The story of Miri and her fibromyalgia, which is rooted in a psychosomatic interdependence, is examined from the perspective of Jung therapy.  Her personal shadow is investigated as is the interweaving and enmeshment of her physical body, mind and emotions.

Keywords: internal influences, emotions, psychic energy, psychosomatic

Miri, a 52 year old woman, first came to me 4 years ago for therapy because she was stuck both in the father complex and in the mother complex. She said then, and she still says, that she would like change in her life to occur, but she does not know who or what should change and she is afraid of change.

She is married and has two daughters, who were then 20 years old and 24 years old, both living at home with her and her husband. The family was constantly fighting and yelling at one another, except for the husband, who was mostly quietly absorbing insults mainly from his wife. They came as a couple for several sessions and then Miri decided that she wanted to come alone. She wanted to be the center of attention and not hear criticism from her husband.

Miri did not work, had never worked outside the home, and did not function as a housewife. The only thing she did was sometimes to cook. Her husband and the girls did all the shopping, cleaning and household chores. Miri has fibromyalgia, which many believe is rooted in a psychosomatic interdependence: the physical body, the mind and emotions are intertwined and are interconnected dimensions of the same entity, the integral human being. When meeting with Miri, I had to keep at the front of my mind the fact that symptoms are often transmuted and transferred from one level to another, responding to external and internal influences and conditions as an effort of the person/ organism/entity to adapt and survive.

She constantly complains about her physical suffering and about her husband who in her eyes is worthless, in spite of the fact that he earns a good living and works in the home doing what a wife would usually be doing. She insults him and yells at him in front of the girls, with no inhibitions or boundaries.

Miri spent the day mostly in bed, watching TV or sitting on the porch or sometimes going out to meet friends at a café. She complained that she was depressed and constantly in pain. She had medications from her doctors and took larger doses than were prescribed until she had to go into the hospital to be de-toxified. Miri reported that she did not want to live and that her life had no meaning, especially not with the husband that she had, but she did not have the energy to change things.

When in our discussions it was suggested that maybe she could change her thoughts, feelings and/or her behaviors, she resisted strongly and objected to any possibilities or options. She claimed that I did not understand how much she was suffering both physically and emotionally and that there is no hope for her for a better life. At this point I was still reflecting for her the "not good enough" mother, the evil witch part, which has been slowly changing during the therapy process.

In our sessions, Miri brought reports of events, discussions and hurts in her life, both present and past. She complained and reported every session about how others mistreated her and did not care about her. When I asked her to make lists of positive events or people in her life, she could not think of any. When I tried to show her positive aspects of her life, she quickly showed the negative sides. She talked every session about how others are not okay. In the sessions, problems surfaced as did the complexes. From time to time I made an interpretation directed to the core of the complex and awaited Miri's reactions. Since this therapy requires commitment and willingness to meet the truth about oneself, Miri, who did not have enough of these qualities and lacks patience, has become an "on and off" client, coming to sessions on and off – at the beginning once a week and then after several months stopped coming and then returned after 3 months and said that she wants every 2 weeks, and then started adding sessions with every crisis in her life and then asked to come again once in 2 weeks or once a month. Then for several months she came once a month. Right now she is back to every 2 weeks a session.

From the very beginning of Miri's therapy, it was obvious that her fibromyalgia was and is a psychosomatic reaction. This evidently was obvious to her doctor also, as it was he who suggested that she come to me for therapy. During the past four years Miri has been "off and on" involved in the process of self-exploration and discovery aimed at freeing psychic energy blocked and locked in complexes. During this time, her symptoms have reduced in intensity and she has improved her daily functioning which more significantly allows her to live a fuller life. She no longer spends whole days in bed and sometimes goes shopping with the girls or with her husband.

Her relationships with her two daughters has greatly improved. One daughter has left the nest and now lives with a boy-friend, visiting on weekends. Her relationship with her husband has not significantly improved – she still yells at him, insults him and claims he is worthless, in spite of the fact that he is the one who supports her in all ways: physically, economically and emotionally. Miri's memories and narratives are changing as the therapy progresses and therefore I am relating to her stories and reports as transference material. I am working on myself to be non-judgmental and as free as possible from expectations.

