When the Body Speaks - Psychosomatic Symptoms, Metaphors and the Stories We Carry

Aug 18

6 min read

Years ago, I worked with a woman who had been struggling with severe neck problems for almost two years. She had sought medical help, but the problem persisted.

As she began telling me about what had been happening in her life during those same years, she spoke about a particularly difficult relationship. Somewhere in the middle of telling her story, she said:

“He has been such a pain in the neck!”

We both stopped.

And looked at each other.

There it was.

Not a diagnosis. Not proof that this person had caused her neck problem. But suddenly, her own words had given us something interesting to become curious about.

What if the emotional stress she had been living with was one of the factors contributing to what her body had been experiencing?

It was one of those moments in therapy that stayed with me. Because sometimes, the body seems to find a language for things we have not fully processed mentally or emotionally.

And sometimes, remarkably, our own metaphors seem to find the body too.

Our language is already embodied

We say someone is a pain in the neck. Something is hard to stomach. We are sick with worry. We carry the weight of the world on our shoulders. Someone makes our blood boil. We feel choked up. Our heart aches.

These are metaphors, not medical diagnoses. Neck pain is not simply caused by a difficult person, stomach problems are not automatically caused by something we cannot emotionally “digest,” and high blood pressure is not simply anger made physical. Bodies and illness are far more complex than that. But I have learned not to dismiss the language people naturally use when they describe their lives. Sometimes it offers a doorway into an experience that has not yet found another way to be expressed.

The metaphor isn’t the diagnosis. It is a doorway.

What if the tests are normal, but the symptoms are still real?

Many people arrive in therapy after months, sometimes years, of physical discomfort. They have had investigations. The scans may be reassuring. Blood tests may be normal. Nothing alarming or structurally significant has been found.

And yet the symptom remains. The stomach continues to churn. The chest tightens. The shoulders remain tense. The headaches return. Sleep is disturbed. The heart races. The body feels exhausted or constantly on alert.

The absence of a clear structural medical finding does not mean someone is imagining their symptoms. Nor does “psychosomatic” mean “not real.” A more useful way of understanding it is that psychological, emotional and physiological processes can interact because the mind, brain, nervous system and body are part of one living system.

The gut knows something about this

The gut is one of the clearest places where modern medicine has moved away from a simple mind-versus-body explanation.

What were once often called “functional” gastrointestinal problems are now increasingly understood through the gut-brain axis. The Rome Foundation uses the term Disorders of Gut–Brain Interaction (DGBI) to describe conditions involving complex interactions among the gut, nervous system, brain, motility, sensitivity, immune processes and other biological factors.

In practice, this means that stress and emotional states can influence digestion and gut sensitivity, while signals from the gut can also influence mood, arousal and the nervous system.

The conversation goes both ways.

I have worked with people who experience persistent gastric or stomach discomfort even after medical investigations have been reassuring. Their discomfort is real. Sometimes, when we begin looking beyond the stomach itself, we discover a nervous system that has been living in vigilance for a very long time.

The body under stress

I have experienced this connection in my own life too.

There was a period when I was dealing with considerable difficulty in a past workplace. Alongside it came anger, frustration and a strong sense of helplessness and powerlessness. Around that period, I noticed my blood pressure rising. Can I say that the workplace caused my blood pressure to increase? No. Blood pressure is influenced by many factors and should always be medically assessed. But prolonged stress is physiologically real. When we perceive threat, stress hormones are released, heart rate can increase, blood vessels respond, muscles prepare for action and blood pressure can temporarily rise. The body does not simply observe what is happening in our lives. It participates in it.

Sometimes the symptom and the story seem to rhyme

I sometimes notice something similar when people describe dizziness, vertigo or feeling unsteady. Vertigo can have important medical causes and needs appropriate medical assessment. I would never tell someone that feeling emotionally ungrounded is the cause of their vertigo. But if a person tells me, in the same conversation, that life feels overwhelming, that everything is happening at once, that her world feels as though it is spinning and she cannot find her footing, I might become curious.

“When your world feels as though it is spinning physically, is there anywhere in your life where it feels as though everything is spinning emotionally too?”

