Understanding Somatization through the Prism of Deficit Pathology and Winnicott's False Self

In this article, the author investigates the wide variation in historical and contemporary understandings of somatization. The article explores the rewards of understanding somatization as a deficit pathology and proposes an integration of deficit pathology theory and Winnicott's theory of self to better understand the causes of somatization. The author postulates a link between the formation of a pathological false self and somatoform symptoms and draws on Killingmo's description of conflict and deficit pathology to integrate the defensive organization (false self) with the concept of deficit. The false self is conceptualized as a defensive organization that is born in a climate of deficit, including early childhood trauma. Therapeutic implications include a focus on experiencing meaning, working with alexithymia, and providing the client an opportunity to confront the painful reality of their unmet needs, in a safe and holding environment not afforded to them in childhood. The author outlines the therapeutic goal of moving toward a renewed sense of ‘equilibrium of self’, where a person can freely and safely demonstrate vulnerability as well as meet their own needs. This in turn works to reduce the need for the protection of a pathological false self and the tightly bound somatoform symptomatology.