Eyes and ears are poor witnesses if we have souls that do not understand their language.


Semiotics is the study of signs - and that means the study of life. For we are surrounded by a world of signs. Everything we experience in our everyday world addresses us or 'speaks to us' in a certain way - it has a particular meaning or significance for us. In signifying particular meanings, all the events we experience have a sign character. Our very sensory perception of the world is a type of language, whose vocabulary consists of familiar and nameable things. What we perceive as everyday objects can be compared to 'words' in this perceptual vocabulary. Simply to see a tree as a tree, for example, requires that 'treeness' be a part of our visual vocabulary. The sign function of a phenomenon has to do with its place in a larger pattern of significance. We recognise a 'table' as a 'table' because we understand it as something we can sit round, eat on, use to place other objects on etc. But the sensory meaning of a phenomenon is something quite distinct from its place within such a larger pattern of significance.

Our perceptual vocabulary is one way in which we all make sense of the world. People also need to make sense of their personal experience of themselves and of the world of signs in which they dwell. If they have difficulty in doing so they may themselves signify this difficulty in different ways - for example through their speech and behavioural signs, or through body signals or symptoms. If they lose their ability to make sense of themselves and of the world around them they may seek help from a friend or counsellor, therapist or physician in 'sorting things out' or 'sorting themselves out'. Their desire is to 'make sense' of their experience of themselves and of the world. For most people, including many counsellors and therapists, however, 'making sense' of experience means finding new ways to signify this sense. A counsellor for example, may perceive the signs of emotion behind a person's words, and helps a client to signify their emotions more precisely or more fully - either in words or through body self-expression. But signifying something we feel or sense is not the same as what I call 'sentience' - the capacity to directly feel or sense significance. Sentience is not signified sense but sensed significance - what Eugene Gendlin has called "felt sense".

Gendlin points out that without felt sense it would be impossible for us to feel at a loss for words, to feel what we mean without yet having the words to express it. Nor would we be able to assess the 'fittingness' of our words and concepts, to sense whether or not they are truly in resonance with our own or other people's felt meanings or intents. But there is a deeper significance to the notion of felt sense or directly sensed significance. Generally, if someone talks about an experienced event or emotion, then they are seeking to 'make sense' of it by signifying it through words. But what is it that is actually signified by their words? Is it merely, as conventional semiotics would have it, some mental image or recollection of the emotions or events experienced. Or is it rather that through language we do not merely signify or 'refer' to specific events or emotions but seek to express the sensed meaning or significance that they hold for us.

What distinguishes the semiotics of felt sense from conventional semiotics is the understanding that the very experiences we represent in language are just as much signifiers of specific sensed meanings or significances as the words with which we refer to them.

The Semiotics of Felt Sense challenges certain basic superstitions regarding the nature of signs deriving from Peircean semiotics:

   1. The superstition that signs are signifiers of some pre-given 'thing'. The sense of a sign is its         reference to this thing - whether a fact or feeling, thing or thought, event or emotion.
   2. The superstition that signs refer primarily to each other - that the sense of a sign is         reducible to its relation to other signs, its place within a larger sign system or pattern of         significance.
   3. The superstition that the sense of a sign is something purely mental such as the thought or        image or memory that it evokes in our minds.
   4. The superstition that meaning or sense is a property of signs and signs system, not an         intrinsic dimension of sensory experience of the world and not intrinsic to experienced         events and phenomena.

What these semiotic superstitions have in common is that they themselves define a particular way of making sense of the world - that particular 'semiostructure' which defines our consensual reality. The world of consensual reality is a world of signified sense structured by conventionalised signifiers with standardised 'senses'. It is a 'semiostructure' which leaves no room for sentience - for that '6th sense' or 'felt sense' that constitutes sensed significance.

The semiotics of felt sense is based on the revolutionary understanding that a sign, any sign, is not essentially a signifier of some 'thing' - whether an event, emotion or experienced reality of any sort. Instead the latter are themselves signs. As such, however, they are bearers of a directly felt or sensed meaning that transcends their conventional signification. Conventional significations have to do with the way 'one thing points to another', as for example, a road sign may point to a supermarket. Indeed the root meaning of the word 'sense' is a 'way' or 'direction'. But just as a road sign does not essentially point to a thing - the supermarket - but points us to its direction, so is the essential meaning or 'sense' of any sign a direction of awareness. Sensing the significance of a sign does not mean interpreting what it signifies, looking for some 'thing' that it points to. It means letting our own awareness be directed by it in a specific way. The meaning of a person's body language - a look in their eyes for example - lies not in something they are looking at but in the way of looking at and seeing that thing. The look in their eyes reveals the character of their gaze, which is not an object, internal or external, but a direction of awareness toned and coloured by a particular mood or mode of awareness.

In the semiotics of felt sense, meaning or significance is not seen as a property of signs at all - whether road signs, words, body signals, dream symbols or physical symptoms. For whilst felt sense can be carried over or communicated through signs and through the word (dia-logos), it is not something that can be defined in words or reduced to some 'thing' that a sign points to.

The sensed significance of a sign always transcends its conventional or signified sense. Though the signified sense of a red traffic light signal is 'stop', the felt significance of having to stop, here and now, at this traffic light, on this particular journey, undertaken for this particular end, in the particular context of their lives, will be quite different for every person who stops at the signal. More seriously, a patient's symptoms may be taken by a physician as a sign in the conventional sense - taken as signifying or pointing to some 'thing' such as a possible organic 'disease'. Alternatively, however, both the sign and the supposed 'thing' to which it points may be taken as something that directs the physician's awareness in such way as to give them a direct sense of the patient's felt dis-ease. Similarly, a dream symbol may be taken by a psychoanalyst as sign of some other 'thing' - a repressed drive or desire for example. But in interpreting it in this way, the psychoanalyst, like the physician, is merely locating a sign within a conventionalised structure of signification - treating one thing as a sign that merely points to another. When the analyst interprets dream symbols, or when the analysand 'free associates' around them, what they come up with are but further symbols - further signifiers in a chain of signification. Medical diagnosis and psychoanalytic interpretation consist in 'explaining' one sign as the signifier of another. The bodily symptoms is taken as a sign of an organic disorder. The dream symbol is taken as a sign of an unconscious wish or desire. The question of what the disorder or desire may itself be a symbol of is reduced to a question of its physical 'causes' or psychological 'repression'.

The sensed meaning of a poem, painting or piece of music can in no way be reduced to the words with which we represent it or to some 'things' it depicts. Similarly, the sensed significance of a dream symbol or body symptom, indeed of any phenomena we may be aware of, is, by contrast, not reducible to some other sign or set of signs, whether these take the form of verbal signifiers of some 'thing' that these words are taken to signify. Felt sense is not some 'thing' we are aware or unconscious of, but rather consists of sensed modes and directions of awareness as such. A good example is music. The meaning we are aware of in the richly textured tone-colours of a symphony lies in the patterned harmonic textures, tones and colourations of awareness that the music itself expresses. The music can 'evoke' feelings through its tones and textures only because it is the resonant expression of patterned harmonic tones and textures of feeling. Its meaning does not lie in the thoughts or images it evokes, for these too, merely give actual or manifest form to the different potential patterns of significance sensed as feeling tones.

Both the sensed significance of words and the inner meaning of musical tones lies in their wordless inner resonances. Indeed the same can be said regarding the sensed significance of all sensory phenomena. The infant does not hear a sound as that of a 'car passing by' or 'a clock ticking', for cars and clocks are 'things' we can signify in words only by virtue of their place within the conventionalised structure of signification that constitutes the adult world. For the infant, the sounds it hears are not the sounds of some pre-given 'things' such as cars or clocks. Rather what these things themselves 'are' and 'mean' for the infant is the particular way the infant senses them sounding and resounding within their field awareness.

True sentience is not empathy but inner resonance. The importance of this in psychotherapy cannot be underestimated. To mentally register through some outward sign, a word or body signal for example, that a person is in a certain type of pain or distress, or that they are experiencing a specific emotion such as sadness or guilt, is one thing. But to attune to the felt, bodily sense of the specific 'mood' or 'tonality' of this person's pain or distress, this person's sadness or guilt, is quite another. Registering and 'reading' signs is the basis of emotional 'empathy'. Attunement to felt sense is the basis of what I call organismic resonance. The semiotics of felt sense is of no mere theoretical significance. It points to a fundamental paradigm shift in the practice of both psychotherapy and somatic medicine. For paradoxically, the very attempt on the part of psychotherapists, psychoanalysts or physicians to 'make sense' of a client's experience and find out what their problems 'really' are turns into an attempt to reduce their felt sense of its significance to one 'central' or 'basic' signifier among others - identified according the semiotic framework of their own professional training, theoretical models and practices.

From a semiotic point of view, felt sense is an attunement to potential patterns of significance. The latter are in turn the source of all manifest or actual patterns - including linguistic patterns, mental patterns of thought, emotional patterns, existential or 'life patterns' and patterns of experienced events of all sorts. Gendlin points out that people tend to refer back to their unformulated felt sense of particular dimensions of their experience only when they are at a loss for words or do not know how to respond to a situation. The real reason why attending to felt sense helps us find appropriate words or responses that express what we mean is that through felt sense we attune to a field of awareness consisting of those potential patterns of speech and action which are the source of all actual patterns that we might embody and express.

Not just our own words or deeds but all experienced events are themselves actualised or manifest patterns of significance emerging from a field of potential or unmanifest patterns. That is why they possess an intrinsic sense that we can feel directly. Both language and experienced events give outer, phenomenal form to these patterns, and in doing so function as phenomenal signifiers of these patterns. The importance of talking specifically of signifiers of felt sense is that they include more than just words. A dream symbol or bodily symptom, life situation or event is also a signifier, giving manifest form to particular potential patterns of significance - but leaving other potential patterns unmanifest. That is because any phenomenal signifiers - any actualised pattern of speech or action, thought or emotion, emotions or experienced events, can give form to only one potential field-pattern of significance. In doing so it leaves other patterns unmanifest - unperceived, unspoken, unthought. Were it not for felt sense, these unmanifest patterns would remain also unsensed and unfelt, for felt sense is also our awareness of the 'excess' of potential meaning or significance that no phenomenal signifier can every express.

Our felt sense of the excess and unmanifest significance of experienced phenomena - objects or events, people or situations, words - is treated as something merely 'subjective', or as some dubious 'sixth sense' belonging to the realm or the extraordinary and paranormal. And in a certain sense this is right, for felt sense is our 'sixth sense' - but one that is the hidden basis of all others. For our five senses are what give manifest, experiential form to that source field of potential patterns of significance which felt sense links us to. However, signifiers of any type, whether verbal or experiential, not only give expression to felt sense but also enframe it in a particular way, giving form to certain potential field-patterns of significance and leaving others unformed and unformulated. The result, unfortunately, is an entire culture and civilization in which meaning as such is identified not with intrinsically meaningful dimensions of the world, but only with formal signifiers that 'refer' to things in the world i.e. words or visual signs, mental images or mathematical signs, scientific diagrams or observational 'data', religious symbols and scriptures etc. Because of this meaning is seen primarily as a function of language and sign-systems. Experience is placed in a secondary role as that which is 'signified' by these sign-systems. The relation between language, experienced reality and felt sense can be visualized in the form of an inverted triangle.

