to Body Image and Body Ego
Jean Goodwin and Reina Attias
Whenever patients in psychotherapy tell us about the self or the history of the self, they are also telling us about the body and its history. When the personal history involves childhood trauma, it is a history about pain in the body, about distorted images of the body and about a body-self whose functioning has been disrupted by trauma.
Some patients with a history of childhood trauma come into treatment with a litany of bodily symptoms and disturbances of bodily sensations. These patients tell us about headaches, stomachaches and other unexplained pain ( Chapperon 1996); anesthesias; sexual and self-harm impulses; and sleep and eating disturbances ( Goodwin and Attias 1993). However, in other clinical situations, such as those discussed in this chapter, it is not apparent at the beginning of treatment that there is a sense of damage in the bodily sphere that must be addressed. Patients like those discussed here generally present with a desire to improve ego functioning. They sense a lack of personal cohesion. It is sometimes difficult for them to organize their emotions, their narratives or the world around them. They feel ineffective in the world and in relationships, which never seem to reach the level of intimacy they desire.
As these patients tell us in more detail about the way they think about themselves, they demonstrate a fundamental difficulty in identifying the self with the body. Their image of the body may be highly inaccurate, lead-