And then we see what emerges. The point is not to impose meaning onto the body. The point is to listen more widely.

A whole-person way of understanding symptoms

This way of thinking is not new. In 1977, physician and psychiatrist George Engel challenged medicine to move beyond a purely biomedical view of illness. His biopsychosocial model proposed that biological, psychological and social factors all contribute to how health and illness are experienced. Today, this whole-person understanding can be seen in areas such as pain science, psychophysiology, psychosomatic medicine and the study of gut–brain interaction. Clinicians and researchers including gastroenterologist and psychosomatic medicine specialist Dr Douglas Drossman have helped advance biopsychosocial approaches to gastrointestinal symptoms.

So perhaps the most useful question is not always: “Is this physical or psychological?”

Perhaps it is: “What is happening across the whole system?”

Biology. Nervous system. Thoughts. Emotions. Relationships. Environment. History. Sleep. Stress. Safety. Connection. Loss. The body lives through all of it.

When the body has been on guard for too long

Imagine living for months in a state of vigilance. Something feels wrong. Something might happen. You cannot completely relax. You keep going because you have to.

The nervous system does not respond only to obvious physical danger. Conflict, chronic uncertainty, hostile environments, unresolved trauma, relational threat, shame, grief and prolonged helplessness can all create significant physiological stress.

Over time, people may notice muscle tension, altered breathing, sleep disturbance, headaches, gut sensitivity, fatigue, palpitations or other bodily symptoms. This does not mean every symptom is caused by stress. It means stress is one part of the whole clinical picture worth considering. There may be no visible wound, yet the system may still be struggling.

Instead of asking, “What is wrong with my body?”

Sometimes I invite people to become curious in a different way:

• When did this begin?

• What was happening in your life around that time?

• What changed before the symptom appeared or became worse?

• Who were you around?

• What were you unable to say?

• What were you having to tolerate?

• What emotion had nowhere to go?

• Where in your life have you felt helpless, unsafe, overwhelmed or unable to rest?

And perhaps one of the most compassionate questions we can ask is:

“What has my body been responding to?”

Not because every illness hides an emotional story. It does not. But sometimes the timeline tells us something. Sometimes a symptom worsens around a particular relationship, environment or period of stress. Sometimes the body settles when a person feels safer. Sometimes nothing obvious emerges at all, and that is important too. Curiosity is different from certainty.

Your body is not the enemy

One of the shifts I hope people experience through therapy is moving away from fighting their bodies. Sometimes the body is not betraying us. Sometimes it has simply been working very hard for a very long time. The tightness, vigilance, exhaustion, racing heart, stomach discomfort or tension may be part of a system that has learned: I need to stay ready. I cannot completely relax yet. Something is not safe.

Therapy can offer another kind of conversation with the body. Alongside appropriate medical care, we can become curious about the nervous system, relationships, emotions, boundaries, old wounds and present-day stresses. We can learn ways to regulate. We can notice what activates the system and what helps it settle. And we can give language to experiences that may have been carried silently for years. Sometimes, as what has been held inside begins to find words, something in the body begins to soften.

Perhaps the body is asking for our attention

If your medical investigations have been reassuring but your body continues to speak, the question may not simply be: “Why is my body doing this to me?”

Perhaps we can also ask: “What might my body be responding to and what becomes possible when I begin to listen?”

Sometimes therapy begins right there.

A note on medical care

Persistent, new, severe or changing physical symptoms should always be appropriately assessed by a qualified medical professional. Psychotherapy is not a substitute for medical diagnosis or treatment. A whole-person approach means considering psychological and nervous-system factors alongside, not instead of , appropriate medical care.

References & Further Reading

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.

Drossman, D. A., & Hasler, W. L. (2016). Rome IV-Functional GI disorders: Disorders of gut-brain interaction. Gastroenterology, 150(6), 1257–1261.

The Rome Foundation. Disorders of Gut–Brain Interaction (DGBI): clinical and educational resources on the gut–brain relationship.

American Heart Association. Stress and Heart Health: information on physiological stress responses and cardiovascular health.

Harvard Health Publishing. The gut-brain connection: accessible overview of the bidirectional relationship between the brain, emotions and gastrointestinal function.