Diagram 1

Conventional semiotics understands language as a sign system whose main role is to refer to, represent or 'signify' experienced events. Meaning or sense is identified with manifest or signified sense - verbal signifiers and the experienced reality they represent or refer to. But as the poet knows well, language can only truly do justice to our experience of the world if it is in resonance with felt sense - if it helps to give form to unformulated or unmanifest patterns of significance that are always latent in experienced reality itself. Felt sense is our link with the unsignified meaning of experienced events - with those potential patterns of signification that are the source of all actual patterns of experience and language. If we see the purpose of language as one of giving some sort of literal account of experienced reality, we ignore its true role - which is to confirm and agree on the 'reality' of whatever actual pattern of significance it was by which we first made sense of experienced events and emotions. But language can serve another function too, that of giving expression to our felt sense of different potential patterns of significance - those patterns that we chose not to actualize in our experience, and therefore have difficulty describing in words. If this function of language is ignored, felt sense is sacrificed to signified sense. Language is reduced to the status of a set of conventional patterns of signification designed to affirm a consensual reality - a set of agreed pattern of significance within our experience. Those whose experience or modes of expression falls outside these ordered patterns of signification and whose experience falls outside these ordered patterns of significance, may then be regarded as suffering from some sort of disorder, as 'deviant' or as 'mad' i.e. in need of psychiatric help or psychotherapy.

The Semiotics of Felt Sense in Psychotherapy

The semiotics of felt sense marks a fundamental paradigm shift in the focus of psychotherapy:

   •   From 'feelings' and their 'meanings', to felt meanings as such.
   •   From a focus on meanings that are mentally enframed in words to those that are felt in a         wordless, bodily way.
   •   From a focus on reported facts or feelings to a focus on the felt meaning or sense of those         facts or feelings.
   •   From a focus on signifying feelings in words to a focus on feeling the significance of words         and other signifiers such as body signal.
   •   From a focus on conventionally signified senses to a focus on personally sensed significances         or 'felt sense'.
   •   From a focus on some 'thing' that a client's signs and signals might signify or points to, to a         focus on the way they give form to felt sense.
   •   From a focus on conventionally signified sense, to a focus on as yet unformulated and         unsignified senses that are as-yet only felt.
   •   From a focus on actual patterns of significance in a client's experience, to a focus on         potential experiential patterns.
   •   From a focus on actual patterns of linguistic signification shared in the therapeutic dialogue         to a focus on potential linguistic patterns.
   •   From the therapist's own felt sense of a client's signs to a felt resonance with the client's         own felt sense of their significance.
   •   From felt, bodily sense to the felt, bodily self and a felt, bodily resonance with others.

Up till now, however, psychotherapy has been dominated by what could be called semiotic reductionism. The therapist takes literally a client's linguistic account of experienced events and emotions. Though it may be understood (as in cognitive behavioural therapy) that a client's emotional responses to an experienced event may be shaped by their own 'cognitive' interpretation of it, what is not generally understood is that the event described by the client was 'real' for them only because it fitted into the particular pattern of significance by which they made sense of it - through which they could experience it as part of a meaningfully ordered reality. If a client is unable to make sense of their experience, the therapist sees their functions as helping them to do so - and in this way to re-establish a sense of order. One way of doing this is by seeking a different pattern of significance in the client's experience, and gaining agreement with the client on the nature of this pattern. What this new pattern of experiential significance looks like depends on the linguistic patterns of signification used to describe it.

The self-defined role of psychotherapists and counsellors is to help the client to find significance in their lived experience and to give form to unformulated dimensions of this experience. The task is to register and read the signs that indicate a client's feeling and to help them signify those feelings. But helping a client to signify or 'express' their feelings or reading the signs they give of such feelings is not the same thing as feeling the significance of a client's signifiers - sensing the inner resonances of their words and body language and directly sensing the inner significance of the events and emotions connected with them. For the latter are not 'signifieds' but signifiers - patterns of signification which reinforce those patterns of significance that shape a client's experience.

In the professional practice of psychotherapy, felt sense or meaning is all too easily enframed and eclipsed by language - by the therapist's own signifiers and patterns of signification. As soon as a therapist or client gains a felt sense of something important, the temptation is to transform it into some form of signifier, for example by putting it into words. The original felt sense that was the source of the signifiers is then eclipsed by its translation, identified with and enframed by it. The result is that neither therapist or client is then able to check out their own 'translation' by referring back to the original - the felt bodily sense that was its source.

Unfortunately the entire framework of psychotherapy and counselling training encourages this premature foreclosure and enframement of felt sense, guided as it is by the belief that listening to a client is merely a prelude to providing some form of verbal response to the client, one that helps them make sense of their experience in terms of conventional signifiers. Truly deep listening on the other hand, is not about 'making sense' of what one hears, but using one's hearing to directly sense in significance. Only by patiently staying with one's own '6th sense' - the unformulated, sensed significance of another person's words and body language - can one find signifiers (words or images) that are fully in resonance with this 6th sense - our felt, bodily sense of meaning or significance. A signifier in resonance with felt sense will not enframe and eclipse the felt sense it translates, reducing it to some stereotyped or conventional signification. Instead it will amplify felt sense, and help one to stay in touch with it. The capacity to stay in touch with felt sense is the condition for transforming it into a felt resonance with the client's own felt sense of the inner meaning or significance of the events and emotions they experience. That is because felt sense is itself an attunement to underlying field-patterns of significance that transcend conventional significations.

Deep therapy requires deep listening. Deep listening is resonant listening, and is so in a double sense. For it is the transformation of felt sense not only into fully resonant signifiers, but also into a direct 'field-resonance' with another person. Both these forms of resonance amplify felt sense and amplify one another. Many of the theoretical models on which psychotherapy and counselling are currently based are a substitute for a deeper understanding of listening itself as an attunement to felt sense and a medium of felt resonance. Similarly, many therapeutic and counselling relationships are a substitute for deep, resonant listening in social relationships in general and in the client's own relationships in particular. The semiotics of felt sense is therefore of fundamental importance for the training of psychotherapists of all sorts. In addition, it provides the missing link between psychotherapy, on the one hand and somatic medicine on the other. That is because felt sense or meaning is indeed something only experienced in a bodily way - but precisely for that reason it is easily confused with bodily sensations and symptoms, emotions or 'energies'.

Gendlin speaks of the process of 'focussing' by which anyone (in this case either therapist or client) both open a space of awareness within their bodies, and focus on their bodily felt sense of their current state of being, and then allow mental signifiers - words or images - to arise which give form to and provide a 'handle' on this felt sense. He describes the next stage of the process as one "resonating" back and forth between a given word or image and the felt sense that is its source. If the word or image is a genuinely fitting one, in full resonance with felt sense, we will feel this too in a bodily way - experiencing a felt shift in our inner bodily awareness and sense of self. But resonating back and forth between mental signifiers and felt sense in order to check out the fittingness of the former is impossible if, as so often happens, words and images arise in a person's mind without them being aware of the felt bodily sense that is their source. It is also impossible if, as I believe so often happens in the therapeutic process, mental signifiers immediately enframe and eclipse felt sense that is their source, leaving no inner space and no time for alternative, and possibly more fitting or resonant patterns of signification to emerge.

According to the biologist Rupert Sheldrake, the biological form (morphe) of any organism is stabilised and maintained by resonance with its own underlying organising pattern or 'morphic field'. I use Sheldrake's term morphic resonance to also describe the process by which linguistic forms - patterns of signification - are stabilised by resonance with the particular field-patterns of significance they give form to. The power of language to entrap, enframe and eclipse felt sense, as well as its power to express felt sense, are both expressions of morphic resonance - the relation between a particular pattern of significance or meaning and the particular linguistic pattern or pattern of signification which gives it form.

Language does not only express meanings but also enframes and eclipses other potential meanings. The eclipse of felt sense arises because, through language, certain potential meanings or patterns of significance are stabilised through resonance with their own formed linguistic expression. The selected patterns of significance not only find linguistic expression at the expense of other potential patterns, but also blocked the latter from expression in different linguistic patterns of signification. Only through felt sense do we stay in touch with unsignified senses - with those alternate, potential patterns of signification and the alternative potential patterns of significance they can express. A truly 'fitting' or 'resonant' signifier is not merely one that expresses or resonates with felt sense. It is one whose inner resonance gives expression to felt sense without enframing it completely, one that is able to signify particular senses without eclipsing as yet unsignified ones. A resonating linguistic formulation is one that formulates certain patterns of significance in our experiences whilst at the same time putting us more deeply in touch with our own unformulated experience and the deeper pattern of sense or significance we feel within it.

The Relational Dimension of Felt Sense

When Gendlin writes himself of the role of felt sense and the 'focussing' process in psychotherapy, he sees the role of the therapist as that of helping the client to focus themselves i.e. to go through the stages of opening an inner space of bodily self-awareness, focussing on felt sense, letting it take shape in words and images and then 'resonating' back and forth between these mental signifiers and felt bodily sense until a 'felt shift' occurs - a change in what I would term the client's felt self. What Gendlin does not fully address or explore is the relational dimension of 'focusing', not simply as a gateway to felt sense and the felt significance but as a medium of deepened contact or felt resonance between two people - for example a therapist and their client.

The following diagrams seeks to fill this gap by representing the relational dynamics operating within a bipersonal or dyadic field in terms of the semiotics of felt sense. It does so by distinguishing two distinct levels of interrelatedness between people - that of felt bodily sense (SEN) and that of mental signifiers (SIG). By 'signifiers' I refer not only to individual words or images but to verbal interventions or interpretations of any sort, and indeed whole patterns of signification - whole frameworks of verbal interaction and communication, serving as these do, to enframe felt sense.

The dyadic field can of course be seen specifically as the relational field of interaction between a therapist of any sort (psychotherapist or counsellor, physician or psychoanalyst) and their client (whether patient, counsellee or analysand).

Diagram 1

A signifier can either be in resonance with felt sense, lack resonance with it or be in dissonance with it. Morphic resonance is the vertical or diagonal relation between felt sense (one's own or others) and its signifiers (one's own or others). As Gendlin points out, only by staying with felt sense even after we have given it form through a sensation, emotion or thought can we compare our own signifiers with our original felt sense and check out if the former are fully in resonance with the latter. If they are, this resonance will amplify felt sense and bring about what Gendlin calls the "felt shift" in our bodily awareness of self and other. Here I restrict the term 'morphic resonance' to indicate this state of resonance between felt sense and its formed expression - including different forms of somatic expression.

In Diagram 1 the diagonals represent what in psychoanalysis is referred to as 'transference' and 'counter transference' - 'transference' being the way a therapist's signifiers (words, touch, body language) evoke or give form to felt sense or meaning in the client; and 'counter-transference' being the way the client's signifiers give form to the therapist's felt sense and felt self. In these diagonals too, the basic relation is one of ''morphic resonance' i.e. resonance - or lack of resonance - or dissonance - between felt sense and its phenomenal signifiers (whether the latter be psychic or somatic, verbal or non-verbal, sensory or emotional).

