Symptoms, Symptoms, Everywhere                                       

(Originally published in Voices: The Art and Science of Psychotherapy, 2000.)

Death is a symptom of life, and vice versa.  Each of us, along with every tree, rock and bird we encounter, is a symptom of Life.  In general I would say that a symptom is something we can see which indicates the presence of something else, probably larger, we cannot see.

In the current mainstream medical model a symptom is thought to be a manifestation of some larger disease entity or process.  If one assumes a finite number of diseases and a finite number of possible symptoms, then one can play the diagnosis game.  Simply be the first one to assess all the symptoms and deduce from them the correct diagnosis.  Once the diagnosis is established, the rest is easy; just apply the proper treatment and cure will follow.  If it doesn’t, you have probably botched the diagnosis and/or the treatment.  Try again; if you and a few colleagues don’t achieve a cure after several attempts, the patient can be declared incurable.  Remember to ignore those New Age philosophers who would complain that your model is too reductionistic.  

(The diagnosis-->treatment model has traditionally been reserved for explicitly medical interventions, usually involving drugs and/or surgery.  However, mainstream psychology has recently become very interested in developing “protocols,” which define THE correct treatment for a given diagnosis.  These protocols mimic the pseudoscience which has formed the basis for much medical treatment, and have the same inhibitory effect on the creative intuition and curing-through-connection that has traditionally been the foundation of all meaningful clinical endeavors.)

To complain that someone’s model is “too reductionistic” may imply that the complainer has a less reductionistic model to offer, or perhaps a more reductionistic one that is presumed to be more accurate.  This may be why I have always liked the title of the book All Sickness is Homesickness, by Dianne Connelly.  I tend to believe that she wrote it at too tender an age, when her brilliance as an acupuncture practitioner and poet were not yet balanced with the wisdom that  comes with being an elder.  Nevertheless, the title alone has been a source of inspiration for me many times, seeming as it does to reflect a profound wisdom.   Home may or may not be where the heart is, but it certainly can be thought of as the place where the soul resides.  If I were to rewrite the title to Dianne Connelly’s book, I might call it All Sickness is a Result of Alienation from Some Part of the Soul.  

Some years ago I found a recently-shed snake skin in the grass outside my office.  It was precisely as long as I am tall, and I took it to be a very good omen as well as a reminder of the nature of our work.  I didn’t quite have the nerve to hang it on the wall in my office as a constant reminder to people that they come here to shed their old skins, but have trotted it out once or twice when the moment seemed to call for it.  I don’t know what would happen to a snake that refused to shed its old skin, but I certainly would expect there to be a symptom of some kind.

If all sickness is indeed a result of alienation from some part of the soul, then all therapy must involve some form of reconciliation, reclaiming, or reconnecting with the soul.  I have taken to referring to psychotherapy as the “midwifery of intimacy,” with the image of intimacy occurring along several lines or meridians that lead out from the consciously experiencing self to a number of different entities (click here to view Figure 1).  I use the term “midwifery” to indicate that the psychotherapist does not seek to initiate or force anything, but rather attempts to serve a naturally occurring process by gently helping the client to remove cognitive, emotional and spiritual obstacles to the natural flow of intimacy.  It is not the therapist’s job to initiate conception or to use overly-forceful measures in the delivery--no scheduled C-sections and no pitocin.  

It may sometimes be some other professional’s job to intervene forcefully, even against the will of the person in question, but I would not consider such an intervention to be psychotherapy.  Jay Haley used to refer to this category of professionals as “agents of social control.”  Members of this group could be a police officer, a psychiatrist and/or psychologist who signs an order for involuntary hospitalization, or anyone else who forcibly and without invitation restrains or directs the behavior of another person.  Someone’s acting in such a way may save the life of the person who is the object of this action, or of some other person for that matter, but it is not a role which I believe to be compatible with the role of the psychotherapist.  On a few occasions I have felt myself compelled to act in such a way toward someone whom I had been seeing in therapy, and I have never felt that it was possible to return fully to the therapeutic relationship afterwards.  I think at times I have been able to be something of a counselor, but not a psychotherapist.  I believe that the rupture in trust, and hence the possibility for deepening of intimacy, is essentially irreversible.  I am quite certain, at a minimum, that it is beyond my capacity to reverse it.  The client’s relationship with the therapist is one of the primary areas in which the therapist is meant to midwife intimacy, so a rupture in this domain seems almost inevitably to be fatal for the therapy.

