Psychosomatic Medicine 15:425-432 (1953)
© 1953 American Psychosomatic Society

Some Patterns of Somatic Displacement

¹ Institute for Psychosomatic and Psychiatric Research and Training of the Michael Reese Hospital, Chicago, Illinois

An attempt has been made to set down some general observations and formulations concerning somatic displacements in man which are influenced by psychological events. Emphasis has been laid on the usual psychological and physiological characteristics of the various areas and functional systems of the body in influencing somatic displacements. These factors must be considered in addition to the individual events of patients' lives.

The relative predominance of psychological or physiological factors in determining the course of displacements has been considered. Psychological (symbolic) factors appear to be predominant in producing the displacements along any of the dimensions of the body, length, breadth, and thickness, as for instance, in displacements from below upward. Psychological elements are also predominant in determining shifts from the interior of the body toward the surface and vice-versa. However, tendencies toward such displacements probably are reinforced by underlying physiological inclinations toward reciprocal relationships between the regions affected, as for example, between the inside and the surface of the body. Other displacements, though initiated by psychological events, appear in their outcome to be the result of physiological processes, and are themselves without psychological significance. An instance of this is the vasodepressor syncope described by Engel and Romano.

Three types of displacement have been discussed in more detail and illustrated by examples from clinical experience.

Shifts from the body to the head and the reverse, are influenced by the psychological significance of the head in relation to the body. It was noted that in a person with symptoms elsewhere in the body, the development of a symptom located in the head generally indicates that feelings and ideas are coming closer to consciousness and volitional activity.

In individuals who have both internal and surface symptoms in their repertoire of somatic reactions, shifts of symptoms from the interior of the body toward the body surface occur as conflicts over more mature, relatively realistic problems, such as heterosexual matters, become prominent. Symptoms related to the interior of the body are more likely to be connected with pregenital problems and relationships to internalized objects.

Secretory activities in skin and other nonvoluntary organs often function in reciprocal relation to muscle activity. Shifts from muscle to skin or other secretory activity occur most frequently when muscle is or is about to be activated, and then undergoes inhibition. This is observable when rage reactions are inhibited and weeping takes their place as a means of discharge of tension.

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