Diagram 2 is a representation of the basic relational pattern which, I believe, much psychotherapy training encourages - a pattern deficient in a fundamental way. In this field-matrix, the arrows indicate a therapist accessing felt sense counter-transferentially through 'empathy' with a client's signifiers. The problem is that the therapist no sooner gains an empathic sense of something significant to the client than this felt sense is expressed, indeed experienced, through particular signifiers of it - through formed thoughts or emotions, perceptions or sensations, interpretations or 'insights'. These are then relayed to the client, verbally or non-verbally, in the hope that they will help the client to understand themselves better. In the process however, not only is the therapist's felt sense framed by its own experiential or expressive signifiers, the latter also serve to frame or 'reframe' the client's felt sense (downward arrow).

Diagram 2

This pattern is automatically reinforced wherever therapists are (a) not trained to experience and stay with felt sense as such, and (b) not explicitly taught that felt meaning or sense, like the felt self, is something that by its very nature tends to withdraw in the very process of giving form to itself. In gestalt terms, felt sense and the felt self, as the inner ground from which all 'figures' emerge, disappears in its very manifestation, replaced by a relation between foreground figures and background field. In Diagram 2 I have included a broken line going from SEN (client) to SEN (therapist). This acknowledges that a good therapist may pick up something that is not 'figure' or 'background' but comes directly from the client's own felt sense and felt self, and their own felt relation to the events and emotions they describe. Notice however, that the therapeutic process then appears as a clockwise cycle, enriched by transference and counter-transference.

Diagram 3

In this respect, my model of the therapeutic process can be represented as the exact reverse of the conventional model:

Diagram 4

Here the therapist refers their own signifiers back to felt sense and their felt self, checking to see if they are fully resonant with it. Once a certain level of resonance is achieved felt sense is amplified and altered - what Gendlin calls the 'felt shift'. But rather than immediately relaying their own signifiers (no matter how resonant they are with the client own feelings) the therapist continues to "focus" - to attend to and stay with felt sense. Only in this way can felt sense transform into a felt resonance with the client's own felt sense and own felt self. If this field-resonance is established, it will also be experienced as a felt shift and throw up new signifiers. It is only through this counter-clockwise cycle that a fully resonant Dyadic Field can be created, represented in Diagram 5 below:

Diagram 5

Felt sense is a gateway to resonance with the felt self - one's own felt self and that of others. It is also the gateway to a field-resonance with others, and to as-yet unmanifest patterns of significance linking self and other.

Diagram 6 represents the fundamental Semiotic Matrix that constitutes the Dyadic Field. The upper field of the Semiotic Matrix is a domain of already signified sense or 'Signification'. This consists of actual field-patterns of significance of the sort manifest in phenomenal signifiers and represented in languages and sign system. The lower field is a domain of sensed significance or 'Felt Sense' made up of as-yet unmanifest or potential field-patterns of significance.

Diagram 6

The failure to distinguish the two domains of Signification and Felt Sense, signified sense and sensed significance, is reflected in a failure to fully acknowledge a whole range of parallel distinctions of profound scientific as well as spiritual significance - a failure not only to signify these distinctions in language but even to experience them in everyday life. Medicine fails to acknowledge the distinction between a patient's felt dis-ease and diagnostically-labelled diseases or disorders - with the result that patients are themselves encouraged to confuse or identify the one with the other. And neither semiotics nor linguistics have any place for felt sense or the unformulated dimensions of experience it links us to, concentrating only on sign systems, formal signifiers or the formulated dimensions of experience and phenomenal signifiers they refer to.

Felt Sense and the Felt Self

In the semiotics of felt sense, diseases of the body and mind are seen as the expression of a felt dis-ease of the inner human being. When we are ill we do not 'feel ourselves'. That is not because we are the victims of foreign bodies such as micro-organisms, toxins or antigens - what immunology and oncology describe as 'non-self' molecules or cells. Fundamental dis-ease, our 'not feeling ourselves', arises because we are on the way to 'feeling another self' - but have not yet found the way to embody and express that new sense of self.

What I call self-states are field-states of awareness with which we are completely identified. These are experienced as tonalities and textures of awareness, which, like moods, so completely permeate our felt sense of self and so colour our awareness of the world that we are hardly aware of them - unless they change. New field-states of awareness however, may be initially experienced as threatening- in dissonance with an established sense of self, or in dissonance with mental and emotional patterns that express that existing sense of self.

What we call the 'self' has a field character, consisting of a unique range of self-states - uniquely toned intensities and colourations of awareness, bearing within them unique field-patterns of awareness that shape our personal reality. Illness, dis-ease and dissonance are a natural part of the health process by which we learn to resonate with new aspects of our own larger identity or self-field. Illness is the bodily expression of dissonant organismic field-states of awareness in which our beliefs and world picture distort our experience of new self-states and deny expression to them. They form part of a mental immune system whose function is not to protect our bodies from infection or colonisation by foreign bodies - so-called 'non-self' cells - but to protect our self-experience from infection by aspects of ourselves that we still experience as foreign or 'non-self'.

Our self-experience not only shapes and colours our experience of other people and the world, but is also reshaped and recoloured by it, allowing us to experience new aspects of ourselves, to identify with new self-states or selves. In this way we grow as individuals, learning to give expression to new potentials latent within our own self-field, doing so through resonance with the self-fields of others and with their actual patterns of self-expression. Health, from this point of view is not a continuous state of undifferentiated well-being, balance or harmony but a continuous process of change or metamorphosis, based on a balance of balance and imbalance, a harmony of resonance and dissonance through which we give expression to new psychic potentials of our inner being - our as yet unexpressed psychic genes.

Through respiration, circulation and metabolism, our bodies have no natural difficulty in absorbing foreign matter and reconstituting themselves from it. Our own inability to process the raw material of our experience, using it not only to reconstitute, but to recreate and reshape our selves from it - hinders and interferes with the organismic field-patterns that shape and sustain our bodies' own respiratory, circulatory and metabolic patterns. Soma-semiotics understands physiological disorders as a precise symbolic expression of disorders of psychic respiration, circulation, metabolism and immune functioning. These in turn are the expression of a felt dis-ease which is the expression of dissonant field-states of awareness - a lack of resonance with new and hitherto foreign field-state of awareness that form part of our larger identity or 'self-field'. This lack of resonance with aspects of ourselves may be experienced initially as dissonances in our relationships with other people or our environment, as 'stress' induced by dissonances we experience in other people and our environment, or as 'cognitive dissonance' - beliefs that are in conflict with each other or with our own internally sensed environment.

Felt dis-ease is first and foremost a muddied or dissonant organismic field-state of awareness. Resonance stabilizes and sustains the physiological expression of particular organismic field-patterns. Dissonance, on the other hand can distort those patterns, degrade or weaken their physiological expression, or deny expression to a previously unmanifest pattern. But resonance and dissonance are also complementary. Without dissonance, dominant field-patterns cannot distort or degrade in a way that allows new field-patterns to manifest. At the same time dissonance can also distort or deny expression to those new field-patterns.

Organismic field states are stabilized through resonance between organismic field-patterns and their manifestation as mental and emotional patterns, sensory and motor patterns, physiological and neurological patterns. Lack of resonance can result in felt dis-ease i.e. a muddied, hollow or discordant field-state of bodily self-awareness - an 'unsound' state lacking a clear resonant tonality. That is why we speak of people 'sounding well' or being in 'sound' condition. Dis-ease can also arise from resonances or discordances between individual field-states, field-patterns and field-tonalities of awareness and those manifest in a person's familial and social fields. When someone speaks of feeling socially 'stifled' or of having no 'room to breathe' this is not usually meant in a literal, bodily sense, but nor is it a 'mere' bodily metaphor. It is a description of a felt organismic state. Conversely, however if someone breathes more freely as a result of feeling their 'spirits' lift, then it is their actual bodily breathing that is the metaphor - a living, biological 'metaphor' of their inner being. A person can jog or exercise, or practice Yogic breathing exercises for hours, days or years without it significantly affecting their fundamental respiration - without it bringing new sources of spiritual meaning and inspiration into their lives. But a person can be neither spiritually inspired nor dispirited without it being instantaneously embodied in their physical breathing. The organism is the instrument with which we constantly translate states of being into mental and physical states, and transform basic capacities of our being into organic functions.

According to Martin Heidegger "We cannot say that the organ has capacities, but must say that the capacity has organs….capability, articulating itself into capacities creating organs characterizes the organism as such."

Respiration, for example, is not merely an organic bodily function but the embodiment of a fundamental capacity of our being. That is the capacity to engage in a rhythmic exchange with the 'atmosphere' of our life-world - 'breathing in' our own awareness of it, drawing meaning and inspiration from it, and in turn allowing our awareness to flow back out into it - whether as a simple exhalation of breath or as meaningfully shaped and toned exhalation, as speech. At what point does the air we inhale become a part of us? At what point does our exhaled air cease, not only to be a part of our bodies but a part of us? Whether we draw into our awareness a 'breathtaking' landscape or an 'idea', we feel moved to inhale and then exhale deeply. Why? Because breathing is the embodiment of our fundamental organismic capacity to fully take into ourselves our awareness of something other than self, and in turn allow that awareness to flow out again into the atmosphere or field of awareness linking us with the world. The words 'respiration, inspiration, aspiration etc. come from the Latin spirare - to breathe - just as the Greek word psyche originally meant the 'breath' that vitalised an otherwise lifeless corpse (soma). To speak in a modern way of the 'psychosomatic' dimension of breathing disorders such as asthma, to either claim or dispute their 'psychogenic' causation therefore misses the point. It ignores the question of what breathing as such fundamentally is - not as an organic function of our body but as an organismic capacity of our being. Changes in the pattern and flow of our bodily breathing embody differently patterned flows of awareness.

Specific organic dysfunctions such as respiratory, circulatory, digestive dysfunction are the manifestation of the relation between inner organismic capacities and their embodiment in organic functions - for example the relation between an individual's inner or psychical respiration or metabolism and their physical respiration or metabolism. Outer metabolism is the functioning of the body in digesting and metabolising foodstuffs. Inner metabolism is the individual's capacity to digest and metabolise their own experience of themselves and the world. Every experience of the self is an experience of something or someone other than self - whether another person, a piece of music, or a percept of any form. Conversely, every experience of something or someone other than self affects our self-experience. It is not the same self we experience washing up, being with a close friend or partner, engaging with another person professionally or participating in a social or mass event.

Interaction with the world and other people is a way of expanding our identity of felt sense or self-experience by incorporating elements previously perceived as 'other than self'. What I call the mental immune system (MIS) governs the relation between our experience of others and otherness and our self-experience, maintaining a more or less rigid or flexible, closed or permeable boundary between that which we experience as 'self' and that which we experience as 'not-self'. Paradoxically however, over-active inner or mental immune defences can stretch and ultimately weaken the body's own immune functioning. By shutting down, not 'letting things get to us' we create a situation in which it is our bodies that do the 'letting in' - becoming biologically vulnerable to antigens or 'non-self' elements such as viruses. The illness we contract however, may in turn have a meaning, allowing us to relax our inner immune system and mental defences, giving us time to catch up with ourselves and to process or digest particular experiences. Just as the body incorporates foreign elements whilst maintaining its patterned integrity so does the self. But whilst the body stops growing the self never does - needing not only to maintain a sense of identity but to expand that identity. It does so by accepting new field-states of awareness as self-states, new ways of experiencing the self and the world coloured by a specific feeling tone that was hitherto felt as unfamiliar or foreign.