Miri's personal shadow

Her personal shadow, in contrast to the collective shadow, was formed in response to the distressing experiences her child ego felt in the process of growing up as the first child, a girl, with Iraqi parents, especially the father, who wanted a boy and then she was born- a great disappointment. Her mother also wanted a boy and so did not accept her with love and caring, and displaced on her all her disappointments and frustrations. After Miri, two brothers were born and they received the love and attention that Miri desired. She reported that at times she felt that she did not really exist and could never satisfy her parents' expectations.

Her personal shadow was mainly composed of contents of oedipal senses of shame and inferiority. These feelings are seen in the pictures and collages she created. These copy-paste computer collages show both her physical pain and her metaphorical projection; for instance, the picture where the figure is covered with slashes and cuts from knives and the knives are still cutting into the woman's body. When Miri talked about the picture, she reported that she feels like the figure full of cuts and slashes. She also metaphorically slashed and cut herself; she did this in part by creating hurtful and hurting relationships with all the people who were close to her in her life.

We know the importance of the quality of the early care-giver relationship in determining a person's potential to establish a secure base from which to explore the world and to create functional relationships. Eagle¹ gives us 'a reminder that real traumatic events happen to children and that these real events exert a strong developmental influence on the way children experience the world and relate to others in the future.' These are reflected in Miri pictorial creations in which she consciously describes her fibromyalgia, and unconsciously demonstrates her mother and father complexes. When Miri talked about her mother and father and their relationship, she described her father as treating the mother in the same way as she treated her husband; she adopted her father's mode of behavior. She described her mother as an unhappy woman who did not have any life outside the house and was despised and mistreated by her husband.

On the whole, the childhood atmosphere was demanding, rigid, critical, with many rules and much criticism. She had married at age 18 in order to get away from this depressive atmosphere and then went on to recreate a similar atmosphere in her new home. This is an example of how she metaphorically "cut and slashed" herself. At the age of 40, when she was depressed, she "gave herself" or better still, created, fibromyalgia, an auto-immune disease, which gave her the legitimacy to: 1. give up the idea of creating a different family pattern; 2. stay in bed; and 3. suffer emotionally and physically.

When thinking about my part in her working through her mother complex and how this therapy had become an "off-and-on" therapy, I realized that this was and is Miri‘s way of keeping control and not becoming trapped by me, the "mother witch", that she originally saw in me, and perhaps also I functioned as the controlling critical and judgmental father for her; I was aware of this pitfall and did not judge her: nevertheless, she assigned me this role. She experienced any comments I made as critical parental reproaches.

Miri described her picture of a meat-grinder in two ways: one was how she felt the physical pain of having fibromyalgia and the second association was of how her parents emotionally put her in a meat-grinder and took away any and all of her individuality and tried to make her into what they wanted – grounded up balls of meat with no separate individuality. She felt deeply alienated from her parents and brothers and then created a family in which there is an accumulation of individual and collective frustration, anger, and resentment.

Moreover, perhaps Miri's creation of an "off-and-on" therapy is also her way of practicing separations from a "mother" figure; perhaps this allows Miri to venture confidently, to explore her attachment and separations from me, and to have the repeated experiences of "safe separateness" and individuality.

Miri 's creative mind-brain parts used and have been using to this day, vivid visual imagery to both describe her physical pain and to process emotional states of mind, similar to the dream processing. Miri is mostly a feeling type function, coming to quick spontaneous decisions and behaviors based upon her feeling values. She clearly is not a thinking type, which deals with issues slowly, methodically and deliberately. So, according to Jung, her feeling function is "superior".

The emotional states of mind are implicit, locked in the unconscious or subconscious, and trying to emerge through her pictorial creations, into consciousness. In our sessions, in the non-threatening environment and with her using her vivid visual imagery, Miri was able to be in touch with her childhood emotional experiences which may have created negative states of emotional arousal which can lead to the overproduction of stress proteins and in this way contributed to the fibromyalgia. Rossi² speaks about experimentation with animals and changes in the structure of the mind-brain and hormones which are the result of emotional arousal.

According to Jung³– "The contents of the shadow are not only of an infantile-sexual character, but are altogether incompatible contents and tendencies, partly immoral, partly unaesthetic, partly again of an irrational, imaginary nature" … These are also "germs of new life and vital possibilities for the future."

