The idea that there is a link between emotional state and physical health is not new, this view having been held, albeit by a minority of physicians, since the time of Hippocrates. However, as any GP is well aware, there are some people who are particularly prone to develop physical symptoms in response to stress or the hardships of life. These people are often frequent attenders at GP practices, the 'complex' or 'heart-sink' patients with diverse problems or long-term chronic illnesses, seeking a cure for symptoms that do not seem to respond to conventional medical interventions.
GPs, aware of the family and life circumstances of their patients, may suspect that it is these emotional difficulties that are being expressed through their symptoms. However, this is a group of patients who are notoriously difficult to work with psychologically, and who often do not respond to conventional counselling and therapeutic approaches.
In this chapter, working from a basis of psychoanalytic theory and drawing on clinical experience gained in a range of settings, I explore the diverse ways in which writing can be used to supplement therapeutic work with this client group and why they may find it particularly useful.
This link between the mind and body has been long recognised in psychoanalytical theory. Freud never used the term 'psychosomatic', but he did believe that feelings of depression could bring about organic disease in predisposed individuals, whereas happiness could have a rejuvenating effect (Freud 1905).
Later theorists focused on the gradual development of emotions and thought processes as they start to separate out from physical sensations in the weeks and months after birth. Winnicott (1960) suggests that this begins in very early infancy, and depends on reliable and responsive physical care of the infant by the parents or carers. It is this that allows the very young baby to start to make sense of the world,