From Psycho-somatics to Soma-semiotics

Psychic and somatic dimensions of dis-ease are by nature distinct but inseparable, the human organism itself being a psychic body of awareness whose field-patterns are the foundation of physiological functioning. Dis-ease is a field-state of organismic or bodily self-awareness expressed in somatic and emotional states. However it is of fundamental importance to recognize that the latter are themselves meaningful signifiers of a felt sense of dis-ease which is not intrinsically pathological, but the harbinger of a new sense of self - part of the health process. Somatic and emotional states are themselves somatic and emotional interpretations of a felt organismic dis-ease. Like interpretative medical diagnoses themselves, however, they play an important role in giving that dis-ease a pathological character.

Conventional medicine, not only orthodox medicine but also many forms of alternative medicine, sees symptoms as literal signs of an underlying somatic or psychological pathology rather than as metaphorical signifiers of a felt sense of dis-ease. The physician's first act is to separate the patient as a human being from their symptoms, to objectify the latter and to reduce them to signs of some 'thing' lying behind them. The therapeutic relationship takes the form of a "We and It" relationship. Diagnosis is based both on the patient's verbal reports and on the results of examinations or tests. Both the patient's words or verbal signifiers and symptoms or somatic signifiers they describe are treated as signs pointing to an underlying disorder or disease which constitutes their 'cause'. This is rather like looking for the physical 'causes' of a person's words or body language rather than understanding their meaning. The human body is the fleshly three-dimensional text whose inner dimensions of meaning cannot be discovered through any internal physical examination or testing. Both the patient's words and the symptoms they describe are symbols or signifiers of a felt sense of dis-ease with many layers of meaning.

It was Freud who first introduced the concept of "organ speech" (Organsprache) as a direct expression of the unconscious. Indeed, when he was 82 years old he formulated what he called the second fundamental principle of psychoanalysis - one whose implications have been largely ignored. According to this principle, what is truly psychical manifests itself primarily in what were previously considered merely as parallel 'concomitant' somatic phenomena. Organismic Medicine understands the 'body' or 'soma' as the outwardly perceived physical form of the human organism. The psyche or soul is its psychic interiority. What we call the 'mind' is a mental body of beliefs that constitutes the outer skin of the organism, reflecting both its internally sensed physical environment and its outer image of itself within that environment. In contrast to this understanding of the unity of the human organism, 'holistic' talk of the unity of 'body', 'mind' and 'spirit' effectively treats the organism as a mere assemblage of separate parts. As for the relation of 'psyche' and 'soma', it makes no sense to speak of the psychogenic or psychosomatic 'causation' of organic illness. For the relation of psyche and soma is not fundamentally causal but semiotic. Semiotics being the science of signs, soma-semiotics explores the relation between the patient's felt organismic sense of dis-ease, and its dual expression in both symptoms or somatic signifiers and in verbal or other mental signifiers.

Diagram 1

The disturbed organismic capacity arises from the patient's experience of a particular event or emotion as 'hard to stomach' - psychically 'indigestible'. Many writers have alluded to the metaphorical significance of symptoms and their verbal signifiers. Thus we can interpret the metaphorical significance of heart disease as an expression of 'loss of heart' or 'heartlessness' or asthmatic symptoms as an expression of 'feeling stifled' or having 'no room to breathe'. The more fundamental question however, is why an event or emotion should be experienced as psychically 'indigestible', 'stifling' or an attack on one's 'heart'. Organismic Medicine understands the patient's felt sense of dis-ease as the avoidance of an alteration in their felt sense of self. The psychical incapacity is the flip side of a latent psychical capacity which would, if exercised, lead to this changed organismic sense of self - giving birth to an altered field-state of bodily self-awareness.

Diagram 2 shows the felt self as the hidden centre of the triangle linking an organismic incapacity and a felt sense of dis-ease to its metaphorical expression in both language and organic functions. The broken arrows represent the path of the healing process - an alteration in the patient's felt sense of self which leads to a change both in their symptoms or organ speech and their way of speaking about themselves.

Diagram 2

Many people who have successfully recovered from a serious disease do not simply 'feel themselves' again, but feel imbued with a new spirit, permeated by a new sense of self. This altered sense of self is no mere by-product of the healing process but its very essence. The soma-semiotic aetiology of ill-health, on the other hand, is represented in Diagram 3 below.

Diagram 3

Diagram 3 shows the fundamental aetiological process by which a patient identifies their felt organismic sense of dis-ease with felt bodily sensations and interprets the latter as a sign of a medical disease pathology. As a result, however their felt sense of dis-ease begins to be distorted both by the beliefs through which they mentally interpret their bodily sensations and impulses and the fears accompanying these beliefs. The result is a triadic vicious circle which is pathogenic in nature, creating what may be properly called a miasm - a complex pathological field-state and field-pattern of awareness which replaces a clearly tuned and toned sense of self. The real heart of the patient's condition, therefore, is not any actual or imagined pathology but a miasm. This makes the diagnosis difficult, for the patient's presentation indirectly expresses their felt dis-ease but is a direct expression of the miasm already created through their own distorted mental and medical interpretation of it.

The fundamental distinction between miasms and actual disease pathologies was acknowledged by Hahnemann, the founder of homoeopathic medicine. Hahnemann however, sought a typology of miasms based on the major diseases of his time such as syphilis and tuberculosis. Later homoeopaths retained this typology, arguing that because the miasm was something deeper and more fundamental than any specific disease pathology, the nomenclature of miasms was not of central importance. A more fundamental understanding of the miasm however, allows us to see that changes in medical nomenclature and in the major diseases which medical practice confronts are of fundamental significance - playing a major role in the aetiology and iatrogenesis of the miasms. Put simply, if it is the 'war' against heart disease that preoccupies medical science and fear of heart disease that preoccupies patients, then their heart miasms are actively encouraged - not because heart disease 'happens' to have become a major disease pathology but because it has become a dominant signifier distorting patient's beliefs and bodily experience of dis-ease.

Diagram 4 shows the way in which the patient's presentation of their miasm to a therapist (physician, psychotherapist or alternative practitioner) takes the form both of words or verbal symbols of their dis-ease, and the actual somatic symbols or symptoms these point to. Both patient and therapist however, may understand the patient's words and emotions only in a literalistic way - as a statement or feeling about their symptoms - rather than understanding both the words and the symptoms as metaphors of a felt dis-ease (broken arrows). A patient, for example, may talk about their heart symptoms without the physician taking the word 'heart' or the symptoms themselves as metaphorical signifiers with many potential dimensions of meaning. Patient and therapist thus collude in (a) reducing the significance of the patients language to its literal signification in describing somatic symptoms and (b) seeing the symptoms themselves as signs of an underlying pathology rather than as metaphorical signifiers of a felt dis-ease, and (c) ignoring the role of medical beliefs shared in common by patient and physician in shaping the miasm i.e. giving a typical disease pattern to this dis-ease.

Diagram 4

Both physician and patient dwell not only in their physical bodies but in their own private or shared mental body - their body of beliefs. A mental belief is fundamentally an expression of the 'subjective' or felt meaning of a person's bodily experience and emotions, but one which, paradoxically, is represented as a fact - an objective truth about their bodies or emotions. Even the most organismically sensitive physician, psychotherapist or alternative practitioner may not fully recognize this. Instead, following the medical model, they fall prey to the pressure of couching their own direct feeling cognition of the patient's organism - their miasm and the dis-ease it expresses - as a factual 'diagnostic' statement about the patient's bodily condition and its causes, physical or emotional.

The Semiotics of Felt Sense in Medical Practice

We can measure heart rate and blood pressure and its effects. We cannot measure heartbreak, loss of heart or heartlessness and its effects.

Case Example 1

An elderly woman whose husband Harry has recently died from a heart attack finds herself suffering chest pains at night and goes to see her GP. The physician is only interested in her symptoms as signs of a possible organic disorder which might be 'causing' them. He sends her to a consultant to test for possible heart conditions. Proving inconclusive, the consultant ends up diagnosing mild angina, and prescribes beta-blockers. These in turn prove to have little effect on the patient's symptoms. On visiting her GP a second time however, the latter recalls her recent bereavement and, as a result, begins to read the somatic 'text' of her symptoms in a different way, understanding them in the life context of her loss and the pain it be may be causing her. Rather than seeking a purely medical diagnosis of the patient's symptoms he himself listens to his patient in a genuinely patient and heartfelt way. Suddenly an insight flashes through his mind that constitutes a more fundamental diagnosis. He 'sees' that she may be suffering from a doubly broken heart "the one that killed Harry, and the one you're left alive with, that hurts when you're most alone in the middle of the night…the broken heart that gave up and the one that has to carry on painfully." The heartfelt hearing of the patient and the heart-to-heart talk that ensue are the first time anyone has ever acknowledged the pain of her grief. It gives her the strength of heart to acknowledge and bear it in a new way. The patient's heart symptoms disappear as metaphorical signifiers of her broken heart, not through an intellectual understanding of this significance but through a direct response from the inner heart of the physician - an exercise of his organismic capacity for heartfelt hearing.

This case vignette, presented by Dr David Zigmond in an article on different modes of patient-physician communication, goes to the heart of the contrast between medical diagnosis and fundamental diagnosis. The term 'diagnosis' means 'through knowing' (dia-gnosis). Gnosis derives from the Greek gignostikein - to 'know' in the sense of being familiar or intimate with. Gnosis is not knowledge of or about something, but the sort of knowing we refer to when we speak of knowing someone well or intimately. The relation that distinguishes this type of knowing is one in which, as Heidegger put it "we ourselves are related and in which the relation vibrates through our basic comportment." Medical knowledge, like other forms of scientific knowledge, including psychology, is knowledge of or about. It represents the outer relationships between things or between people as if this were quite independent of our inner relation to them - our inner bearing towards them.

The change in the GP's relationship to the patient in the second consultation was crucial. Rather than simply bringing to bear his medical-biological knowledge of the heart he had the patience to bear with his patient - to acknowledge her heartbreak and bear it with her in a heartfelt way. As a result she no longer felt herself so painfully alone in bearing it, and was able as a result, to find a new bearing towards the loss that occasioned it. The paradox is, that despite the inconclusiveness of the medical tests, without adopting this bearing the patient might well have gone on to 'somatise' the pain of her lonely grief through increasingly acute symptoms, using them to feel and communicate it indirectly through a type of 'organ speech'. The GP's new bearing was preventative in the deepest sense, forestalling a process whereby this patient might well have ended up as a genuine 'heart case' requiring medical intervention or a 'heart sink' case in which no conclusive, measurable signs could be found of any organic disorder. When doctors speak of the 'heart-sink' patient perhaps all that is referred to is the type of patient that all too clearly needs this type of 'deep' fundamental diagnosis, rather than fruitless attempts to diagnose their symptoms in the ordinary way.

As Foucault puts it "To ask what is the essence of a disease is like asking what is the nature of the essence of a word." Our felt understanding of the sense or meaning of a word always has to do with connotations that transcend its given meaning or denotation. Just as the same words can have a different felt meaning to different people, so can the same disease symptoms. This felt meaning may not however be manifest, visible, or expressible. It belongs to the realm of unformulated experience. But for what Foucault describes as the clinical gaze what counts is only what is visible - manifest or expressible. In Diagram 1 below the black squares represent manifest or expressible symptoms in the way these are perceived by the physicians - as diagnostic signs of a generic disease type. The figures within the squares however, represent the varying 'shapes' of different patient's personal felt experience of the same symptoms or disease. The shaded area within these figures represents their inner dis-ease as such - the organismic field-state that finds expression in their symptoms. Together, these constitute the patient's miasm in distinction from their medically diagnosed condition.