Miri's personal shadow contains both negative and positive qualities of the self which were disowned, rejected and abandoned in childhood because they were unappreciated and condemned by her parents. These contents appear in her collages and in her pictures and need to be appreciated and valued. Her personal shadow includes her emotions and characteristics which were the result of her cold and sternly rigid upbringing. The contents center around power and gender issues and control, connected to the reality of her early helplessness and inadequacies.^4–6

An important element that needs to be stressed in the case of Miri is that throughout her childhood and continuing to the present, she felt that she was not enough: not good enough, not smart enough, not talented enough, and not the right gender. Experiences of this kind evoke and foster grandiose fantasies and infantile omnipotence as defenses against feelings of helplessness, anxiety, and dread. This sort of experience may also damage the development of symbolic thinking.

Miri was deprived in her infancy, throughout her childhood and until the present, of a strong and secure emotional container; she also lacked a sense of culturally accepted behavioral boundaries (she used to throw things at her husband and daughters); she lacked the capacity to contain and process her emotions. Miri uses and needs our sessions to build the safe emotional container in which she can work through her primitive feelings.⁷

Previously she had used her insults, accusations, criticisms, and aggressive behaviors to attack others, causing them to keep a distance,⁸ and to protect herself. In the process of therapy we are trying to understand why she developed her fibromyalgia as an auto-immune disease and attacked herself, rather than turning her aggressions outwards.

The absence of a "good enough" caring primal figure caused Miri to be unable to metabolize and integrate her distressing primitive experiences. We can see in her pictures and collages the imagery that is activated, and it is archetypal and terrifying. Nevertheless, she possessed enough innate resilience and received enough love so that she had the potential to build a solid secure container within the therapeutic alliance, enabling her to counteract and reduce some of the fibromyalgic symptoms and dysfunctional behaviors.⁹

Miri, transference, and counter-transference

At this stage in therapy, I functioned and am functioning for Miri, as the ideal mother figure, or transferential mother. However, I had feelings of criticism and judgment when I saw and heard how she treated her husband and daughters. It evoked in me antagonism. This made me doubt my ability to be effective. I realized that what I was feeling was what others had projected on her and what she projects on others.^10,11

The process of projective identification caused me to be more direct and active in the sessions, setting very clear boundaries, demands and critiques; for example, when we discussed how Miri speaks to her husband and daughters, we did several gestalt chair exercises so that she would experience what her behavior causes others to feel. She experienced what it feels like to be spoken to like that and she began to change her behavior towards her daughters.

Miri also felt slightly better physically than when she first created the pictorial images (she reported discomfort of 7, 8 or 9 instead of the previous more than 10), and related to the aches and pains, lack of energy, and feelings of melting in her pictorial creations; examples of two relevant pictures are the one where she is lying on a sofa and melting, and the one where a figure is being compressed in a compressor.

Everything that we said and did has had an impact that is seen and heard today. She is a little more correct and polite in her communications with her husband. Miri's transference and projections onto me were not as chaotic and violent as were those onto her husband. She was chaotic and violent towards him, as seen in her physically throwing things at him and screaming; these behaviors are changing for the better.

Miri has become able to talk about her pain and frustrations instead of projecting them, and acting out her emotions. A space has been created in which she feels closer to me. Slowly she is improving her relationships with others. Much work still needs to be done, but the non-threatening secure space in which the work could be done, has been created.

None.

There is no conflicts of interest.

1. Eagle M. The developmental perspectives of   attachment and psychoanalytic theory. In: P Goldberg, R Muir, J Ker, editors. Attachment Theory, London:  Analytic Press; 2000.
2. Rossi EL. Sacred spaces and places in healing dreams: gene expression and brain growth in rehabilitation. Psychological Perspectives. 2004;47(1):48–63.
3. Jung CG.  Collected works, Princeton: Bollingen.
4. Definitions. 1921;6.
5. On psychic energy. 1928;8.
6. Archetypes of the collective unconscious. 1934;9.
7. Psychological aspects of the mother archetype. 1938;9.
8. Conscious, unconscious, and individuation. 1939;9.
9. Sidoli M, Davies M. Jungian child psychotherapy: Individuation in Childhood, London: Karnac; 1988.  
10. Von Franz ML. The problem of the Puer Aeternus, New York: Spring Publications; 1970.
11. Farzadkia M, Farhangi A, Shahnam A. Comparison of Effectiveness of Intensive Short-Term Dynamic Psychotherapy and Mindfulness-Based Stress Reduction in Depression and Severity of Symptoms in Women with Fibromyalgia. Jundishapur Journal of Chronic Disease Care. 2023;2(3):e133803.