‘Symptom’ is a term used more often in medicine. A symptom is always related with a particular reality, which it announced or revealed by the syptom. Diseases have symptoms, and it is through them that an ailment or illness can manifest itself. The ailment can be detected through the symptoms the body manifests.
Symptoms indicate the presence of some anomaly in the functioning of the body and are felt by the patient who can describe them with greater or lesser accuracy. Symptoms are subjectively perceived by the sufferer and descriptively passed along to the physician, who has no access to the patient’s feeling of suffering. It is the physician’s job to interpret the description of subjective symptoms in order to make the diagnosis.
Symptoms and signs are different, because signs although also indicating an anomaly or an ailment, signs can be objectively observed by others.
Pain is a symptom felt only by the patient; it is what he/she feels.
Pain, as a symptom, certainly comes from some dysfunction within the body, or within the psyche in the case of mental pain, but no one can feel it with us or in our place. Pain is a symptom. What remains is to determine of what. The symptom is always the symptom of something that is not itself. The symptom is quite a negligible thing in and of itself, except in that it always serves to reveal another existing condition.
Hypertension, in medical terms, is not a symptom in that usually the patient has no notion that he/she suffers from it. It can be a sign that also reveals another condition when it is measured objectively, becoming something observable by others as well. Fever is certainly a symptom of the flu when subjectively felt by the sufferer, but it becomes an objective sign for the doctor when he/she measures and quantifies it through some sort of tool, such as a thermometer.
Symptom is therefore everything that can be subjectively perceived by the patient as an anomaly in the functioning of his/her own body. In contrast, a sign, which can also indicate the body’s inability to function, can instead be universally observed and described by any outside observer.
Clearly, the better trained the observer in medical arts, the better he/she can relate an observed sign to the pathology which it is manifesting, something which the subjectivity of the symptom does not allow. However great the level of education and precise the description on the part of the sufferer, it can only serve to aid the doctor in reaching a better diagnosis.
Outside the strictly clinical field, the notion of symptom raises some interesting problems. Pain, we have seen, is a good example of that which applies to symptom: a subjective perception only describable by the one who suffers its. But the question that must be asked is this: What is the pain a symptom of? Naturally, it is one of a bodily dysfunction, but not only that. Let us consider the following example in the field of anthropology, given to us by Pierre Clastres. Amongst the Guayaki people, as in all other cultures, there exist rites of passage which mark both a boy’s and a girl’s becoming an adult. One of these rites, performed by a shaman, consists of a scarring ritual with cuts to a person’s back using a particularly sharp stones pulled out of streams of running water.
From the beginning, the youth of the Guayaki culture gave themselves up for this ritual without it causing any great specific sensation of pain. Until one day when the first young girl refused to participate in the scarring rite saying specifically that it indeed was too painful. Thus, we should say then that the threshold of pain had become dislodged. The limit of what was tolerable had ceased to be the same. What then was this pain a symptom of? In the opinion of Clastres, it was not a question of a clinical symptom relative to the body but a symptom of something more vast, which is cultural mutation. It was the entire culture contained up to that point within a certain threshold of pain which became dislodged and which made pain a symptom.
It should be noted that if pain was a symptom then the scarring was originally seen as a sign whose significance was totally cultural. Signs which were inscribed upon the body not as a subjective symptom of something different but as a message emblematically signed as the passage to adulthood and the fullest integration into the community on equal footing with other members.
If in medical terminology the word “symptom” designates everything that can be constituted in a discipline called semiology, then this term, outside the realm of medicine, also designates the other type of knowledge which the Swiss linguist Ferdinand de Saussure focused on in his studies of signs in general.
The notion of signs, however, is not identified entirely with what can be understood as symptom since what characterises the latter is only precariously transmissible, which is the opposite of what happens with the sign located in the very core of the communicative process.
The subjectivity of the symptom, given that it exists as an experience lived to the full, does not afford it the characteristics of an objective sign that allows for communicative transmission, at least in its integrality. The symptom will always have some margin of the unspeakable. Once again, the example of pain illustrates this idea well. As a symptom, it expresses something ill or deficient. The communication of a painful perception can take place, of course, through language, but never completely because some things are unable to be spoken completely. There are limits to language. Pain can, in certain cases, be expressed in crying, which is an in-articulation falling outside the realm of language. Pain as symptom also expresses itself as a pre-linguistic scream. And even more primitively, if we can indeed put it in these terms, the symptom which pain reveals can also express itself in silence, which is sometimes the most “eloquent” form of doing it.
If, in the last case, we have silence as the strongest force to express pain as a symptom, the ill which is at its origin is impossible to reach unless there is some form of silent expression which can transmit the pain as a symptom to us. This is what child psychology has achieved in asking children to draw as their main form of expression.
It is evident that in the case of adults, who are in full possession of their linguistic capacities, the work of the eventual psychoanalytical process consists of finding the verbal expression adequate enough for identifying the symptom or describing it, which is not always easy or completely possible, given the limits of language. For example, one should think about the difficulty which always exists in describing a dream whose symptomatic character rarely doubtful.
One of Freud’s first patients described the analytical process as a “talking cure.” Describing the symptoms, as in the case of the dream, is the first pathway – the true pathway, as Freud called it – to get to where it hurts.
In psychoanalysis, the symptom is just the surface on which a reality insists and persists in manifesting itself. In order for this reality to become accessible and identifiable, the symptom contributes decisively. The reality of the pain and its true cause identified, proceeding to the cure can be properly attempted.
The symptom thus appears as a way to manifest what is unspeakable about pain. The symptom is not a form of language but rather a perceptive manifestation that points out the way for something located at the root of all ailment.
What comes next is what it – the symptom – allows.