Diagram 1

Diagram 2 is a model of the traditional "We-It" relationship between physician and patient, in which the physician's principle is to separate the patients felt dis-ease from their manifest medically-recognized disease symptoms and turn the latter into an "It" - some 'thing' that is 'wrong' with the patient and that can be turned into an object of clinical diagnosis and treatment.

Diagram 2

Diagram 3 represents the way in which a miasm - the field-pattern of the patient's inner dis-ease - can take on the form of a typical disease pattern. This may happen either because the disease pattern is identified by the physician as a possible cause of their symptoms or because the patient has already begun to interpret their felt dis-ease as an incipient disease - knowing that only in this way will it receive recognition by the physician.

Diagram 3

X-rays photographs, magnetic resonance scans and thermal imaging all show a different picture of the human body and brain. None of them reveal the organizing field-patterns of awareness that constitute the human organism, and the manifold fields it inhabits. Nor do they show the role of an individual's thoughts and beliefs in shaping the physiological and physiognomic, bodily and behavioural expression of different organismic field-patterns. Whilst it is true that cognitive behavioural therapy, and alternative medicine and the new field of psychoneuroimmunology all offer accounts of how a person's beliefs can affect their bodily well-being, forging evidential or speculative links between 'mind' and 'body', none of these accounts distinguish the human 'mind' or 'body' on the one hand from the human organism on the other, or recognize mental and physical states as the expression or embodiment of organismic states - field-states of awareness.

A field-state is a dynamic relation between a potential field-pattern of awareness and its actualisation. This relation can take the form of resonance or dissonance. Resonance stabilizes and sustains the actualisation or physical manifestation of a potential field-pattern. Dissonance, on the other hand can distort that manifestation, degrade a previously resonant manifestation of it, or deny expression to a previously unmanifest pattern. Resonance and dissonance go hand in hand. Without dissonance, dominant field-patterns cannot distort or degrade in a way that allows new field-patterns to manifest. At the same time dissonance can also distort or deny expression to those new field-patterns. Dis-ease is the experience of dissonant, degrading and/or newly emerging field-states of the human organism. But what we call the 'mind' is an integral part of the human organism, a body of thought-patterns or beliefs, more or less in resonance with one another, which actively in-form these field-states or distort them in line with social thought patterns and medical belief systems. These constitute a type of social text inscribed into the very texture of the patient's experience of dis-ease whilst at the same time ignoring its social and relational context.

A secretary who feels abused and humiliated by her boss but incapable of facing up to him for fear of losing her job, develops instead an 'angry' skin rash on her face. The GP or alternative practitioner she visits may know nothing of this situation and ask no questions that bring it to light. A diagnosis is made and treatment given which may or may not be effective. The greater danger, as in Zigmond's case study, is that the treatment is effective, for this may leave the patient with no option but to manifest or 'somatise' her dis-ease in another, perhaps more serious or life-threatening way. All healing is fundamentally 'self-healing' in the deepest sense - discovering that hitherto unknown, unmanifest and unfelt self that is capable of meeting the challenges the individual faces.

The Practice of Organismic Medicine

It is only through gaining a more detailed picture of the social and biographical context of an individual patient's symptoms, that a somatic therapist, guided by the principles of soma-semiotics can begin to practice their own specific form of organismic therapy. The first step on this road is to break with all forms of diagnosis that are not based on a direct organismic resonance with the patient's miasm and the inner dis-ease it expresses. Organismic resonance is not the same thing as emotional empathy. We can register a sign of somatic discomfort or emotional distress in a person, and feel empathy or compassion for them, without in any way attuning to the highly individual 'feeling tone' or 'field-quality' of just this person's discomfort or distress, this person's pain or despair, this person's sadness or anger. Instead of immediately trying to form a clinical picture of the person's condition, whether from their description of it or from the emotions connected with it, the somatic therapist will seek to gain as detailed a picture as possible of the patient's life and life-world.

This indirectly gained picture of the patient's outer life in turn provides a framework for a direct organismic resonance with their inner dis-ease. Together they facilitate insight into the miasm. To understand the miasm means to understand the patient's own relation to that psychical dis-ease - the way they themselves understand or interpret it mentally. For herein lies the key to the way they express it emotionally and embody it somatically. The patient dwells not only in a physical body but in a mental body of beliefs. It is this body of beliefs which shapes the depth, tone and texture of their bodily self-awareness, and with it, their own organism as a toned and textured body of awareness. The body of beliefs is the shaping mental skin or envelope of the human organism - not only the organism of a patient but that of a physician or therapist of any sort. The fundamental aim of the therapist should not be that of the conventional physician - namely to simply incorporate the patient's experience of ill-health into the mental body of beliefs that constitutes their particular brand of medical 'knowledge'. Rather it should be to understand the patient's own body of beliefs on the one hand, and its role in shaping their felt experience of dis-ease into the miasm that the patient suffers from.

The second condition for the effective practice of organismic therapy is that the therapist ceases to regard 'diagnosis' as a mere prelude to some form of treatment. Healing, for the patient, begins and ends with being fully heard as a human being. This means having the feeling that the therapist is able to feel the way they do - capable of not just intellectually understanding or emotionally 'empathising' with the patient's experienced dis-ease but able to feel it as a miasm within themselves. Reaching this point is fundamental dia-gnosis - knowing through intimate inner acquaintance. It is also fundamental therapy - the healing that comes from the therapist's capacity to identify with and internalise the patient's miasm, working with it in the healing womb of their own organism.

Hahnemann's understanding of the organism as musical instrument or organon and his definition of illness as "mistuned vitality" raises the question of the healer's ability to use his or her own organism as a medium of direct resonant attunement to that of the patient. This is certainly a possibility he recognized, as evidenced by his own respect for the work of Anton Mesmer and the practice of mesmeric or 'magnetic healing'. Most forms of medicine seek to affect the human organism indirectly, from without. Mesmer practiced a form of direct organismic healing based on the resonant contact and communication between the organism of the healer and that of the patient, one well summed up by his follower Tardy de Montravel:

"The nerves of the two human beings can be compared to chords of two musical instruments placed in the greatest possible harmony and union. When the chord is played on one instrument, a corresponding chord is created by resonance in the other instrument."

Diagram 1 represents a state of organismic resonance between patient and therapist, through which the therapist has achieved a state of organismic identification - gained a direct felt sense of the patient's own organismic field-state or miasm within their own organism.

Diagram 1

Organismic identification is not the same as physical or emotional identification. We cannot feel another person's physical pain or discomfort, their emotional despair or distress - nor should the therapist seek to do so. What they can identify with is (1) the unique field-quality and field-tonality of a particular patient's own awareness of pain or despair, discomfort or distress, and (2) the field-depth and field-texture of the patient's organism or bodily self-awareness as such.

Case Example 2

A visibly stocky and muscular patient feels light or weightless to the therapist. Though she has a 'sunny' disposition, which can be sensed organismically as radiation of light and warmth it is as if her awareness were constantly streaming outwards towards the world and other people rather than inwards towards her own self. This was reflected in the fact that though she talked a lot about others and showed great emotional perceptiveness she never spoke directly about her own feelings or her experience of herself. A felt sense develops in the therapist of a hollow texture of the patient's bodily self-awareness - her awareness entirely dwelling on the mental outer surface of her organism and in the outer world, and lacking any centre in its bodily, psychic interiority. Her sparkling eyes and talkative vitality betrayed a lacking field-depth and field-intensity in the patient's inner bodily self-awareness. Her entire awareness of herself seemed outwardly oriented, merged with her awareness of others and head centred rather than inwardly or body centred.

The therapist's direct organismic awareness of the patient was given significance by both her somatic complaints and the verbal information she communicated. In a brief telephone call with this client the therapist got an intuitive sense that the patient was not just alone in the house, but in a sort of vacuum. Later the patient reported that she was indeed alone in the house at the time, but also had, for a change, no external problems, her own or others, to focus her awareness on. It was at this time she experienced a somatic crisis. This took the form of an allergic shock reaction in which her body tissues swelled, she felt like a balloon and due to constriction of her throat it became almost impossible for her to breathe or speak.

The therapist's organismic sense of this crisis was that the patient's body was expanding to fill an external vacuum created by the patient's lack of inner bodily self-awareness. That it was intensifying her bodily self-awareness and using her physical body to substitute for the otherwise non-existent boundary between self and other in her organism or body of awareness. An untrammelled and unmeasured flow of awareness between self and world was physically disrupted through her body making it almost impossible for breath to flow in and out. The shock reaction in other words, was not a response to a specific allergen but her immune system going into hyperdrive in order to compensate for a lack of boundedness in her organism and a lack of differentiation between self and other reflected in her language and way of speaking.

Here we have a clear example of an organic function (the auto-immune system) compensating for a weak or non-existent psychical capacity to form a firm organismic boundary or skin of awareness of self and of other. Her most continuous somatic symptom was itchy skin eruptions from which she scratched to the point of drawing blood - as if to break into herself from the outside. Biographical questioning revealed that in her childhood the patient has suffered from constant fears of her mother dying while she was at school, confirming the therapist's organismic sense of an absent differentiation of self and a significant other in the form of the mother. This too was related to the deathly hollowness of her organism, which as a vital and formative inner body is also a 'mother-body'. Because of this hollowness, fiery intensities of awareness have not only no firm boundary to contain them but no organismic surface to rise to in the first place. The patient's somatic sensation of intense bodily heat and going 'red in the face' during the somatic crisis allowed her inner fire to condense and rise to a surface rather than being dissipated in the ordinary way as the warmth and light of her normal radiant or sunny disposition. A dream shared by the patient revealed an intense fear of darkness. Her predominant skin symptoms - hot and itchy eruptions - were reminiscent of sunspots - concentrations of heat that made her physically aware of an organismic skin she lacked psychically and made up for through a continuous mental skein of thoughts about others.

Therapy did not take the form of physical diagnosis and treatment, psychological explanations of symptoms or psychoanalytic interpretations focusing on emotional issues and their source in parent-child relationships. The fundamental therapy was the fundamental dia-gnosis - the therapist's capacity to stay with his own felt, organismic sense of the patient's inner vacuum and lack of boundedness - despite all her surface vitality and talkativeness. This in turn induced a state of field-resonance with the patient's own organism - allowing her to feel its hollowness for the first time. The therapist then used his own organism to directly induce a sense of inner warmth in the organism of the patient, helping her to feel her own body not as a vacuum emptied of awareness but as a vessel or hearth - filled with a warm glow of awareness stemming from her own life-fire.

