Symptom as Ritual

A symptom is a kind of motif. A repeating pattern. A ritual.

Think about ritual — all cultures, all religions that I'm aware of have their rituals, repetitions, the practices they return to over and over, some every day. "When I am in my darkest, scariest moments, I return to prayer, meditation, a few repeated words..."

It's worth thinking about symptoms in a similar way. "When I am in my moments of fear, I respond with my familiar way of holding myself. My familiar ritual. I constrict. I depress. I shut something down in myself. I say familiar words to myself."

The Prayer of the Six-Year-Old

Maybe it seems strange to call this a ritual. I'm aware that people don't often feel like they're choosing their symptom — that it's something that just comes over them, like a morning storm.

But if we think about how a symptom is made, it is usually the best adjustment available in a challenging moment. And often we are very young when we make it. Imagine a child of six, finding the handiest, most helpful, most creative response they can muster to a situation that feels overwhelming or unsafe. Maybe the environment is chaotic. Maybe the pain is coming from the person they are most dependent on. Maybe they are simply too small for what life is bringing.

It might be a set of words they learned to say to themselves — don't be weak, don't be a baby, hold it together — words that shut down the trembling just long enough to get through. It might be the way they learned to hold their breath and go numb when things got too loud, too frightening, too much. It might be a way of performing — smiling, achieving, being the capable one — so that no one would see how scared they really were. It might be food — the comfort of eating when comfort couldn't be found anywhere else. Or its opposite — the hard, clean feeling of restriction, which at least gave back some sense of control when everything else felt uncontrollable. It might be the way they learned to disappear into work, or into other people's needs, or into a screen, or into their own head.

Each of these is a technology. A finely made thing. Constructed under pressure, often very young, with whatever materials were available. And it worked. Well enough, at the time. Well enough to get through.

That was our prayer, our mantra, our worry stone and our Om. That was the ritual that soothed us and kept us safer in a chaotic or frightening world.

And here is something interesting: we often cannot predict what will happen in a situation that unnerves us — but we can almost certainly predict our symptom. How we will meet it. What will come. Maybe that is the point. In a world that cannot be controlled, the symptom offers a strange and painful form of certainty. It is the one thing we know how to make. The one thing we can count on.

A repeated recognizable form. An Amen.

Not Another Ritual — Another World

This raises another question. If we view the symptom as ritual, a logical conclusion might be that to remove an unwanted symptom, one could simply create another ritual. Some approaches to therapy are akin to this: "Replace those negative thoughts with these words of affirmation." And maybe this works for some, or works as part of a larger strategy.

But in Gestalt we understand that the symptom points to a world — and a world points back. Not just a past struggle, but a world one expects to find.

"I ritually avoid contact because I know I will be intruded on and then I'll be defenseless." This is a statement about past, present, and future. The emerging world.

"I ritually apologize because my difference will be an affront to you" — past, present, and future.

So we don't require another ritual so much as another world. A field perspective in therapy looks at this self-making, world-making capacity. It's not just "what kind of world was I originally responding to" — it's also "what kind of world am I expecting to find in each new encounter?"

Faith in a New World

Our symptom ritual carries us through, making the passage to the next moment. It can certainly help us navigate a familiar world with terrain we know.

But faith in a new world is something different. It requires an opening rather than a closing off, a loosening of the gates rather than a fortifying of them. And for some people, hoping is simply too dangerous — because at its core it holds too much dread. To hope is to risk a world that doesn't come.

So I end with a question that probably has relevance well beyond the consulting room: what does it take to disrupt a world?

This isn't rhetorical. This question is required for all of us — especially therapists.

Written by Jeffrey Allison, LCSW, Clinic Director at the Gestalt Associates for Psychotherapy and Training in NYC. A graduate of GAP, Jeff was drawn to Gestalt psychotherapy because of its emphasis on healing and growth rather than pathology. "Gestalt therapy connects us to the dynamic process of becoming, and therefore to the beauty of life itself."