On the other hand, something which is fatal for a therapy may readily be preferred over something which is physically fatal to a person.  Someone who is still alive can start a new therapy and begin the process of midwifing intimacy with a different therapist, perhaps even using the old therapist as a consultant to the new therapeutic diad initially.

Of course the methods for midwifing intimacy along the various meridians in Figure 1 are not always referred to as psychotherapy, but I see psychotherapy as the grandmother of them all.  If I understand the message of A Course in Miracles and its companion booklet, Psychotherapy: Purpose, Process, and Practice,  Jesus seems to share this perception.  

It also appears to me that intimacy along each of these meridians is synergistic with the others.  That is, the successful midwifing of intimacy along any one meridian will result in an enhancement, or at least the greater possibility of an enhancement, of the intimacy along each of the others.

The refusal to mourn, which Shelly Kopp (1969) has described  eloquently, seems to be a very common blockage of the connection to one’s soul.  It often is associated with the refusal to forgive, a posture which in turn represents a blockage in the flow of intimacy--usually intimacy with God or with another person.  Hence the psychotherapist’s job often involves the facilitation of grieving and forgiveness, in order to midwife the flow of intimacy along these meridians.

In my very rudimentary understanding of acupuncture, symptoms arise as a result in a blockage of some sort of vital energy flowing along certain meridians in the body.  The needles are meant to free up is this flow of energy.  Interestingly, the point on the body that is needled is often one which is quite distant from both the location where the practitioner believes that the actual blockage has occurred as well as the site where the symptom is manifested.  This distance apparently gives the practitioner more leverage in some way.  The subtlety of the diagnosis and treatment process reminds me very much of psychotherapy, especially in the way that the best intervention may not involve a direct assault on the actual presenting symptom.  

In a sense then, psychotherapy is to the soul what acupuncture is to the body.  Of course many acupuncture practitioners would say that they too are treating the soul.  Perhaps the only difference between all the different types of healing is the way one chooses to access the soul.  Psychotherapy does it through the mind; acupuncture, massage therapy, allopathic medicine, homeopathic medicine and their many cousins enter through the portal of the body.  Those who claim to do spiritual healing by means of prayer, shamanic journeying and the like, may be the only ones who attempt to address the soul directly, without intermediaries. 

A person’s first adventure in either psychotherapy or acupuncture is usually initiated by a presenting symptom, such as chronic pain, depression, addiction or cancer, from which relief is sought.  At this stage the symptom is often viewed by its owner as a rather encapsulated event, perhaps an illness/disorder, which is to be subdued or removed by the treatment.  The words we most long to hear from a surgeon are: “We got it all.”  However, anyone who has ever been through a 12-step program knows that being “in recovery” continues long after the cessation of the addictive behavior in question, and touches almost every aspect of one’s life.  Similarly, surgeons like Bernie Siegel  encourage their patients to use cancer as a “wake-up call,” even when all physical traces of malignancy have been successfully excised.  In the model herein proposed, it is the soul that sends the call to awaken.  A soul ignored may well have more fury than a woman scorned.    

The issue of a soul’s being ignored is sometimes presented in a very clear form in the course of family therapy.  Often the therapy is initiated by a call from a parent whose child is manifesting symptoms of depression, is unexpectedly pregnant, or is calling home from the police station.  The parents are often desperate at this point, willing to try almost anything, and the most delicate and artistic family therapy can occur during these early contacts with the family.  The challenge is to reframe the family crisis in such a way that it becomes a opportunity for all members of the family to do some healthy connecting--with their own souls and with each other--rather than a source of unmitigated shame and pain.    Failure to meet this challenge may result, in a worst case scenario, in the family’s decision to treat the identified patient as a cancer which needs to be forcefully subdued or even removed.  I have found such failures to be enormously painful at times.    