Just as there are organismic counterparts to every organ and physiological function (in this case the skin and auto-immune function) so there are also inner psychical counterparts to physical phenomena such as space and time, closeness and distance, warmth and coolness, light and darkness, lightness and heaviness, sound and density, charge and polarity, electricity and magnetism. This applies also to the elements such as fluidity (water), solidity (earth) and gaseousness (air). The organism is composed of different combinations of these inner energies and elements - qualities of inner warmth and inner light for example. But it is of the utmost importance not to confuse our felt sense of these qualities with bodily sensations of some physical or vital 'energy'. The warmth we feel radiating from a human being for example, is neither a measurable property of their physical body (temperature) nor some mysterious inner energy that we happen to be aware of. It is a quality of their awareness of themselves and the world that others then feel bathed in and warmed by. Just as we can feel inwardly close to someone even though they are miles away, so can our feelings towards someone have a warm quality even though our bodies are freezing. Just as our organism, as a body of awareness, is not less but more fundamentally real than any physical phenomena we are aware of, so are inner closeness or distance, warmth or coolness, lightness and darkness, fluidity or solidity etc. more fundamentally real than their physical counterparts.

When we feel a person's warmth or see the radiance of their gaze we are not speaking of any physical heat or light emanated by their bodies. Nor are we merely speaking metaphorically. To believe so is to imply that the warmth or light we feel emanating from a human being is somehow less real than a measurable temperature of the human body or the measurable light reflected by their eyes. To talk, as many alternative practitioners do, of a person's bodily 'energy' and of 'energy medicine' seems to imbue our felt, organismic sense of other human beings with a more tangible 'objective' reality than a mere 'subjective' feeling about them. At the same time however, it is an evasion of the basic question of what is more real or fundamental - the human body or the human being, energetic relationships betweens bodies in space and time, or inner relationships between beings. To say that it is energy that links or relates things and people is one thing. Put the other way round, we can say that the essence of energy is relationality as such.

The principal instrument of Fundamental Therapy is the therapist's own organism and organismic awareness. The Fundamental Therapist is one whose own organism has become a new inner organ of perception, transforming their otherwise undifferentiated organismic awareness - 'felt sense' or '6th sense' - into a highly differentiated set of inner senses. These allow a direct feeling cognition of the inner field-tonalities, field-qualities and field-textures of another person's organism. The medium of this feeling cognition is 'feeling tone'. For like the audible tones and chords of music, inner feeling tones possess potential qualities of warmth and coolness, lightness and darkness, levity and gravity etc just as they also possess different tonal 'colours', different 'timbres', different elemental textures such as fluidity and solidity, airiness or fieriness and different sonic 'shapes' such as roundedness or angularity.

When we say of someone that they are 'warm and friendly', 'cold and hostile', 'remote and arrogant', 'heavy with remorse' etc. we use phrases which, as verbal signifiers, unite two quite distinct levels of meaning or signification, possessing both an organismic signification and a mental-emotional one. Let us say that someone with an emotional history of abandonment, abuse or deprivation of human warmth develops a 'cold' outer bearing. Others may perceive this bearing as emotionally hostile, defensive, aggressive, remote, cut off, arrogant. Indeed simply to describe someone as 'cold' has an emotional connotation. This shows that in language, as in life, people have not yet developed the capacity to distinguish fundamental qualities of organismic feeling tone such as inner warmth and coldness, light and darkness etc. from the way these qualities are emotionally experienced and expressed - both in others and in ourselves. But it is precisely the capacity to distinguish the mental-emotional and organismic significance of particular somatic or behavioural symptoms that is the foundation of Organismic Medicine, Diagnosis and Therapy.

Organismic States and Temperaments

Diagrams 1 & 2 show the two systems of coordinates which allow us to represent a patient's organismic state or temperament. In Diagram 1 the vertices of the inner triangle link points on three polar axes: that of inner warmth and coolness, inner darkness and light, and inner gravity or lightness. The points represent the organismic state of an individual in relation to these three coordinate axes, which meet at a common centre or organismic core uniting inner darkness, weight or gravity, and inner heat.

Diagram 1

The vertices of the large triangle in Diagram 2 represent the three elements of air, water and earth, and plot the organismic temperament of the individual as a single point in greater or lesser proximity to these vertices, representing a greater or lesser degree of organismic airiness, fluidity or solidity respectively.

Diagram 2

Case Example 3

A patient with a history of ethnic and cultural alienation, social isolation and exclusion, and institutional rejection or persecution, developed a very hot and volatile temperament, which he experienced through deep feelings of resentment and rage and expressed from time to time in aggressive outbursts or longs period of bitter hostile silence and withdrawal. The patient's repeated experiences of being socially 'left out in the cold' due to his own intense, dark, heavy and watery organismic temperament threatened him with a sense of inner emotional emptiness, deprivation and coldness. This he could counter through an innate inner warmth and a capacity for deep inner contact with others - all of these, however being values he found rejected in the social, cultural and institutional environments around him, thus creating a vicious cycle reinforcing his childhood experience. His organismic adaptation to this environment consisted in transforming the darkness of his isolation and the innate heat of his own natural intensity, into glowing warmth of soul, into burning emotional fire and/or into an intuitive light which he attempted to transform in a cool intellectual way into a medium of social acceptance and recognition - using it to develop innovative methodologies in his professional work as a teacher. Finding that his professional conscientiousness and theoretical innovations were also rejected as values in his institutional environment irrespective of their practical and market value, brought on a series of mental-emotional and somatic crises that compounded his initial problems.

This patient's organismic temperament - an inner heat of intensity and a dark watery heaviness or gravity - combined to produce glowing inner warmth and emotional depth of insight on the one hand, or an over-heated emotional or intellectual life on the other. His somatic symptoms had clear organismic dimensions: a chronic depressive reaction to the ingestion of solids, heavy smoking associated with lack of a spiritually oxygenating value atmosphere around him, regular burn out due to the burn up of somatic energy in the form of intellectual fire and its dissipation as intellectual light. His mental-emotional symptoms initially took the form of extreme emotional lability or volatility, explosions or implosions, including frequent expressions of emotional distress through crying or rage. At a critical point in his professional career and domestic life he contracted an acute pneumonia with very high fever and considerable pain in breathing, which depleted his vitality over many years. At the point of consultation he was experiencing marked weight loss, diabetic symptoms, shortness of breath, physical and mental weakness, and occasional brief blackouts. These symptoms were accompanied by greater than usual sensitivity to cold.

My organismic sense of these symptoms was that the solid and fluid elements of his constitution were being burnt out and vaporized, causing a grave weakening of inner fire or vitality and with it a dissipation of the light of his awareness - blacking out. These were associated with a life-style of giving out in an unsustainable way - generating ideas and giving to others from his own inner fire without a supportive environmental milieu of any sort. My organismic diagnosis of the patient was that the key psychic capacity displayed in the symptoms and organic dysfunctions was the capacity for peripheral organismic cooling. The patient's long-standing cold sensitivity and his now weakened peripheral and brain circulation substituted for the psychic ability to adopt an inner bearing of cool detachment and objectivity. The lacking balance of coolness and warmth was replaced by an alternating cycle of warmth concentrating in darkness only to dissipate as light. Whilst he was able to cool this heat and crystallize and solidify its light intellectually, in his relations to other people and to society, any appearance of emotional 'coldness' was a deception - hiding either a hot-headed irritability or buried volcanic emotions. Therapy consisted in showing him how to 'cool' organismically by:

   1. accepting feelings of bitter emotional coldness (rather than countering them with inner         warmth or heating up emotionally)
   2. learning to sustain an inner bearing attitude of cold detachment and neutrality whilst         separating it from any emotions of hostility or indifference.
   3. learning to feel this cool bearing on the periphery of his organism, to distinguish it from felt         bodily sensations of physical coldness, and to recall and intensify it when necessary (as an         alternative to heating up or shedding warmth and light).

The result would not be the fixation of a permanent state of mental or emotional 'coldness' but a stabilization and evening out of inner warmth in the patient's organism and emotional life - an inwardly cool periphery allowing this warmth to re-gather and concentrate in his organismic core as inner vitality or life-fire.

There is a fundamental difference between retuning an instrument and playing it. Similarly there is a fundamental difference between a therapy which retunes or restores harmony and resonance to a patient's organism and one which teaches them to play a different type of music on it - to embody new tonalities and textures of awareness. The Fundamental Therapist is someone who has learnt to play the instrument of their own organism - to modulate their own organismic field-state and feeling tones in the same way in which, in speaking, we shape and modulate the vibratory qualities of our own vocal tones. In this way the therapist can not only perceive but respond directly to the organismic feeling tones and field-states of others - using their own organism as an instrument of resonant inner communication with the patient. The therapist's capacity to stay with their own wordless, organismic awareness of the patient's dis-ease brings about a field-resonance with the patient's own felt sense of dis-ease. This in turn brings about a felt shift both in the quality of the field linking therapist and patient and in the patient's felt sense of self.

The Homoeopathic Principle

When we leave our mother's womb we continue to dwell in the womb of our own organism. Illness can be compared to a form of pregnancy which allows us to give birth to new aspects of our inner being - the part of us that is never fully born and constitutes an inexhaustible source field of inner potentials of being - experienced as new field-states of awareness. Pregnancy is not an illness, even though it may be accompanied by symptoms of a different sort or lead to a painful labour with greater or lesser risk of 'complications'. Pregnancy can lead to birth. It can also lead to the death of the mother or child. But if illness is itself essentially a form of pregnancy then allopathic medicine works on the principle of throwing the baby out with the bathwater - seeking to eliminate all bodily or behavioural expressions of organismic pregnancy and labour. It does so through the use of drugs - and now gene therapy - to affect the human organism from without, inducing field-patterns and field-states running counter to those expressed in the patient's symptoms. The term 'allopathic' is itself significant, deriving from the Greek allos, meaning 'other' and pathein - to feel. Allopathic therapies run directly counter to the understanding that illness itself is fundamentally a response to a felt sense of otherness. Allopathic therapies work to overcome this sense of otherness and help the patient to 'feel themselves' again, rather than helping them to feel and identify with other selves. Many complementary therapies also work in an allopathic manner - aiming to restore a sense of well-being in tune with the patient's 'normal' state of being rather than encouraging identification with new states of being. Only a relatively small number of therapies have offered a fundamental alternative to allopathic medicine rather than complementing it in different ways. Homoeopathic medicine, psychoanalytic medicine, somatic psychotherapy, 'pathosophy' and 'process oriented psychology' each make use of different elements of Organismic Medicine, though with lesser emphasis on the place of the individual in the social organism and on the relational dimensions of health and healing. They have in common the fundamental homoeopathic principle of treating 'like with like'. In the case of homoeopathic medicine itself this principle is applied through the administration of small, highly diluted quantities or 'potentiations' of a natural substance known to produce symptoms similar to that from which the patient is suffering. As Hahnemann initially understood it, the effect was to bring about an aggravation of the symptoms. This in turn however, would provoke a healing crisis - stimulating the patient's life-force or inner vitality to a sufficient degree to 'apprehend' and counteract the disease. Later he revised his views on the necessity for a crisis-like aggravation of symptoms, having found that even higher dilutions could be effective in a more subtle way.

From the point of view of Organismic Medicine there are nine basic dynamics governing the relation between, on the one hand, organismic capacities such as inner psychical respiration, circulation and metabolism, and, on the other hand the bodily or mental functions that are their outer counterparts.

