms that are manufactured or exaggerated for the purpose of benefitting from the rights associated with what the American psychologist Talcott Parsons called ‘the sick role’ (1951), in particular, to attract attention and sympathy, to be exempted from normal social roles, and, at the same time, to be absolved from any blame for the sickness. A factitious disorder with mostly physical symptoms is sometimes called Münchausen Syndrome, after the 18^th century Prussian cavalry officer Baron Münchausen who was one the greatest liars in recorded history. One of his many ‘hair-raising’ claims was to have pulled himself up from a swamp by the hair on his head, or, in an alternative version, by the straps of his boots. Whereas a factitious disorder is defined by symptoms that are manufactured or exaggerated for the purpose of benefitting from the privileges of the sick role, malingering is defined by symptoms that are manufactured or exaggerated for a purpose other than benefitting from the privileges of the sick role. This purpose is usually much more concrete than the secondary gain deriving from the sick role, for instance, evading the police, claiming some form of compensation, or obtaining a bed for the night. It should be absolutely clear that such patterns of behaviour are very different from somatisation – even though, it has to be said, I have often observed cases of overlap.

In recent decades, it has become increasingly clear that psychological stressors can lead to physical symptoms not only by the psychological defence of somatisation but also by physical processes involving the nervous, endocrine, and immune systems. Since Robert Ader’s initial experiments on lab rats in the 1970s, the field of psychoneuroimmunology has taken off spectacularly. The large and ever increasing body of evidence that it has uncovered has led to the mainstream recognition not only of the adverse effects of psychological stress on health, recovery, and ageing, but also of the beneficial effects of positive emotions such as happiness, motivation, and a sense of purpose. Here again, modern science has only just caught up with the wisdom of the Ancients, who were well aware of the link between psychological wellbeing and good health.

In one of Plato’s early dialogues, the Charmides, Socrates tells the young Charmides, who has been suffering from headaches, about a charm for headaches that he had recently learned from one of the mystical physicians to the king of Thrace. According to this physician, however, it is best to cure the soul before curing the body, since health and happiness ultimately depend on the state of the soul. ‘He said the soul was treated with certain charms, my dear Charmides, and that these charms were beautiful words.’ As the virtue of temperance (sophrosyne) is the marker of the health of the soul, Socrates asks Charmides whether he thinks that he is sufficiently temperate. The Charmides takes place in 432 BC, the year of Socrate’s return to Athens from service at the battle of Potidaea, and its subject, as it turns out, is no less than the nature of sophrosyne, a philosophical term loosely translated as ‘temperance’ but with the etymological meaning ‘healthy mindedness’. As is typical with Plato, the dialogue ends in a state of aporia (a state of inconclusive non-knowledge), with Socrates accusing himself of being a worthless inquirer and a ‘babbler’. Charmides concludes that he can hardly be expected to know whether he is sufficiently temperate if not even Socrates is able to define temperance for him.

Whereas Plato associates health with the virtues and in particular with temperance (‘healthy mindedness’), Aristotle associates health with the Supreme Good for man. This Supreme Good, he says, is eudaimonia, a philosophical term that is often translated as ‘happiness’ but is perhaps best translated as ‘human flourishing’. In short, Aristotle argues that to understand the essence of a thing, it is necessary to understand its distinctive function. For example, one cannot understand what it is to be a gardener unless one can understand that the distinctive function of a gardener is ‘to tend to a garden with a certain degree of skill’. Whereas human beings need nourishment like plants and have sentience like animals, their distinctive function, says Aristotle, is their unique capacity to reason. Thus, the Supreme Good, or Happiness, for human beings is to lead a life that enables them to exercise and to develop their reason, and that is in accordance with rational principles. Part of living life according to rational principles is to seek out the right sorts of pleasure, underplaying those brutish pleasures such as food and sex that are only pleasurable incidentally in that they act as restoratives, and privileging those higher pleasures such as contemplation and friendship that are pleasurable by nature and therefore cannot admit of either pain or excess. To pursue the higher pleasures is ‘to stimulate the action of the healthy nature’ (NE, Book VII), and to be healthy is not only to be free from pain and disease, but also and most importantly to flourish according to our essential nature as human beings. So, although Plato associates health with ‘healthy mindedness’ and Aristotle with the Supreme Good, once the Supreme Good is unpacked it becomes very clear that this is merely a difference of emphasis, and that Plato and Aristotle are not in any fundamental disagreement on this issue.

Adapted from Hide and Seek: The Psychology of Self-Deception.