I sometimes entertain the idea that the family itself also has a soul.  In fact I sometimes think that anytime two or more people join together for a common purpose a new soul is born which represents that group.  The members of the group may not be conscious of its soul’s purpose, and consulting work with families, churches and even corporations may involve an attempt to bring this purpose into the conscious awareness of the members.  This is an area of cutting-edge research which I find very exciting.

Some of the most interesting research I have ever seen in the past has to do with how a person reacts to the first psychotic episode he or she experiences, usually as a young adult.  Over 20 years ago I summarized some of this research (Rhead, 1978), and I am still much influenced by it.  A number of researchers made a comparison of two ways to approach these “first-break” persons.  One approach emphasized pharmacologic suppression of the symptoms until they abated, so that the chemical suppression was no longer necessary, or at least was needed in smaller doses.  This approach was dubbed “sealing over.”  The other approach, called “integration,” involved providing a safe physical and interpersonal environment in which the symptoms could find full expression without suppression and an attempt could be made to understand their significance for the individual experiencing them. The latter approach was associated with a better adjustment after the psychotic episode and a lower risk of future recurrence of psychotic episodes.  If one takes the psychotic symptoms as an warning that a major alienation from some part of the soul exists, then paying attention to where soul connections need to be made seems beneficial.  Medicating the symptoms may be the equivalent of chemically stifling the cries of a baby.  The parents may get more sleep, but there is a risk that the baby will grow up malnourished and have difficulty in recognizing its needs and in getting them met.

Although it is clear to me what I am talking about, it may not be so for you, the reader.  I will therefore offer the following case, to see if I can put some flesh on these theoretical bones.  A 45 year-old attorney comes to me complaining of “stress,”  and a need for “better communication” with his wife.  He has not been in therapy before and hopes that I can teach him some relaxation techniques and tell him some ways to approach his wife effectively for sex and conversation, preferably in a few visits. He is not sleeping well, rarely has sex with his wife, even less frequently has a conversation with her about anything that feels meaningful, has minimal pleasurable contact with his children in spite of the fact that they are bright and share interests in various things with him, longs for more than an obligatory relationship with his mother but cannot summon the courage to confront her about her own self-destructive use of alcohol, is on the verge of having an affair, is occasionally slightly frightened by his own drinking, repeatedly sabotages his professional and financial success, has lost touch with old friends with whom he remembers warm contact, and has nobody in whom he can confide most of this.  I explain to him that I the kind of work I do and which I think would be genuinely helpful to him would take longer and range further than he has anticipated.  Fortunately the image he had of me before coming in was positive enough for him to give me the benefit of the doubt and we start working individually.  His wife joins us for a few sessions, but is definitely not interested in the expanded agenda and departs the therapy.  Within the next 2 or 3 years she departs the marriage also, and his therapy evolves to include a group along with the individual work.  Ultimately he leaves individual and stays several years with the group, expressing with increasing frequency his gratitude for how the group has changed his life.

So all symptoms are potentially fire alarms.  In this case the alarm may have to do with the absence of fire rather than its presence, as in Sam Keen’s term “fire in the belly.”  Psychotherapy seeks to provide the fire with access to a gentle and steady supply of oxygen, with the assumption that the soul already has enough inherent fuel to burn away the impurities that block its full expression.



Rhead, John C.  “The Implications of Psychedelic Drug Research for Integration and 

Sealing Over as Recovery Styles from Acute Psychosis,” Journal of Psychedelic Drugs, Vol. 10, No. 1, 1978, pages 57-64.

Kopp, Sheldon B.  “The Refusal to Mourn,” Voices, Vol. 5, No. 1, 1969, pages 30-35.