   1. A weakened organismic capacity weakens a bodily or mental function.
   2. A weakened bodily or mental function weakens an organismic capacity.
   3. A strengthened organismic capacity strengthens a bodily or mental function.
   4. A strengthened bodily or mental function strengthens an organismic capacity.
   5. A bodily or mental function compensates for an under-active organismic capacity.
   6. An over-active bodily or mental function weakens an organismic capacity.
   7. A weakened organismic capacity strengthens a mental or bodily function.
   8. A weakened mental or bodily function strengthens an organismic capacity.
   9. Dissonant, disturbed or distorted psychical functions disturb or distort organic functions or         produce dissonances between them.

The subtleties and complexities of homoeopathic healing explored by Hahnemann are an expressing of these diverse and contradictory dynamics, each of which may be more or less relevant to any given patient. All however, are expressions of the relationships of like to like which exist between organismic capacities and organic functions.

The general homoeopathic principle of treating like with like can be applied in psychological as well as physical medicine. In the Process Oriented Psychology of the Jungian analyst Arnold Mindell, it takes the form of encouraging the patient to feel their symptoms more rather than less intensely, to actively amplify or 'aggravate' their felt sensations of pain or discomfort. He found that this would bring about the release of emotions, mental images and inner comprehensions that expressed the felt meaning of their symptoms. Mindell applies this method to all types of symptoms, and to all dimensions of the patient's experience of disease - mental, emotional and somatic. If a patient fears death for example, he might ask them, there and then, to die - to feel themselves dying. Encouraging the patient to follow their own 'process' in this way, though it can result in apparently 'miraculous' healing, is not, for Mindell a calculated psychological technique designed to heal. He understands that for some patients, death itself is part of their process - their path of healing in the sense of once again becoming whole. His work is therefore a fundamental challenge to the historic and hitherto unquestioned premise of all forms of medicine - the fundamental belief that the purpose of medicine is to heal or cure disease. Mindell's fundamental motto could be 'feeling not healing'. This means following a disease symptom back to its source in a fundamental dis-ease, and allowing the process of that dis-ease to take its course psychically - on an aware level. Mindell understands mental symptoms as expressions of the 'dream body' - his term for the human psychic organism. In a nutshell therefore, the illness process is a type of bodily dreaming and its symptoms are somatic symbols or 'body dreams'.

From the point of view of Organismic Medicine it makes no more sense to regard sickness as an 'unnatural' deviation from health than it does to regard dreaming as an unnatural disruption of sleep, or nightmares as an unhealthy type of dream. The medical model of illness, based on the premise that illness is a meaningless deviation from health, is as outdated as certain pre-Freudian 'scientific' beliefs that dreams are meaningless discharges of neurological energy.

Organismic Medicine understands dreaming as one of two principal functions of the human organism. The other function is bodying - the organism being the instrument with which we embody our capacities of being and give bodily expression to feelings - to inner field-states, field-qualities and field-patterns of awareness. Bodying is not the same thing as 'somatising' - the unconscious production of somatic symptoms as an indirect expression and communication of psychic states. On the contrary, somatisation can be understood as an incapacity to body a felt dis-ease - to communicate it in a direct bodily way. In the contemporary psychoanalytic model of somatic disorders, somatisation is understood as a failure of symbolization. More specifically, it is seen as an expression of alexithymia - a deficient lexicon of verbal symbols by which to identify and process feelings. But ability to express and communicate feelings in words is inseparable from the ability to experience and communicate them in a bodily way. Psychoanalysis focuses only on the relative poverty or richness of a patient's verbal-emotional language or 'literacy', not on the poverty or richness of their emotional body language and its expressive vocabulary or 'lexicon'. But finding appropriate words and body language to directly express and communicate psychic states is also a form of the basic homoeopathic principle of 'treating like with like'. For only if a patient's verbal and non-verbal signifiers are 'isomorphic' or 'congruent' with their feelings, can they establish a direct inner resonance with their felt bodily sense of dis-ease - rather than experiencing and expressing this dis-ease indirectly through bodily sensations and disease symptoms. Diagram 1 represents the process of bodying as a healing process by which the patient, rather than concentrating on the symptoms (represented by the black square in (a), is able to (b) find a body language isomorphic with the shape of felt dis-ease (represented by the shaded area) and thus (b) once again feel comfortable in their own bodies (the circle).

Diagram 1

Where the patient lacks a direct felt sense of their own inner dis-ease sufficient to give this symbolic form, therapy can help in two distinct ways - by reading the symbolism of the patient's symptoms or by establishing a direct felt resonance with the patient's felt dis-ease. Ultimately these two approaches are inseparable. For unless the therapist has themselves a direct felt sense of the patient's inner dis-ease, they can neither resonate with it organismically nor can they read the patient's symptoms as an expression of it.

Reading the symbolism of patient's symptoms, of course, does not mean merely interpreting them in terms of some pre-conceived intellectual framework. It is very important however, to have (1) a detailed life picture of the larger biographical context of the patient's illness, and (2) a detailed medical picture of its bodily text - the exact physiological functions and processes involved in it. It was for this reason that the Argentinean psychoanalyst Luis Chiozza developed a new team approach to the psychosomatic study and treatment of the 'organic patient' - bringing physicians and psychoanalysts together to piece together what he calls a 'pathobiography' - the hidden story of a patient's illness. It takes the form of a short rewriting of the patient's life story, but in terms which reveal the symbolic parallels between (1) significant biographical events in the patient's life and (2) significant medical terms used to explain the physiological 'story' behind the patient's organic symptoms. The pathobiography, put together by the clinical team, is not only a diagnostic instrument but the main instrument of therapy - its presentation to the patient being designed to induce a direct awareness of the psychical significance of their symptoms in the context of their life as a whole - thereby giving the patient for the first time an opportunity - no more and no less - to consider an alternative bearing towards life which breaks with old patterns.

Case Example 4

In his book "Hidden Affects in Somatic Disorders" Chiozza presents a series of individual cases studies, each of which is designed not only to shed light on the "hidden story" of a particular patient's illness, but in doing so to reveal the general psychical significance of particular organ and organic dysfunction. Indeed in each case Chiozza begins by considering organic functions themselves as psychical signifiers, then moves on to analysing the signification of specific organic dysfunctions, and finally links these to significant patterns of events in the individual patient's life. What follows is a summary, not of an individual case study but of Chiozza's study of a broader case - that of the psoriatic patient or the psoriatic 'character' as such.

The starting point of his presentation is therefore the general psychical signification of the skin as container for the self and as contact surface with others. This echoes Freud's view that "the ego is first and foremost a bodily ego", having its source in "bodily sensations, chiefly those springing from the surface of the body". This is the key idea developed in Anzieu's concept of the "ego skin" or "skin ego". For Chiozza on the other hand "the skin exists as an organ simultaneously with the fantasy of a skin-ego" and the latter is not to be considered as something derivative of the former. Psychical and somatic skins are understood as joint expressions of something more fundamental than either. In practice Chiozza tends to identify this 'thing in itself' or 'skin in itself' with specific "unconscious fantasies" which find expression in key linguistic signifiers with a double vector of signification, capable of being used to refer both to a psychical and physical skin.


irritable / inflamed / exposed / vulnerable / wounded / raw
thin-skinned / thick-skinned / sensitive / insensitive
to get under one's skin / to develop a hard skin / second skin
to be flayed by criticism
to be skinned alive

But in order to understand the "specific unconscious fantasy" of a particular skin disorder such as a psoriasis, Chiozza also attends to the deeper significance which can be discovered in the precise physiology and medical pathophysiology of skin function.

He interprets hyperkeratosis or thickening of the corneal layer of the skin as an attempt by the patient to develop a thick skin as protection against hyper-sensitivity to criticism or rejection, or a lack of 'caressing' praise and comforting contact. Both contact deprivation and flaying criticism or lack of caressing lead to contact avoidance - aided by the shame experienced by the patient at his or her own diseased skin.

Physiologically, however, the hyperkeratosis involves an over-production of immature cells deficient in their ability to produce keratin - reflecting in Chiozza's understanding, an accelerated, precocious but incomplete growth of the ego. Their adhesion being defective, corneal cells are constantly shed - flaking, peeling or scaling off. The psoriatic patient's 'thick skin' is the constantly shed surface of a sensitive, inflamed and reddened substrate, accentuated by the proliferation of sub epidermal blood vessels. Chiozza sees the constant desquamation or shedding of scaly skin as analogous to a reptile regularly sloughing off its own scaly skin. He understands this as a physiological metaphor of the constantly failing attempt on the part of the psoriatic patient to replace one skin with another - in order to adapt to their environment and achieve the longed-for sense of acceptance and recognition and supportive social contact. In practice the result is the very opposite, producing a surface appearance that accentuates the patient's self-disgust - a continuing fear of rejection by others that goes together with self-rejection. This self-rejection is reflected physiologically in the fact that psoriasis is also considered a type of auto-immune disorder.

In his accompanying individual case study Chiozza attaches particular significance to a number of events and emotions in the patient's life: his feeling of aloneness following a move to another country at the age of 14; his felt need to take care of his mother, who became mentally ill after the move; how scared he was by his mother's symptoms; his felt lack of affectionate physical contact from both parents; his fear of and subsequent desertion by his girlfriend; his attempt to harden himself in the face of this desertion and be tough enough to face life alone despite his feelings of hurt and vulnerability, his taking responsibilities in his father's factory but being scathed with criticism and shamed in front of other employees. Chiozza sees in these events someone who needed to grow up fast and develop a thick skin to take care of his mother, who adopted adult responsibilities only to be met with wounding criticism and who still bore the burden of an unmet need to be taken care of, caressed and comforted himself - against which he still attempted to toughen himself up. As is often the case however, this psychoanalytic picture gives no clue as to what might actually help the patient, given the ineradicable facts of his own past feelings and family history. The "hidden affects" or "unconscious fantasies" which Chiozza sees as so important in understanding illness seem in this case, as in others not to be hidden or unconscious at all, but rather to have been "affects" consciously experienced by the patient as part of his reality.

Chiozza's allusion to a third, more fundamental reality behind both somatic symptoms and the verbal signifiers associated with them, is well grounded and supported by Freud's own suspicion that these may have a common source. Indeed Freud went further, suggesting that language itself may have not initially served a signifying function, but rather served facial expressions as a form of body language. Speech as such is nothing disembodied but a function of speech organs - in this sense it is itself a form of organ speech. Organismic Medicine understands both organic functions and the speech organs as the medium through which organismic capacities are exercised, and organismic states are embodied and expressed. But the human organism can be identified neither with the physical body nor with the mind - or a mental body of linguistic signifiers. It is itself a psychical body of awareness. The thick skin sought by the psoriatic patient is neither a physical skin nor a mental skin. The patient's precociously and precariously hardened mental and physical skin both stood in, as signifiers, for a secure organismic skin. This organismic skin does indeed have a reality more fundamental than either a bodily skin or mental skin-ego. Organismic Medicine understands the mind and ego as something quite distinct from the soul or psyche, and the mental skin-ego is something quite distinct from the psychical or soul skin that is the true boundary of the organism - understood as a psychical body in itself. Whereas the ego may indeed be thought of as a mental image or projection of the physical body's skin surface or boundary, the organismic skin is the surface of that boundless psychic interiority which alone is worthy of the name 'soul'.

When we speak of 'handling' someone affectionately, or of their being 'thick skinned' it is neither a mode of outer physical contact nor the outer physical skin we are referring to but rather our handling of their psychic body or organism and the nature of its skin. What is missing in Chiozza's analysis is an understanding of the patient's lack of inner, organismic contact with others - not physical contact or verbal caressing alone.

As is typical in psychotherapeutic discourse, Chiozza's key analytical signifiers are almost entirely affectual - referring to emotions of fear, loss, isolation, shame, humiliation, woundedness, vulnerability, rage, disgust etc. By definition however, an 'emotion' is an e-motion - an outward motion of awareness from the individual's organismic core to its surface periphery or skin. Understood organismically, skin disorders in particular are an expression not of deeply buried or 'unconscious' affects but of emotions just below the surface. Fundamental Therapy, for a patient such as that described by Chiozza, would consist in truly getting beneath the skin of these surface emotions and their somatic expression. and providing genuine inner support and 'holding' - giving the patient the supportive psychical containment and contact that he lacked in the past. For in the history of the psoriatic patient it is not a lack of surface skin contact or affirmative verbal communication that counts most but the psychical containment that these can provide - for example through the enveloping and contactful embrace of the parent or the enveloping world of fantasy images provided by parental storytelling.

In Chiozza's analysis of the 'psoriatic character', as in his analyses of the 'diabetic' or 'asthmatic' character, he is at pains to point out that he is referring to a psychic disposition only. It does not mean that the individual will necessarily contract the disease associated with this disposition. Nevertheless, should they do so, this is a clear sign of a particular psychical disposition. The latter however, cannot be reduced to either to a mental, emotional or physical disposition. Nor is it fundamentally a genetic or biological disposition but an organismic one. This cannot be understood as a relation only of mental, emotional or physical factors. The fundamental elements of an organismic state or constitution are themselves elemental in character. They have to do with elements of inner time and space, inner fullness and hollowness, inner closeness and distance, inner warmth and coolness, inner solidity and fluidity, and other such fundamental elemental polarities. The individual's mental, emotional and somatic life is an expression of the elemental state or the basic elemental state or constitution of their organism or psychical body. But this in turn is an expression of the individual's inner organismic capacities of being - inner warmth for example, being itself a function of our capacity to move inwardly closer to others, and inner space being a function of our capacity to feel enveloped and at home in our own organismic skin or periphery.

The Organismic Periphery

Mental patterns and emotions are not something separate from the human organism as a whole but are a part of it - the former constituting its patterned periphery and the latter reflecting motions of awareness to and from that periphery. Unlike other organs, brain and skin have no inner counterparts in the human organism. That is because it is not the brain so much as the mind as such which constitutes the outer skin or periphery of the organism - its 'ego skin' or 'skin ego' (Anzieu). But like any membrane it unites an inner and an outer surfaces. The latter is a complex membrane consisting of patterns thought and language. These constitute a web or nexus of mental and verbal signifiers. These are as Freud intuited, a "projection" of sensations primarily from the body's outer surface - a type of mental body image. But our inner awareness of these same sensations has an immediate felt sense of significance, which may or may not get through to us. Similarly, our own thoughts have inner resonances or undertones which we may or may not be aware of, and that shape the inner surface or lining of our ego-skin or organismic periphery. This can therefore be visualised, like our bodily skin, as having three layers.

The Threefold Layering of the Organismic Periphery:

   1. The mental or ego skin, a surface of reflective verbal signifiers.
   2. The emotional or self skin: a surface of felt bodily sensations.
   3. The soul skin: the felt inner sense or meaning of those sensations or signifiers.

The first layer can be compared to text printed on a sheet of paper, the second layer to the sheet of paper itself. The third layer however, is our awareness of the sense or meaning of the text, which we can only glean through our own sensory awareness of the text as printed paper.

The ego skin corresponds to what Winnicott called the 'mind psyche'. The emotional or self-skin is the boundary of what he called the 'psyche-soma'. This is indeed the skin that we refer to when we describe someone as sensitive, irritable or 'thick-skinned'. But that skin has an underside - the inner surface of an unbounded psychic interiority in which bodily sensations and signifiers arising from our body's surface are transformed into their inner counterparts - meaningfully patterned tones, intensities and textures of awareness as such. And not all emotions are essentially e-motions or outward motions. Sadness and depression for example, are surface emotional interpretations of what are essentially inward movements of awareness from the individual's surface or periphery to their inner core.

The Organismic Core

At the core of the human organism is what Hahnemann described as the vital principle or life force (Lebenskraft), Freud as libido and Reich as bioenergy or 'orgone'. Mesmer named it 'life-fire', echoing the Stoic philosophers, who, following Heraclitus, had seen the cosmos and all its basic elements as an expression of an 'intelligent fire' - a fire of awareness (noos) that was more than just one material element among others. Outer fire as we know, is both creative and destructive. Without it there would be no life on earth and through it life is also destroyed. But at the core of the organism is an inner fire or life-fire essentially inimical to any natural, physical element. Through it, all material elements - the air, water and solids taken in by the body are spiritualised and in this sense destroyed. The spiritual destruction of matter takes the form of a transformation of outer energies and elements into inner ones. This transformation of outer elements and material substance into their spiritually 'vitalized' inner counterparts lies at the basis of homoeopathic dilution or potentiation. Psychoanalysis identifies felt sense or meaning with felt libidinal sensation, and interprets all signifiers as expressions of libidinal drives and desires. But inner 'life fire' is not the heat of libidinal desire or orgone energy but the spiritual flame of creation and destruction - the formative and transformative activity latent within awareness itself.

Awareness is the very inwardness of energy in all its forms. And it is the inward movement of awareness from our own organismic periphery towards our own spiritual core that is the condition of release and radiation of energy from this core towards our organic bodily periphery. The organismic core is the inner spiritual centre of gravity of the human body, located, like its physical counterpart, in the abdomen. Called the 'hara' in Japanese, it is one of three major centres of the human organism, the others being head and heart. Once again, it must be emphasized that these are not energy centres with their own energy fields but localized centres of awareness within the larger field of awareness that constitutes the self and takes the shape of the inner body or organism. The organismic periphery links the outer field of our sensory awareness of the world with the field of our inner bodily self-awareness. The organismic core links the psychic interiority of our bodies with those inner fields and planes of awareness within which the organism itself takes shape and in which it continues to dwell like a fish in an ocean. On this analogy the patient's ego-awareness can be compared to a fish's awareness of itself as a life-form separate and apart from the ocean as a whole and from other fish and life-forms within in. The patient's organismic awareness on the other hand, can be compared to a fish's awareness of itself as a part of the ocean as a whole, and connected to other fish and life-forms through it. This connection is not merely an outward one but an inward one, each of the fish and other life-forms in the ocean being self-manifestations of the life of the ocean as a whole. Herein lies the clue to the nature of true self-awareness as opposed to ego-awareness. The 'inner self' of the patient, like that of any other individual, lies in there own awareness of being one self-manifestation of a larger 'oceanic' field of awareness - and of a larger identity which does not exclude but includes aspects reflected in all other fishes and life-forms. The relation of patients to their own inner self is mediated by their relation to their own organismic core. This core is not a localized part of the organismic periphery, comparable to a sense organ such as the eye or skin, but a centre of vitality deep within the body's felt interiority - linking us not only to our own potentials and capacities of being and to the felt interiority of other human beings, and to their potentials and capacities of being. The organism is the womb-body or 'mother body' (German Mutterleib) with which we constantly body and give birth to these potentials - giving them physical, emotional, and mental form. Organismic awareness is felt sense of our organism's own formative potentials and of the field-patterns of significance through which they link us to others.

The Social Dimension of Organismic Health

In his major work entitled "The Organism" the neurologist Kurt Goldstein described how organismic capacities are exercised in the form of ordered or organized performances such as walking or talking, writing or reading, calculating or describing. The latter are in turn a response to a specific social and environmental field or 'milieu'. If organs are damaged these performances are hindered. Not being able to embody certain capacities through the functioning of its organs the organism cannot 'function' properly i.e. cannot respond adequately to a particular milieu. This does not mean however, that it is incapable of coping in a different milieu. Goldstein's point is that organic 'disease', even among animals, is not something intrinsic to a living organism but has to do with the relationship between an organism and its milieu. Every change in this relation alters both. For human beings in particular however, loss of ability to exercise their capacities and fulfil their potentials through ordered performances in their existing milieu can be experienced as a 'catastrophic' threat - tantamount to loss of meaning and loss of being or 'essence'. For Goldstein "This…the organism's being, is its raison d'etre. All individual processes take their meaning from and are determined by this being. We describe this as the organism's essence." As a result, "health is not an objective condition which can be understood by the methods of natural science alone. It is rather a condition related to the mental attitude by which the individual has to value what is essential for his life. "Health" appears thus as a value; its value consists in the individual's capacity to actualise his nature to the degree, that for him at least, is essential. "Being sick" appears as a loss or diminution of value, the value of self-realization, of existence. "Health in other words, is not the physical or mental ability of an individual to function effectively or 'normally' within a pre-given physical or social environment - their milieu. Health is value fulfilment - the individual's ability to find or shape a milieu in which their intrinsic values or potentials of being can be fulfilled as capacities through ordered performances.

According to Goldstein, every organism, including the human organism, dwells in two environments - a 'positive' one to which it can respond effectively through its performances and a 'negative' one to which it cannot. Together these make up its milieu. Disease is not the expression of an inborn genetic 'weakness' of the organism in 'adapting' to its environment, but an inability on the part of the individual being to adapt that environment to its needs - to find or create the appropriate milieu for itself. Stimuli impinging from a negative environment may damage organs, disturb, derange or disable the organism's responses and performances or render them inadequate. The natural response of the individual is to avoid such impingements and/or to alter its positive environment so that it places less demands on functions that are organically impaired - or in danger of becoming so. Neither the bodily and behavioural symptoms of 'disease' necessarily point to organic 'causes', however. Instead they may themselves be healthy and adaptive responses to a negative environment - an attempt to escape that environment or transform it into a life-enhancing milieu. For the individual too, is on one level a cell within a larger social body that may itself be more or less healthy. The health of the individual and their relation to society cannot therefore be separated from the general health of human relations in society - the health of the social organism.

That is why Maslow rejected "our present easy distinction between sickness and health, at least as far as surface symptoms are concerned."

Does sickness mean having symptoms? I maintain now that sickness might consist of not having symptoms when you should. Does health mean being symptom-free? I deny it. Which of the Nazis at Auschwitz or Dachau were healthy? Those with a stricken conscience or those with a nice, clear, happy conscience? Was it possible for a profoundly human person not to feel conflict, suffering, depression, rage, etc.?"

A sick social organism may reject a healthy cell, treating the individual - or an entire group - as a malignant foreign body or antigen. If the individual suffers or even becomes sick as a result of this response is this a healthy response or not? Is it the task of medical science to seek the technological annihilation or 'final solution' to all symptoms of social dis-ease or of the individual's dis-ease with society. Or is its fundamental task to tackle sickness of the social organism itself - a sickness of human relations that lie at the heart of both individual and social ill-health, and one that is no more clearly expressed than in its own pathological forms of medical diagnosis and treatment? At the heart of this sickness is not simply lack of 'body awareness' or emotionally empathy for others but a lack of organismic awareness. The latter is both the essence of 'felt sense', the foundation of our sense of self, and the basis of our capacity for deep organismic resonance with others.